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Women who have given birth only via cesarean are less likely than those with vaginal deliveries to report stress incontinence

Women with a history of only cesarean delivery are 40 percent less likely to suffer from stress incontinence later in life than women who delivered their children vaginally, according to a recent study supported by the Agency for Healthcare Research and Quality (HS06865). There has been increased interest in recent years in elective cesarean delivery to reduce the long-term maternal risk of pelvic floor disorders such as incontinence, but more studies are needed to clarify the long-term risks, benefits, and costs of cesarean delivery, according to researchers from Johns Hopkins University.

For the study, the researchers surveyed 1,299 women scheduled for elective hysterectomy about the number of children they had borne (parity), route of delivery, other factors (such as obesity and uterine fibroids), and bladder symptoms to investigate the association between reproductive factors and bladder symptoms. They found that both stress incontinence (leaking of urine due to laughing or other activities that increase abdominal pressure) and urinary urgency (sudden urge to urinate) increased nearly two-fold after a single delivery. The prevalence of stress incontinence was further increased with more births, most notably among women who had four or more deliveries. However, after controlling for parity and other characteristics, women who had a history of cesarean delivery were 40 percent less likely to report stress incontinence than women with a history of vaginal delivery.

The diagnosis of uterine prolapse was associated with both stress incontinence and urinary urgency, independent of parity and route of delivery. Uterine fibroids were not associated with stress incontinence but were significantly associated with urinary urgency. Obesity emerged as an important risk factor for both stress incontinence and urinary urgency in this group.

More details are in "Parity and route of delivery: Does cesarean delivery reduce bladder symptoms later in life?" by Victoria L. Handa, M.D., Lynn Harvey, B.S., Harold E. Fox, M.D., and Kristen H. Kjerulff, Ph.D., in the American Journal of Obstetrics and Gynecology 191, pp. 463-469, 2004.

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