Postpartum urinary incontinence linked to mental health

A UT Southwestern Medical Center study of hundreds of underserved women found that depression and anxiety, as well as physical factors like high BMI and childbirth, are associated with longer-lasting postpartum urinary incontinence. The findings, published in the journal Urogynecology, shed light on these stigmatized but largely treatable conditions, the researchers say.

“Our study builds a bridge between two important components of health care that are often overlooked and neglected: postpartum care and mental health,” said Sonia Bhandari-Randhawa, MD, a second-year urology and gynecology fellow at UT Southwestern, who co-led the study with David Rahn, MD, professor of obstetrics and gynecology at UTSW.

Dr. Bhandari Randhawa explained that in October 2020, clinicians from UT Southwestern and Parkland Health launched Extended Maternal and Child Care After Pregnancy (eMCAP), a community-based program that provides care to underserved women in Dallas County for one year after delivery. Women enrolled in the program undergo a baseline assessment after delivery and then check in frequently for the next 12 months. Patients undergo a physical exam and answer questions about a variety of physical and mental health conditions for treatment or referral purposes.

Curious about the potential overlap between postpartum urinary incontinence and mental health in this group, Dr. Bhandari-Randhawa, Dr. Rahn and their colleagues evaluated responses provided by 419 eMCAP patients 12 months after delivery as part of a validated survey designed to evaluate voiding dysfunction, anxiety, and depression. They looked for associations between these conditions and other factors, such as demographic and economic data, maternal age, previous parity, BMI, fetal birth weight, and mode of delivery.

The data showed that urinary incontinence was common: About 1 in 3 participants suffered from stress incontinence, meaning leaking urine with sudden movements like coughing, sneezing or jumping; about 1 in 6 suffered from urge incontinence, meaning leaking urine after a sudden, strong urge to urinate even when the bladder isn’t full; and 1 in 9 suffered from overall unpleasant urinary symptoms.

Neither stress nor urge incontinence in these participants was associated with traditional factors such as macrosomia or difficult labor. However, stress incontinence was significantly associated with both higher BMI at birth and higher depression questionnaire scores. Urge incontinence was significantly associated with both higher past parity and higher anxiety questionnaire scores. In general, the study showed that bothersome voiding symptoms were associated with both higher past parity and higher anxiety scores.

The relationship between urinary incontinence and mental health is a “chicken-and-egg question” that was not addressed in the study, Dr Rahn said, but previous research has shown a link between the stigma of urinary incontinence and poor mental health.

“Severe incontinence can make people feel isolated and embarrassed and can make it difficult for them to connect socially. It’s not hard to imagine that urinary incontinence can lead to psychological problems,” he said.

Dr Bhandari Randhawa added that the study may encourage health professionals to ask about urinary incontinence and mental health during postnatal appointments.

“Even if there isn’t time to have in-depth discussions about these topics, it’s really important for health care providers to ask about urinary incontinence, depression and anxiety,” she said. “Getting the appropriate referrals for these treatable conditions can make a big difference in patients’ lives.”