Urinary incontinence in pregnancy and the puerperium: A prospective study

Objective: Pregnancy and childbirth are commonly thought to be associated with the development of urinary incontinence and lower urinary tract symptoms. The purpose of this study was to assess the relationship, if any, between pregnancy and the development of lower urinary tract symptoms. Study Design: A prospective study of lower urinary tract symptoms was carried out in a cohort of pregnant women who answered a series of symptom questionnaires and kept a 24-hour bladder chart on which frequency of urination and volumes voided were recorded throughout pregnancy and for 8 weeks after birth. Results: A total of 123 women participated in the study. Mean daily urine output ( P = .01) and the mean number of voids per day ( P = .01) increased with gestational age and declined after delivery. Episodes of urinary incontinence peaked in the third trimester and improved after birth ( P = .001). White women had higher mean voided volumes and fewer voiding episodes than did black women. Ingestion of caffeine was associated with smaller voided volumes and greater frequency of urination. Conclusion: Pregnancy is associated with an increase in urinary incontinence. This phenomenon decreases in the puerperium. Pregnancy and childbirth trauma are important factors in the development of urinary incontinence among women. These findings warrant further investigation. (Am J Obstet Gynecol 1999;181:266-73.)