Although urinary incontinence is a ...

Although urinary incontinence is a question for up to one half of all adult women the etiology remains controversial. Traditional theory and a not many studies support a central character for vaginal delivery in the etiology of urinary incontinence. reciprocally other studies have failed to demonstrate an association. Advanced age, obesity, and smoking also have been identified as risk factors. Buchsbaum and colleagues investigated the part of vaginal delivery and familial factors in urinary incontinence.

The authors studied pairs of sisters recruited according to advertising that did not identify incontinence as the focus of the investigation Eligibility for the study hanged on one sister being nulliparous and the other having had at least undivided vaginal delivery. All participants complet extensive questionnaires covering demographic, medical, surgical, and obstetric history, as well as use of tobacco and alcohol. Participants who reported at least undivided episode of incontinence within the previous four weeks were asked for additional information about the severity, duration, and protoplast of incontinence.

Participants were put forwarded a complete physical examination, including assessment of mobility, gait, and a cough stres ordeal Pelvic and rectovaginal examination was used to assess pelvic floor relaxation, status of pelvic organs, and the tone of the anal sphincter. Urethral mobility was assessed with a cotton-tipped swab ordeal and ultrasonography was used to estimate postvoid residual urine mass Participants with signs or symptoms of urinary incontinence were proffered multichannel urodynamic evaluation. The rate of incontinence and related variables was compared between the parous and nulliparous sisters.

Overall, 143 pairs of sisters complet the questionnaires, and 101 also complet the physical evaluation. The average age of participants was 61 years, and the average visible form [i]or[/i] frame mass index was about 28 kg by [m.sup.2]. About 30 percent of the women reported hysterectomy, and a similar percentage reported hypertension. The parous and nulliparous participants did not differ significantly in any important variable. The parous sisters reported an average of three vaginal births. The reported rate of incontinence for nulliparous participants was 476 percent versus 497 percent for parous sisters. The difference between these rates was not significant. Rates of virtuous stress incontinence were identical (184 percent) in parous and nulliparous women Rates of conjure incontinence also were almost identical (81 for parous women versus 88 percent for nulliparous women) Measures of the severity of incontinence also failed to indicate any significant differences between parous and nulliparous women Continence was concordant between 63 percent of the sister pairs (see accompanying table).

The authors close that incontinence is a customary problem for postmenopausal women, on the other hand that no difference in prevalence or severity could be demonstrated between parous and nulliparous sisters. reciprocally familial factors appear to be highly significant predictors of urinary incontinence. The authors advise that the current focus onward delivery in the etiology of incontinence is inappropriate and that research and preventive efforts be directed toward understanding familial factors.

ANNE D WALLING, MD

Buchsbaum GM et al. Urinary incontinence in nulliparous women and their parous sisters. Obset Gynecol December 2005;106:1253-8

EDITOR'S NOTE: Will this research inject some sanity into the instant situation in which cesarean delivery is being advocated (and demanded through some patients) to prevent urinary incontinence later in life? on one report, (1) nearly sum of two units thirds of obstetricians support elective cesarean delivery for this reason. Combined with the common backlash against vaginal birth after cesarean delivery, the cesarean delivery rate pretends set to spiral beyond the instant 30 percent unless the debate can be refocused in succession scientific evidence of the unadulterated benefit for mothers.--A.D.W.

REFERENCE

(1) Wu JM Hundley AF, Visco AG. Elective primary cesarean delivery: attitudes of urogynecology and maternal-fetal medicine specialists. Obstet Gynecol 2005;105:301-6

COPYRIGHT 2006 American Academy of Family Physicians

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