 Re: Vaginal Birth Not Linked to Urinary Incontinence
Jo,
Thanks for posting the Reuters report.
I hope the results are reproduced.
The Reuter's article stated:
> Clinical evaluation
> of urinary incontinence and genital prolapse was conducted in 101 of the
> pairs.
I didn't see any genital prolapse results mentioned so I went to PubMed (see
abstract below) and didn't see genital prolapse results mentioned there
either.
Incidentally, Paciornik compared indigenous mothers and daughters years
ago..
I don't have the Paciornik cite - but here is what I wrote back in 2004..
vaginal tone)
The Brazilian obstetrician Moyses Paciornik, MD studied people indigenous to
the forests near Curitiba, Brazil.
He and his team found far less uro-genital morbidity (better vaginal tone,
less uterine prolapse, less urinary incontinence) in indigenous grandmothers
than in their daughters. _He thought squatting childbirth practiced by the
grandmothers was the reason their vaginal tone was much better than in their
daughters who gave birth on their backs under modern medical supervision.
He also thought that use of the squatting position as an activity of daily
living improves vaginal tone.
(Paciornik used the opportunity of a cancer survey to measure vaginal tone
with a Kegelometer and take medical histories. _When he returned to
Curitiba, he and his son Claudio - also an obstetrician - set up a birth
center where they did only squatting births. _Claudio's video, "Birth in the
Squatting Position" is quite well known. _When The Lancet published a letter
suggesting that squatting birth is dangerous and then refused to publish the
Paciorniks' report of 25,000 squatting births, I urged Moyses to submit it
to the journal Birth where it was published with my description of the
grisly biomechanics of semistting delivery. _See Birth 1992;19(4):230-1.)
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tone)
http://groups.google.com/group/
sci.med/msg/c5637a6cb4adea17
Here again is the Reuter's report (again, thanks for posting it Jo)..
in article do8r1c$15h1$2@otis.netspace.net.au, Jo at
breastisbest@portjackson.net wrote on 12/20/05 3:48 AM:
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> Vaginal Birth Not Linked to Urinary Incontinence
>
> NEW YORK (Reuters Health) Nov 30 - Compared with their nulliparous
> sisters, women who have given birth vaginally are not at increased risk
> for urinary incontinence, according to a report in the December issue of
> Obstetrics and Gynecology. Rather, familial factors seem to play an
> important role in determining risk.
>
> Previous reports looking at the association between vaginal birth and
> incontinence have been plagued by various methodologic issues, such as
> the use of unvalidated self-report survey instruments and making no
> distinction between the various types of urinary incontinence or disease
> severity.
>
> In the present study, Dr. Gunhilde M. Buchsbaum, from the university of
> Rochester Medical Center in New York, and colleagues used a
> comprehensive questionnaire to assess pelvic floor disorders in 143
> pairs of nulliparous/parous postmenopausal sisters. Clinical evaluation
> of urinary incontinence and genital prolapse was conducted in 101 of the
> pairs.
>
> The rate of urinary incontinence among the parous women was 49.7%, not
> significantly higher than the 47.6% rate seen among the nulliparous
> women, the authors state. Moreover, the type of incontinence and disease
> severity did not differ significantly between the groups.
>
> The same urinary status seen in one sister was often present in the
> other, suggesting that there is an underlying familial disposition
> toward urinary incontinence.
>
> "A genetic predisposition for urinary incontinence needs to be explored
> further because finding a genetic link to this condition would have
> great implications for the direction of basic research, treatment
> approaches, risk management, and potential prophylactic interventions,"
> the authors state.
>
> Obstet Gynecol 2005;106:1253-1258.
Here's the PubMed abstract for the Buchsbaum et al. study..
Obstet Gynecol. 2005 Dec;106(6):1253-8. PubMed abstract
_
Urinary incontinence in nulliparous women and their parous sisters.
Buchsbaum GM, Duecy EE, Kerr LA, Huang LS, Guzick DS.
Departments of Obstetrics and Gynecology and Biostatistics and Computational
Biology, university of Rochester Medical Center, Rochester, New York; and
Department of Urology, university of Utah, Salt Lake City, Utah.
OBJECTIVE: To investigate the role of vaginal delivery and familial factors
in the development of urinary incontinence by comparing the prevalence of
this condition in nulliparous women and their parous sisters. METHODS: A
sample of 143 pairs of nulliparous/parous postmenopausal sisters completed a
comprehensive questionnaire regarding symptoms of pelvic floor disorders. Of
these, 101 pairs underwent clinical evaluation of urinary incontinence and
genital prolapse. RESULTS: Among this sample of biological sisters, urinary
incontinence was reported by 47.6% of nulliparous women and by 49.7% of
parous women (P = .782). We found no difference in the severity or type of
urinary incontinence between these 2 groups. There was a high concordance in
continence status, however, within biological sisters. CONCLUSION: Vaginal
birth does not seem to be associated with urinary incontinence in
postmenopausal women. Considering the high concordance in continence status
between sister pairs, and considering that the majority of parous women are
continent, an underlying familial predisposition toward the development of
urinary incontinence may be present. LEVEL OF EVIDENCE: II-2.
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Interestingly, they do not seem to mention the parity of the parous women.
Todd
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