Effect of childbirth on pelvic organ support and quality of life: a longitudinal cohort study

Abstract

Although childbirth is known to be a major risk factor for pelvic floor disorders, there is a paucity of prospective, long-term data addressing this issue. The aim of our study was to evaluate the changes of pelvic organ support, symptoms and quality of life (QOL) after childbirth. Pelvic organ support was objectively assessed using the Pelvic Organ Prolapse Quantification method (POP-Q) and pelvic floor symptoms were subjectively evaluated using a validated questionnaire performed in the second trimester, 14 weeks, 1 and 5 years after delivery. We recruited 182 nulliparae and 97 (53.3 %) returned for follow-up at 5 years. POP-Q stage after vaginal delivery (VD) worsened at all time points. After caesarean the worsening in POP-Q stage was temporary at 14 weeks. Prolapse symptoms worsened at 14 weeks (p<0.001) and 1 year (p=0.006) after VD but not at 5 years. No changes in prolapse symptoms occurred after caesarean. Significant increase in faecal incontinence was observed in both delivery groups 5 years after delivery. For all pelvic floor disorder domains there were no significant changes in QOL irrespective of mode of delivery, except for worsening in general sexual QOL after VD. Five years after childbirth the stage of prolapse worsened after VD but not after caesarean. However, there was no impact on prolapse symptoms or QOL. After VD women were more likely to experience a worsening in general sex score, but no other difference in QOL measures.