Pelvic floor disorders following vaginal or cesarean delivery.
OBJECTIVE
Pelvic floor disorders affect women of all ages and are associated with significant economic burden and poor quality of life. Current literature suggests an association between childbirth and these disorders. In this review, we summarize recent advancements in our understanding of this association.


RESULTS
Vaginal childbirth appears to be strongly associated with stress urinary incontinence and pelvic organ prolapse. There is less evidence to suggest an association between vaginal delivery and overactive bladder symptoms. History of more than one perineal laceration increases the likelihood of developing prolapse. Similar association has not been established for episiotomy. Disruption or denervation of structural components of pelvic floor support system, particularly levator ani muscle complex, is associated with later development of pelvic floor disorders. Imbalance in homeostasis of connective tissue remodeling of the vaginal wall from overstretching during childbirth is another possible mechanism.


CONCLUSIONS
Pelvic floor disorders represent a significant health problem affecting women of all ages. Identification of potential modifiable risk factors and advancement in understanding of the underlying pathophysiology is crucial for primary and secondary prevention of these disorders and for improvement in treatment strategies.
Department of Gynecology and Obstetrics, Johns Hopkins School of Medicine, Baltimore, Maryland, USA.
Hafsa
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Memon
Victoria L
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Handa
D000368:Aged; D000369:Aged, 80 and over; D002585:Cesarean Section / Q000009:adverse effects*; D036861:Delivery, Obstetric / Q000009:adverse effects*; D005242:Fecal Incontinence / Q000209:etiology; D005260:Female; D006801:Humans; D008875:Middle Aged; D017773:Pelvic Floor / Q000293:injuries; D059952:Pelvic Floor Disorders / Q000175:diagnosis / Q000209:etiology* / Q000628:therapy; D056887:Pelvic Organ Prolapse / Q000209:etiology; D012307:Risk Factors; D053201:Urinary Bladder, Overactive / Q000209:etiology; D014550:Urinary Incontinence, Stress / Q000209:etiology