[Pelvic floor and pregnancy].
Congenital factor, obesity, aging, pregnancy and childbirth are the main risk factors for female pelvic floor disorders (urinary incontinence, anal incontinence, pelvic organ prolapse, dyspareunia). Vaginal delivery may cause injury to the pudendal nerve, the anal sphincter, or the anal sphincter. However the link between these injuries and pelvic floor symptoms is not always determined and we still ignore what might be the ways of prevention. Of the many obstetrical methods proposed to prevent postpartum symptoms, episiotomy, delivery in vertical position, delayed pushing, perineal massage, warm pack, pelvic floor rehabilitation, results are disappointing or limited. Caesarean section is followed by less postnatal urinary incontinence than vaginal childbirth. However this difference tends to disappear with time and following childbirth. Limit the number of instrumental extractions and prefer the vacuum to forceps could reduce pelvic floor disorders after childbirth. Ultrasound examination of the anal sphincter after a second-degree perineal tear is useful to detect and repair infra-clinic anal sphincter lesions. Scientific data is insufficient to justify an elective cesarean section in order to avoid pelvic floor symptoms in a woman without previous disorders.
Fritel
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Service de gynécologie-obstétrique, centre hospitalier Camille-Guérin, rue du Dr Luc-Montagnier, Rocade Est, BP 669, 86106 Châtellerault, France. xavier.fritel@inserm.fr
D001003:Anal Canal / Q000293:injuries; D036861:Delivery, Obstetric / Q000009:adverse effects / Q000379:methods; D004414:Dyspareunia / Q000209:etiology / Q000517:prevention & control / Q000628:therapy; D005242:Fecal Incontinence / Q000209:etiology / Q000517:prevention & control / Q000628:therapy; D005260:Female; D005836:Genitalia, Female / Q000294:innervation; D006801:Humans; D017773:Pelvic Floor; D056887:Pelvic Organ Prolapse / Q000209:etiology / Q000517:prevention & control / Q000628:therapy; D010502:Perineum / Q000293:injuries; D011247:Pregnancy; D011248:Pregnancy Complications / Q000517:prevention & control; D014549:Urinary Incontinence / Q000209:etiology / Q000517:prevention & control / Q000628:therapy