Abstract
The aim of this study was to evaluate and compare the pelvic floor muscles (PFM) function of nulliparous and primiparous women with history of vaginal delivery and cesarean section. This study took place at the Women’s Health Research Laboratory, in the Department of Physical Therapy at Federal University of São Carlos, Brazil. Sixty volunteers were included between 18 and 40 years-old; regarding the primiparous, the assessment was done strictly from one to three years postpartum. A sample of 20 participants in each group was determined: vaginal delivery group, cesarean group and nulliparous group. Procedures included vaginal palpation, vaginal manometry and surface electromyography of the PFM. Non-parametric variables were analyzed using Kruskal-Wallis test or Mann-Whitney test and parametric variables using One-way ANOVA. A significance level of 5% was adopted. No significant difference was found between groups in relation to the function of the PFM evaluated by digital palpation (p = 0.75), vaginal manometry (p = 0.25) and surface electromyography (p = 0.465). The function of the PFM was similar between primiparous and nulliparous.
Highlights
Pelvic floor muscles (PFM) work along with bone structures, fascia and ligaments to promote support to the pelvic organs and maintain urinary and anal continence [1, 2]
Non-inclusion criteria were: current or previous BMI ≥ 30 kg/m2, current pregnancy, instrumental vaginal delivery, motor or neurological deficit in the lower extremity, prior abortion after 12 weeks of pregnancy, smoking, alcoholism or use of illicit drugs, pelvic organ prolapse extending beyond the vaginal introitus, urinary tract infection, diabetes mellitus, constipation and absence of voluntary PFM contraction verified by digital palpation
No significant difference was found between groups in relation to the function of the PFM evaluated by digital palpation (p = 0.75), vaginal manometry (p = 0.25) and surface electromyography
Summary
Pelvic floor muscles (PFM) work along with bone structures, fascia and ligaments to promote support to the pelvic organs and maintain urinary and anal continence [1, 2]. Pregnancy and delivery may contribute to the occurrence of PFM disorders, such as pelvic organ prolapse and urinary incontinence (UI) [2]. The long-term effects of mode of delivery on PFM function remain inconclusive in the literature. Typical pregnancy-related physiological, mechanical and hormonal changes, such as overloading of the pregnant uterus on the bladder and PFM, increased progesterone levels, smooth muscle relaxation and connective tissue remodeling, can compromise PFM function [3], being pregnancy considered a risk factor for UI [4]. The PFM performs marked distension to allow the passage of the fetal head through the birth canal [5]. Skeletal muscle fibers might reach their elastic limit culminating in trauma, which may occur within the muscle body or at the muscle insertion, being partial or complete [5]
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