Impact of childbirth and mode of delivery on vaginal resting pressure and on pelvic floor muscle strength and endurance

Hilde, Gunvor; Stær-Jensen, Jette; Siafarikas, Franziska; Engh, Marie Ellstrøm; Brækken, Ingeborg Hoff; Bø, Kari

doi:10.1016/j.ajog.2012.10.878

Cited by 71 publications

(68 citation statements)

References 32 publications

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“…Both studies had fewer women in their analysis compared to our study, 68 and 110 respectively. We did see a decline in VRP, PFM strength and endurance following delivery in both groups, which may be seen as a response to the effect of pregnancy and delivery found in our study group [26] and in the study by Elenskaia et al [27]. This did not seem to influence differences between those with or without dyspareunia.…”

Section: Discussionsupporting

confidence: 49%

Dyspareunia and pelvic floor muscle function before and during pregnancy and after childbirth

et al. 2014

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This file was dowloaded from the institutional repository Brage NIH -brage.bibsys.no/nih Tennfjord, M. K., Hilde, G., Staer-Jensen, J., Ellstrøm Engh, M., Bø, K. (2014).Dyspareunia and pelvic floor muscle function before and during pregnancy and during pregnancy and after childbirth. ABSTRACT Introduction and hypothesis:There is limited knowledge on dyspareunia during pregnancy and postpartum and the role of the pelvic floor muscles (PFM) in women with dyspareunia. Aims of the study were to investigate presence of dyspareunia before, during pregnancy and postpartum and to compare vaginal resting pressure (VRP), PFM strength and endurance between women with and without dyspareunia. It was hypothesized that there is no difference in PFM variables between women with and without dyspareunia. Methods: Three hundred nulliparous women participated in this prospective cohort and answered questions about dyspareunia and level of bother at gestational weeks 22 and 37, 6 and 12 months postpartum and retrospectively prior to their pregnancies using ICIQFLUTSsex. PFM variables were assessed by manometer at gestational week 22, 6 and 12 months postpartum. Comparisons between groups were analyzed using independent-samples t test.Results: Twenty-eight and 30% of the women reported dyspareunia at pre-pregnancy and at gestational week 22, respectively. At gestational week 37, 6 and 12 months postpartum, the number was 40%, 45% and 33%, respectively. No difference in PFM variables were found between women with or without dyspareunia. Level of bother was higher postpartum than before and during pregnancy. Conclusion: Symptoms of dyspareunia were common at all time points. No link could be made between PFM function and dyspareunia. Women suffering from dyspareunia postpartum reported it as bothersome. Our findings suggest that women should be asked about symptoms of dyspareunia related to pregnancy, and that future research should aim for preventative and treatment strategies.

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Section: Discussionsupporting

confidence: 49%

Dyspareunia and pelvic floor muscle function before and during pregnancy and after childbirth

et al. 2014

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“…With respect to physiological cross-sectional area, even though statistical significance was not achieved, the predicted isometric force generating capacity of all PFMs was decreased in younger vaginally parous group, compared to younger nulliparous controls. This finding suggests a potential mechanism for clinically identified PFM weakness in vaginally parous women, preceding the onset of symptomatic PFD (9, 10). We anticipate that the parity-related changes in the PFM architectural design, identified in this study, are likely more pronounced in the presence of symptomatic PFDs.…”

Section: Commentmentioning

confidence: 88%

“…Donors with history of pelvic radiation, gynecologic or colorectal malignancy, pelvic metastasis, connective tissue disorder, myopathy, colectomy or proctectomy were also excluded. In contrast to vaginal delivery, PFM injury is rarely observed after cesarean childbirth (23, 24), and PFM strength is unchanged by abdominal deliveries (9). Thus, nulliparous donors (n=8) and donors with a history of Cesarean deliveries only (n=3) were designated as vaginally nulliparous .…”

Section: Methodsmentioning

confidence: 99%

“…Although such investigations have been invaluable in establishing a framework for the role of PFM dysfunction in the pathogenesis of PFDs (7, 8), significant knowledge gaps remain. Importantly, decreased PFM strength precedes the onset of symptomatic PFDs (9, 10); a third of women with pelvic organ prolapse do not exhibit radiological defects in PFMs (8) and stress urinary incontinence is more frequent in women with minimal, compared to major, levator ani defects on magnetic resonance imaging (MRI) (11). Prolapse and urinary incontinence can, of course, result from a compromise in the integrity of the striated urethral sphincter or pelvic connective tissue supportive structures.…”

Section: Introductionmentioning

confidence: 99%

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Impact of vaginal parity and aging on the architectural design of pelvic floor muscles

Alperin

Cook

Tuttle

et al. 2016

American Journal of Obstetrics and Gynecology

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Background Vaginal delivery and aging are key risk factors for pelvic floor muscle dysfunction, which is a critical component of pelvic floor disorders. However, alterations in the PFM intrinsic structure due to childbirth and aging that lead to muscle dysfunction remain elusive. Objectives To determine the impact of vaginal deliveries and aging on human cadaveric PFM architecture, the strongest predictor of active muscle function. Study Design Coccygeus, iliococcygeus and pubovisceralis were obtained from younger, ≤ 51 years, vaginally nulliparous (N=5) and vaginally parous (N=6), and older, >51 years, vaginally nulliparous (N=6) and vaginally parous (N=6) donors without history of PFDs. Architectural parameters, predictive of muscle’s excursion and force-generating capacity, were determined using validated methods. Intramuscular collagen content was quantified by hydroxyproline assay. Main effects of parity and aging and the interactions were determined using two-way ANOVA, with Tukey’s post-hoc testing with significance level of 0.05. Results The mean age of younger and older donors differed by ~40 years (P=0.001), but was similar between nulliparous and parous donors within each age group (P>0.9). Median parity was 2 (range 1–3) in younger and older vaginally parous groups, P=0.7. The main impact of parity was increased fiber length in the more proximal coccygeus (P=0.03), and iliococcygeus (P=0.04). Aging changes manifested as decreased physiological cross sectional area across all pelvic floor muscles, P<0.05, which substantially exceeded the age-related decline in muscle mass. Physiological cross sectional area was lower in younger vaginally parous, compared to younger vaginally nulliparous pelvic floor muscles, however the differences did not reach statistical significance. Pelvic floor muscles’ collagen content was not altered by parity, but increased dramatically with aging, P<0.05. Conclusions Increased fiber length in more proximal pelvic floor muscles likely represents an adaptive response to the chronically increased load placed on these muscles by the displaced apical structures, presumably as a consequence of vaginal delivery. In younger specimens, a consistent trend towards decrease in force generating capacity of all pelvic floor muscles in parous group suggests a potential mechanism for clinically identified pelvic floor muscle weakness in vaginally parous women. The substantial decrease in predicted muscle force production and fibrosis with aging represent likely mechanisms for the pelvic floor muscle dysfunction in older women.

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“…Hilde et al16 ) and Hsieh et al17 ) conducted studies on the effect of endurance of the pelvic floor muscles on urinary incontinence related to different modes of delivery. Victoria et al9 ) reported that urinary incontinence related to impairment of the pelvic floor muscles was more strongly related to vaginal delivery than to Cesarean section.…”

Section: Introductionmentioning

confidence: 99%

How Different Modes of Child Delivery Influence Abdominal Muscle Activities in the Active Straight Leg Raise

et al. 2014

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[Purpose] The purpose of this study was to examine the activities of the abdominal muscles of women who had experienced vaginal delivery in comparison with those who had experienced Cesarean childbirth. [Subjects and Methods] A total of 14 subjects (7 vaginal delivery, 7 Cesarean section) performed an active straight leg raise to 20 cm above the ground, and we measured the activities of the internal oblique abdominal muscle, the external oblique abdominal muscle, and the rectus abdominal muscle on both sides using electromyography. The effort required to raise the leg was scored on a Likert scale. Then, the subjects conducted maximum isometric contraction for hip joint flexion with the leg raised at 20 cm, and maximum torque and abdominal muscle activities were measured using electromyography. [Results] During the active straight leg raise, abdominal muscle activities were higher in the Cesarean section subjects. The Likert scale did not show a significant difference. The activities of the abdominal muscles and the maximum torque of the hip joint flexion at maximum isometric contraction were higher in the vaginal delivery subjects. [Conclusion] The abdominal muscles of Cesarean section subjects showed greater recruitment for maintaining pelvic stability during the active straight leg raising, but were relatively weaker when powerful force was required. Therefore, we consider that more abdominal muscle training is necessary for maintaining pelvic stability of Cesarean section subjects.

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Impact of childbirth and mode of delivery on vaginal resting pressure and on pelvic floor muscle strength and endurance

Cited by 71 publications

References 32 publications

Dyspareunia and pelvic floor muscle function before and during pregnancy and after childbirth

Dyspareunia and pelvic floor muscle function before and during pregnancy and after childbirth

Impact of vaginal parity and aging on the architectural design of pelvic floor muscles

How Different Modes of Child Delivery Influence Abdominal Muscle Activities in the Active Straight Leg Raise

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