Childbirth and Pelvic Floor Dysfunction: Things You Should Know

Childbirth is an Important Event in a Woman’s Life

Vaginal childbirth is the most common mode of delivery and it has been associated with increased incidence of pelvic floor disorders later in life. In this article, we review and summarize current associating pelvic floor disorders with vaginal childbirth.

The exact mechanism of injury associating vaginal delivery with pelvic floor disorders is not known, but is likely multifactorial, potentially including mechanical and neurovascular injury to the pelvic floor.

It is important to note that, although vaginal delivery appears to be the most important predisposing factor for PFDs.

As the baby grows, the enlarging uterus causes pressure on the bladder below it. This extra stress on the bladder makes it easier for any additional exertion, to push urine out of the bladder. During a first pregnancy, more than one-third of women develop temporary stress incontinence.

Risk Factors to PFDs

In this review, the authors focus on the accumulating evidence linking obstetrical events and the incidence of PFDs later in life and focuses on the association between these disorders and various obstetrical variables:

Instrumental vaginal delivery with use of forceps***; Perineal lacerations, tears***; Vacuum delivery was associated with increased probability of anal sphincter injuries**; Prolonged second stage of labor > 100 min***; Infant birth weight > 3,900 Kg**; Large fetal head circumference > 35,5 cm**; Advanced maternal age at first birth: 35,5 years**; Obesity*; First vaginal birth*; Multiparity: number of births > 3*.

Classification of Postpartum

Group I: Elective caesarean section; Asymptomatic childbearing women after vaginal birth.

Group II: Vaginal delivery with risk factors (more than 3); Symptomatic childbearing women with signs of pelvic floor dysfunction.

Pelvic Floor Rehabilitation

In general, PFR for CW is proposed 6 weeks after vaginal delivery only on symptomatic patients. The number of sessions is limited to 6, on weekly basis and between 30 to 45 minutes, under a control of a trained physiotherapist (physical therapist).

The therapy is mostly pelvic floor exercises training program and Kegel unsupervised exercises as home care. Biofeedback and vaginal electrical stimulation are not first line treatment. Health insurance covers rarely these services prescribed by a doctor after childbirth.

Other countries in Europe, like France, are much more attune to this health issue. The main goal of the French program, which was instituted in 1985, by Alain P. Bourcier is to prevent postpartum incontinence and pelvic organ prolapse, and to restore sexual function—all major factors in a women’s health and well-being.

In many countries, a pelvic floor evaluation and PT postpartum is not part of delivery culture and the most common is to be instructed “to do Kegels”.

Most women recover normally and pelvic floor disorders occur soon after birth in only a few women. Number of treatment sessions depends on the woman’s problems and is not determined beforehand.

A symptomatic group with obstetric risk factors and/or weak pelvic floor strength and/or pelvic floor disorders (UI, FI and POP) need to be assessed before referred to a trained health care provider.

For these women, childbirth results in devastating consequences and physiotherapy sessions are necessary to help them during at least one year before to refer them to undergo surgery.

Ideally, after delivery, every woman should be offered conservative pelvic floor treatment, but logistics and costs make this option unrealistic. The critical question is then how to select postpartum women for this type of follow-up evaluation.

Physical Activities and Pelvic Floor Dysfunction: Things You Should Know

Can your Favorite Sport be Damaging Your Pelvic Floor ?

There is a growing interest in the physical activity levels of children and adolescent youth from health. Further, adolescent females are an important focus due to the risks of a sedentary lifestyle and the benefits of an active lifestyle among female youth being well documented.

Lesser well known is that many physically active women of all ages are likely to suffer from loss of bladder control as well as pelvic floor relaxation.

Physically active women are more likely than sedentary women to experience incontinence and the problem is most common in high-impact sports.

Women have a « continence threshold » which corresponds to the amount of time which the pelvic floor muscles can withstand efforts and repetitive impacts. If the 'threshold' is exceeded, these muscles are fatigued and lose their efficiency.

It was published at the American Congress of Sports Medicine (Bourcier AP, Juras JC: Urinary incontinence in sports and fitness activities. Medicine & Science in Sports & Exercise. 1994, 26) that the type of sports played can have a major impact on the risk of developing a pelvic floor dysfunction. A classification defined three groups based on the amount of pressure generated on the pelvic floor and increased awareness of the risks according to one’s personal choice of sport. A classification defined three groups based on the amount of pressure generated on the pelvic floor and increased awareness of the risks according to one’s personal choice of sport.

Overactive bladder (OAB) defined as urgency, with or without urge incontinence is a common condition during running and has a significant impact of quality of life on female recreational runners

The Pelvic Floor Muscles and the Core

The pelvic floor muscles work as part of the ‘core' to regulate the internal pressure in the abdominal cylinder along with the abdominal, back and breathing muscles. The majority of physical activities do not involve a voluntary contraction of the pelvic floor muscles during the performance of exercise, this increases intra-abdominal pressure.

If any of the muscles of the ‘core’, including the pelvic floor, are weakened or damaged, this coordinated automatic action may be altered. In this situation, during exercises that increase the internal abdominal pressure, there is a potential to overload the pelvic floor. If a problem already exists, then pelvic floor symptoms can potentially become worse.

It is important to note that some exercises that increase intra-abdominal pressure have the potential to place more stress on the pelvic floor. Examples of these exercises include: abdominal exercises (sit ups, curl ups, crunches, double leg lifts, exercises on machines); deep lunges or side lunges; wide legged or deep squats; jump squats; lifting or pressing heavy weights; high bench step up step down.

Doing these activities on a regular or frequent basis can most definitely have a negative impact to your pelvic floor. What’s worse is that in most cases women don’t realize their pelvic floor is dysfunctional until they become incontinent or have a prolapse.