Urine Leakage Not Due to Childbirth
Study of Sisters: Blame Genes, Not Kids, for Later-Life Urinary Incontinence
WebMD News Archive
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
"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
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
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
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."