Pelvic floor disorders following vaginal or cesarean delivery

Abstract

Purpose of review Pelvic floor disorders affect women of all ages and are associated with significant economic burden and poor quality of life. Current literature suggests an association between childbirth and these disorders. In this review, we summarize recent advancements in our understanding of this association. Recent findings Vaginal childbirth appears to be strongly associated with stress urinary incontinence and pelvic organ prolapse. There is less evidence to suggest an association between vaginal delivery and overactive bladder symptoms. History of more than one perineal laceration increases the likelihood of developing prolapse. Similar association has not been established for episiotomy. Disruption or denervation of structural components of pelvic floor support system, particularly levator ani muscle complex, is associated with later development of pelvic floor disorders. Imbalance in homeostasis of connective tissue remodeling of the vaginal wall from overstretching during childbirth is another possible mechanism. Summary Pelvic floor disorders represent a significant health problem affecting women of all ages. Identification of potential modifiable risk factors and advancement in understanding of the underlying pathophysiology is crucial for primary and secondary prevention of these disorders and for improvement in treatment strategies.

Pelvic floor dysfunction, and effects of pregnancy and mode of delivery on pelvic floor

“…This study indicates that CD may not be protective against UI [28]. In another study, a strong relationship was found between VD, UI, and POP, but no relationship was observed between VD and urge incontinence [29].…”

“…Disorders that occur during hemostasis depending on microdamage of connective tissue and extreme stress of the vaginal wall are the other factors that contribute to the development of POP [29]. Compared to nonpregnant women, the urethrovesical angle was found to be significantly increased in postpartum women [25].…”

“…In a review article, it was stated that, although operative VD is defined as an important risk factor for PFD, this is a multifactorial event and pregnancy itself was found to be the most important risk factor [29]. A study that showed protective effect of elective CD on stress UI only suggested that, when potential risks are considered, obstetricians should not recommend CD to prevent UI, FI, and POP in the absence of any other indications [43].…”

“…One of the important components of PFD is UI that severely disrupts patients' quality of life [15,29]. Dealing with this issue, in a retrospective Norway EPINCONT study, women aged 65 years were examined to investigate the effects of route of delivery, VD versus CD, on incontinence by looking at the medical birth records.…”

O Uso De Aplicativos Móveis Nas Disfunções Pélvicas

“…Portanto, qualquer alteração em um ou mais componentes desse complexo anatômico-funcional pode gerar alguma disfunção, caso as estruturas íntegras não sejam capazes de suprir o desequilíbrio provocado 4,5,6 . O tratamento das disfunções do assoalho pélvico envolve intervenções conservadoras e cirúrgicas.…”