What harm does a second delivery to the pelvic floor?
OBJECTIVE
To compare the pelvic floor function of primiparous women to women after a second delivery regarding symptoms of urinary and anal incontinence, anal sphincter ruptures and bladder-neck mobility.


METHODS
A questionnaire evaluating symptoms of urinary and anal incontinence was used in nulliparous women before and 27 months after childbirth. Furthermore these symptoms were correlated with functional changes of the pelvic floor based on a careful gynecologic examination as well as perineal and endoanal ultrasound.


RESULTS
112 nulliparous women were included, 49 women returned for follow-up on average 27 months (SD 4.4 months) after the first delivery. 39 women (group A) had just one delivery, 10 women (group B ? 10/49) had had a second delivery. Apart from levator ani muscle strength, no significant difference between pelvic floor function of group A vs group B was demonstrable. Furthermore, we could show no significant difference for symptoms of urinary (11 (28.2%) vs. 5 (50.0%)) and anal incontinence (14 (35.9%) vs. 4 (40.0%)) between both groups. However, we found a lasting increase of stress urinary and anal incontinence as well as overactive bladder symptoms after one or more deliveries. The position of the bladder neck at rest was lower in both groups compared to the position before the first delivery and bladder neck mobility increased after one or more deliveries.


CONCLUSIONS
Our study shows several statistically significant changes of the pelvic floor function even on average 27 months after delivery, but a subsequent delivery did not compromise the pelvic floor any further.
Jundt
Katharina
K
Department of Gynecology and Obstetrics - Campus Innenstadt, Ludwig-Maximilians-University, 80337 München, Germany. katharina.jundt@med.uni-muenchen.de
Scheer
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I
von Bodungen
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V
Krumbachner
F
F
Friese
K
K
Peschers
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UM
D036861:Delivery, Obstetric / Q000009:adverse effects*; D005242:Fecal Incontinence / Q000503:physiopathology; D005260:Female; D006801:Humans; D017773:Pelvic Floor / Q000502:physiology*; D011247:Pregnancy; D011795:Surveys and Questionnaires; D014550:Urinary Incontinence, Stress / Q000503:physiopathology