Childbirth and pelvic floor disorders

Excerpt

In this special issue of the International Urogynecology Journal, we focus on research from around the world on the impact of childbirth on pelvic floor function. Over the past two decades, the mechanisms underlying pelvic floor dysfunction following birth are better defined, and we better understand how to recognize, avoid, and treat severe perineal lacerations following birth. Less well defined is how to prevent subsequent incontinence and prolapse, other than the avoidance of vaginal birth. Some evidence for the impact of vaginal birth on pelvic floor dysfunction is contradictory. For example, although we know that vaginal birth is associated with a greater impact on the levator ani [1], for women who have sustained a prior anal sphincter injury, a subsequent vaginal birth was not associated with worsening of bowel symptoms or sphincter integrity [2]. Why are some women severely affected by a single uncomplicated vaginal birth and others not affected after five similar births? We are still discovering underlying mechanisms that may help us to individualize birth plans. For example, ligamentous laxity may be associated with increased risk of obstetrical anal sphincter laceration with a sensitivity of 75% [3]. Nonetheless, much is to be discovered about the causes, identification, prevention, and treatment of childbirth-associated pelvic floor trauma. …