Trajectories, bother, and risk factors of lower urinary tract symptoms during the first postpartum year: a prospective cohort study

Lower urinary tract symptoms (LUTS) are common after childbirth and may adversely affect women’s quality of life. However, most postpartum studies have focused on urinary incontinence or symptom prevalence at a single time point, with limited information on longitudinal symptom trajectories, symptom-specific burden, and factors associated with LUTS during the first postpartum year, particularly in Asian populations. This prospective cohort study was conducted at a tertiary referral hospital in Beijing, China. A total of 2,190 women completed assessments at 42 days and one year postpartum using the International Consultation on Incontinence Questionnaire-Female Lower Urinary Tract Symptoms (ICIQ-FLUTS). Prevalence, longitudinal trajectories, and symptom-specific bother were evaluated. Multivariable logistic regression identified factors associated with postpartum LUTS. At one year postpartum, 56.0% of women reported at least one LUTS. Storage symptoms were more common than voiding symptoms (45.2% vs. 25.4%). Stress urinary incontinence (SUI) was the most prevalent symptom (26.3%). Nocturia and daytime frequency demonstrated the greatest improvement, whereas SUI was the only symptom to increase in prevalence, with 15.9% of women experiencing worsening or new-onset symptoms ( P < 0.001). Although urgency urinary incontinence (UUI) affected 13.5% of women, it was the most bothersome symptom, with 93.1% reporting any bother and 32.3% reporting moderate-to-severe bother. Vaginal delivery, particularly forceps delivery, and multiparity were independently associated with several LUTS outcomes, whereas pelvic floor rehabilitation was associated with lower odds of urinary incontinence-related symptoms. More than half of women continue to experience LUTS one year postpartum. Postpartum LUTS follow dynamic trajectories, and symptom burden may not be reflected by prevalence alone. These findings support extended postpartum surveillance and patient-centred outcomes.