Urine Leakage Not Due to Childbirth

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Dec. 2, 2005 - Doctors think it's true. Patients think it's true. And urogynecologist Gunhilde M. Buchsbaum, MD, thought vaginal childbirth put women at risk of urinary incontinence.

Not any more. Buchsbaum, an associate professor at the University of Rochester, N.Y., now thinks childbirth has nothing to do with whether a woman suffers urinary incontinence after menopause.

And she has a good reason to think so. Buchsbaum's team studied pairs of postmenopausal sisters. In each pair, one sister had at least one child by vaginal delivery. The other never had a child. No matter how the researchers looked at it, the results came out the same.

"In a group of sisters where half were childless and half had children, we found no difference in urinary incontinence," Buchsbaum tells WebMD. "There was no difference in type of incontinence, overall prevalence of incontinence, or severity of incontinence."

The findings appear in the December issue of Obstetrics & Gynecology.

Sisters and Urinary Incontinence

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It's very common for doctors to think that vaginal delivery puts a woman at risk of urinary incontinence. In fact, a recent survey found that 62% of urogynecologists would support a woman's decision to choose to have a C-section to prevent it.

Yet studies on childbirth and urinary incontinence are divided. Some show a risk, others fail to find one.

Buchsbaum's interest in the issue came when she was contacted by a nearby convent.

"The mother superior said, 'I think we have a problem,'" she recalls.

As they reached the age of menopause, many of the nuns were suffering urinary incontinence. Yet medical examination revealed the obvious: None of the women had ever had a child.

Preliminary studies led Buchsbaum to suspect that childbirth is not a woman's major lifetime risk factor for urinary incontinence. So she and her colleagues designed the current study.

Sisters' Sisters and Urinary Incontinence

At first, the researchers looked at the convent sisters and the sisters' married sisters. The study was later expanded to include other postmenopausal sister pairs where one had had a child by vaginal delivery and the other never gave birth.

The researchers looked at whether the women suffered urinary incontinence. They looked at whether they suffered stress incontinence (involuntary urination caused by activity such as coughing), urge incontinence (urination caused by overactive bladder), or mixed incontinence. They looked at incontinence severity. In every regard, the women who gave birth were no more likely to suffer urinary incontinence than their childless sisters.

"Everyone says vaginal delivery causes incontinence, so we looked at sisters sharing a genetic pool, to see what is the greatest risk factor -- having kids or coming from same family," Buchsbaum says. "Childbirth is no risk factor -- none."

Genetic Risk for Urinary Incontinence?

While having a child wasn't a risk for urinary incontinence, having a sister with the problem was a different story.

"Out of every three sister pairs, two had same status: Either both leaked urine or neither leaked urine," Buchsbaum says. "That's more than you would see by chance."

And when one sister had urinary incontinence and the other didn't, the sister with the problem was no more likely to have given birth than to be childless.

"So we think there is probably some genetic component that may predispose somebody for incontinence or not," Buchsbaum says. "Because we saw women with eight kids and no incontinence."

This doesn't surprise Niall Galloway, MD, medical director of the Emory Continence Center at the Emory University School of Medicine in Atlanta.

"I believe, based on the medical literature and our own experience, that urinary incontinence is a familial disease," Galloway tells WebMD. "The risks are going to be greater to daughters of women who already have these problems."

Not all women are built the same way, Galloway notes. This means vaginal delivery has different consequences for different women.

"The pelvic floor of one woman is different from another's, just as the telephone book of Ellijay, Ga., is different from that of Atlanta," Galloway says. "Life is not fair. Some women are going to be able to produce multiple children by vaginal delivery and never have a moment's setback. Others are going to have a single child, and their pelvic floor will be damaged forever."

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