UroToday - The International Continence Society (ICS) has simplified the definition of urinary incontinence as the complaint of any involuntary leakage of urine. Urinary incontinence in women during pregnancy - with prevalence of urinary incontinence being reported before, during and after pregnancy is 3.6%, 43.7% and 14.67% respectively. Most of the studies from developed and developing countries confirm that the prevalence of urinary incontinence substantially increases during pregnancy and is associated with parity, age and body mass index. Apart from urinary incontinence, which has been focused on by most studies, other urinary symptoms such as increased urinary frequency, nocturia, hesitancy, and burning micturition are also seen to be common in pregnant women. In India there is very scarce data available regarding urinary incontinence and other urological problems during pregnancy.

Therefore, from January 2008 to July 2008, we conducted a study on 240 women attending the antenatal clinic of the unit in our hospital for various urinary problems during pregnancy. Our designed questionnaire included details such as obstetric history and reporting of various urinary symptoms such as frequency, nocturia, burning micturition, urinary hesitancy, hematuria, urinary incontinence, urinary tract infection and any interruption in daily life due to these symptoms.

The mean age of women in the study was 26.5 years, with most women being homemakers (79.4%) and the majority (66.5%) being illiterate or having less than higher secondary education.

Most of the women (50.1%) were in the third trimester of pregnancy while 37.8% were in second trimester and 12.1% were in the first trimester. Our study showed that the majority of urinary problems like urinary frequency, nocturia, burning micturition, hesitancy and urinary incontinence were significantly more common during pregnancy than prior to pregnancy (P10/day) was seen in 40.8% women during pregnancy as compared to 3.8% before pregnancy. Urinary incontinence was seen in 25.8% women during pregnancy as compared to 8.2 % prior to pregnancy. Nocturia, burning micturition, urinary tract infection urinary hesitancy and bother was observed in 72.9% vs 50.6%, 21.3% vs 3.8%, 4.6% vs 1.6%, 14.6% vs 1.6% and 22.1% vs 2.7 % respectively during and prior to pregnancy. The prevalence of urinary incontinence and urinary problems was much higher during the third trimester of pregnancy than in second or first trimesters. Stress incontinence was 19.2% during pregnancy as compared to 6.6% prior to pregnancy.

The present study also found steady and significant increases in the risk of urinary incontinence with advancing age. In our study, 57.14% of women >35 years of age reported urinary incontinence as compared to 17.97% in the 20-24 year age group. Risk of urinary incontinence, increased to 37.04% with parity of >3 as compared to 18.75% in nulliparus. Prior vaginal delivery was also a risk factor with prevalence of urinary incontinence being 42.81% in women who had 4 vaginal deliveries as compared to 27.27% in women who had no vaginal delivery.

There is a common notion that urinary incontinence is less prevalent in India and other developing countries. This is probably attributable to the lack of awareness amongst women who consider it to be a "normal" or physiological process during pregnancy and are hesitant to report their problems unless specifically asked, or unless they perceive a significant deterioration in quality-of-life.

Our study confirms the high prevalence, in India, of urinary incontinence and other urological problems during pregnancy - with the greatest prevalence observed in the third trimester. Our study also stresses the need to ask patients direct questions about urological symptoms during pregnancy to identify the exact nature of these conditions and to offer appropriate treatment for their symptoms so they do not suffer in silence.

J. B. Sharma, Shena Aggarwal, Saurabh Singhal, S. Kumar and K. K. Roy as part of Beyond the Abstract on UroToday

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