Int Urogynecol J DOI 10.1007/s00192-015-2690-0
ORIGINAL ARTICLE
Prevalence and predictors of urinary/anal incontinence after vaginal delivery: prospective study of Nigerian women Kingsley Chukwu Obioha 1 & Emmanuel Onyebuchi Ugwu 1 & Samuel Nnamdi Obi 1 & Cyril Chukwudi Dim 1 & Theophilus Chimezie Oguanuo 1
Received: 5 July 2014 / Accepted: 11 March 2015 # The International Urogynecological Association 2015
Abstract Introduction and hypothesis Urinary and anal incontinence are major public health problems impacting on the quality of life of affected women, with resultant loss of self-esteem. Despite the anticipated magnitude of this public health problem in sub-Saharan Africa, there is paucity of data on the prevalence of urinary and/or anal incontinence after childbirth in the region. This study determined the prevalence and predictors of urinary and anal incontinence after vaginal delivery among women in Enugu, southeastern Nigeria. Methods This was a longitudinal study of 230 consecutive parturients at the University of Nigeria Teaching Hospital, Enugu, Nigeria. Eligible women were followed up immediately, 6 weeks, and 3 months postpartum to assess the development of urinary and/or anal incontinence using validated questionnaires. Results Overall, 28 women had urinary incontinence, giving a cumulative prevalence rate of 12.2 %. The cumulative prevalence rate was 13.5 % for anal incontinence and 3 % for combined urinary and anal incontinence. Age, social class, parity, prolonged second stage of labor, and neonatal birth weight were significantly associated with postpartum urinary incontinence (P < 0.05). On the other hand, age, parity, prolonged second stage of labor, episiotomy, and instrumental vaginal delivery were significantly associated with postpartum anal incontinence (P 0. Mild UI was defined as total ICIQ-UI-SF score 1–6 and as moderate to severe incontinence as total score of > 6 [19, 20]. Stress urinary incontinence (SUI) was defined as patient’s report of involuntary leakage of urine when coughing, sneezing, laughing, or exercising; urgency urinary incontinence (UUI) as patient’s report of involuntary leakage of urine before she gets to the toilet or convenience; overflow urinary incontinence (OUI) as patient’s report of involuntary leakage of urine when she is asleep, and fistulous (VVF) incontinence as patient’s report of involuntary leakage of urine all the time (continuous leakage of urine) [19, 20]. On the other hand, a woman is said to have developed AI if she gave affirmative response (yes) to question 1 of the AI questionnaire. Flatus incontinence was defined as patient’s report of involuntary leakage of flatus only and fecal incontinence (FI) as patient’s report of involuntary leakage of feces only (Appendix 2). Cumulative prevalence rate of UI was defined as the proportion of women who ever reported any type of UI during the 3-month follow-up and cumulative AI as the proportion of women who ever reported any type of AI during the 3 months of follow-up. Urinary or AI at delivery was defined as the patient’s report of UI or AI at the time of discharge, usually on the second day postpartum. A woman’s social class was defined as described by Olusanya et al. [21]. Thus, high social class was defined as belonging to class I or II, while low social class was defined as belonging to class III, IV, or V. All the data collected from the study were keyed into the Statistical Package for Social Sciences (SPSS) computer software version 17 for Windows. Statistical analyses were both descriptive and inferential at 95 % confidence level. Continuous variables were analyzed using mean, standard deviation (SD), and Student’s t test. Categorical data were analyzed
using proportions and Fishers exact test. Determinants that had significant association (P
ORIGINAL ARTICLE
Prevalence and predictors of urinary/anal incontinence after vaginal delivery: prospective study of Nigerian women Kingsley Chukwu Obioha 1 & Emmanuel Onyebuchi Ugwu 1 & Samuel Nnamdi Obi 1 & Cyril Chukwudi Dim 1 & Theophilus Chimezie Oguanuo 1
Received: 5 July 2014 / Accepted: 11 March 2015 # The International Urogynecological Association 2015
Abstract Introduction and hypothesis Urinary and anal incontinence are major public health problems impacting on the quality of life of affected women, with resultant loss of self-esteem. Despite the anticipated magnitude of this public health problem in sub-Saharan Africa, there is paucity of data on the prevalence of urinary and/or anal incontinence after childbirth in the region. This study determined the prevalence and predictors of urinary and anal incontinence after vaginal delivery among women in Enugu, southeastern Nigeria. Methods This was a longitudinal study of 230 consecutive parturients at the University of Nigeria Teaching Hospital, Enugu, Nigeria. Eligible women were followed up immediately, 6 weeks, and 3 months postpartum to assess the development of urinary and/or anal incontinence using validated questionnaires. Results Overall, 28 women had urinary incontinence, giving a cumulative prevalence rate of 12.2 %. The cumulative prevalence rate was 13.5 % for anal incontinence and 3 % for combined urinary and anal incontinence. Age, social class, parity, prolonged second stage of labor, and neonatal birth weight were significantly associated with postpartum urinary incontinence (P < 0.05). On the other hand, age, parity, prolonged second stage of labor, episiotomy, and instrumental vaginal delivery were significantly associated with postpartum anal incontinence (P 0. Mild UI was defined as total ICIQ-UI-SF score 1–6 and as moderate to severe incontinence as total score of > 6 [19, 20]. Stress urinary incontinence (SUI) was defined as patient’s report of involuntary leakage of urine when coughing, sneezing, laughing, or exercising; urgency urinary incontinence (UUI) as patient’s report of involuntary leakage of urine before she gets to the toilet or convenience; overflow urinary incontinence (OUI) as patient’s report of involuntary leakage of urine when she is asleep, and fistulous (VVF) incontinence as patient’s report of involuntary leakage of urine all the time (continuous leakage of urine) [19, 20]. On the other hand, a woman is said to have developed AI if she gave affirmative response (yes) to question 1 of the AI questionnaire. Flatus incontinence was defined as patient’s report of involuntary leakage of flatus only and fecal incontinence (FI) as patient’s report of involuntary leakage of feces only (Appendix 2). Cumulative prevalence rate of UI was defined as the proportion of women who ever reported any type of UI during the 3-month follow-up and cumulative AI as the proportion of women who ever reported any type of AI during the 3 months of follow-up. Urinary or AI at delivery was defined as the patient’s report of UI or AI at the time of discharge, usually on the second day postpartum. A woman’s social class was defined as described by Olusanya et al. [21]. Thus, high social class was defined as belonging to class I or II, while low social class was defined as belonging to class III, IV, or V. All the data collected from the study were keyed into the Statistical Package for Social Sciences (SPSS) computer software version 17 for Windows. Statistical analyses were both descriptive and inferential at 95 % confidence level. Continuous variables were analyzed using mean, standard deviation (SD), and Student’s t test. Categorical data were analyzed
using proportions and Fishers exact test. Determinants that had significant association (P
