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Urine Leakage Not Due to Childbirth

Study of Sisters: Blame Genes, Not Kids, for Later-Life Urinary Incontinence

Genetic Risk for Urinary Incontinence? continued...

"Out of every three sister pairs, two had same status: Either both leaked urine or neither leaked urine," Buchsbaum says. "That's more than you would see by chance."

And when one sister had urinary incontinence and the other didn't, the sister with the problem was no more likely to have given birth than to be childless.

"So we think there is probably some genetic component that may predispose somebody for incontinence or not," Buchsbaum says. "Because we saw women with eight kids and no incontinence."

This doesn't surprise Niall Galloway, MD, medical director of the Emory Continence Center at the Emory University School of Medicine in Atlanta.

"I believe, based on the medical literature and our own experience, that urinary incontinence is a familial disease," Galloway tells WebMD. "The risks are going to be greater to daughters of women who already have these problems."

Not all women are built the same way, Galloway notes. This means vaginal delivery has different consequences for different women.

"The pelvic floor of one woman is different from another's, just as the telephone book of Ellijay, Ga., is different from that of Atlanta," Galloway says. "Life is not fair. Some women are going to be able to produce multiple children by vaginal delivery and never have a moment's setback. Others are going to have a single child, and their pelvic floor will be damaged forever."

Childbirth Still a Suspect in Earlier-Life Incontinence

Buchsbaum's study finds no lifetime risk of urinary incontinence. She is quick to point out that it does not say anything about whether vaginal delivery brings on urinary incontinence sooner than it might otherwise appear.

The Buchsbaum study is important, says Neeraj Kohli, MD, MBA, director of urogynecology at Brigham and Women's Hospital and assistant professor at Harvard Medical School, Boston. But Kohli says that vaginal childbirth does appear linked to earlier onset of urinary incontinence.

"I see patients who are 40, who had their last delivery five years ago, and they have urinary incontinence and their sisters don't have it," Kohli tells WebMD. "As patients get older, vaginal delivery is less of a causative issue. But in the younger population, vaginal deliver might be more of a cause of pelvic-floor dysfunction -- including urinary incontinence."

Kohli agrees with Galloway that different women have different problems with vaginal delivery. And Kohli, Galloway, and Buchsbaum all agree that pregnant women considering having a C-section in order to avoid urinary incontinence should have a long talk with their doctor.

"I make recommendations specific to individual patients," Kohli says. "If someone had incontinence or pelvic prolapse after her first delivery, I might recommend C-section for her next one, because every subsequent delivery causes further trauma. If I have a small woman with a big baby, we would probably recommend C-section also. But at the end of the day, if a patient says to her doctor, 'I want a primary elective C-section,' there should be an extended discussion."

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