Urinary Incontinence during Pregnancy, in Early Puerperium and in the Period after Late Puerperium – Significance of the Issue

Abstract

Urinary incontinence (UI) is a condition of involuntary leakage of urine. The first manifestation of UI in women is often during pregnancy, with the predominant type being stress incontinence. For the first time in Bulgaria a retrospective cohort questionnaire study was conducted aiming to determine the frequency, type, severity and risk factors of urinary incontinence during pregnancy, in early puerperium and in the period after late puerperium. The study was performed in two separate groups of patients – 129 women who gave birth in the period April-May 2024, where the information was taken from self-report questionnaire surveys and refers to their pregnancy and early puerperium, and 147 women who gave birth via normal delivery in the period January-March 2024. In the second group the information was taken through PAPI (Pen-and-Paper Personal Interviews) and refers to their condition in the late puerperium. Our cohort study found that women suffer more often from SUI during pregnancy and after the puerperium. Statistically significant risk factors for involuntary leakage of urine were the age of over 35 years, BMI >30 kg/m², and prior normal birth. Although mild and in a lower percentage moderate urinary incontinence dominates during pregnancy, it has an adverse impact on the psychoemotional state and social life of patients, which requires increased medical interest for early detection of this problem. Based on data from a number of studies and meta-analyses, the main changes that occur in the mother's organism, which are identified as predisposing to the development of urinary incontinence are decreased bladder capacity, excess weight gain during pregnancy, impaired connective tissue remodelling, neural injury, weakness of the urethral sphincter, injury to the pelvic muscles and fascial injury. The findings from our scientific study will increase the awareness of healthcare professionals about SUI and contribute to the design of programmes for prevention and subsequent treatment of incontinence starting from its first manifestations, which will ensure a better quality of life for our patients and reduce the risk of occurrence in old age.