Skip to main content

Advertisement

SpringerLink
Log in

The effect of pregnancy and childbirth on pelvic floor muscle function

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

Abstract

Introduction and hypothesis

The effect of pregnancy and mode of delivery on pelvic floor muscle function (PFMF) is unclear. Our aim was to prospectively evaluate the effect of pregnancy and childbirth on PFMF.

Methods

Subjective (Oxford scale) and objective (perineometry) assessments of PFMF were performed at 20 and 36 weeks gestation and at 14 weeks and 12 months after delivery. The resting pressure (RP) and the maximum squeeze pressure (MSP) were recorded.

Results

Four hundred three women (182 nulliparous and 221 multiparous) were recruited. Two hundred ninety-four (73%) delivered vaginally and 92 (23%) by caesarean section. RP and MSP improved significantly (p < 0.01) during pregnancy. After childbirth, a significant decrease in PFMF was demonstrated, which recovered completely by 1 year in majority of women.

Conclusions

There appears to be a physiological increment in PFMF during pregnancy. The pelvic floor weakens temporarily after childbirth but contractility appears to recover by 1 year irrespective of the mode of delivery.

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

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

References

  1. Kegel AH (1948) Progressive resistance exercise in the functional restoration of the perineal muscles. Am J Obstet Gynecol 56(2):238–248

    PubMed  CAS  Google Scholar 

  2. Devreese A, Staes F, De Weerdt W et al (2004) Clinical evaluation of pelvic floor muscle function in continent and incontinent women. Neurourol Urodyn 23(3):190–197

    Article  PubMed  Google Scholar 

  3. DeLancey J, Morgan D, Fenner D et al (2007) Comparison of levator ani muscle defects and function in women with and without pelvic organ prolapse. Obstet Gynecol 109:295–302

    Article  PubMed  Google Scholar 

  4. Lowenstein L, Gruenwald I, Gartman I, Vardi Y (2010) Can stronger pelvic muscle floor improve sexual function? Int Urogynecol J Pelvic Floor Dysfunct 21(5):553–556

    Article  Google Scholar 

  5. DeLancey JO, Kearney R, Chou Q, Speights S, Binno S (2003) The appearance of levator ani muscle abnormalities in magnetic resonance images after vaginal delivery. Obstet Gynecol 101(1):46–53

    Article  PubMed  Google Scholar 

  6. Dietz HP, Schierlitz L (2005) Pelvic floor trauma in childbirth—myth or reality? Aust N Z J Obstet Gynaecol 45(1):3–11

    Article  PubMed  CAS  Google Scholar 

  7. Allen RE, Hosker GL, Smith AR, Warrell DW (1990) Pelvic floor damage and childbirth: a neurophysiological study. Br J Obstet Gynaecol 97(9):770–779

    Article  PubMed  CAS  Google Scholar 

  8. Snooks SJ, Swash M, Mathers SE, Henry MM (1990) Effect of vaginal delivery on the pelvic floor: a 5-year follow-up. Br J Surg 77(12):1358–1360

    Article  PubMed  CAS  Google Scholar 

  9. Sultan AH, Kamm MA, Hudson CN (1994) Pudendal nerve damage during labour: prospective study before and after childbirth. Br J Obstet Gynaecol 101(1):22–28

    Article  PubMed  CAS  Google Scholar 

  10. Rortveit G, Daltveit AK, Hannestad YS, Hunskaar S (2003) Urinary incontinence after vaginal delivery or cesarean section. N Engl J Med 348(10):900–907

    Article  PubMed  Google Scholar 

  11. Hannah ME, Whyte H, Hannah WJ et al (2004) Maternal outcomes at 2 years after planned cesarean section versus planned vaginal birth for breech presentation at term: the international randomized Term Breech Trial. Am J Obstet Gynecol 191(3):917–927

    Article  PubMed  Google Scholar 

  12. de Oliveira C, Lopes MA, Carla Longo e Pereira L, Zugaib M (2007) Effects of pelvic floor muscle training during pregnancy. Clinics (Sao Paulo) 62(4):439–446

    Google Scholar 

  13. Gordon H, Logue M (1985) Perineal muscle function after childbirth. Lancet 2(8447):123–125

    Article  PubMed  CAS  Google Scholar 

  14. Peschers UM, Schaer GN, DeLancey JO, Schuessler B (1997) Levator ani function before and after childbirth. Br J Obstet Gynaecol 104(9):1004–1008

    Article  PubMed  CAS  Google Scholar 

  15. Caroci Ade S, Riesco ML, Sousa Wda S et al (2010) Analysis of pelvic floor musculature function during pregnancy and postpartum: a cohort study: (a prospective cohort study to assess the PFMS by perineometry and digital vaginal palpation during pregnancy and following vaginal or caesarean childbirth). J Clin Nurs 19(17–18):2424–2433

    Article  PubMed  Google Scholar 

  16. Laycock J (1994) Clinical evaluation of the pelvic floor. In: Schuessler B, Laycock J, Norton P, Stanton S (eds) Pelvic floor re-education: principles and practice. Springer, London, pp 42–47

    Google Scholar 

  17. Bø K, Sherburn M (2005) Evaluation of female pelvic-floor muscle function and strength. Phys Ther 85(3):269–282

    PubMed  Google Scholar 

  18. South MM, Stinnett SS, Sanders DB, Weidner AC (2009) Levator ani denervation and reinnervation 6 months after childbirth. Am J Obstet Gynecol 200(5):519

    PubMed  Google Scholar 

  19. Kearney R, Miller JM, Ashton-Miller JA, DeLancey JO (2006) Obstetric factors associated with levator ani muscle injury after vaginal birth. Obstet Gynecol 107(1):144–149

    Article  PubMed  Google Scholar 

  20. Valsky DV, Lipschuetz M, Bord A (2009) Fetal head circumference and length of second stage of labor are risk factors for levator ani muscle injury, diagnosed by 3-dimensional transperineal ultrasound in primiparous women. Am J Obstet Gynecol 201(1):91

    Article  PubMed  Google Scholar 

  21. Dixon JS, Gosling JA (1994) Histomorphology of the pelvic floor muscle. In: Schuessler B, Laycock J, Norton P, Stanton S (eds) Pelvic floor re-education: principles and practice. Springer, London, pp 28–33

    Google Scholar 

  22. Paterson CM, Saunders NS, Wadsworth J (1992) The characteristics of the second stage of labour in 25,069 singleton deliveries in the North West Thames Health Region, 1988. Br J Obstet Gynaecol 99(5):377–380

    Article  PubMed  CAS  Google Scholar 

  23. Ashton-Miller JA, Delancey JO (2009) On the biomechanics of vaginal birth and common sequelae. Annu Rev Biomed Eng 11:163–176

    Article  PubMed  CAS  Google Scholar 

  24. Dougherty MC, Abrams R, McKey PL (1986) An instrument to assess the dynamic characteristics of the circumvaginal musculature. Nurs Res 35(4):202–206

    Article  PubMed  CAS  Google Scholar 

  25. Bo K, Kvarstein B, Hagen R, Larsen S (1990) Pelvic floor muscle exercise for the treatment of female stress urinary incontinence: I. Reliability of vaginal pressure measurements of pelvic floor muscle strength. Neurourol Urodyn 9:471–477

    Article  Google Scholar 

  26. Rahmani N, Mohseni-Bandpei MA (2011) Application of perineometer in the assessment of pelvic floor muscle strength and endurance: a reliability study. J Bodyw Mov Ther 15(2):209–214

    Article  PubMed  Google Scholar 

  27. Bø K, Finckenhagen HB (2001) Vaginal palpation of pelvic floor muscle strength: inter-test reproducibility and comparison between palpation and vaginal squeeze pressure. Acta Obstet Gynecol Scand 80(10):883–887

    PubMed  Google Scholar 

  28. Ashton-Miller JA, DeLancey JO (2007) Functional anatomy of the female pelvic floor. Ann N Y Acad Sci 1101:266–296

    Article  PubMed  Google Scholar 

  29. Dietz HP, Lanzarone V (2005) Levator trauma after vaginal delivery. Obstet Gynecol 106(4):707–712

    Article  PubMed  Google Scholar 

  30. Shek KL, Dietz HP (2010) Intrapartum risk factors for levator trauma. BJOG 117(12):1485–1492

    Article  PubMed  CAS  Google Scholar 

  31. Dietz HP, Shek C (2008) Levator avulsion and grading of pelvic floor muscle strength. Int Urogynecol J Pelvic Floor Dysfunct 19(5):633–636

    Article  PubMed  CAS  Google Scholar 

  32. Dietz HP, Kirby A, Shek KL, Bedwell PJ (2009) Does avulsion of the puborectalis muscle affect bladder function? Int Urogynecol J Pelvic Floor Dysfunct 20(8):967–972

    Article  PubMed  CAS  Google Scholar 

  33. Chantarasorn V, Shek KL, Dietz HP (2011) Sonographic detection of puborectalis muscle avulsion is not associated with anal incontinence. Aust N Z J Obstet Gynaecol 51(2):130–135

    Article  PubMed  Google Scholar 

  34. Wei JT, De Lancey JO (2004) Functional anatomy of the pelvic floor and lower urinary tract. Clin Obstet Gynecol 47(1):3–17

    Article  PubMed  Google Scholar 

  35. Sultan AH, Stanton SL (1996) Preserving the pelvic floor and perineum during childbirth—elective caesarean section? Br J Obstet Gynaecol 103(8):731–734

    Article  PubMed  CAS  Google Scholar 

  36. Rizk DE (2009) Minimizing the risk of childbirth-induced pelvic floor dysfunctions in the developing world: "preventive" urogynecology. Int Urogynecol J Pelvic Floor Dysfunct 20(6):615–617

    Article  PubMed  Google Scholar 

Download references

Conflicts of interest

None.

Author information

Authors and Affiliations

  1. Croydon University Hospital, 530 London Road, Croydon, CR7 7YE, UK

    Ksena Elenskaia, Ranee Thakar, Abdul Hameed Sultan, Inka Scheer & Andrew Beggs

Authors
  1. Ksena Elenskaia
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Ranee Thakar
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Abdul Hameed Sultan
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Inka Scheer
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Andrew Beggs
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Ranee Thakar.

Additional information

Source of financial support

Ksenia Elenskaia and Inka Scheer were funded by the Mayday Childbirth Charity Fund. In addition, Ksenia Elenskaia received an unconditional education grant from Johnson & Johnson. Andrew Beggs acknowledges funding from the Mason Medical Research Foundation, Cancer Research UK and the Peel Medical Research Trust.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Elenskaia, K., Thakar, R., Sultan, A.H. et al. The effect of pregnancy and childbirth on pelvic floor muscle function. Int Urogynecol J 22, 1421–1427 (2011). https://doi.org/10.1007/s00192-011-1501-5

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00192-011-1501-5

Keywords

Search

Navigation