Incontinence During Pregnancy:Prevalence and Opportunities for Continence Promotion

EDITORIAL COMMENT: We accepted this paper for publication because urinary incontinence is a common and an important problem in women, and pregnancy, the duration of the second stage of labour, and/or the type of delivery (forceps ± episiotomy) are factors of unquestionable aetiological importance. We were disappointed that this careful study did not seek information from these 304 women concerning faecal incontinence which may also be caused by damage to pelvic floor muscles or their nerve supply during vaginal delivery, especially when achieved by the mid‐forceps operation. Readers may ponder the implications, in terms of testing women's pelvic floor muscles during vaginal examinations during pregnancy or labour, of the finding that 86% of the women in this study indicated that information regarding urine leakage and bladder control should be given routinely to women in pregnancy. We agree with the authors that longitudinal studies are necessary to document the associations between pregnancy variables and significant urinary (and faecal) incontinence that persists after pregnancy. The editor has discussed this paper with a physiotherapist who reviewed it. It seems certain that many if not most medical practitioners do not see the problems discussed in this paper as do practising physiotherapists, who advocate that during a routine vaginal examination the woman's pelvic floor muscles should be tested the acts of bearing down and pelvic muscle contraction be differentiated ‐ and the woman informed of the importance of her control of these muscles during normal delivery. The association between forceps delivery and urinary incontinence found in this study does not establish a causal relationship; it may be prolonged pushing in the second stage of labour and the indication for the forceps delivery (cephalopelvic disproportion, failure of anterior rotation from occipitoposterior position), rather than the manoeuvre itself that is responsible. In this study women who reported no previous deliveries were grouped with those having Caesarean deliveries only, so that the risk of urinary incontinence with vaginal delivery versus Caesarean section was not calculated. Summary: A cross‐sectional study using a structured interview was conducted with 304 women in the postnatal ward of a large NSW teaching hospital. Women were asked about any incontinence experienced in the last month of pregnancy, and about advice and interventions for bladder control or incontinence the