Pelvic floor disorders are an issue of concern in women. Childbirth significantly increments the risk of pelvic floor disorders later in life. A recent study in the United States depicts how the mode of delivery can impact the risk of pelvic floor disorders in the future.
Pelvic floor disorders occur due to weakening or tears in the muscles of the pelvic floor. The pelvic area contains uterus, vagina, bladder and rectum. The risk of pelvic floor disorders increases with delivery. There are very few studies on pelvic floor disorders. However, these diseases have a marked impact on women’s quality of life.
Pelvic floor disorders include stress urinary incontinence (uncontrolled urination with activities that increases abdominal pressure like coughing, lifting heavy weights, and abdominal exercises), overactive bladder (repeated and urgent urination), anal incontinence (uncontrolled bowel movements), and pelvic organ prolapse (slipping down of an organ from its place). The mode of delivery during childbirth can play a major role in causing the pelvic floor disorders.
Researchers conducted a study to determine how the mode of delivery can affect the risk of pelvic floor disorders. They conducted the study in a community hospital in the United States from 2008 to 2013 and published in JAMA.
In this study, 1528 women were evaluated based upon their mode of childbirth, whether it is Caesarean delivery or spontaneous vaginal delivery or operative vaginal delivery. They also considered the participants’ Body mass index (BMI), race, and genital hiatus size (from urethral meatus to posterior hymen). Annual examinations were conducted for pelvic floor disorders (stress urinary incontinence, overactive bladder, anal incontinence, and pelvic organ prolapse) for nine years via a questionnaire and physical examination.
The study found that Caesarean deliveries had a lower incidence of stress urinary incontinence, overactive bladder and pelvic organ prolapse. Operative vaginal deliveries lead to an increased risk of anal incontinence and pelvic organ prolapse. Women with larger genital hiatus were more prone to pelvic organ prolapse, irrespective of the mode of childbirth.
The researchers also observed that incontinence of urine and stool developed earlier than prolapse. This is because the effect of injury to pelvic muscles takes time to evolve. On the other hand, injury to urethral sphincter causes incontinence hence, manifests early. Black women had less risk of anal incontinence. Obese women had a greater risk of urinary and anal incontinence. Women who had three pregnancies showed more risk of prolapse.
The researchers conducted this study in a single place and the data may not imply to the whole population in general. The study did not include the progression of mild disorders to severe grade. Shorter study period could not delineate the patterns of this condition in elderly women.
Nevertheless, this study had a good number of participants, adequate follow-up and reliable methods. In the words of Dr. Victoria Handa, Professor of Gynecology and Obstetrics at the Johns Hopkins University School of Medicine and Director of Gynecology and Obstetrics at Johns Hopkins Bay view Medical Center, “We knew that these disorders are more common after childbirth, but now after following these women for 10 years, we have a good sense of how delivery mode impacts a woman’s risk of developing a pelvic floor disorder.”
The mode of delivery contributes to the development of pelvic floor disorders. Childbirth requires deliberate care, keeping in mind the future risks of pelvic floor disorders.
Written by Dr. Radhika Baitari, MS
- Blomquist JL, Muñoz A, Carroll M, Handa VL. Association of Delivery Mode With Pelvic Floor Disorder After Childbirth. JAMA. 2018;320(23):2438–2447. doi:10.1001/jama.2018.18315
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