Long-term consequences of vaginal delivery on the pelvic floor
Women are more likely to experience urinary incontinence, prolapse and faecal incontinence 20 years after one vaginal delivery rather than one caesarean section, finds new research published in a thesis from Sahlgrenska Academy, Sweden.
Urinary incontinence, prolapse and faecal incontinence are common conditions affecting adult women of all ages and can have a negative influence on quality of life.
This unique study looked at the prevalence and risk factors for urinary incontinence, prolapse and faecal incontinence 20 years after vaginal delivery (VD) or caesarean section (CS).
The SWEPOP (Swedish pregnancy, obesity and pelvic floor) study was conducted in 2008 and data was obtained from the Medical Birth Register (MBR) about women who had delivered only one child between 1985-1988 and had no further children. A questionnaire was sent to the women in 2008 and 6, 148 completed it answering questions on height, weight, urinary or faecal incontinence, genital prolapse, menstrual status, hysterectomy, the menopause and hormone treatment.
Two decades after one childbirth, VD was associated with a 67% increased odds of UI, and UI being present for more than 10 years later increased by 275% compared to CS. Current BMI was the most important BMI-determinant for UI, which is important, since BMI is modifiable.
The single most important risk factor for symptomatic prolapse was delivery via the vaginal route. Birthweight above 4 500g was a risk factor for symptomatic prolapse after VD. Symptomatic prolapse was also an important risk factor for UI and UI >10 years.
The prevalence of faecal incontinence was higher after VD compared with CS. Perineal tear of the 2nd degree almost doubled the prevalence of faecal incontinence. Episiotomy was protective against late faecal incontinence.
The prevalence of urinary incontinence, prolapse and faecal incontinence did not differ between women delivered by acute compared to elective caesarean section, indicating that it is not until the fetus passes through the delivery canal that the injuries occur that causes these pelvic floor disorders.
This is the first study of its kind to show that one vaginal delivery influences the long-term risk of developimg urinary incontinence, prolapse and faecal incontinence compared to one caesarean section. The results of this study provide important new information for women who are concerned that a vaginal delivery will lead to long-term pelvic floor damage. However it is important to note that when choosing the most suitable form of delivery it is necessary to consider numerous medical issues that can potentially influence the health of the mother and child.
The thesis Long-term consequences of vaginal delivery on the pelvic floor. A comparison with caesarean section in one-para women was defended on January 25, 2013.
Link to thesis: https://gupea.ub.gu.se/handle/2077/31701
For more information please contact:
Dr Maria Gyhagen, gynecologist and researcher, Sahlgrenska Academy, Gothenburg University
+46 739 891514
maria.gyhagen@vgregion.se
Supervisor, Ian Milsom, Professor of Obstetrics & Gynecology, Sahlgrenska Academy, Gothenburg University, +46 705 371602, ian.milsom@gu.se
Press Officer
Krister Svahn
Sahlgrenska Academy, University of Gothenburg
46766-18 38 69
4631-786 3869
krister.svahn@sahlgrenska.gu.se
The Sahlgrenska Academy is the faculty of health sciences at the University of Gothenburg. Education and research are conducted within the fields of pharmacy, medicine, odontology and health care sciences. About 4,000 undergraduate students and 1,200 postgraduate students are enrolled at Sahlgrenska Academy. Around 1,400 people work at the Sahlgrenska Academy. 850 of them are researchers and/or teachers. 2009 Sahlgrenska Academy had a turnover of 2,100 million SEK.
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