What will childbirth do to my pelvic floor?

Childbirth is a significant event in any women’s life. It’s important to know that childbirth is strongly associated with increased incidence of pelvic floor disorders later in life. To understand Pelvic Floor Disorders (PFDs), it is crucial to know what the pelvic floor is and how it is affected by childbirth.

The Pelvic Floor is made up of muscles, bones and ligaments that cross the body from front to back and side to side. In females, the pelvic floor supports organs like the uterus, bladder, and rectum. In addition, the muscles play a role in opening and closing the vagina, urethra, and anus and help optimise circulation in the lower half of the body. PFDs encompass stress urinary incontinence, overactive bladder syndrome, pelvic organ prolapse and faecal incontinence.

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Various factors that can lead to PFDs from childbirth:

Parity (the number of children birthed)

Several studies have shown that women who have children are more commonly affected by PFDs than women of the same age group, without child. With increasing number of childbirths, the prevalence of urinary incontinence, pelvic organ prolapse and faecal incontinence increases.

Mode of delivery

There is a misconception that Caesarean section birth prevents the occurrence of PFDs while in fact Caesarean section only mildly reduces the risk of developing PFDs. In a recent study, vaginal childbirth was associated with twice the risk of developing bothersome symptoms of stress incontinence compared with women who delivered exclusively via caesarean.

Maternal age

Delayed childbearing has been identified as a risk factor for PFDs, irrespective of mode of delivery. There is a strong connection between symptoms of stress incontinence and maternal age of 30 years or older at the first childbirth.

Operative vaginal delivery

Operative Vaginal Delivery/Instrumental Vaginal Delivery refers to the use of traction devices such as forceps and vacuums, to assist childbirth along with uterine contractions and maternal expulsive efforts. Operative Vaginal Delivery is associated with a fourfold increase in the adjusted odds for stress incontinence and overactive bladder syndrome, while increased with eightfold for pelvic organ prolapse.

Mechanical injury to the pelvic floor

Mechanical support to the pelvis is provided by the pelvic muscles and bony attachments. During delivery of the baby, the pelvic tissues may be subjected to damage. As the head crowns, the ligaments that hold the pelvic supporting muscles to the pelvic bones may tear. The pelvic muscles may also get injured.  Any damage to the muscles may lead to the widening of the perineum (gap in the midline through which passes the urethra, vagina and rectum), thus causing the downward descent of the pelvic organs.

Denervation injury

The pudendal nerve controls the muscles responsible for the opening and closing of the urethra and rectum, and therefore plays an important role in maintaining continence. Stretching and compression injury to the nerve has been reported in about 40% cases of vaginal deliveries. Many of the pelvic injuries are reversible, leads to the return of continence after childbirth. However, during severe injury to the nerve, return of the function may be delayed.

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PFDS are common conditions and are responsible for significant financial and emotional burden to patients. However, in the light of currently available data, doctor’s efforts should be directed towards exposure to modifiable risk factors, such as minimising the use of forceps, shortening of duration of active pushing and increase vigilance for anal sphincter injuries.

Fortunately, there are currently existing treatments for PFDs. While it may take several weeks or months after delivery for the struggles you face to diminish, you should seek medical help if your symptoms are severe and impacting your quality of life.

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