Vaginal childbirth and pelvic floor disorders

Abstract

Childbirth is an important event in a woman's life. Vaginal childbirth is the most common mode of delivery and it has been associated with increased incidence of pelvic floor disorders later in life. In this article, the authors review and summarize current literature associating pelvic floor disorders with vaginal childbirth. Stress urinary incontinence and pelvic organ prolapse are strongly associated with vaginal childbirth and parity. The exact mechanism of injury associating vaginal delivery with pelvic floor disorders is not known, but is likely multifactorial, potentially including mechanical and neurovascular injury to the pelvic floor. Observational studies have identified certain obstetrical exposures as risk factors for pelvic floor disorders. These factors often coexist in clusters; hence, the isolated effect of these variables on the pelvic floor is difficult to study.

Figure 1. Clustering of obstetrical exposures in a population of 418 primiparous women who delivered vaginally

There is substantial overlap in the occurrence of these characteristics, each of which may be associated with the later development of pelvic floor disorders. ASLAC: Anal sphincter laceration; OVD: Operative vaginal delivery. Data taken from [13]. © Johns Hopkins University, 2013.

Figure 2

Multifactorial nature of obstetrical trauma leading to pelvic floor disorders.