DOES CHILDBIRTH CAUSE INCONTINENCE?

Everyone who has had a child knows that once a baby is born, life is never the same again. Women also know that their bodies are never exactly the way they were before they gave birth. Recent evidence tells of just how different a woman’s body may become after labor and delivery. Women who have not delivered a child vaginally rarely develop incontinence or pelvic muscle relaxation, while women who have vaginal deliveries sometimes do. Again, be assured that most women will not go on to develop incontinence after childbirth.

This chapter is to help you understand what we know about why some women who delivered babies have problems with incontinence, but it may also cause you concern about those women yet to deliver or yet to even conceive. Will their ability to stay dry when they get older be compromised by childbirth? What should they do? What should they be told? Understand that we are still at an early stage of fact-finding for this new information, but this chapter will consider the answers to these questions.

There are many factors that can lead to incontinence - the strength of the pelvic supporting structures that you were born with; the forces these structures have resisted over the years, including childbirth, heavy lifting, and straining during bowel movements; your ability to heal if these tissues are injured; the effect of the ageing process on the collagen that gives strength to these structures. Probably no one factor is completely responsible for the development of

incontinence. Further research is needed to help clarify the importance of each possible cause and the interplay between them. This research will likely benefit those women who are yet to have children.

We do know the connection between incontinence and childbirth has been implied for a long time. When gynecologists see women for problems of incontinence, they are not surprised to find the most severe problems often in those women who had many children or who delivered large babies. Recently doctors started working out the details of these relationships and are looking for the specific reasons why some women go on to develop incontinence and other women never have this problem. Although the studies are preliminary and involve only small numbers of women, some details are starting to emerge.

About 10-20% of women who have a vaginal delivery will be bothered by prolapse, bulging of the bladder, rectum or uterus into the vagina, by the time they reach 50 years old. Women who deliver one child have a 3 times greater risk of developing prolapse than women who have not had children. Women who delivered two children have a 5 times increased risk, and women with four or more children have an 11 times greater likelihood of developing this problem. Women who need to push the baby out longer than one hour or who deliver larger babies appear to be at a greater risk of developing incontinence later in their lives. There is increasing evidence that childbirth is responsible for much of the injury to the muscles and nerves of the pelvis. This injury eventually leads to urinary loss and pelvic prolapse. Most women are not aware of this somewhat new information. In fact, many doctors are not apprised of the recently collected data. This chapter explains what we know, so far, about incontinence and childbirth.

• IS INCONTINENCE COMMON DURING PREGNANCY?
• DOES A LONG LABOR LEAD TO INCONTINENCE?
• CAN VAGINAL DELIVERY LEAD TO INCONTINENCE?
• WHAT ROLE DOES FORCEPS DELIVERY PLAY IN INCONTINENCE?
• DO DOCTORS HAVE NON-MEDICAL REASONS TO AVOID CESAREAN SECTIONS?
• DOES CHILDBIRTH INEVITABLY LEAD TO INCONTINENCE?
• CAN CHILDBIRTH WEAKEN THE BLADDER?
• CAN KEGEL EXERCISES DURING PREGNANCY PREVENT INCONTINENCE?
• CAN CHILDBIRTH WEAKEN THE RECTUM?
• CAN CHILDBIRTH LEAD TO ANAL INCONTINENCE?
• CAN EPISIOTOMY LEAD TO ANAL INCONTINENCE?
• CAN PELVIC INJURY RESULTING FROM DELIVERY BE FULLY REPAIRED?
• DOES CESAREAN SECTION PROTECT AGAINST PROLAPSE AND INCONTINENCE?
• CAN ANYTHING BE DONE TO PREVENT INCONTINENCE THAT RESULTS FROM CHILDBIRTH?

Edited Excerpts from our book
The Incontinence Solution

By William H. Parker, MD, Amy E. Rosenman, MD, and Rachel Parker

Order The Incontinence Solution directly from Amazon.com.

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