Editorial
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World J Obstet Gynecol. Nov 10, 2013; 2(4): 74-79
Published online Nov 10, 2013. doi: 10.5317/wjog.v2.i4.74
Female urinary incontinence during pregnancy and after delivery: Clinical impact and contributing factors
Paolo Mannella, Giulia Palla, Gonzalo Pérez-Roncero, María T López-Baena, Faustino R Pérez-López
Paolo Mannella, Giulia Palla, Division of Obstetrics and Gynecology, Center of Pelvic Disorders, University of Pisa, Hospital of Pisa, 56100 Pisa, Italy
Gonzalo Pérez-Roncero, María T López-Baena, Faustino R Pérez-López, Red de Investigación de Ginecología, Obstetricia y Reproducción, Instituto Aragonés de Ciencias de la Salud, 50009 Zaragoza, Spain
Faustino R Pérez-López, Department of Obstetrics and Gynecology, University of Zaragoza School of Medicine, 50009 Zaragoza, Spain
Author contributions: All authors contributed to this paper.
Correspondence to: Faustino R Pérez-López, Professor, Department of Obstetrics and Gynecology, University of Zaragoza School of Medicine, Domingo Miral s/n, 50009 Zaragoza, Spain. faustino.perez@unizar.es
Telephone: +34-976-761734 Fax: +34-976-761735
Received: March 6, 2013
Revised: September 18, 2013
Accepted: October 16, 2013
Published online: November 10, 2013
Processing time: 255 Days and 22.7 Hours
Abstract

Urinary incontinence (UI) is a common condition affecting adult women of all ages and it could have a negative influence on quality of life. The etiology of UI is multifactorial, but some of the most important risk factors are obesity and ageing, as well as adverse obstetric events. Pregnancy and delivery per se have been implicated in the etiology of UI. Although several studies have demonstrated a direct association between UI and vaginal delivery in short, medium and long-term, the role of childbirth on the risk of UI remains controversial. The mechanical strain during delivery may induce injuries to the muscle, connective and neural structures. Vaginal birth can be associated with relaxation or disruption of fascial and ligamentous supports of pelvic organs. Parity, instrumental delivery, prolonged labor and increased birth weights have always been considered risk factors for pelvic floor injury. Also genetic factors have been recently raised up but still there are not appropriate guidelines or measures to reduce significantly the incidence of UI. The role of pelvic floor muscle training (PFMT) in the prevention and treatment of UI is still unclear. However, PFMT seems to be useful when supervised training is conducted and it could be incorporated as a routine part of women’s exercise programmes during pregnancy and after childbirth.

Keywords: Urinary incontinence; Pregnancy; Delivery; Cesarean section; Forceps; Episiotomy; Obesity; Collagen; Pelvic floor muscle training

Core tip: The mechanical strain during delivery may induce injuries to the muscle, connective and neural structures. Vaginal birth can be associated with relaxation or disruption of fascial and ligamentous supports of pelvic organs. Parity, instrumental delivery, prolonged labor and increased birthweight have always been considered risk factors for pelvic floor injury. Also genetic factors have been recently raised up but still there are not appropriate guidelines or measures to reduce significantly the incidence of urinary incontinence.