| August 2005 · Vol. 17, No. 8 CASE-BASED LEARNING
When does vaginal delivery invite incontinence?
Cesarean or no cesarean, only a few factors can reduce risk of pelvic floor damage, and not all are controllable. What to counsel the worried, incontinent gravida.
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Fast Track
Women can have neurologic pelvic floor dysfunction yet have normal findings
30 years after delivery, fecal incontinence is equally prevalent among women who delivered vaginally or by cesarean
Elective cesarean protects only against stress incontinence—not other urinary or fecal symptoms
The effect of delivery on incontinence has perhaps been overstated
Pelvic floor injury is more likely with attempted forceps delivery than with emergent c-section at full dilatation
Term Breech Trial: No differences in incontinence and sexual function between planned cesarean and planned vaginal delivery
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K.L.
Calvert,
MDSpecialist Registrar, Department of Obstetrics and Gynecology Cheltenham General Hospital Cheltenham,
England Rachel
E.
Liebling,
MDSpecialist Registrar, Department of Obstetrics-Gynecology and Women’s Health, Royal United Hospital,
Bath, England
MARISOL’S CASE
Marisol, a 32-year-old physiotherapist expecting her second child, presents to your antenatal clinic at 20 weeks’ gestation. She complains of urinary incontinence, which has been worsening throughout this pregnancy, and wants to know what can be done about it.
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