Long-term consequences of vaginal delivery on the pelvic floor. A comparison with caesarean section in one-para women

Abstract: Abstract Long-term consequences of vaginal delivery on the pelvic floor: A comparison with caesarean section in one-parae women Urinary incontinence (UI), symptomatic pelvic organ prolapse (sPOP), and faecal and anal incontinence (FI and AI) are the three major sequelae of childbirth. It has as yet not been finally settled whether in the long term vaginal delivery (VD) is detrimental to pelvic floor function in comparison to caesarean section (CS). The aim of this thesis was to study the influence of childbirth on the long-term prevalence of these pelvic floor disorders (PFD) and their putative obstetric and non-obstetric risk factors by comparing two large cohorts of women after one VD compared to one CS in 2008, 20 years after childbirth. This national cohort study included 5236 one-parae women who gave birth in 1985-1988 and returned a questionnaire on PFD in 2008. Self-reported information was linked to obstetric data from the Swedish Medical Birth Register. The prevalence of UI; UI for more than 10 years; subtypes of UI; severe, significant and bothersome UI; sPOP; AI, severe AI; FI; were consistently higher after VD compared to CS. After one VD the prevalence of FI increased by about 4%, UI by 12% and sPOP by about 8%, compared to one CS. After a VD women with sPOP had an almost tripled prevalence of UI compared with CS. A ≥2nd degree perineal tear was associated with an almost doubled prevalence of FI. Episiotomy during VD was protective for FI. BMI was second to VD the most important risk factor for PFD, which is important since it is modifiable. In conclusion, one single VD was associated with an increased prevalence of all three of the most important pelvic floor disorders - UI, sPOP, and FI - 20 years after giving birth to one child. Key-words; Vaginal delivery, caesarean section, urinary incontinence, subtypes, bothersome, severity, pelvic organ prolapse, anal incontinence, faecal incontinence, long-term, epidemiology, body mass index, episiotomy, perineal tear. ISBN 978-91-628-8594-6 http://hdl.handle.net/2077/31701