[Influence of pregnancy and delivery to the pelvic floor]

Abstract

One third of women will suffer from urinary incontinence 3 to 6 months after birth, one in ten from anal incontinence and one percent from prolapse. The risk for uterine prolapse increases with future vaginal pregnancies, an indication for an elective cesarean section however must be balanced based on the multifactorial nature and the low prevalence of prolapse against the risks of a cesarean section especially of placental pathology in future pregnancies. The correlation between mode of delivery and urinary incontinence decreases with increasing number of pregnancies and with follow up after 65 years. Anal incontinence depends mostly from the mode of delivery and occurs often in combination with a high sphincter laceration or damage of the pudendus nerve. Due to different definitions and populations and lack of randomised studies the prevalence and risk calculations are divergent. In the absence of evidence and the presence of established placental risks in future pregnancies a general recommendation for an elective caesarean section is not justified. Decisions on the mode of delivery can be complex which is why established risk factors, life style factors and preventive evidence based methods are important informations for the antenatal care consultation. To identify women with a high risk for pelvic floor disorders is part of ongoing research.