Epidurals cut risk of incontinence in later life—study

The procedure lowers the damage caused to levator muscles, key muscles which hold up internal organs, thereby cutting the risk of incontinence in later life, researchers say.

Incontinence occurs when the pelvic muscles lose their strength to uphold the vital internal organs like the bladder and uterus. Depending on severity of muscle damage, the symptoms include urinary and faecal incontinence, chronic constipation, and sexual problems.

One vaginal delivery makes a woman four times more likely to suffer incontinence. The odds double with two vaginal births.

In general, 10 percent of the women who deliver vaginally suffer damage to their levator muscles, 30 percent of the women who have a forceps delivery experience muscle damage, researchers say.

Details of the study
Researchers from the Nepean Clinical School of Medicine in Sydney, Australia, assessed nearly 400 childbirths occurring between 2005 and 2008.

A-third of the women who underwent either a planned or emergency Caesarean section, thus no cases of muscle damage or tearing, were excluded for the study.

Of those who delivered vaginally, about 13 percent suffered muscle damage.

The risk of muscle tearing was slightly lower among women whose childbirth was assisted with a ventouse, as against those whose delivery was not assisted.

However, use of forceps raised the risk of damage. Thirty percent of the forceps deliveries resulted in muscle injury, researchers found.

Also, the duration of labor was crucial; the longer span of pushing was strongly associated with higher muscle injury.

But overall, women who had an epidural during labor ran a lower risk of muscle damage, researchers found.

“The finding that epidurals may provide a protective effect by reducing levator damage is reassuring,” BJOG editor-in-chief, Professor Philip Steer said.

“The short-term priority is to reduce pain during childbirth but the longer term effect of reducing muscle damage and prolapse is welcome,” Steer added.

The speculated reasons for protection
While the researchers are not sure how a pain relieving procedure confers protection against muscle damage, they believe that epidurals cut the potential damage from premature or over-pushing, as women are likely to push only when they feel contractions.

Also, as epidurals temporarily paralyze muscles, they are less likely to be injured, researchers say.

The findings of the study are published in the international obstetrics journal BJOG.