Childbirth Not the Only Contributor to Overactive Bladder

Overactive bladder symptoms affected by time since delivery and type of delivery and obesity

/ Author:  / Reviewed by: Joseph V. Madia, MD Beth Bolt, RPh

(RxWiki News) The strain of vaginal childbirth can result in bladder leakage problems. For some women, the problem will likely get better with time, but for others it might get worse.

Bladder leakage or overactive bladder sends countless women running to the bathroom. This bladder problem is often attributed to childbirth. Little is known about whether cesarean birth (surgical delivery) can also cause these problems and whether the problems get better or worse with time.

A recently published study found that bladder problems were worse in the early years after a vaginal birth, but decreased in time. Symptoms in obese women who had a cesarean birth, however, can get worse with time.

"Talk to your doctor about your overactive bladder symptoms."

Victoria L. Handa, MD, from the Department of Gynecology and Obstetrics at Johns Hopkins Bayview Medical Center in Baltimore, MD, and a team of researchers conducted this study.

The study enrolled 1,481 women who had given birth five to 10 years ago, either by vaginal or cesarean delivery.

These women were asked to complete a questionnaire when they entered the study (baseline) and every year after until the study ended after five years. The questionnaire asked about bladder problems related to leakage, urgent need to urinate, frequency of urination and waking at night to urinate. Women scored each item on the survey from 0, indicating no bother, to 100, indicating the most possible bother.

Additional information was gathered about the women’s body mass index (BMI), which was used as a measure of body composition. A BMI of less than or equal to 25 was considered normal, while 25 to 30 was considered overweight. A BMI of 30 and over was considered obese.

Results of this research showed that, at the start of the study, symptoms related to bladder leakage were rated highly bothersome by 2.3 percent of women who had cesarean deliveries and 14.2 percent of women who delivered vaginally.

At the baseline point, overactive bladder symptoms of urgent and frequent need to urinate were scored as highly bothersome by 1.4 percent of the women in the cesarean group and by 6 percent of the women in the vaginal delivery group.

The research team found that the odds of urine leakage from activities or from coughing or sneezing increased 6 percent every year after the first cesarean birth. However, the odds of this type of bladder leakage did not increase in the years after vaginal delivery.

The odds of bladder leakage symptoms were increased 2.5 fold in obese women compared to women who were not obese in the cesarean group. The odds were not increased in obese women compared to non-obese women in the vaginal delivery group.

The chance of developing symptoms of overactive bladder was increased 2.6 to 2.9 fold in obese women in the cesarean group compared to non-obese women. 

Only the overactive bladder symptom of waking to urinate was increased in the obese women in the vaginal delivery group. Those women had 1.4-fold increased odds compared to women in the vaginal delivery group who were not obese.

One limitation of this study noted by the authors was that bladder leakage was not measured, just estimated by the study participants. The authors also commented that their findings may represent just the period of time studied and may not be sustained over a longer time.

“Our results ... demonstrate that obesity is an important risk factor for bladder symptoms and therefore obesity control should be a primary target for reduction of incontinence and incontinence severity among [women who had borne children],” the authors concluded.

"Overactive bladder, or detrusor instability, is a condition where women have the urge to urinate at low volumes. Vaginal childbirth increases the likelihood of this condition but not Cesarean sections. There are, however, other irritants, the most common being caffeinated products," said Andre Hall, MD, who practices obstetrics and gynecology at Birth & Women's Care in Fayetteville, NC.

"The take-home message is that if a woman notices symptoms consistent with an overactive bladder, she should eliminate the irritants and seek medical care for consideration of medicine," Dr. Hall said.

This study appeared in the March issue of Neurology and Urodynamics.

Funding for the research was provided by a grant from the Eunice Kennedy Shriver National Institute of Child Health and Human Development.

The authors disclosed no conflicts of interest.

Review Date: 
March 26, 2014
Last Updated:
March 27, 2014