The problem is clear, but there is no simple solution

Papers p 1241

Postpartum urinary incontinence is an important and often overlooked form of maternal morbidity. In this issue Chiarelli and Cockburn (p 1241)1 highlight and confirm the work of other investigators who have shown that vaginal delivery induces urinary incontinence, especially the first vaginal birth.2 Many clinical studies have attempted to discover the particular obstetric event that causes the incontinence. The obvious suspects include large babies and “difficult deliveries” marked by lengthy pushing phases with or without instrumentation. No clear single event has been found to be responsible, suggesting that postpartum urinary incontinence arises from a multifactorial physiological insult. The consequences of this pathophysiology are not limited to urinary incontinence. Pelvic organ prolapse (cystocele, rectocele, and uterine prolapse) and anal incontinence are also troublesome sequelae of vaginal delivery. These prevalent pelvic problems receive even less than the scant attention paid to postpartum urinary incontinence. …