Longitudinal study ties incontinence to lifestyle.(News)

MONTREAL -- Female urinary and fecal incontinence is associated with lifestyle, according to a recent longitudinal study.

"Body mass index, smoking, and hormone replacement therapy remain bad news for the pelvic floor," said Kaven Baessler, M.D., who conducted the study at Royal Women's Hospital in Brisbane, Australia.

Speaking at the annual meeting of the International Continence Society, Dr. Baessler, who has since moved to Charite University Hospital in Berlin, said neither age nor mode of delivery was associated with incontinence in her study population of 443 women aged 40-80 years.

"In some studies, age definitely plays a role but the women in this study were already aged 40 and up--age had taken its toll already when we assessed them," she said in an interview. "The results would be different when more premenopausal and younger women are considered. That vaginal delivery and parity itself plays a role in women aged 30-50 is not a question."

The data were analyzed based on three delivery modes: women who'd had no births, women with a cesarean delivery, and women who'd had either a spontaneous or instrumental delivery. This analysis showed no association between any of these three categories and incontinence.

The study grouped together women who'd had either a spontaneous or instrumental vaginal delivery. U.S. studies that have looked exclusively at women who've undergone instrumental delivery or episiotomy have shown an association between these procedures and pelvic floor damage, Luis Sanz, M.D., head of the urogynecology and pelvic surgery program at Virginia Hospital Center, Arlington, noted in an interview.

At the meeting Dr. Baessler said, "Many people want to blame something, and vaginal delivery is so easy to blame. Many studies with large numbers have shown that cesarean section increases the risk of ...