title: Clustering of pelvic floor disorders 20 years after one vaginal or one cesarean birth.
abstract: OBJECTIVE
  The objective was to assess the prevalence and risk factors for co-occurring pelvic floor disorders (PFDs): urinary incontinence (UI), symptomatic pelvic organ prolapse (sPOP), and fecal incontinence (FI), 20 years after one vaginal (VD) or one cesarean (CS) delivery.
  
  
  METHODS
  We carried out a registry-based national cohort study of primiparae who delivered during the period 1985-1988 and had no further deliveries. Medical Birth Registry data were linked to data from postal questionnaires distributed 20 years post-partum (response rate 65.2%, n = 5,236). Main outcome measures were prevalence and risk factors for combined and isolated PFDs.
  
  
  RESULTS
  The prevalence of any PFD was 46.5; 31.7% had one symptom and 14.8% had two or more. Co-occurring symptoms doubled after VD (17.1%) compared with CS (8.4%) (adjOR 2.26; 95% CI 1.84-2.79). The strongest association was observed between VD and having all three symptoms (adjOR 5.20; 95% CI 2.73-9.91), followed by the combination of sPOP and UI (adjOR 3.38; 95% CI 2.24-5.10). The degree of frustration perceived by the women because of pelvic floor dysfunction increased with each additional co-occurring PFD (p < 0.001). The strongest risk factors for clustering of PFDs were: VD (OR 2.19; 95% CI 1.75-2.73), family history (OR 2.03; 95% CI 1.73-2.34), and ≥2 degree tear (OR 1.78; 95% CI 1.24-2.55). Vacuum extraction and episiotomy were not risk factors.
  
  
  CONCLUSIONS
  The prevalence of co-occurring PFDs was high and was doubled in women after VD compared with CS. Women with UI most likely had it as an isolated symptom, whereas FI and sPOP more often occurred in combination.
authors.affiliation: Department of Obstetrics and Gynecology, Sahlgrenska Academy at Gothenburg University, Gothenburg, Sweden, maria.gyhagen@vgregion.se.
authors.forename: Maria
authors.initials: M
authors.lastname: Gyhagen
authors.forename: Sigvard
authors.initials: S
authors.lastname: Åkervall
authors.forename: Ian
authors.initials: I
authors.lastname: Milsom
mesh_terms: D015992:Body Mass Index; D002585:Cesarean Section / Q000706:statistics & numerical data; D015897:Comorbidity; D036861:Delivery, Obstetric / Q000706:statistics & numerical data*; D005242:Fecal Incontinence / Q000453:epidemiology* / Q000523:psychology; D005260:Female; D005500:Follow-Up Studies; D005639:Frustration; D006801:Humans; D022125:Lacerations / Q000453:epidemiology; D008423:Maternal Age; D008875:Middle Aged; D010298:Parity; D056887:Pelvic Organ Prolapse / Q000453:epidemiology* / Q000523:psychology; D010502:Perineum / Q000293:injuries; D015995:Prevalence; D012042:Registries; D013029:Space-Time Clustering; D011795:Surveys and Questionnaires; D013548:Sweden / Q000453:epidemiology; D014549:Urinary Incontinence / Q000453:epidemiology* / Q000523:psychology