Postpartum depression, urge urinary incontinence, and overactive bladder syndrome: is there an association?

The purpose of this prospective, cross-sectional study was to determine if there was an association between postpartum depression and symptoms of overactive bladder in postpartum women. At their 6 week postpartum visit, participants completed questionnaires regarding lifestyle, personal health, urinary incontinence, and depression symptoms, including the Urge-Urinary Distress Inventory (URGE-UDI), the Urge-Incontinence Impact Questionnaire (URGE-IIQ) and the Edinburgh Postnatal Depression Scale (EPDS). Past medical history, including obstetric variables, family history, and medications were extracted from the medical record. One hundred patients completed the questionnaires at the University of Michigan Hospital and 46 patients at the University of Virginia Hospital (mean age 29.2 +/- 6.1 years; 18-47 years) at their postpartum visit (mean time 45.2 +/- 9.4 days postpartum; 11-79 days). Sixteen percent of the women had depression (EPDS score of > 12) or were borderline (EPDS score of 9-12) for postpartum depression. There was no difference in age and race in women with and without depression. Type of delivery, vaginal vs cesarean section did not significantly impact their URGE-UDI or URGE-IIQ score. There was a significant correlation between the URGE-IIQ score and depression (0.24, p=0.003), but not the URGE-UDI score. In this cross-sectional study, we found an association between postpartum depression and symptoms of urge incontinence. Because birth is a predictable event, further studies evaluating the causal relationships and physiologic changes linking depression and incontinence can be studied using this model.