Skip to main content

Advertisement

SpringerLink
Log in

Cross-sectional study of early postpartum pelvic floor dysfunction and related bother in primiparous women 6–10 weeks postpartum

  • Original Article
  • Published:
International Urogynecology Journal Aims and scope Submit manuscript

Abstract

Introduction and hypothesis

To study the prevalence of pelvic floor dysfunction and related bother in primiparous women 6–10 weeks postpartum, comparing vaginal and cesarean delivery.

Methods

Cross-sectional study of 721 mothers with singleton births in Reykjavik, Iceland, 2015 to 2017, using an electronic questionnaire. Information on urinary and anal incontinence, pelvic organ prolapse and sexual dysfunction with related bother (trouble, nuisance, worry, annoyance) was collected. Main outcome measures were prevalence of pelvic floor dysfunction and related bother.

Results

The overall prevalence of urinary and anal incontinence was 48% and 60%, respectively. Bother regarding urinary symptoms was experienced by 27% and for anal symptoms by 56%. Pelvic organ prolapse was noted by 29%, with less than half finding this bothersome. Fifty-five percent were sexually active, of whom 66% reported coital pain. Of all the women, 48% considered sexual issues bothersome. Urinary incontinence and pelvic organ prolapse were more prevalent in women who delivered vaginally compared to cesarean section, but no differences were observed for anal incontinence and coital pain. Compared to women with BMI < 25, obesity was a predictor for urinary incontinence after vaginal delivery (OR 1.94; 95% CI 1.20–3.14). Birthweight > 50th percentile was predictive for urgency incontinence after vaginal delivery (OR 1.53; 95% CI 1.05–2.21). Episiotomy predicted more anal incontinence (OR 2.19; 95% CI 1.30–3.67). No associations between maternal and delivery characteristics were found for pelvic floor dysfunction after cesarean section.

Conclusions

Bothersome pelvic floor dysfunction symptoms are prevalent among first-time mothers in the immediate postpartum period.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

Abbreviations

AI:

anal incontinence

APFQ:

Australian Pelvic Floor Questionnaire

BMI:

body mass index

CI:

confidence interval

OR:

odds ratio

PFD:

pelvic floor dysfunction

PFM:

pelvic floor muscles

POP:

pelvic organ prolapse

SD:

standard deviation

SUI:

stress urinary incontinence

UI:

urinary incontinence

UUI:

urgency urinary incontinence

References

  1. Morkved S, Bo K. Prevalence of urinary incontinence during pregnancy and postpartum. Int Urogynecol J Pelvic Floor Dysfunct. 1999;10:394–8.

    Article  CAS  Google Scholar 

  2. Borello-France D, Burgio KL, Richter HE, Zyczynski H, Fitzgerald MP, Whitehead W, et al. Fecal and urinary incontinence in primiparous women. Obstet Gynecol. 2006;108:863–72. https://doi.org/10.1097/01.AOG.0000232504.32589.3b.

    Article  PubMed  Google Scholar 

  3. Memon HU, Handa VL. Vaginal childbirth and pelvic floor disorders. Womens Heal (l Engl). 2013;9:265–7. https://doi.org/10.2217/whe.13.17.

    Article  CAS  Google Scholar 

  4. Sigurdardottir T, Steingrimsdottir T, Arnason A, Bø K. Pelvic floor muscle function before and after first childbirth. Int Urogynecol J. 2011;22:1497–503. https://doi.org/10.1007/s00192-011-1518-9.

    Article  PubMed  Google Scholar 

  5. Hilde G, Stær-Jensen J, Siafarikas F, Engh ME, Brækken IH, Bo K. Impact of childbirth and mode of delivery on vaginal resting pressure and on pelvic floor muscle strength and endurance. Am J Obstet Gynecol. 2013;208:50.e1–7. https://doi.org/10.1016/j.ajog.2012.10.878.

    Article  Google Scholar 

  6. Rogers RG, Pauls RN, Thakar R, Morin M, Kuhn A, Petri E, et al. An international Urogynecological association (IUGA)/international continence society (ICS) joint report on the terminology for the assessment of sexual health of women with pelvic floor dysfunction. Neurourol Urodyn. 2018. https://doi.org/10.1002/nau.23508.

  7. Lagaert L, Weyers S, Van Kerrebroeck H, Elaut E. Postpartum dyspareunia and sexual functioning: a prospective cohort study. Eur J Contracept Reprod Heal Care. 2017. https://doi.org/10.1080/13625187.2017.1315938.

  8. Rodriguez-Mias NL, Martinez-Franco E, Aguado J, Sanchez E, Amat-Tardiu L. Pelvic organ prolapse and stress urinary incontinence, do they share the same risk factors? Eur J Obs Gynecol Reprod Biol. 2015;190:52–7. https://doi.org/10.1016/j.ejogrb.2015.04.015.

    Article  Google Scholar 

  9. Reimers C, Staer-Jensen J, Siafarikas F, Saltyte-Benth J, Bo K, Ellstrom EM. Change in pelvic organ support during pregnancy and the first year postpartum: a longitudinal study. BJOG. 2016;123:821–9. https://doi.org/10.1111/1471-0528.13432.

    Article  CAS  PubMed  Google Scholar 

  10. Vrijens D, Berghmans B, Nieman F, van Os J, van Koeveringe G, Leue C. Prevalence of anxiety and depressive symptoms and their association with pelvic floor dysfunctions—a cross sectional cohort study at a pelvic care Centre. Neurourol Urodyn. 2017;36:1816–23. https://doi.org/10.1002/nau.23186.

    Article  PubMed  Google Scholar 

  11. Cattani L, Gillor M, Dietz HP. Does flatus incontinence matter? Int Urogynecol J. 2019;30:1673–7. https://doi.org/10.1007/s00192-018-3835-8.

    Article  PubMed  Google Scholar 

  12. Bols EM, Hendriks EJ, Berghmans BC, Baeten CG, Nijhuis JG, de Bie RA. A systematic review of etiological factors for postpartum fecal incontinence. Acta Obs Gynecol Scand. 2010;89:302–14. https://doi.org/10.3109/00016340903576004.

    Article  Google Scholar 

  13. Löfling L, Bröms G, Bahmanyar S, Kieler H. Maternal and infant characteristics: differences and similarities between the Nordic countries and the US. Clin Epidemiol. 2016;8:285–94. https://doi.org/10.2147/CLEP.S106126.

    Article  PubMed  PubMed Central  Google Scholar 

  14. Rortveit G, Hannestad YS. Association between mode of delivery and pelvic floor dysfunction. Tidsskr Nor Laegeforen. 2014;134:1848–52. https://doi.org/10.4045/tidsskr.13.0860.

    Article  PubMed  Google Scholar 

  15. Baessler K, O’Neill SM, Maher CF, Battistutta D. A validated self-administered female pelvic floor questionnaire. Int Urogynecol J. 2010;21:163–72. https://doi.org/10.1007/s00192-009-0997-4.

    Article  PubMed  Google Scholar 

  16. Beaton DE, Bombardier C, Guillemin F, Ferraz MB. Guidelines for the process of cross-cultural adaptation of self-report measures. Spine (Phila Pa 1976). 2000;25:3186–91.

    Article  CAS  Google Scholar 

  17. Lipschuetz M, Cohen SM, Liebergall-Wischnitzer M, Zbedat K, Hochner-Celnikier D, Lavy Y, et al. Degree of bother from pelvic floor dysfunction in women one year after first delivery. Eur J Obs Gynecol Reprod Biol. 2015;191:90–4. https://doi.org/10.1016/j.ejogrb.2015.05.015.

    Article  Google Scholar 

  18. Nelson RL, Furner SE, Westercamp M, Farquhar C. Cesarean delivery for the prevention of anal incontinence. Cochrane Database Syst Rev 2010:CD006756. https://doi.org/10.1002/14651858.CD006756.pub2.

  19. Sveinsdottir E, Gottfredsdottir H, Vernhardsdottir AS, Tryggvadottir GB, Geirsson RT. Effects of an intervention program for reducing severe perineal trauma during the second stage of labor. Birth. 2019;46:371–8. https://doi.org/10.1111/birt.12409.

    Article  PubMed  Google Scholar 

  20. DeLancey JO, Kane Low L, Miller JM, Patel DA, Tumbarello JA. Graphic integration of causal factors of pelvic floor disorders: an integrated life span model. Am J Obstet Gynecol. 2008;199:610.e1–5. https://doi.org/10.1016/j.ajog.2008.04.001.

    Article  Google Scholar 

  21. Cescon C, Riva D, Začesta V, Drusany-Starič K, Martsidis K, Protsepko O, et al. Effect of vaginal delivery on the external anal sphincter muscle innervation pattern evaluated by multichannel surface EMG: results of the multicentre study TASI-2. Int Urogynecol J. 2014;25:1491–9. https://doi.org/10.1007/s00192-014-2375-0.

    Article  PubMed  Google Scholar 

  22. Reimers C, Siafarikas F, Stær-Jensen J, Småstuen MC, Bø K, Ellström EM. Risk factors for anatomic pelvic organ prolapse at 6 weeks postpartum: a prospective observational study. Int Urogynecol J. 2019. https://doi.org/10.1007/s00192-018-3650-2.

  23. Matthies LM, Wallwiener M, Sohn C, Reck C, Müller M, Wallwiener S. The influence of partnership quality and breastfeeding on postpartum female sexual function. Arch Gynecol Obstet. 2019;299:69–77. https://doi.org/10.1007/s00404-018-4925-z.

    Article  PubMed  Google Scholar 

  24. Tennfjord MK, Hilde G, Staer-Jensen J, Ellstrom Engh M, Bo K. Dyspareunia and pelvic floor muscle function before and during pregnancy and after childbirth. Int Urogynecol J. 2014;25:1227–35. https://doi.org/10.1007/s00192-014-2373-2.

    Article  CAS  PubMed  Google Scholar 

  25. Thorsdottir I, Thorisdottir AV, Palsson GI. The diet of Icelandic infants. Results from a research on infants’diet, growth and iron status 2005–2007. Reykjavík 2008. https://www.landlaeknir.is/servlet/file/store93/item11592/Ungbarnaskyrsla.pdf.

  26. Baessler K, Mowat A, Maher CF. The minimal important difference of the Australian pelvic floor questionnaire. Int Urogynecol J. 2019;30:115–22. https://doi.org/10.1007/s00192-018-3724-1.

    Article  PubMed  Google Scholar 

  27. Morkved S, Bo K. Effect of postpartum pelvic floor muscle training in prevention and treatment of urinary incontinence: a one-year follow up. BJOG. 2000;107:1022–8.

    Article  CAS  Google Scholar 

  28. Sigurdardottir T, Steingrimsdottir T, Geirsson R, Halldorsson T, Aspelund T, Bø K. Can postpartum pelvic floor muscle training reduce urinary and anal incontinence?: an assessor-blinded randomized controlled trial. Am J Obstet Gynecol. 2020;222:247.e1–8. https://doi.org/10.1016/j.ajog.2019.09.011.

    Article  Google Scholar 

  29. Woodley SJ, Lawrenson P, Boyle R, Cody JD, Mørkved S, Kernohan A, et al. Pelvic floor muscle training for preventing and treating urinary and faecal incontinence in antenatal and postnatal women. Cochrane Database Syst Rev. 2020;5:CD007471 https://doi.org/10.1002/14651858.CD007471.pub4.

    Article  PubMed  Google Scholar 

  30. Staer-Jensen J, Siafarikas F, Hilde G, Benth JS, Bo K, Engh ME. Postpartum recovery of levator hiatus and bladder neck mobility in relation to pregnancy. Obstet Gynecol. 2015;125:531–9. https://doi.org/10.1097/AOG.0000000000000645.

    Article  PubMed  Google Scholar 

Download references

Acknowledgements

We thank the staff midwifes at the maternity ward for helping with recruitment of participants and appreciate the permission given by Dr. Kaven Baessler and co-authors to translate and use the Australian Pelvic Floor Questionnaire.

Funding

This study has received grants from following funds: University of Iceland Research Fund. Public Health Fund, Icelandic Directorate of Health. Icelandic Physiotherapy Association Science Fund. Landspitali Science Fund.

Author information

Authors and Affiliations

  1. Faculty of Medicine, School of Health Sciences, University of Iceland, Vatnsmýrarvegi 16, 101, Reykjavík, Iceland

    Thorgerdur Sigurdardottir, Thora Steingrimsdottir, Thor Aspelund & Reynir T. Geirsson

  2. Department of Obstetrics and Gynecology, Landspitali University Hospital, Reykjavik, Iceland

    Thorgerdur Sigurdardottir, Thora Steingrimsdottir & Reynir T. Geirsson

  3. Department of Sports Medicine, Norwegian School of Sports Sciences, Oslo, Norway

    Kari Bø

  4. Department of Obstetrics and Gynecology, Akershus University Hospital, Lørenskog, Norway

    Kari Bø

  5. Faculty of Food Sciences and Nutrition, School of Health Sciences, University of Iceland, Reykjavik, Iceland

    Thorhallur I. Halldorsson

Authors
  1. Thorgerdur Sigurdardottir
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Kari Bø
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Thora Steingrimsdottir
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Thorhallur I. Halldorsson
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Thor Aspelund
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Reynir T. Geirsson
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

Sigurdardottir, Steingrimsdottir, Geirsson and Bø contributed to the design, execution, analysis and interpretation of the study, while Halldorsson and Aspelund contributed to the design and analysis of the material. All authors have contributed to the writing of the manuscript.

Corresponding author

Correspondence to Thorgerdur Sigurdardottir.

Ethics declarations

Details of ethics approval

Ethical approval was obtained from Icelandic National Bioethics Committee (Ref: VSN-13-189), and the Data Protection Authority granted permission as well (Ref: 2014030475TS/−−). The study was conducted in accordance with the Helsinki Declaration on human experimentation.

Disclosure of interests

The authors report no conflict of interest.

Additional information

Publisher’s note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Publisher’s note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Sigurdardottir, T., Bø, K., Steingrimsdottir, T. et al. Cross-sectional study of early postpartum pelvic floor dysfunction and related bother in primiparous women 6–10 weeks postpartum. Int Urogynecol J 32, 1847–1855 (2021). https://doi.org/10.1007/s00192-021-04813-y

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00192-021-04813-y

Keywords

Search

Navigation