Pelvic floor disorders 5-10 years after vaginal or cesarean childbirth
Open accessAbstract
OBJECTIVE: To estimate differences in pelvic floor disorders by mode of delivery. METHODS: We recruited 1,011 women for a longitudinal cohort study 5-10 years after first delivery. Using hospital records, we classified each birth as: cesarean without labor, cesarean during active labor, cesarean after complete cervical dilation, spontaneous vaginal birth, or operative vaginal birth. At enrollment, stress incontinence, overactive bladder, anal incontinence, and prolapse symptoms were assessed with a validated questionnaire. Pelvic organ support was assessed using the Pelvic Organ Prolapse Quantification system. Logistic regression analysis was used to estimate the relative odds of each pelvic floor disorder by obstetric history, adjusting for relevant confounders. RESULTS: Compared with cesarean without labor, spontaneous vaginal birth was associated with a significantly greater odds of stress incontinence (odds ratio [OR] 2.9, 95% confidence interval [CI] 1.5-5.5) and prolapse to or beyond the hymen (OR 5.6, 95% CI 2.2-14.7). Operative vaginal birth significantly increased the odds for all pelvic floor disorders, especially prolapse (OR 7.5, 95% CI 2.7-20.9). These results suggest that 6.8 additional operative births or 8.9 spontaneous vaginal births, relative to cesarean births, would lead to one additional case of prolapse. Among women delivering exclusively by cesarean, neither active labor nor complete cervical dilation increased the odds for any pelvic floor disorder considered, although the study had less than 80% power to detect a doubling of the odds with these exposures. CONCLUSION: Although spontaneous vaginal delivery was significantly associated with stress incontinence and prolapse, the most dramatic risk was associated with operative vaginal birth. LEVEL OF EVIDENCE: II.
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Pelvic floor disorders are associated with childbirth.
“Epidemiologic studies suggest that pelvic floor disorders are associated with childbirth, because these conditions are strongly associated with parity 5 and are more common after vaginal birth vs cesarean birth.6”
From Association of Delivery Mode With Pelvic Floor Disorders After Childbirth. (2018) · cites this paper as [5]
Symptomatic pelvic organ prolapse was defined by a positive response to a vaginal bulge question; this response correlates with examination findings but has higher specificity than sensitivity and underreports true prevalence.
“A positive response correlates with the presence of a vaginal bulge on examination(12) however the question has higher specificity than sensitivity for pelvic organ prolapse based on exam.(12)”
From Urinary incontinence and disability in community-dwelling women: A cross-sectional study: Urinary Incontinence and Disability in Ambulatory Women (2015) · cites this paper as [13]
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Self-citationLongitudinal changes in overactive bladder and stress incontinence among parous women
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Longitudinal study of quantitative changes in pelvic organ support among parous women.
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Symptomatic pelvic floor disorders and its associated factors in South-Central Ethiopia
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Prediction Models for Postpartum Urinary and Fecal Incontinence in Primiparous Women
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Genital Hiatus Size and the Development of Prolapse Among Parous Women
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Self-citationThree-dimensional shape differences in the bony pelvis of women with pelvic floor disorders
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Self-citationLongitudinal Changes in the Genital Hiatus Preceding the Development of Pelvic Organ Prolapse
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Self-citationAre hypertension and diabetes mellitus risk factors for pelvic organ prolapse?
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Mode of delivery and subsequent fertility
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Self-citationLevator Morphology and Strength After Obstetric Avulsion of the Levator Ani Muscle
Handa, V. L., Blomquist, J. L., Roem, J., Muñoz, Á., & Dietz, H. P. (2018) · Urogynecology · doi:10.1097/spv.0000000000000641 · Cited by 33 · see citing works
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Breastfeeding and pelvic floor disorders one to two decades after vaginal delivery
Lovejoy, D. A., Roem, J., Blomquist, J. L., Pandya, P. R., & Handa, V. L. (2019) · American Journal of Obstetrics and Gynecology · doi:10.1016/j.ajog.2019.05.010 · Cited by 32 · see citing works
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Childbirth and Female Sexual Function Later in Life
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Li, Z., Xu, T., Li, Z., Gong, J., Liu, Q., Wang, Y., Wang, J., Xia, Z., & Zhu, L. (2018) · Climacteric · doi:10.1080/13697137.2018.1520824 · Cited by 29 · see citing works
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Pelvic floor dysfunction after vaginal and cesarean delivery among singleton primiparas
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Maternal complications and risk factors associated with assisted vaginal delivery
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Knowledge of Pelvic Floor Disorders in Obstetrics
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Joint hypermobility, obstetrical outcomes, and pelvic floor disorders
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“Prolapse estimates using this question underreport the true prevalence of prolapse on examination.(13)”
MethodLaparoscopic vaginal lateral suspension: technical aspects and initial experience
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Variables Affecting Intra-abdominal Pressure During Lifting in the Early Postpartum Period
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American Urogynecologic Society Prolapse Consensus Conference Summary Report
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Self-citationPelvic Floor Health Education: Can a Workshop Enhance Patient Counseling During Pregnancy?
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- Authors
- Handa, V. L., Blomquist, J. L., Knoepp, L. R., Hoskey, K. A., McDermott, K. C., & Muñoz, A.
- Affiliations
- Greater Baltimore Medical Center (US)
- Venue
- Obstetrics & Gynecology
- Published
- 2011-10
- Volume
- 118
- Issue
- 4
- Pages
- 777-784
- ISSN
- 0029-7844 (ISSN-L)
- PMC
- PMC3178744
- OpenAlex
- W2155715307
- Cited by
- 345
- References
- 30
- Citations by year
- 2026: 13 · 2025: 23 · 2024: 38 · 2023: 20 · 2022: 19 · 2021: 23 · 2020: 34 · 2019: 23 · 2018: 23 · 2017: 22 · 2016: 23 · 2015: 24 · 2014: 17 · 2013: 12 · 2012: 25
- FWCI
- 13.51
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- Obstetrics and Gynecology (publishedVersion)
- PubMed (publishedVersion)
- PubMed Central (acceptedVersion)
- Funders
- Eunice Kennedy Shriver National Institute of Child Health and Human Development (R01HD056275)
- Topics
- Health Sciences › Medicine › Rheumatology › Pelvic floor disorders treatments
- Health Sciences › Medicine › Obstetrics and Gynecology › Maternal and Perinatal Health Interventions
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Pregnancy-related medical research
- Keywords
- pelvic floor dysfunction, mode of delivery, cesarean section, vaginal delivery, instrumental delivery, stress urinary incontinence, overactive bladder, anal incontinence, pelvic organ prolapse, pelvic organ support, postpartum women
- MeSH terms
- Adult, Cesarean Section, Fecal Incontinence, Female, Humans, Obstetric Labor Complications, Longitudinal Studies, Pregnancy, Prospective Studies, Surveys and Questionnaires, Urinary Incontinence, Stress, Pelvic Floor, Parturition, Urinary Bladder, Overactive, Pelvic Organ Prolapse
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