NEUROUROLOGY & FEMALE UROLOGY

How do the Prevalences of Urogenital Symptoms Change During Pregnancy?
van Brummen HJ, Bruinse HW, van der Bom JG, Heintz AP, van der Vaart CH
Department of Perinatology and Gynecology, University Medical Center Utrecht, Utrecht, The Netherlands
Neurourol Urodyn. 2006; 25: 135-9

• Aim: The aim of this study was to report the changes in prevalences of urogenital symptoms during pregnancy and to evaluate the amount of bother nulliparous pregnant women experience from these symptoms.
• Methods: We have used a prospective longitudinal cohort study design. Five hundred fifteen nulliparous women with a singleton pregnancy were recruited from 10 midwifery practices between January 2002 and July 2003. The women received postal questionnaires. Urogenital symptoms were assessed with the Dutch version of the standardized and validated Urogenital Distress Inventory (UDI). We analyzed our data on item level and on the clustering of items.
• Results: The prevalences of the frequency and urgency symptoms are high at 12 weeks (74% and 63%) and remain stable during pregnancy. The prevalences of urinary incontinence and voiding difficulties increase with gestational age. Frequency disappears in 12% in late pregnancy, urgency in 22%, and stress incontinence in 23%. The prevalence of bothersome frequency symptoms is much higher than of urinary incontinence (21% compared to 6%). All UDI subscales increase significantly during pregnancy.
• Conclusions: Urogenital symptoms occur in almost all women during pregnancy. Whereas the prevalence of overactive bladder symptoms is high and remains stable from early pregnancy on, the prevalences of urinary incontinence symptoms increase with gestational age. Despite the high prevalences of symptoms, the majority of women report not to be bothered by it.
  
  
• Editorial Comment
  The authors study a large number of women during their first pregnancy and quantify both the prevalence and level of bother of the voiding symptoms that developed during this period. The investigation found that by twelve weeks of pregnancy, urgency and frequency had been identified and this symptom remained stable during pregnancy. In contrast, the incidence of urinary incontinence increased as the pregnancy matured. The authors concluded that though almost all women in pregnancy have some voiding dysfunction and the prevalence of overactive bladder symptoms is quite high from early on, the majority of women are not bothered by these symptoms.
  That nulliparous women have a known rate of voiding dysfunction is well known and quoted by the authors of this manuscript. Perhaps the pregnant women of this study felt almost no bother from their urinary symptoms secondary due to the understanding that this was a self limited phenomena that would cease because of: it was the miracle of childbirth; or, the life changes and challenges associated with a maturing pregnancy reduced voiding dysfunction to a lower priority on the list of physical, mental and situational events that may affect and bother the pregnant female. A clear message from this article is that almost all women who are pregnant will have some kind of voiding dysfunction with urge and frequency starting early and urinary incontinence continuing to worsen as the pregnancy continues; nevertheless, the physician probably will not be challenged to find a solution to this problem for the pregnant woman does not view it as a significant bother.

Dr. Steven P. Petrou
Associate Professor of Urology
Associate Dean, Mayo Clinic College of Medicine
Jacksonville, Florida, USA