OBJECTIVE The objective was to estimate the effect of vaginal childbirth and other obstetric exposures on pelvic muscle strength 6–11 years after delivery and to investigate the relationship between pelvic muscle strength and pelvic floor disorders. METHODS Among 666 parous women, pelvic muscle strength was measured with a perineometer 6–11 years after delivery. Obstetric exposures were classified by review of hospital records. Pelvic floor outcomes, including 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. Kruskal-Wallis tests were used to estimate the univariable associations of obstetric exposures and pelvic floor outcomes with peak muscle strength. Stepwise multivariable linear regression models were used to estimate the association between obstetric exposures and muscle strength. RESULTS In comparison with women who delivered all of their children by cesarean, peak muscle strength and duration of contraction were reduced among women with a history of vaginal delivery (39 compared with 29 cm H2O, P<.001). Pelvic muscle strength was further reduced after history of forceps delivery (17 cm H2O, P<.001). After vaginal delivery, reduced pelvic muscle strength was associated with symptoms of anal incontinence (P=.028) and pelvic organ prolapse on examination (P=.025); these associations were not observed among those who had delivered exclusively by cesarean. CONCLUSION Pelvic muscle strength almost a decade after childbirth is affected by vaginal delivery and by forceps delivery. Although statistically significant, some of the differences observed were small in magnitude.

OBJECTIVE To establish the extent to which care-seeking for urinary incontinence is a function of symptom bother; and to identify bother-score thresholds that predict care-seeking in the first two decades after delivery. METHODS In this longitudinal cohort, women were assessed annually for symptom bother related to stress urinary incontinence (SUI) and overactive bladder (OAB), as well as for recent episodes of care-seeking for urinary symptoms. Because the goal was to model care-seeking as a function of the woman’s characteristics at her prior visit, women who completed ≥two consecutive visits were included. The population was randomly divided into “training” (model development) and “testing” (model validation) sets. The predictive model was developed in the training set. For SUI and OAB bother scores, we identified thresholds to define statistically distinct probabilities of care-seeking. A multivariable model was created, including SUI and OAB bother categories as well as characteristics associated with care seeking at the P<0.05 level. The resultant prediction model was then applied to the “testing set”; predicted and observed care-seeking frequencies were compared. RESULTS Care-seeking was strongly associated with SUI and OAB bother. We defined three categories for OAB score and four categories for SUI score. The resulting twelve risk categories were then collapsed into five distinct risk-groups. These groups accurately predicted care-seeking in the testing set (area under the receiver-operating curve 0.760 (95% confidence interval 0.713, 0.807). Inclusion of other risk factors did not improve the model. CONCLUSIONS Symptom bother is a strong determinant of care-seeking in the first two decades after delivery. These results define five ordinal categories that predict seeking-care for urinary symptoms in a community population.