Pelvic Floor Dysfunction Two Decades After Childbirth: Urinary, Fecal Incontinence, and Prolapse

A new study examined pelvic floor dysfunction (PFD), including urinary incontinence (UI), fecal incontinence (FI), and prolapse, in women 20+ years after childbirth, focusing on the impact of delivery mode and demographic factors. 

This cohort study, with long-term follow-up, involved women who gave birth in 1993/1994 in maternity units in Aberdeen, Birmingham (UK), and Dunedin (NZ). Postal questionnaires were sent out 20 years later in New Zealand and 26 years later in the UK, with 6,195 participants. The study used regression analyses to explore associations between risk factors and symptoms of UI, FI, and prolapse.

Results from 2,270 respondents were as follows – 61% reported UI, 22% reported FI, and 17% experienced prolapse symptoms. Women who had only undergone cesarean sections (CS) had a significantly lower risk of UI, FI, and symptoms of prolapse, such as "something coming down" (SCD), compared to those who had only spontaneous vaginal deliveries (SVDs). However, any forceps delivery was linked to an increased risk of FI but not UI or SCD. All PFD outcomes were associated with higher current BMIs.

The findings suggested that the prevalence of PFD increases up to 26 years after childbirth, with the mode of delivery playing a significant role. While exclusive CS is associated with reduced risks for UI, FI, and prolapse symptoms, PFD remains common for decades after childbirth.

Pregnant women should receive thorough counseling on the risks of post-natal PFD, including the influence of delivery mode and the importance of maintaining a healthy weight and performing regular pelvic floor exercises. Women should be encouraged to seek advice for managing PFD rather than accepting it as a normal consequence of childbirth and aging. Further research should focus on developing a risk prediction tool to support these findings in clinical practice.

Source: Hagen S, Sellers C, Elders A, et al. BJOG: An International Journal of Obstetrics & Gynaecology. 2024 Jul 4.