What Harm Does a Second Delivery to the Pelvic Floor?

Overview

Journal Eur J Med Res

Publisher Biomed Central

Specialty General Medicine

Date 2010 Oct 16

PMID 20947474

Citations 5

Authors

Katharina Jundt

I Scheer

V von Bodungen

F Krumbachner

K Friese

U M Peschers

Affiliations

Soon will be listed here.

Abstract

Objective: To compare the pelvic floor function of primiparous women to women after a second delivery regarding symptoms of urinary and anal incontinence, anal sphincter ruptures and bladder-neck mobility.

Methods: A questionnaire evaluating symptoms of urinary and anal incontinence was used in nulliparous women before and 27 months after childbirth. Furthermore these symptoms were correlated with functional changes of the pelvic floor based on a careful gynecologic examination as well as perineal and endoanal ultrasound.

Results: 112 nulliparous women were included, 49 women returned for follow-up on average 27 months (SD 4.4 months) after the first delivery. 39 women (group A) had just one delivery, 10 women (group B ? 10/49) had had a second delivery. Apart from levator ani muscle strength, no significant difference between pelvic floor function of group A vs group B was demonstrable. Furthermore, we could show no significant difference for symptoms of urinary (11 (28.2%) vs. 5 (50.0%)) and anal incontinence (14 (35.9%) vs. 4 (40.0%)) between both groups. However, we found a lasting increase of stress urinary and anal incontinence as well as overactive bladder symptoms after one or more deliveries. The position of the bladder neck at rest was lower in both groups compared to the position before the first delivery and bladder neck mobility increased after one or more deliveries.

Discussion: Our study shows several statistically significant changes of the pelvic floor function even on average 27 months after delivery, but a subsequent delivery did not compromise the pelvic floor any further.

Citing Articles

Association of the second birth mode of delivery and interval with maternal pelvic floor changes: a prospective cohort study.

Wu X, Zheng X, Yi X, Fan B BMC Pregnancy Childbirth. 2024; 24(1):178.

PMID: 38454330 PMC: 10918865. DOI: 10.1186/s12884-024-06366-6.

Relationship between urethral motion profile and parity assessed by translabial ultrasound imaging.

Maes N, Lakerveld T, Dekelver D, Jacquemyn Y, Neels H Arch Gynecol Obstet. 2023; 307(6):1833-1838.

PMID: 36795144 PMC: 9933794. DOI: 10.1007/s00404-022-06897-3.

The effect of parity on the function of pelvic floor musculature in the long term: cross-sectional study.

Bertacini D, Beleza A, Driusso P Obstet Gynecol Sci. 2020; 63(5):577-585.

PMID: 32933227 PMC: 7494773. DOI: 10.5468/ogs.19236.

The investigation and treatment of female pelvic floor dysfunction.

Jundt K, Peschers U, Kentenich H Dtsch Arztebl Int. 2015; 112(33-34):564-74.

PMID: 26356560 PMC: 4570968. DOI: 10.3238/arztebl.2015.0564.

Risk of recurrence, subsequent mode of birth and morbidity for women who experienced severe perineal trauma in a first birth in New South Wales between 2000-2008: a population based data linkage study.

Priddis H, Dahlen H, Schmied V, Sneddon A, Kettle C, Brown C BMC Pregnancy Childbirth. 2013; 13:89.

PMID: 23565655 PMC: 3635942. DOI: 10.1186/1471-2393-13-89.

References

McKenna D, Ester J, Fischer J . Elective cesarean delivery for women with a previous anal sphincter rupture. Am J Obstet Gynecol. 2003; 189(5):1251-6. DOI: 10.1067/s0002-9378(03)00621-5. View

Baydock S, Flood C, Schulz J, MacDonald D, Esau D, Jones S . Prevalence and risk factors for urinary and fecal incontinence four months after vaginal delivery. J Obstet Gynaecol Can. 2009; 31(1):36-41. DOI: 10.1016/s1701-2163(16)34051-8. View

Bump R, Mattiasson A, Bo K, Brubaker L, DeLancey J, Klarskov P . The standardization of terminology of female pelvic organ prolapse and pelvic floor dysfunction. Am J Obstet Gynecol. 1996; 175(1):10-7. DOI: 10.1016/s0002-9378(96)70243-0. View

Hatem M, Fraser W, Lepire E . Postpartum urinary and anal incontinence: a population-based study of quality of life of primiparous women in Quebec. J Obstet Gynaecol Can. 2005; 27(7):682-8. DOI: 10.1016/s1701-2163(16)30546-1. View

Snooks S, Setchell M, Swash M, Henry M . Injury to innervation of pelvic floor sphincter musculature in childbirth. Lancet. 1984; 2(8402):546-50. DOI: 10.1016/s0140-6736(84)90766-9. View

Rortveit G, Daltveit A, Hannestad Y, Hunskaar S . Urinary incontinence after vaginal delivery or cesarean section. N Engl J Med. 2003; 348(10):900-7. DOI: 10.1056/NEJMoa021788. View

Snooks S, Swash M, Mathers S, Henry M . Effect of vaginal delivery on the pelvic floor: a 5-year follow-up. Br J Surg. 1990; 77(12):1358-60. DOI: 10.1002/bjs.1800771213. View

Jundt K, Scheer I, Schiessl B, Karl K, Friese K, Peschers U . Incontinence, bladder neck mobility, and sphincter ruptures in primiparous women. Eur J Med Res. 2010; 15(6):246-52. PMC: 3351993. DOI: 10.1186/2047-783x-15-6-246. View

Rortveit G, Hunskaar S . Urinary incontinence and age at the first and last delivery: the Norwegian HUNT/EPINCONT study. Am J Obstet Gynecol. 2006; 195(2):433-8. DOI: 10.1016/j.ajog.2006.01.023. View

10.

Pollack J, Nordenstam J, Brismar S, Lopez A, Altman D, Zetterstrom J . Anal incontinence after vaginal delivery: a five-year prospective cohort study. Obstet Gynecol. 2004; 104(6):1397-402. DOI: 10.1097/01.AOG.0000147597.45349.e8. View

11.

Allen R, Hosker G, Smith A, WARRELL D . Pelvic floor damage and childbirth: a neurophysiological study. Br J Obstet Gynaecol. 1990; 97(9):770-9. DOI: 10.1111/j.1471-0528.1990.tb02570.x. View

12.

Fynes M, DONNELLY V, Behan M, OConnell P, OHerlihy C . Effect of second vaginal delivery on anorectal physiology and faecal continence: a prospective study. Lancet. 1999; 354(9183):983-6. DOI: 10.1016/S0140-6736(98)11205-9. View

13.

Yilmaz E, Nas T, Korucuoglu U, Guler I . Manometric evaluation of anal sphincter function after vaginal and cesarean delivery. Int J Gynaecol Obstet. 2008; 103(2):162-5. DOI: 10.1016/j.ijgo.2008.06.018. View

14.

Sultan A, Kamm M, Hudson C, Nicholls J, Bartram C . Endosonography of the anal sphincters: normal anatomy and comparison with manometry. Clin Radiol. 1994; 49(6):368-74. DOI: 10.1016/s0009-9260(05)81819-7. View

15.

Viktrup L, Rortveit G, Lose G . Risk of stress urinary incontinence twelve years after the first pregnancy and delivery. Obstet Gynecol. 2006; 108(2):248-54. DOI: 10.1097/01.AOG.0000226860.01127.0e. View

16.

Snooks S, Swash M, Henry M, Setchell M . Risk factors in childbirth causing damage to the pelvic floor innervation. Int J Colorectal Dis. 1986; 1(1):20-4. DOI: 10.1007/BF01648831. View

17.

Sultan A, Kamm M, Hudson C, Thomas J, Bartram C . Anal-sphincter disruption during vaginal delivery. N Engl J Med. 1993; 329(26):1905-11. DOI: 10.1056/NEJM199312233292601. View

18.

Schaer G, Koechli O, Schuessler B, Haller U . Perineal ultrasound for evaluating the bladder neck in urinary stress incontinence. Obstet Gynecol. 1995; 85(2):220-4. DOI: 10.1016/0029-7844(94)00369-O. View

19.

Scheer I, Thakar R, Sultan A . Mode of delivery after previous obstetric anal sphincter injuries (OASIS)--a reappraisal?. Int Urogynecol J Pelvic Floor Dysfunct. 2009; 20(9):1095-101. DOI: 10.1007/s00192-009-0908-8. View

20.

Deen K, Kumar D, G Williams J, Olliff J, Keighley M . The prevalence of anal sphincter defects in faecal incontinence: a prospective endosonic study. Gut. 1993; 34(5):685-8. PMC: 1374190. DOI: 10.1136/gut.34.5.685. View