MONTREAL — Female urinary and fecal incontinence is associated with lifestyle, according to a recent longitudinal study.
“Body mass index, smoking, and hormone replacement therapy remain bad news for the pelvic floor,” said Kaven Baessler, M.D., who conducted the study at Royal Women's Hospital in Brisbane, Australia.
Speaking at the annual meeting of the International Continence Society, Dr. Baessler, who has since moved to Charité University Hospital in Berlin, said neither age nor mode of delivery was associated with incontinence in her study population of 443 women aged 40–80 years.
“In some studies, age definitely plays a role, but the women in this study were already aged 40 and up—age had taken its toll already when we assessed them,” she said in an interview. “Results would be different when more premenopausal and younger women are considered. That vaginal delivery and parity itself plays a role in women aged 30–50 is not a question.”
The data were analyzed based on three delivery modes: women who'd had no births, women with a cesarean delivery, and women who'd had either a spontaneous or instrumental delivery. This analysis showed no association between any of these three categories and incontinence.
The study grouped together women who'd had either a spontaneous or instrumental vaginal delivery. U.S. studies that have looked exclusively at women who've undergone instrumental delivery or episiotomy have shown an association between these procedures and pelvic floor damage, Luis Sanz, M.D., head of the urogynecology and pelvic surgery program at Virginia Hospital Center, Arlington, noted in an interview.
At the meeting Dr. Baessler said, “Many people want to blame something, and vaginal delivery is so easy to blame. Many studies with large numbers have shown that cesarean section increases the risk of incontinence just slightly less than vaginal delivery, so it is pregnancy itself that is the risk factor.”
The study randomly sampled women from the list of registered voters and assessed them with an interview, a clinical exam, and a validated pelvic floor function questionnaire. These assessments were repeated a year later.
Urinary and fecal incontinence increased significantly between the two assessments. At baseline, 47% of the population reported stress urinary incontinence (SUI), 30% reported urge urinary incontinence (UUI), and about 11% reported fecal incontinence. An additional 16% of previously asymptomatic women reported SUI, 16% reported UUI, and roughly 7% reported fecal incontinence at the second assessment.
SUI was associated with high body mass index (odds ratio 1.56 for BMI between 25 and 30, and OR 1.8 for BMI over 30) and waist circumference of more than 88 cm (OR 1.6), but not with hormone therapy (HT), smoking, age, or mode of delivery.
Urge incontinence was associated with HT use (OR 2.17), but not with BMI, waist circumference, age, smoking, or mode of delivery.
Fecal incontinence for loose stool was associated with BMI over 30 (OR 2.9) and waist circumference of more than 88 cm (OR 3.64), but not with age, smoking, mode of delivery, or HT use.
Fecal incontinence for formed stool was associated with current smoking (OR 3.57), but not with age, HT, BMI, waist circumference, or mode of delivery.
“Health care providers have to inform and educate their patients about these factors,” Dr. Baessler said. “And women should also take greater responsibility for their lifestyle.”