International Urogynecology Journal

, Volume 22, Issue 9, pp 1135–1141 | Cite as

Is cesarean section a real panacea to prevent pelvic organ disorders?

  • Onder Koc
  • Bulent Duran
  • Safak Ozdemırcı
  • Yesim Bakar
  • Nuriye Ozengin
Original Article

Abstract

Introduction and hypothesis

The aim of this study is to compare the pelvic floor muscle strength after vaginal delivery vs. after cesarean section.

Methods

Five groups of 50 cases each were designated as follows: nullipara (control group), spontaneous vaginal delivery (SVD), repeat SVD (SVD-R), cesarean section (CS), and repeat CS (CS-R). Perineometric measurements, stress urinary incontinence (SUI) symptoms, pelvic organ prolapse quantification examinations, and Incontinence-Specific Quality of Life Questionnaire (IQOL) were evaluated.

Results

In all delivery groups, pelvic muscle strength was significantly lower than the control group (65.10 ± 15.69, 56.29 ± 17.39, 54.28 ± 20.08, 56.82 ± 17.62, and 57.92 ± 16.45 (cm H2O± SD) for the control, SVD, SVD-R, CS, and CS-R groups, respectively; p < 0.05). However, no significant difference was found among the delivery groups. There were significant differences in SUI symptoms between the control (2%) and SVD-R (26%) groups and between the SVD (10%) and SVD-R groups (p < 0.001 and p = 0.037, respectively). No statistically significant correlations between IQOL and perineometric measurements were noted (r = 0.097 and p = 0.598).

Conclusions

Pregnancy increases postpartum muscle weakness independent of the mode of delivery. Increased SUI symptoms are associated with vaginal delivery.

Keywords

Vaginal delivery Cesarean section Pelvic floor muscle weakness Quality of life 

References

  1. 1.
    Kenton K, Mueller ER (2006) The global burden of female pelvic floor disorders. Br J Urol 98:1–5Google Scholar
  2. 2.
    Bo K, Sherburn M (2005) Evaluation of female pelvic-floor muscle function and strength. Phys Ther 85(3):269–282PubMedGoogle Scholar
  3. 3.
    Allen RE, Hosker GL, Smith AR, Warrell DW (1990) Pelvic floor damage and childbirth: a neurophysiological study. Br J Obstet Gynaecol 97(9):770–779PubMedCrossRefGoogle Scholar
  4. 4.
    Gregory WT, Nygaard I (2004) Childbirth and pelvic floor disorders. Clin Obstet Gynecol 47:394–403PubMedCrossRefGoogle Scholar
  5. 5.
    Swash M, Snooks SJ, Henry MM (1985) Unifying concept of pelvic floor disorders and incontinence. J R Soc Med 78(11):906–911PubMedGoogle Scholar
  6. 6.
    Petros PE (2010) Diagnosis of connective tissue damage. In: Petros PE (ed) The female pelvic floor—function, dysfunction and management according to the integral theory, 3rd edn. Springer, Berlin, pp 50–82Google Scholar
  7. 7.
    Petros PE, Ulmsten U (1990) An integral theory of female urinary incontinence. Acta Obstet Gynecol Scand 69(Suppl 153):1–79Google Scholar
  8. 8.
    Wagner TH, Patrick DL, Bavendam TG, Martin ML, Buesching DP (1996) Quality of life of persons with urinary incontinence: development of a new measure. Urology 47(1):67–71, discussion 71–72PubMedCrossRefGoogle Scholar
  9. 9.
    Serati M, Salvatore S, Khullar V, Uccella S, Bertelli E, Ghezzi F, Bolis P (2008) Prospective study to assess risk factors for pelvic floor dysfunction after delivery. Acta Obstet Gynecol Scand 87(3):313–318PubMedCrossRefGoogle Scholar
  10. 10.
    Viktrup L, Lose G, Rolff M, Barfoed K (1992) The symptoms of stress incontinence caused by pregnancy or delivery in primiparas. Obstet Gynecol 79:945–949PubMedGoogle Scholar
  11. 11.
    Sampselle CM, DeLancey J, Ashton-Miller J (1996) Urinary incontinence in pregnancy and postpartum. Neurourol Urodyn 15:329–330Google Scholar
  12. 12.
    Høiberg K, Salvig JD, Winsløw NA, Lose G, Secher NJ (1999) Urinary incontinence: prevalence and risk factors at 16 weeks of gestation. BJOG 106:842–850CrossRefGoogle Scholar
  13. 13.
    Ball TL, Douglas GR, Fulkerson LL (1950) Topographic urethrography (part II). Am J Obstet Gynecol 69(6):1252–1259Google Scholar
  14. 14.
    Francis WJA (1960) Disturbance of bladder function in relation to pregnancy. Journal of Obstets & Gynaecol of British Empire 67:353–366CrossRefGoogle Scholar
  15. 15.
    Petros PE, Ulmsten U (1997) Role of the pelvic floor in bladder neck opening and closure: I muscle forces. Int Urogynecol J 8:74–80CrossRefGoogle Scholar
  16. 16.
    Petros PE, Ulmsten U (1997) Role of the pelvic floor in bladder neck opening and closure: II vagina. Int Urogynecol J 8:69–73CrossRefGoogle Scholar
  17. 17.
    Bump RC, Mattiasson A, Bø K, Brubaker LP, DeLancey JO, Klarskov P, Shull BL, Smith AR (1996) The standardization of terminology of female pelvic organ prolapse and pelvic floor dysfunction. Am J Obstet Gynecol 175(1):10–17PubMedCrossRefGoogle Scholar
  18. 18.
    Thompson JA, O'Sullivan PB, Briffa NK, Neumann P (2006) Assessment of voluntary pelvic floor muscle contraction in continent and incontinent women using transperineal ultrasound, manual muscle testing and vaginal squeeze pressure measurements. Int Urogynecol J Pelvic Floor Dysfunct 17(6):624–630PubMedCrossRefGoogle Scholar
  19. 19.
    Hintze J (2001) NCSS and PASS. Number Cruncher Statistical Systems. Kaysville, Utah. http://www.ncss.com. Accessed 15 Jun 2009
  20. 20.
    Hundley AF, Wu JM, Visco AG (2005) A comparison of perineometer to brink score for assessment of pelvic floor muscle strength. Am J Obstet Gynecol 192:1583–1591PubMedCrossRefGoogle Scholar
  21. 21.
    Patel PD, Amrute KV, Badlani GH (2007) Pelvic organ prolapse and stress urinary incontinence: a review of etiological factors. Indian J Urol 23(2):135–141PubMedCrossRefGoogle Scholar
  22. 22.
    Bø K, Kvarstein B, Hagen R, Larsen S (1990) Pelvic floor muscle exercise for the treatment of female stress urinary incontinence: II. Validity of vaginal pressure measurements of pelvic floor muscle strength and the necessity of supplementary methods for control of correct contraction. Neurourol Urodyn 9:479–487CrossRefGoogle Scholar
  23. 23.
    Dougherty MC, Abrams R, McKey PL (1986) An instrument to assess the dynamic characteristics of the circumvaginal musculature. Nurs Res 35:202–206PubMedCrossRefGoogle Scholar
  24. 24.
    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 80:883–887PubMedGoogle Scholar
  25. 25.
    Frawley H, Galea M, Phillips B, Sherburn M, Bø K (2006) Effect of test position on pelvic floor muscle assessment. Int Urogynecol J Pelvic Floor Dysfunct 17:365–371PubMedCrossRefGoogle Scholar
  26. 26.
    Groutz A, Rimon E, Peled S et al (2004) Cesarean section: does it really prevent the development of postpartum stress urinary incontinence? A prospective study of 363 women one year after their first delivery. Neurourol Urodyn 23:2–6PubMedCrossRefGoogle Scholar
  27. 27.
    Van Brummen HJ, Bruinse HW, van de Pol G, Heintz AP, van der Vaart CH (2007) The effect of vaginal and Caesarean delivery on lower urinary tract symptoms: what makes the difference? Int Urogynecol J Pelvic Floor Dysfunct 18(2):133–139PubMedGoogle Scholar
  28. 28.
    Bushnell DM, Martin ML, Summers KH, Svihra J, Lionis C, Patrick DL (2005) Quality of life of women with urinary incontinence: cross-cultural performance of 15 language versions of the I-QOL. Qual Life Res 14(8):1901–1913PubMedCrossRefGoogle Scholar
  29. 29.
    Fleming N, Newton ER, Roberts J (2003) Changes in postpartum perineal muscle function in women with and without episiotomies. Journal of Midwifery & Women’s Health 48:53–59CrossRefGoogle Scholar
  30. 30.
    Marshall K, Walsh DM, Baxter GD (2002) The effect of a first vaginal delivery on the integrity of the pelvic floor musculature. Clin Rehabil 16(7):795–799PubMedCrossRefGoogle Scholar
  31. 31.
    Caroci Ade S, Riesco ML, Sousa Wda S, Cotrim AC, Sena EM, Rocha NL, Fontes CN (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):2424–2433PubMedCrossRefGoogle Scholar
  32. 32.
    McKinnie V, Swift SE, Wang W et al (2005) The effect of pregnancy and mode of delivery on the prevalence of urinary and fecal incontinence. Am J Obstet Gynecol 193:512–518PubMedCrossRefGoogle Scholar
  33. 33.
    Borello-France D, Burgio KL, Richter HE et al (2006) Fecal and urinary incontinence in primiparous women. Obstet Gynecol 108(4):863–872PubMedCrossRefGoogle Scholar
  34. 34.
    Press JZ, Klein MC, Kaczorowski J, Liston RM, von Dadelszen P (2007) Does cesarean section reduce postpartum urinary incontinence? A systematic review. Birth 34(3):228–237PubMedCrossRefGoogle Scholar
  35. 35.
    MacLennan AH, Taylor AW, Wilson DH, Wilson D (2000) The prevalence of pelvic floor disorders and their relationship to gender, age, parity and mode of delivery. BJOG 107(12):1460–1470PubMedCrossRefGoogle Scholar
  36. 36.
    Wilson PD, Herbison R, Herbison GP (1996) Obstetric practice and the prevalence of urinary incontinence three months after delivery. BMJ 103:154–161Google Scholar
  37. 37.
    Farrel SA, Allen VM, Baskett TF (2001) Parturition and urinary incontinence in primiparas. Obstet Gynecol 97(3):350–356CrossRefGoogle Scholar
  38. 38.
    Peyrat L, Haillot O, Bruyere F, Boutin JM, Bertrand P, Lanson Y (2002) Prevalence and risk factors of urinary incontinence in young and middle-aged women. Br J Urol Int 89:61–66Google Scholar
  39. 39.
    Rortveit G, Daltveit AK, Hannestad YS, Hunskaar S (2003) Urinary incontinence after vaginal delivery or cesarean section. N Engl J Med 348:900–907PubMedCrossRefGoogle Scholar
  40. 40.
    Lal M, H Mann C, Callender R, Radley S (2003) Does cesarean delivery prevent anal incontinence? Obstet Gynecol 101(2):305–312Google Scholar
  41. 41.
    Fitzpatrick M, O’Herlihy C (2001) The effects of labour and delivery on the pelvic floor. Best Pract Res Clin Obstet Gynaecol 15(1):63–79PubMedCrossRefGoogle Scholar
  42. 42.
    Norton C, Hosker G, Brazzelli M (2006) Biofeedback and/or sphincter exercises for the treatment of faecal incontinence in adults. Cochrane Database of Systematic Reviews Issue 3, Art. No. CD002111Google Scholar
  43. 43.
    Zanetti MRD, Castro RA, Rotta AL, Santos PD, Sartori M, Girão MJBC (2007) Impact of supervised physiotherapeutic pelvic floor exercises for treating female stress urinary incontinence. São Paulo Med J 125:265–269PubMedCrossRefGoogle Scholar
  44. 44.
    Castro RA, Arruda RM, Zanetti RD, Santos PD, Sartori MGF, Girão MJBC (2008) Single-blind, randomised, controlled trial of pelvic floor muscle training, electrical stimulation, vaginal cones and no active treatment in the management of stress urinary incontinence. Clinics 63:465–472PubMedCrossRefGoogle Scholar
  45. 45.
    Örnö AK, Marsál K, Herbst A (2008) Ultrasonographic anatomy of perineal structures during pregnancy and immediately following obstetric injury. Ultrasound Obstet Gynecol 32:527–534PubMedCrossRefGoogle Scholar
  46. 46.
    der Zalm PJ Voorham-van, Nijeholt GAB Lycklama à, Elzevier HW, Putter H, Pelger RCM (2008) Diagnostic investigation of the pelvic floor: a helpful tool in the approach in patients with complaints of micturition, defecation and/or sexual dysfunction. J Sex Med 5:864–871CrossRefGoogle Scholar
  47. 47.
    Braekken IH, Majida M, Engh ME, Bø K (2009) Test-retest reliability of pelvic floor muscle contraction measured by 4D ultrasound. Neurourol Urodyn 28:68–73PubMedCrossRefGoogle Scholar
  48. 48.
    Rechberger T, Uldbjerg N, Oxlund H (1988) Connective tissue changes in the cervix during normal pregnancy and pregnancy complicated by a cervical incompetence. Obstets Gynecol 71:563–567Google Scholar
  49. 49.
    Petros PE, Swash M, Kakulas B (2008) Stress urinary incontinence results from muscle weakness and ligamentous laxity in the pelvic floor. J Pelviperineology 27:107–109Google Scholar

Copyright information

© The International Urogynecological Association 2011

Authors and Affiliations

  • Onder Koc
    • 1
  • Bulent Duran
    • 1
  • Safak Ozdemırcı
    • 2
  • Yesim Bakar
    • 3
  • Nuriye Ozengin
    • 3
  1. 1.Department of Obstetrics and Gynecology, Faculty of MedicineAbant Izzet Baysal UniversityGolkoyTurkey
  2. 2.Department of Obstetrics and Gynecology, Simav City HospitalKütahyaTurkey
  3. 3.School of Physical Therapy and RehabilitationAbant Izzet Baysal UniversityGolkoyTurkey

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