Study shows high rates of incontinence and prolapse in women years after childbirth

A new study by Glasgow Caledonian University has revealed high rates of urinary and faecal incontinence, and pelvic organ prolapse in women up to 26 years after childbirth, and being overweight was a contributory factor.

The research findings, published in BJOG: An International Journal of Obstetrics & Gynaecology, found 61% of women surveyed had recently experienced urinary incontinence, 22% faecal incontinence and 17% prolapse symptoms.

There were differences in the rates depending on how the women’s babies had been delivered. Women who only ever had caesarean section deliveries had the lowest risk of urinary incontinence, faecal incontinence and prolapse symptoms, however, their rates were still high (53%, 16%, 9% respectively).

Women who had a forceps delivery at any time were more likely to report faecal incontinence compared to the women who had normal unassisted vaginal deliveries (26% versus 20%).

Being overweight was associated with a higher risk of urinary and faecal incontinence, and prolapse regardless of how they gave birth because of the pressure that extra weight puts on the pelvic floor.

The study, led by Professor of Health Services Research Suzanne Hagen, in the University’s School of Health and Life Sciences (SHLS), initially involved 8,000 women who had given birth at maternity units in Aberdeen, Birmingham, and Dunedin in New Zealand, in 1993 and 1994. The women were sent follow-up questionnaires 20-26 years later and 2,270 responded.

Professor Hagen said: “This was a unique study that really delved into the extent of the problem and the findings were pretty stark for all women after childbirth, regardless of how they had their babies.

“What came out loud and clear from this research was that pelvic floor problems which can have distressing effects for women are really common, in the long as well as short term, after giving birth with over half the women involved in the study reporting symptoms, but I was particularly surprised by the high rate of faecal incontinence, which was reported by 22% of women, compared to 13% at the previous survey a decade before. I’m sure this will come as a surprise to a lot of people.

“The findings send a clear message to women and healthcare professionals that preventative measures are important.  Women discuss with their maternity practitioners their childbirth choices, but they can also modify their lifestyle to keep a healthy weight and practice pelvic floor muscle exercises to keep pelvic health problems at bay.

“Losing weight if required can reduce the risk of urinary and faecal incontinence, and prolapse by reducing the downward pressure on the pelvic organs.”

Professor Hagen, who is co-lead of the SHLS Research Centre for Health (ReaCH) Ageing Well Research Group, worked with fellow researcher Dr Ceri Sellers and former colleague Andy Elders, on the project.

The study was carried out in collaboration with the Universities of Aberdeen, Birmingham and Otago in New Zealand, Aberdeen Royal Infirmary and Birmingham Women’s and Children’s NHS Foundation Trust.

The research was funded by the Scottish Government's Chief Scientist Office, and grants from the University of Otago and the New Zealand Continence Association.

Read the full paper, ‘Urinary incontinence, faecal incontinence and pelvic organ prolapse symptoms 20 to 26 years after childbirth: a longitudinal cohort study’, here - https://obgyn.onlinelibrary.wiley.com/doi/10.1111/1471-0528.17913