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    Urine Leakage Not Due to Childbirth

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

    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."

    Galloway offers advice for how women can know whether their pelvic floor is well suited to withstand the rigors of vaginal delivery.

    "The nerves and muscles that enervate the feet are adjacent to those responsible for the pelvic floor," Galloway says. "If you were trying to distinguish whether you are at risk or not, look and see how complete is the form and function of your feet and toes. Those with the best, most versatile feet -- who can spread their toes like fingers -- are more likely to have better function in the pelvic floor."

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