title: Postcesarean pelvic floor dysfunction contributes to undisclosed psychosocial morbidity.
abstract: OBJECTIVE
  To estimate the prevalence and severity of postcesarean pelvic dysfunction.
  
  
  METHODS
  Using biopsychosocial interviewing at home, 184 postcesarean primiparas were compared to 100 vaginally delivered women regarding symptoms of stress incontinence, anal incontinence and dyspareunia. Delivery details were confirmed from medical records.
  
  
  RESULTS
  Comparison of postcesarean vs. vaginally delivered women revealed stress incontinence in 33% vs. 54% and dyspareunia in 27% vs. 46%, both differences reaching statistical significance, unlike anal incontinence, which was manifest in 51% vs. 44%. When compared to emergency cesarean the relative risk of stress incontinence following an elective cesarean was 0.99 (0.71, 1.39), of dyspareunia 1.02 and of anal incontinence 1.05, indicating no statistically significant difference. Thirty (22%) stress incontinent and 4 (3%) fecally incontinent mothers used pads continuously, suggesting severe physical morbidity. Severe dysphoria (depression) was expressed by 41 (35%) stress incontinent mothers, 38 (30%) with dyspareunia and 34 (26%) with anal incontinence; the association of severe dysphoria with dyspareunia was statistically significant (OR = 2.504 [1.362, 4.602]). Few women came forward to seek help.
  
  
  CONCLUSIONS
  Pelvic dysfunction was similar after elective or emergency cesarean. Compared to vaginal delivery, postcesarean stress incontinence and dyspareunia were less frequent but biopsychosocial morbidity could be severe.
authors.affiliation: Women's and Children's Directorate, Dudley Group of Hospitals, National Health Service Trust, Dudley, UK. mira@miralal.freeserve.co.uk
authors.forename: Mira
authors.initials: M
authors.lastname: Lal
authors.forename: Helen M
authors.initials: HM
authors.lastname: Pattison
authors.forename: Teresa F
authors.initials: TF
authors.lastname: Allan
authors.forename: Roger
authors.initials: R
authors.lastname: Callender
mesh_terms: D000328:Adult; D016022:Case-Control Studies; D002585:Cesarean Section / Q000009:adverse effects*; D003863:Depression / Q000453:epidemiology / Q000209:etiology*; D004414:Dyspareunia / Q000453:epidemiology / Q000209:etiology* / Q000523:psychology; D004632:Emergency Medical Services; D004739:England / Q000453:epidemiology; D005260:Female; D006801:Humans; D007407:Interviews as Topic; D010298:Parity; D010358:Patient Participation; D011247:Pregnancy; D015995:Prevalence; D012306:Risk; D014550:Urinary Incontinence, Stress / Q000453:epidemiology / Q000209:etiology / Q000523:psychology*; D055815:Young Adult