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Effects of Pregnancy and Childbirth on the Pelvic Floor

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Abstract

For many women, pregnancy, as well as labor and delivery, represent the key physiological events predisposing to incontinence and pelvic floor dysfunction. Our knowledge of obstetrical pelvic floor injuries, and their connection to incontinence and pelvic floor disorders later on, has vastly increased in recent years. Primary care clinicians addressing urogynecology problems should be aware of the potential effects of pregnancy and childbirth on the pelvic floor.

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References

  1. DeLancey JO. Anatomy and biomechanics of genital prolapse. Clin Obstet Gynecol. 1993;36: 897–909.

    Article  PubMed  CAS  Google Scholar 

  2. Wall LL. The muscles of the pelvic floor. Clin Obstet Gynecol. 1993;36:910–925.

    Article  PubMed  CAS  Google Scholar 

  3. Burnett SJ, Spence-Jones C, Speakman CT, Kamm MA, Hudson CN, Bartram CI. Unsuspected sphincter damage following childbirth revealed by anal endosonography. Br J Radiol. 1991;64:225–227.

    Article  PubMed  CAS  Google Scholar 

  4. Sultan AH, Kamm MA, Hudson CN, Thomas JM, Bartram CI. Anal sphincter disruption during vaginal delivery. N Engl J Med. 1993;329:1905–1911.

    Article  PubMed  CAS  Google Scholar 

  5. Rieger N, Schloithe A, Saccone G, Wattchow D. A prospective study of anal sphincter injury due to childbirth. Scand J Gastroenterol. 1998;33:950–955.

    Article  PubMed  CAS  Google Scholar 

  6. Campbell DM, Behan M, Donnelly VS, O’Herlihy C, O’Connell PR. Endosonographic assessment of postpartum anal sphincter injury using a 120 degree sector scanner. Clin Radiol. 1996;51:559–561.

    Article  PubMed  CAS  Google Scholar 

  7. Zetterstrom J, Mellgren A, Jensen LL et al. Effect of delivery on anal sphincter morphology and function. Dis Colon Rectum. 1999;42(10):1253–1260.

    Article  PubMed  CAS  Google Scholar 

  8. Crawford LA, Quint EH, Pearl ML, DeLancey JO. Incontinence following rupture of the anal sphincter during delivery. Obstet Gynecol. 1993;82:527–531.

    Article  PubMed  CAS  Google Scholar 

  9. Bek KM, Laurberg S. Risks of anal incontinence from subsequent vaginal delivery after a complete obstetric anal sphincter tear. Br J Obstet Gynaecol. 1992;99:724–726.

    PubMed  CAS  Google Scholar 

  10. Go PM, Dunselman GA. Anatomic and functional results of surgical repair after total perineal rupture at delivery. Surg Gynecol Obstet. 1988;166:121–124.

    PubMed  CAS  Google Scholar 

  11. Mellerup Sorenson S, Bondesen H, Istre O, Vilmann P. Perineal rupture following vaginal delivery: long-term consequences. Acta Obstet Gynecol Scand. 1988;67:315–318.

    Google Scholar 

  12. Faltin DL, Sangalli MR, Roche B, Floris L, Boulvain M, Weil A. Does a second delivery increase the risk of anal incontinence? Br J Obstet Gynaecol. 2001;108:684–688.

    Article  CAS  Google Scholar 

  13. Fornell EK, Berg G, Hallbook O, Matthiesen LS, Sjodahal R. Clinical consequences of anal sphincter rupture during vaginal delivery. J Am Coll Surg. 1996;183:553–558.

    PubMed  CAS  Google Scholar 

  14. Groutz A, Fait G, Lessing JB, David MP, Wolman I, Jaffa A, Gordon D. Incidence and obstetric risk factors of postpartum anal incontinence. Scand J Gastroenterol. 1999;34:315–318.

    Article  PubMed  CAS  Google Scholar 

  15. DeLancey JO, Toglia MR, Perucchini D. Internal and external anal sphincter anatomy as it relates to midline obstetric lacerations. Obstet Gynecol. 1997;90:924–927.

    Article  PubMed  CAS  Google Scholar 

  16. Sultan AH, Kamm MA, Hudson CN, Thomas JM, Bartram CI. Anal sphincter disruption during vaginal delivery. N Engl J Med. 1993;329:1905–1911.

    Article  PubMed  CAS  Google Scholar 

  17. Sato T, Konishi F, Minakami H et al. Pelvic floor disturbance after childbirth: vaginal delivery damages the upper levels of sphincter innervation. Dis Colon Rectum. 2001;44:1155–1161.

    Article  PubMed  CAS  Google Scholar 

  18. Shiono P, Klebanoff MA, Carey JC. Midline episiotomies: more harm than good? Obstet Gynecol. 1990;75:765–770.

    PubMed  CAS  Google Scholar 

  19. Klein MC, Gauthier RJ, Robbins JM et al. Relationship of episiotomy to perineal trauma and morbidity, sexual dysfunction, and pelvic floor relaxation. Am J Obstet Gynecol. 1994;171:591–598.

    PubMed  CAS  Google Scholar 

  20. Green JR, Soohoo SL. Factors associated with rectal injury in spontaneous deliveries. Obstet Gynecol. 1989;73:732–738.

    PubMed  CAS  Google Scholar 

  21. Rockner G, Jonasson A, Olund A. The effect of mediolateral episiotomy at delivery on pelvic floor muscle strength evaluated with vaginal cones. Acta Obstet Gynecol Scand. 1991;70:51–54.

    PubMed  CAS  Google Scholar 

  22. Argentine Episiotomy Trial Collaborative Group. Routine vs selective episiotomy: a randomised controlled trial. Lancet. 1993;342(8886-8887):1517–1518.

    Google Scholar 

  23. Klein MC, Gauthier RJ, Jorgensen SH et al. Does episiotomy prevent perineal trauma and pelvic floor relaxation [published correction appears in Online J Curr Clin Trials. 1992 Sep 12;doc 20]? Online J Curr Clin Trials. 1992 Jul 1;doc 10.

    Google Scholar 

  24. Signorello LB, Harlow BL, Chekos AK, Repke JT. Midline episiotomy and anal incontinence: retrospective cohort study. BMJ. 2000;320(7227):86–90.

    Article  PubMed  CAS  Google Scholar 

  25. Signorello LB, Harlow BL, Chekos AK, Repke JT. Postpartum sexual functioning and its relationship to perineal trauma: a retrospective cohort study of primiparous women. Am J Obstet Gynecol. 2001;184:881–888.

    Article  PubMed  CAS  Google Scholar 

  26. Carroli G, Belizan J. Episiotomy for vaginal birth. Cochrane Database Syst Rev. 2000;CD000081.

    Google Scholar 

  27. Peschers UM, Schaer GN, DeLancey JO, Schuessler B. Levator ani function before and after childbirth. Br J Obstet Gynecaecol. 1997;104:1004–1008.

    CAS  Google Scholar 

  28. Allen RE, Hosker GL, Smith AR, Warrell DW. Pelvic floor damage in childbirth: a neurophysiological study. Br J Obstet Gynaecol. 1990;97:770–779.

    PubMed  CAS  Google Scholar 

  29. DeLancey JO, Kearney R, Chou Q, Speights S, Binno S. The appearance of levator ani muscle abnormalities in magnetic resonance images after vaginal delivery. Obstet Gynecol. 2003;101:46–53.

    Article  PubMed  Google Scholar 

  30. Snooks SJ, Swash M, Setchell M, Henry MM. Injury to innervation of pelvic floor sphincter musculature in childbirth. Lancet. 1984;2:546–550.

    Article  PubMed  CAS  Google Scholar 

  31. Snooks SJ, Swash M, Henry MM, Setchell M. Risk factors in childbirth causing damage to the pelvic floor innervation. Int J Colorectal Dis. 1986;1: 20–24.

    Article  PubMed  CAS  Google Scholar 

  32. Mallett VT, Hosker G, Smith ARB, Warrell DW. Pelvic floor damage and childbirth; a neurophysiologic follow-up study. Neuro Urodyn. 1993;12:357–358.

    Google Scholar 

  33. Snooks SJ, Swash M, Mathers SE, Henry MM. Effect of vaginal delivery on the pelvic floor: a 5-year follow-up. Br J Surg. 1990;77:1358–1360.

    Article  PubMed  CAS  Google Scholar 

  34. Snooks SJ, Barnes PR, Swash M. Damage to the innervation of the voluntary anal and periurethral sphincter musculature in incontinence: an electrophysiological study. J Neurol Neurosurg Psychiatry. 1984;47:1269–1273.

    Article  PubMed  CAS  Google Scholar 

  35. Smith AR, Hosker GL, Warrell DW. The role of pudendal nerve damage in the aetiology of genuine stress incontinence in women. Br J Obstet Gynaecol. 1989;96:29–32.

    PubMed  CAS  Google Scholar 

  36. Smith ARB, Hosker GL, Warrell DW. The role of partial denervation of the pelvic floor in the aetiology of genitourinary prolapse and stress incontinence of urine. A neurophysiological study. Br J Obstet Gynaecol. 1989;96:24–28.

    PubMed  CAS  Google Scholar 

  37. Snooks SJ, Henry MM, Swash M. Faecal incontinence due to external anal sphincter division in childbirth is associated with damage to the innervation of the pelvic floor musculature; a double pathology. Br J Obstet Gynecol. 1985;92:824–828.

    CAS  Google Scholar 

  38. Gilpin SA, Gosling JA, Smith AR, Warrell DW. The pathogenesis of genitourinary prolapse and stress incontinence of urine. A histological and histochemical study. Br J Obstet Gynaecol. 1989;96:15–23.

    PubMed  CAS  Google Scholar 

  39. Sharf B, Zilberman A, Sharf M, Mitrani A. Electromyogram of pelvic floor muscles in genital prolapse. Int J Gynaecol Obstet. 1976;14:2–4.

    Google Scholar 

  40. Norton PA. Pelvic floor disorders: the role of fascia and ligaments. Clin Obstet Gynecol. 1993;36:926–938.

    Article  PubMed  CAS  Google Scholar 

  41. Richardson AC, Lyon JB, Williams NL. A new look at pelvic relaxation. Am J Obstet Gynecol. 1976;126:568–571.

    PubMed  CAS  Google Scholar 

  42. Viktrup L, Lose G, Rolff M, Barfoed K. The symptom of stress incontinence caused by pregnancy or delivery in primiparas. Obstet Gynecol. 1992;79:945–949.

    PubMed  CAS  Google Scholar 

  43. Francis WJ. The onset of stress incontinence. J Obstet Gynaecol Br Emp. 1960;67:899–903.

    PubMed  CAS  Google Scholar 

  44. Marshall K, Thompson KA, Walsh DM, Baxter GD. Incidence of urinary incontinence and constipation during pregnancy and postpartum: survey of current findings at the Rotunda Lying-in Hospital. Br J Obstet Gynecol. 1998;105:400–402.

    CAS  Google Scholar 

  45. Stanton SL, Kerr-Wilson R, Harris VG: The incidence of urological symptoms in normal pregnancy. Br J Obstet Gynaecol. 1980;87:897–900.

    PubMed  CAS  Google Scholar 

  46. Meyer S. Schreyer A, De Grandi P, Hohlfeld P. The effects of birth on urinary continence mechanisms and other pelvic floor characteristics. Obstet Gynecol. 1998;92:613–618.

    Article  PubMed  CAS  Google Scholar 

  47. Viktrup L, Lose G: The risk of stress incontinence 5 years after first delivery. Am J Obstet Gynecol. 2001;185:82–87.

    Article  PubMed  CAS  Google Scholar 

  48. Bergman A, McCarthy TA, Ballard CA, Yanai J. Role of the Q-tip test in evaluating stress urinary incontinence. J Reprod Med. 1987;32:273–275.

    PubMed  CAS  Google Scholar 

  49. Peschers U, Schar G, Anthuber C, Schussler B. Postpartal pelvic floor damage: is connective tissue impairment more important than neuromuscular changes? Neuro Urodyn. 1993;12:376–377.

    Google Scholar 

  50. Peschers U, Schaer G, Anthuber C, DeLancey JO, Schuessler B. Changes in vesical neck mobility following vaginal delivery. Obstet Gynecol. 1996;88:1001–1006.

    Article  PubMed  CAS  Google Scholar 

  51. Van Geelen JM, Lemmens WA, Eskes TK, Martin CB. The urethral pressure profile in pregnancy and after delivery in healthy nulliparous women. Am J Obstet Gynecol. 1982;144:636–649.

    PubMed  Google Scholar 

  52. Hojberg KE, Salvig JD, Winslow NA, Lose G, Secher NJ. Urinary incontinence: prevalence and risk factors at 16 weeks of gestation. Br J Obstet Gynaecol. 1999;106:842–850.

    PubMed  CAS  Google Scholar 

  53. Persson J, Wolner-Hanssen P, Rydhstroem H. Obstetric risk factors for stress urinary incontinence: a population-based study. Obstet Gynecol. 2000;96:440–445.

    Article  PubMed  CAS  Google Scholar 

  54. Moller LA, Lose G, Jorgensen T. Risk factors for lower urinary tract symptoms in women 40 to 60 years of age. Obstet Gynecol. 2000;96:446–451.

    Article  Google Scholar 

  55. Rowe JW. The NIH consensus development panel: urinary incontinence in adults. JAMA. 1989;261: 2685–2690.

    Article  Google Scholar 

  56. Sand PK, Dmochowski R, Goldberg RP, McIlwain M, Lucente VR. Does overactive bladder impact interest in sexual activity? Baseline results from the MATRIX study. Paper presented at: 30th Annual Meeting of the International Urogyne cology Society; August 11, 2005; Copenhagen, Denmark.

    Google Scholar 

  57. Buhling KJ, Schmidt S, Robinson JN, Klapp C, Siebert G, Dudenhausen JW. Rate of dyspareunia after delivery in primiparae according to mode of delivery. Eur J Obstet Gynecol Reprod Biol. 2006;124:42–46.

    Article  PubMed  Google Scholar 

  58. Sampselle CM, Miller JM, Mims BL, DeLancey JO, Ashton-Miller JA, Antonakos CL. Effect of pelvic muscle exercise on transient incontinence during pregnancy and after birth. Obstet Gynecol. 1998;91:406–412.

    Article  PubMed  CAS  Google Scholar 

  59. Reilly ET, Freeman RM, Waterfield MR, Waterfield AE, Steggles P, Pedlar F. Prevention of postpartum stress incontinence in primigravidae with increased bladder neck mobility: a randomised controlled trial of antenatal pelvic floor exercises. Br J Obstet Gynaecol. 2002;109:68–76.

    CAS  Google Scholar 

  60. Labrecque M, Eason E, Marcoux S et al. Randomized controlled trial of prevention of perineal trauma by perineal massage during pregnancy. Am J Obstet Gynecol. 1999;180(3 Pt 1):593–600.

    Article  PubMed  CAS  Google Scholar 

  61. Goldberg RP, Abramov, Y, Botros S, et al. Delivery mode is a major environmental determinant of stress urinary incontinence: results of the Evanston Northwestern Twin Sisters Study. AJOG 2005;193(6):2149–2153.

    Google Scholar 

  62. Labrecque M, Eason E, Marcoux S. Randomized trial of perineal massage during pregnancy: perineal symptoms three months after delivery. Am J Obstet Gynecol. 2000;182(1 Pt 1):76–80.

    Article  PubMed  CAS  Google Scholar 

  63. Rasmussen KL; Krue S; Johansson LE; Knudsen HJ; Agger AO. Obesity as a predictor of postpartum urinary symptoms. Acta Obstet Gynecol Scand. 1997;76(4):359–362.

    PubMed  CAS  Google Scholar 

  64. Elia G, Dye TD, Scariati PD. Body mass index and urinary symptoms in women. Int Urogynecol J Pelvic Floor Dysfunct. 2001;12(6):366–369.

    Article  PubMed  CAS  Google Scholar 

  65. Gardosi J, Hutson N, B-Lynch C. Randomised, controlled trial of squatting in the second stage of labour. Lancet. 1989;2(8654):74–77.

    Article  PubMed  CAS  Google Scholar 

  66. Golay J, Vedam S, Sorger L. The squatting position for the second stage of labor: effects on labor and on maternal and fetal well-being. Birth. 1993;20: 73–78.

    PubMed  CAS  Google Scholar 

  67. de Jong PR, Johanson RB, Baxen P, Adrians VD, van der Westhuisen S, Jones PW. Randomised trial comparing the upright and supine positions for the second stage of labour. Br J Obstet Gynaecol. 1997;104:567–671.

    PubMed  Google Scholar 

  68. Gupta JK, Nikodem VC. Woman’s position during second stage of labour. Cochrane Database Syst Rev. 2000;CD002006.

    Google Scholar 

  69. Fraser WD, Marcoux S, Krauss I, Douglas J, Goulet C, Boulvain M. Multicenter, randomized, controlled trial of delayed pushing for nulliparous women in the second stage of labor with continuous epidural analgesia. The PEOPLE (Pushing Early or Pushing Late with Epidural) Study Group. Am J Obstet Gynecol. 2000;182(5):1165–1172.

    Article  PubMed  CAS  Google Scholar 

  70. Hansen SL, Clark SL, Foster JC. Active pushing versus passive fetal descent in the second stage of labor: a randomized controlled trial. Obstet Gynecol. 2002;99(1):29–34.

    Article  PubMed  Google Scholar 

  71. Sampselle CM, Hines S. Spontaneous pushing during birth. Relationship to perineal outcomes. J Nurse Midwifery. 1999;44:36–39.

    Article  PubMed  CAS  Google Scholar 

  72. Parnell C, Langhoff-Roos J, Iversen R, Damgaard P. Pushing method in the expulsive phase of labor. A randomized trial. Acta Obstet Gynecol Scand. 1993;72:31–35.

    PubMed  CAS  Google Scholar 

  73. Janni W, Schiessl B, Peschers U et al. The prognostic impact of a prolonged second stage of labor on maternal and fetal outcome. Acta Obstet Gynecol Scand. 2002;81(3):214–221.

    Article  PubMed  Google Scholar 

  74. Combs CA, Robertson PA, Laros RK. Risk factors for third-degree and fourth-degree perineal lacerations in forceps and vacuum deliveries. Am J Obstet Gynecol. 1990;163:100–104.

    PubMed  CAS  Google Scholar 

  75. Donnelly V, Fynes M, Campbell D, Johnson H, O’Connell PR, O’Herlihy C. Obstetric events leading to anal sphincter damage. Obstet Gynecol. 1998;92:955–961.

    Article  PubMed  CAS  Google Scholar 

  76. Van Kessel K, Reed S, Newton K, Meier A, Lentz G. The second stage of labor and stress urinary incontinence. Am J Obstet Gynecol. 2001;184:1571–1575.

    Article  PubMed  Google Scholar 

  77. Arya LA, Jackson ND, Myers DL, Verma A. Risk of new-onset urinary incontinence after forceps and vacuum delivery in primiparous women. Am J Obstet Gynecol. 2001;185:1318–1323.

    Article  PubMed  CAS  Google Scholar 

  78. Meyer S, Hohlfeld P, Achtari C, Russolo A, De Grandi P. Birth trauma: short and long term effects of forceps delivery compared with spontaneous delivery on various pelvic floor parameters. Br J Obstet Gynaecol. 2000;107:1360–1365.

    CAS  Google Scholar 

  79. Combs CA, Robertson PA, Laros RK Jr. Risk factors for third-degree and fourth-degree perineal lacerations in forceps and vacuum deliveries. Am J Obstet Gynecol. 1990;163(1 Pt 1):100–104.

    PubMed  CAS  Google Scholar 

  80. Sultan AH, Kamm MA, Bartram CI, Hudson CN. Anal sphincter trauma during instrumental delivery. Int J Gynaecol Obstet. 1993;43:263–270.

    Article  PubMed  CAS  Google Scholar 

  81. Wen SW, Liu S, Kramer MS et al. Comparison of maternal and infant outcomes between vacuum extraction and forceps deliveries. Am J Epidemiol. 2001;153:103–107.

    Article  PubMed  CAS  Google Scholar 

  82. Johanson RB, Menon BK. Vacuum extraction versus forceps for assisted vaginal delivery. Cochrane Database Syst Rev. 2000;CD000224.

    Google Scholar 

  83. Jander C, Lyrenas S. Third and fourth degree perineal tears. Predictor factors in a referral hospital. Acta Obstet Gynecol Scand. 2001;80:229–234.

    Article  PubMed  CAS  Google Scholar 

  84. Handa VL, Danielsen BH, Gilbert WM. Obstetric anal sphincter lacerations. Obstet Gynecol. 2001;98:225–230.

    Article  PubMed  CAS  Google Scholar 

  85. Riskin-Mashiah S, O’Brian Smith E, Wilkins IA. Risk factors for severe perineal tear: can we do better? Am J Perinatol. 2002;19:225–234.

    Article  PubMed  Google Scholar 

  86. Snooks SJ, Swash M, Henry MM, Setchell M. Risk factors in childbirth causing damage to the pelvic floor innervation. Int J Color Dis. 1986;1:20–24.

    Article  CAS  Google Scholar 

  87. Groutz A, Gordon D, Keidar R et al. Stress urinary incontinence: prevalence among nulliparous compared with primiparous and grand multiparous premenopausal women. Neurourol Urodyn. 1999; 18:419–425.

    Article  PubMed  CAS  Google Scholar 

  88. Culligan PJ, Myers JA, Goldberg RP, Blackwell L, Gohmann SF, Abell TD. Elective cesarean section to prevent anal incontinence and brachial plexus injuries associated with macrosomia-a decision analysis. Int Urogynecol J Pelvic Floor Dysfunct. 2005;16:19–28; discussion 28.

    Article  PubMed  Google Scholar 

  89. Al-Mufti R, McCarthy A, Fisk NM. Obstetricians’ personal choice and mode of delivery. Lancet. 1996;347:544.

    Article  PubMed  CAS  Google Scholar 

  90. Sultan AH, Kamm MA, Hudson CN. Pudendal nerve damage during labour: prospective study before and after childbirth. Br J Obstet Gynaecol. 1994;101:22–28.

    PubMed  CAS  Google Scholar 

  91. Faundes A, Guarisi T, Pinto-Neto AM. The risk of urinary incontinence of parous women who delivered only by cesarean section. Int J Gynaecol Obstet. 2001;72:41–46.

    Article  PubMed  CAS  Google Scholar 

  92. Goldberg RP, Abramov Y, Botros S et al. Delivery mode is a major environmental determinant of stress urinary incontinence: results of the Evanston-Northwestern Twin Sisters Study. Am J Obstet Gynecol. 2005;193:2149–2153.

    Article  PubMed  Google Scholar 

  93. Fynes M, Donnelly VS, O’Connell PR, O’Herlihy C. Cesarean delivery and anal sphincter injury. Obstet Gynecol. 1998;92(4 Pt 1):496–500.

    Article  PubMed  CAS  Google Scholar 

  94. Meyer S, Hohlfeld P, Achtari C, De Grandi P. Pelvic floor education after vaginal delivery. Obstet Gynecol. 2001;97(5 Pt 1):673–677.

    Article  PubMed  CAS  Google Scholar 

  95. Reilly ET, Freeman RM, Waterfield MR, Waterfield AE, Steggles P, Pedlar F. Prevention of postpartum stress incontinence in primigravidae with increased bladder neck mobility: a randomised controlled trial of antenatal pelvic floor exercises. Br J Obstet Gynaecol. 2002;109:68–76.

    CAS  Google Scholar 

  96. Morkved S, Bo K. The effect of post-natal exercises to strengthen the pelvic floor muscles. Acta Obstet Gynecol Scand. 1996;75:382–385.

    PubMed  CAS  Google Scholar 

  97. Morkved S, Bo K. Effect of postpartum pelvic floor muscle training in prevention and treatment of urinary incontinence: a one-year follow up. Br J Obstet Gynaecol. 2000;107:1022–1028.

    CAS  Google Scholar 

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Goldberg, R.P. (2007). Effects of Pregnancy and Childbirth on the Pelvic Floor. In: Culligan, P.J., Goldberg, R.P. (eds) Urogynecology in Primary Care. Springer, London. https://doi.org/10.1007/978-1-84628-167-9_3

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