Pregnancy, childbirth and the pelvic floor

Abstract

Pregnancy and vaginal delivery are responsible for the onset of genuine stress urinary incontinence, and pelvic floor damage. A striking dearth of prospective studies exists regarding the relationship of pregnancy and delivery to these problems. The vast majority of published data is based on analysis retrieved from questionnaires. Most damage of the pelvic floor obviously occurs during first delivery. Objective findings have demonstrated pudendal nerve damage mostly found after forceps delivery, increased duration of second stage of labour, third degree perineal tear and high birth weight. Episiotomy offers no protection against perineal tears and should be restricted to specified feto-maternal indications. Longitudinal studies are needed to assess long term consequences of pregnancy and child birth on both, lower urinary tract and pelvic floor function.