Postpartum pelvic floor trauma.
OBJECTIVE
There is strong epidemiological evidence linking vaginal childbirth and the development of postpartum incontinence and prolapse. This article examines possible mechanisms of pelvic floor damage related to delivery and their possible consequences.


RESULTS
Histology, imaging and physiology studies have revealed that vaginal delivery results in direct pelvic muscle trauma, disruption of fascial supports and pudendal nerve injury.


CONCLUSIONS
Epidemiology studies implicate parity and childbirth in the development of incontinence and prolapse; however, despite imaging and functional studies revealing damage to the pelvic floor muscles, nerves and fascial supports, it is unclear what the clinical significance of these findings is. In addition, the effect of mode of delivery is uncertain, and although cesarean section reduces the risk of pelvic floor trauma, it is not entirely protective. Further research is required into the effect of pregnancy on pelvic floor dysfunction and the effect of mode of delivery.
Chaliha
Charlotte
C
Department of Obstetrics and Gynaecology, Royal London and St Bartholomew's Hospitals, London E1 1BB, UK. Charlotte.Chaliha@bartsandthelondon.nhs.uk
D005242:Fecal Incontinence / Q000209:etiology; D005260:Female; D006801:Humans; D036801:Parturition; D017773:Pelvic Floor / Q000293:injuries*; D011247:Pregnancy; D011644:Puerperal Disorders / Q000209:etiology*; D014550:Urinary Incontinence, Stress / Q000209:etiology; D014563:Urodynamics; D014596:Uterine Prolapse / Q000209:etiology