Effect of Mode of Delivery on Incidence of Urinary and Anal Incontinence after Childbirth: A Prospective Cohort Study of Nigerian Women

Abstract

BACKGROUND: Urinary incontinence (UI) and anal incontinence (AI) are common postpartum complications that significantly affect quality of life. However, evidence on how mode of delivery influences their incidence remains limited. AIM: To assess the effect of mode of delivery on the incidence of UI and AI among postpartum women. METHODS: This prospective cohort study involved postpartum mothers at a Nigerian tertiary hospital. Women who had cesarean section (CS) formed the exposed group, while those with vaginal delivery (VD) served as controls. The CS group was subdivided into elective CS (A1CS), emergency CS in the first stage of labor (A2CS), and emergency CS in the second stage (A3CS). Participants were followed up postpartum and assessed for UI and AI using validated questionnaires. RESULTS: Vaginal delivery was associated with a significantly higher risk of both UI (RR = 2.8; 95% CI: 1.2-6.5; P = 0.02) and AI (RR = 2.1; 95% CI: 1.1-4.3; P = 0.03) compared to CS overall. Subgroup analysis showed that VD was significantly associated with a higher risk of UI than A1CS (P = 0.03) and A2CS (P = 0.02), but lower than A3CS (P < 0.01). A similar trend was observed for AI, with VD posing greater risk than A1CS (P = 0.02) and A2CS (P = 0.01), but lower risk than A3CS (P < 0.001). Grand multiparity (P = 0.04) and macrosomia (P < 0.001) were also significantly associated with UI but not with AI (P = 0.09 and 0.08, respectively). CONCLUSION: Mode of delivery significantly influences the risk of postpartum UI and AI. Elective and early-stage emergency CS appear to reduce risk, while CS performed in the second stage of labor increases it. These findings support individualized counseling and delivery planning to help mitigate long-term pelvic floor dysfunction in high-risk women.