Obstetric risk factors and pelvic floor dysfunction 20 years after first delivery

Abstract

Introduction and hypothesis: Intrapartum events at first delivery and subsequent childbearing are associated with long-term pelvic floor dysfunction (PFD).

Methods: Primigravidae delivered between 1983-1986 were identified; current addresses traced through the UK National Health Service database (N = 3002). Women completed screening and Sheffield Pelvic Floor Questionnaires (Sheffield-PAQ). Maternity data were obtained from Standard Maternity Information System. Primary outcomes were urinary incontinence (UI), anal incontinence (AI), and prolapse (POP).

Results: Primary response was 62.1%; 53.8% (n = 985) had >or=1 PFD symptom and in 71.5% symptoms were bothersome. UI (OR 0.47 95% CI 0.28, 0.81) and fecal incontinence (FI; OR 0.32 95% CI 0.13, 0.77) risks were lower after first delivery by cesarean section (CS). However, 25% had UI and 12% had FI after delivering exclusively by CS. Obesity was a risk factor independent of obstetric history.

Conclusions: CS provides incomplete or poorly sustained pelvic floor protection by middle age. Obese women were at highest risk and had the most severe symptoms.