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. 2012 Nov;120(5):1021-8.
doi: 10.1097/aog.0b013e318265de39.

Pelvic muscle strength after childbirth

Sarah Friedman  1 , Joan L Blomquist, Joann M Nugent, Kelly C McDermott, Alvaro Muñoz, Victoria L Handa
Affiliations

Pelvic muscle strength after childbirth

Sarah Friedman et al. Obstet Gynecol. 2012 Nov.

Abstract

Objective: The objective was to estimate the effect of vaginal childbirth and other obstetric exposures on pelvic muscle strength 6-11 years after delivery and to investigate the relationship between pelvic muscle strength and pelvic floor disorders.

Methods: Among 666 parous women, pelvic muscle strength was measured with a perineometer 6-11 years after delivery. Obstetric exposures were classified by review of hospital records. Pelvic floor outcomes, including stress incontinence, overactive bladder, anal incontinence, and prolapse symptoms, were assessed with a validated questionnaire. Pelvic organ support was assessed using the Pelvic Organ Prolapse Quantification system. Kruskal-Wallis tests were used to estimate the univariable associations of obstetric exposures and pelvic floor outcomes with peak muscle strength. Stepwise multivariable linear regression models were used to estimate the association between obstetric exposures and muscle strength.

Results: In comparison with women who delivered all of their children by cesarean, peak muscle strength and duration of contraction were reduced among women with a history of vaginal delivery (39 compared with 29 cm H2O, P<.001). Pelvic muscle strength was further reduced after history of forceps delivery (17 cm H2O, P<.001). After vaginal delivery, reduced pelvic muscle strength was associated with symptoms of anal incontinence (P=.028) and pelvic organ prolapse on examination (P=.025); these associations were not observed among those who had delivered exclusively by cesarean.

Conclusion: Pelvic muscle strength almost a decade after childbirth is affected by vaginal delivery and by forceps delivery. Although statistically significant, some of the differences observed were small in magnitude.

Level of evidence: II.

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Conflict of interest statement

Financial Disclosure

The authors did not report any potential conflicts of interest.

Figures

Fig. 1
Fig. 1
Peak contraction pressure, in centimeters of water, for six delivery groups. The middle width of each box is proportional to the number of women in that delivery group. The dashed line shows the mean peak pressure for the delivery groups based on a standard linear regression with five indicators. The mean peak pressure for the three cesarean groups is 39 cm H2O, the mean for spontaneous vaginal delivery and vacuum delivery is 29 cm H2O (P<.001), and the mean for forceps delivery is 17 cm H2O (P<.001). UCD, unlabored cesarean delivery; LCD before 10 cm, labored cesarean delivery performed in active labor but before complete cervical dilation; LCD at 10 cm, labored cesarean delivery performed after complete cervical dilation; SVD, spontaneous vaginal delivery. *P<.001. Friedman. Pelvic Muscle Strength After Childbirth. Obstet Gynecol 2012.
See this image and copyright information in PMC

Comment in

  • Pelvic muscle strength after childbirth.
    Perone N. Perone N. Obstet Gynecol. 2013 Feb;121(2 Pt 1):379-380. doi: 10.1097/AOG.0b013e3182809c16. Obstet Gynecol. 2013. PMID: 23344294 No abstract available.
  • In reply: pelvic muscle.
    Handa V, Blomquist J, Friedman S, Nugent J, McDermott K, Muñoz A. Handa V, et al. Obstet Gynecol. 2013 Feb;121(2 Pt 1):380. doi: 10.1097/AOG.0b013e3182809dc6. Obstet Gynecol. 2013. PMID: 23344295 No abstract available.

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