Exclusive caesarean section delivery and subsequent urinary and faecal incontinence: a 12-year longitudinal study

Objectives To investigate the association between delivery mode history and urinary and faecal incontinence, specifically a history of exclusive caesarean section deliveries. Design Twelve-year longitudinal study. Setting Maternity units in Aberdeen, Birmingham and Dunedin. Population Women who returned postal questionnaires 3 months and 12 years after index birth. Methods Data on all births over a 12-month period were obtained from units and women were followed 3 months, 6 years and 12 years after the birth. Main outcome measures Urinary incontinence (UI) and faecal incontinence (FI) 12 years after index birth. Results Of the 7883 women recruited at 3 months, 3763 were followed up at 12 years: nonresponders were similar in their obstetric factors. After adjustment for parity, body mass index and age at first birth, women who delivered exclusively by caesarean section were less likely to have UI than those who only had spontaneous vaginal births (odds ratio [OR] 0.46, 95% confidence interval [CI] 0.37-0.58), but not if they had a combination of caesarean and spontaneous vaginal births (OR 1.14, 95% CI 0.89-1.47). There was no difference in FI among women who had exclusive caesarean births (OR 0.94, 95% CI 0.66-1.33) or mixed caesarean and spontaneous vaginal births (OR 1.06, 95% CI 0.73 1.54). Conclusions Unless women are resolved to have all their deliveries by the abdominal route (and their medical advisors agree), caesarean section does not protect from subsequent UI. Even among those who do deliver exclusively by caesarean section, 40% still report UI; and this strategy confers no benefit for subsequent FI.