By Author
  By Title
  By Keywords

May 2020, Volume 70, Issue 5

Letter to the Editor

Stress urinary incontinence after child birth - An unreported complication

Hira Nawaz  ( Lahore College of Physical Therapy, LM&DC, Lahore, Pakistan )
Hira Arshad  ( Lahore College of Physical Therapy, LM&DC, Lahore, Pakistan. )
Hafiz Muhammad Asim  ( Lahore College of Physical Therapy, LM&DC, Lahore, Pakistan. )


Madam, Pregnancy and birth trauma are believed to be associated with the development of Stress Urinary Incontinence (SUI). SUI is a widespread condition with the global prevalence ranging from 18.6-67% during pregnancy and 7-56% after delivery which is assumed to decline within six months following delivery.1 It is not a new issue at all. But the increasing trend of not reporting this burdensome condition to the physician urged me to write this letter. Since the aftermath of unreported SUI is devastating. Many studies have been done on incontinence and its impact on postpartum females from several years. In this letter, some of the most recent studies were overviewed. In 2012, a large-scale study was conducted about the prevalence of UI in rural Pakistan, revealed that the prevalence is lower as compared to the studies from the developed world. The prevalence of UI was found to be 11.5%, SUI being most prevalent. SUI continues to remain a taboo with less than half of the women reporting to a physician about their condition. The most likely causes may include embarrassment and shame or limited information about treatment choices. Henceforth, SUI patients struggle in silence and try to deal with it themselves by using pads, limiting fluid intake and avoiding social dealings.2,3 Another large cohort study has shown 37.9% prevalence of persistent UI, at 3 months and at 12 years after delivery.4 The understanding and beliefs about incontinence are potentially significant contributors for seeking treatment strategies. This is particularly true given the repeated finding that considerable proportions of incontinent women do not complain unless they are enquired specifically.5 The whys and wherefores of low consultation rate may include fear of stigmatization and isolation, feeling sinful as unable to perform ritual prayers five times a day, belief that the condition is incurable, or fear that surgery is the only option.6 In addition, the misconception that the condition is a predictable consequence after pregnancy while some might regard UI as a normal part of the ageing process.7 To date, the prevalence and type of UI among women in the general population of Pakistan have not been wellinvestigated. It imposes a great challenge to our healthcare system as until now there is no consensus with regard to consultation or report rate of SUI after pregnancy. There is a clear need of healthcare education and promotion on the high global prevalence, bothersomeness and treatment strategies in an effort to eradicate the social stigma as it enforces a significant emotional, social, and financial burden on the patient. Furthermore, it is vital to understand (1) the knowledge; (2) beliefs; and (3) reactions of women toward their own incontinence, while addressing them with SUI.


Disclaimer: None.

Conflict of interest: None.

Funding disclosure: None.




1. Lin YH, Chang SD, Hsieh WC, Chang YL, Chueh HY, Chao AS, et al. Persistent stress urinary incontinence during pregnancy and one year after delivery; its prevalence, risk factors and impact on quality of life in Taiwanese women: An observational cohort study. Taiwan J Obstet Gynecol 2018; 57: 340-5.

2. Jokhio AH, Rizvi RM, Rizvi J, MacArthur C. Urinary incontinence in women in rural Pakistan: Prevalence, severity, associated factors and impact on life. BJOG 2013;120:180-6.

3. Lose G. The burden of stress urinary incontinence. Eur Urol Suppl 2005; 4: 5-10.

4. MacArthur C, Wilson D, Herbison P, Lancashire RJ, Hagen S, Toozs- Hobson P, et al. Urinary incontinence persisting after childbirth: Extent, delivery history, and effects in a 12-year longitudinal cohort study. BJOG 2016; 123: 1022-9.

5. Ansar H, Adil F, Munir AA. Unreported Urinary and Anal Incontinence in Women. J Liaquat Uni Med Health Sci 2005; 4: 54-9.

6. Wilkinson K. Pakistani women's perceptions and experiences of incontinence. Nurs Stand R Coll Nurs G B 2001; 16: 33-9.

7. Shaw C, Tansey R, Jackson C, Hyde C, Allan R. Barriers to help seeking in people with urinary symptoms. Fam Pract 2001; 18: 48-52.


Journal of the Pakistan Medical Association has agreed to receive and publish manuscripts in accordance with the principles of the following committees: