Exclusive caesarean section delivery and subsequent urinary and faecal incontinence: a 12-year longitudinal study

C MacArthur, C Glazener, R Lancashire, P Herbison, D Wilson, ProLong study group

Research output: Contribution to journalArticle

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Abstract

Objectives To investigate the association between delivery mode history and urinary and faecal incontinence, specifically a history of exclusive caesarean section deliveries.

Design Twelve-year longitudinal study.

Setting Maternity units in Aberdeen, Birmingham and Dunedin.

Population Women who returned postal questionnaires 3 months and 12 years after index birth.

Methods Data on all births over a 12-month period were obtained from units and women were followed 3 months, 6 years and 12 years after the birth.

Main outcome measures Urinary incontinence (UI) and faecal incontinence (FI) 12 years after index birth.

Results Of the 7883 women recruited at 3 months, 3763 were followed up at 12 years: nonresponders were similar in their obstetric factors. After adjustment for parity, body mass index and age at first birth, women who delivered exclusively by caesarean section were less likely to have UI than those who only had spontaneous vaginal births (odds ratio [OR] 0.46, 95% confidence interval [CI] 0.37–0.58), but not if they had a combination of caesarean and spontaneous vaginal births (OR 1.14, 95% CI 0.89–1.47). There was no difference in FI among women who had exclusive caesarean births (OR 0.94, 95% CI 0.66–1.33) or mixed caesarean and spontaneous vaginal births (OR 1.06, 95% CI 0.73–1.54).

Conclusions Unless women are resolved to have all their deliveries by the abdominal route (and their medical advisors agree), caesarean section does not protect from subsequent UI. Even among those who do deliver exclusively by caesarean section, 40% still report UI; and this strategy confers no benefit for subsequent FI.
Original languageEnglish
Pages (from-to)1001-1007
Number of pages7
JournalBJOG-An International Journal of Obstetrics and Gynaecology
Volume118
Issue number8
Early online date8 Apr 2011
DOIs
Publication statusPublished - Jul 2011

Fingerprint

Fecal Incontinence
Urinary Incontinence
Cesarean Section
Longitudinal Studies
Parturition
Odds Ratio
Confidence Intervals
Birth Order
Parity
Obstetrics
Body Mass Index
History
Outcome Assessment (Health Care)

Keywords

  • exclusive caesarean delivery
  • faecal incontinence
  • urinary incontinence

Cite this

Exclusive caesarean section delivery and subsequent urinary and faecal incontinence : a 12-year longitudinal study. / MacArthur, C; Glazener, C; Lancashire, R; Herbison, P; Wilson, D; ProLong study group.

In: BJOG-An International Journal of Obstetrics and Gynaecology, Vol. 118, No. 8, 07.2011, p. 1001-1007.

Research output: Contribution to journalArticle

MacArthur, C ; Glazener, C ; Lancashire, R ; Herbison, P ; Wilson, D ; ProLong study group. / Exclusive caesarean section delivery and subsequent urinary and faecal incontinence : a 12-year longitudinal study. In: BJOG-An International Journal of Obstetrics and Gynaecology. 2011 ; Vol. 118, No. 8. pp. 1001-1007.
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abstract = "Objectives To investigate the association between delivery mode history and urinary and faecal incontinence, specifically a history of exclusive caesarean section deliveries.Design Twelve-year longitudinal study.Setting Maternity units in Aberdeen, Birmingham and Dunedin.Population Women who returned postal questionnaires 3 months and 12 years after index birth.Methods Data on all births over a 12-month period were obtained from units and women were followed 3 months, 6 years and 12 years after the birth.Main outcome measures Urinary incontinence (UI) and faecal incontinence (FI) 12 years after index birth.Results Of the 7883 women recruited at 3 months, 3763 were followed up at 12 years: nonresponders were similar in their obstetric factors. After adjustment for parity, body mass index and age at first birth, women who delivered exclusively by caesarean section were less likely to have UI than those who only had spontaneous vaginal births (odds ratio [OR] 0.46, 95{\%} confidence interval [CI] 0.37–0.58), but not if they had a combination of caesarean and spontaneous vaginal births (OR 1.14, 95{\%} CI 0.89–1.47). There was no difference in FI among women who had exclusive caesarean births (OR 0.94, 95{\%} CI 0.66–1.33) or mixed caesarean and spontaneous vaginal births (OR 1.06, 95{\%} CI 0.73–1.54).Conclusions Unless women are resolved to have all their deliveries by the abdominal route (and their medical advisors agree), caesarean section does not protect from subsequent UI. Even among those who do deliver exclusively by caesarean section, 40{\%} still report UI; and this strategy confers no benefit for subsequent FI.",
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AU - Herbison, P

AU - Wilson, D

AU - ProLong study group

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N2 - Objectives To investigate the association between delivery mode history and urinary and faecal incontinence, specifically a history of exclusive caesarean section deliveries.Design Twelve-year longitudinal study.Setting Maternity units in Aberdeen, Birmingham and Dunedin.Population Women who returned postal questionnaires 3 months and 12 years after index birth.Methods Data on all births over a 12-month period were obtained from units and women were followed 3 months, 6 years and 12 years after the birth.Main outcome measures Urinary incontinence (UI) and faecal incontinence (FI) 12 years after index birth.Results Of the 7883 women recruited at 3 months, 3763 were followed up at 12 years: nonresponders were similar in their obstetric factors. After adjustment for parity, body mass index and age at first birth, women who delivered exclusively by caesarean section were less likely to have UI than those who only had spontaneous vaginal births (odds ratio [OR] 0.46, 95% confidence interval [CI] 0.37–0.58), but not if they had a combination of caesarean and spontaneous vaginal births (OR 1.14, 95% CI 0.89–1.47). There was no difference in FI among women who had exclusive caesarean births (OR 0.94, 95% CI 0.66–1.33) or mixed caesarean and spontaneous vaginal births (OR 1.06, 95% CI 0.73–1.54).Conclusions Unless women are resolved to have all their deliveries by the abdominal route (and their medical advisors agree), caesarean section does not protect from subsequent UI. Even among those who do deliver exclusively by caesarean section, 40% still report UI; and this strategy confers no benefit for subsequent FI.

AB - Objectives To investigate the association between delivery mode history and urinary and faecal incontinence, specifically a history of exclusive caesarean section deliveries.Design Twelve-year longitudinal study.Setting Maternity units in Aberdeen, Birmingham and Dunedin.Population Women who returned postal questionnaires 3 months and 12 years after index birth.Methods Data on all births over a 12-month period were obtained from units and women were followed 3 months, 6 years and 12 years after the birth.Main outcome measures Urinary incontinence (UI) and faecal incontinence (FI) 12 years after index birth.Results Of the 7883 women recruited at 3 months, 3763 were followed up at 12 years: nonresponders were similar in their obstetric factors. After adjustment for parity, body mass index and age at first birth, women who delivered exclusively by caesarean section were less likely to have UI than those who only had spontaneous vaginal births (odds ratio [OR] 0.46, 95% confidence interval [CI] 0.37–0.58), but not if they had a combination of caesarean and spontaneous vaginal births (OR 1.14, 95% CI 0.89–1.47). There was no difference in FI among women who had exclusive caesarean births (OR 0.94, 95% CI 0.66–1.33) or mixed caesarean and spontaneous vaginal births (OR 1.06, 95% CI 0.73–1.54).Conclusions Unless women are resolved to have all their deliveries by the abdominal route (and their medical advisors agree), caesarean section does not protect from subsequent UI. Even among those who do deliver exclusively by caesarean section, 40% still report UI; and this strategy confers no benefit for subsequent FI.

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SN - 1470-0328

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