Anxiety, depression scores tied to risk for postpartum urinary incontinence

Key takeaways:

• Women with higher depression and anxiety scores postpartum were more likely to have stress or urgency urinary incontinence.
• Maternal BMI and parity were also associated with postpartum urinary incontinence.

Women who scored higher on depression and anxiety questionnaires 12 months postpartum were more likely to have stress or urgency urinary incontinence, supporting the need for mental health and bladder leakage screenings, data show.

“About one in three patients have postpartum incontinence to some extent, and it significantly and negatively impacts quality of life,” Sonia Bhandari Randhawa, MD, a third-year urogynecology fellow at University of Texas Southwestern, told Healio. “Postpartum women are already vulnerable and dealing with a new baby, and this is just another layer of a complication that is bothersome for the patient.”

The study, published in Urogynecology, was a planned ancillary cross-sectional analysis of a prospective observational study that included 419 women with high health-related social needs. Most participants identified as Hispanic (77%) or Black (22%); the mean age of women was 28 years. The women were enrolled in extending Maternal Care After Pregnancy (eMCAP), a program launched in 2020 to target health disparities in underserved communities for 12 months postpartum. Participants completed baseline questionnaires at the 1-month postpartum visit and attended follow-up appointments at 3, 6, 9 and 12 months postpartum; at the 9- or 12-month visit, participants were screened for bothersome urinary symptoms using the Urinary Distress Index-6 scale, anxiety with the Generalized Anxiety Disorder-7 scale and depression with the Edinburgh Postnatal Depression Scale. Researchers assessed the associations between stress urinary incontinence and urgent urinary incontinence at 12 months postpartum, depression and anxiety scores and factors including maternal age, BMI, parity, fetal birth weight, delivery mode and laceration type.

“Researchers were already taking care of these patients postpartum and tracking these patients with different indicators to understand what they were going through,” Bhandari Randhawa said during an interview. “We looked at the questionnaires for incontinence and tried to understand how those women were being impacted from that standpoint.”

Researchers found that stress urinary incontinence, which affected 32.5% of enrolled women, was associated with increasing BMI at delivery (OR = 1.03; 95% CI, 1.01-1.07; P = .047) and greater depression screening scores (OR = 1.07; 95% CI, 1.01-1.15; P = .031).

Other factors such as fetal birth weight, delivery mode, degree of laceration and breastfeeding status were not associated with stress urinary incontinence.

Urgency urinary incontinence, which affected 16.5% of women, was associated with

increasing parity (OR = 1.12; 95% CI, 1.06-1.44; P = .008) and higher anxiety screening scores (OR = 1.11; 95% CI, 1.05-1.18; P < .001).

Women who reported urinary symptom bother (11%) were more likely to have greater parity and higher anxiety screening scores.

“We want people to understand that urinary incontinence is treatable,” Bhandari Randhawa told Healio. “This is not something that women simply have to deal with. We know women have urinary incontinence and we are trying to tell people that there is a connection between your anxiety and depression postpartum and urinary leakage. We want providers to ask patients these questions.”

Bhandari Randhawa said the findings reinforce recommendations by ACOG to screen all postpartum patients and offer referrals for treatment of mental health disorders and bladder leakage.

“There is a social taboo to urinary incontinence and some women are reluctant to bring this up,” Bhandari Randhawa told Healio. “We know providers have a lot to discuss with women during postpartum appointments. We are simply saying, ask these questions and then refer. Urogynecologists are seeing these patients, and we are happy to take care of them and alleviate some of their stress and anxiety.”

For more information:

Sonia Bhandari Randhawa, MD, can be reached at sonia.bhandarirandhawa@utsouthwestern.edu.