Effect of vaginal delivery on the pelvic floor: A 5-year follow-up

Abstract

We have studied the pelvic floor musculature and its innervation in 14 of 24 (58 per cent) multiparous women who had been recruited into a study of the effect of childbirth on the pelvic floor as part of a prospective investigation that began in 1983. These 24 women had all delivered by the vaginal route without forceps assistance. Five of the 14 had developed clinical symptoms of stress incontinence 5 years later; two of them had had a further uncomplicated vaginal delivery during this time. There was manometric and neurophysiological evidence of weakness because of partial denervation of the pelvic floor striated sphincter musculature, with pudendal neuropathy, which was more marked in those women with incontinence. These findings provide direct evidence for the hypothesis that pudendal neuropathy due to vaginal delivery persists and may worsen with time.

Alteration of anal sphincter morphology following vaginal delivery revealed by multiplanar anal endosonography

“…Secondly, a significant reduction in maximal squeeze pressure was noted after childbirth, a finding previously described 14,15 , and which seems unlikely to recover with time 16 . However, this reduction did not correlate with the anatomic changes seen, and so may actually represent a diffuse change in sphincter function.…”

Elastic fiber homeostasis requires lysyl oxidase–like 1 protein

“…We speculate that genetic defects in human LOXL1 may lead to clinical syndromes resembling generalized elastolysis affecting skin, lung, large arteries and other organs (e.g., cutis laxa type I; OMIM 219100). Our data also show an unexpected, causal link between elastic fiber homeostasis and pelvic prolapse, a clinical condition strongly correlated with both childbirth and advanced age [21][22][23] . Elastin polymer and soluble elastin-derived peptides also have signaling roles in cell adhesion, migration and proliferation 5,24 .…”

Influence of age, mode of delivery and parity on the prevalence of posterior pelvic floor dysfunctions

“…Several authors have demonstrated an association between pelvic floor dysfunctions (especially involving fecal incontinence, sphincter injury and nerve damage) and age and/or mode of delivery (5,26,28) . Anatomical and functional changes of the pelvic floor (anterior compartment) have also been described (12,16,24,25) .…”