The effect of pregnancy and childbirth on pelvic floor muscle function

  • Ksena Elenskaia
  • Ranee Thakar
  • Abdul Hameed Sultan
  • Inka Scheer
  • Andrew Beggs
Original Article

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.

Keywords

Pelvic floor muscle function Mode of delivery Childbirth Oxford score Perineometry Second stage 

Notes

Conflicts of interest

None.

References

  1. 1.
    Kegel AH (1948) Progressive resistance exercise in the functional restoration of the perineal muscles. Am J Obstet Gynecol 56(2):238–248PubMedGoogle Scholar
  2. 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):190–197PubMedCrossRefGoogle Scholar
  3. 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 109:295–302PubMedCrossRefGoogle Scholar
  4. 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):553–556CrossRefGoogle Scholar
  5. 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):46–53PubMedCrossRefGoogle Scholar
  6. 6.
    Dietz HP, Schierlitz L (2005) Pelvic floor trauma in childbirth—myth or reality? Aust N Z J Obstet Gynaecol 45(1):3–11PubMedCrossRefGoogle Scholar
  7. 7.
    Allen RE, Hosker GL, Smith AR, Warrell DW (1990) Pelvic floor damage and childbirth: a neurophysiological study. Br J Obstet Gynaecol 97(9):770–779PubMedCrossRefGoogle Scholar
  8. 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):1358–1360PubMedCrossRefGoogle Scholar
  9. 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):22–28PubMedCrossRefGoogle Scholar
  10. 10.
    Rortveit G, Daltveit AK, Hannestad YS, Hunskaar S (2003) Urinary incontinence after vaginal delivery or cesarean section. N Engl J Med 348(10):900–907PubMedCrossRefGoogle Scholar
  11. 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):917–927PubMedCrossRefGoogle Scholar
  12. 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):439–446Google Scholar
  13. 13.
    Gordon H, Logue M (1985) Perineal muscle function after childbirth. Lancet 2(8447):123–125PubMedCrossRefGoogle Scholar
  14. 14.
    Peschers UM, Schaer GN, DeLancey JO, Schuessler B (1997) Levator ani function before and after childbirth. Br J Obstet Gynaecol 104(9):1004–1008PubMedCrossRefGoogle Scholar
  15. 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):2424–2433PubMedCrossRefGoogle Scholar
  16. 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 42–47Google Scholar
  17. 17.
    Bø K, Sherburn M (2005) Evaluation of female pelvic-floor muscle function and strength. Phys Ther 85(3):269–282PubMedGoogle Scholar
  18. 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):519PubMedGoogle Scholar
  19. 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):144–149PubMedCrossRefGoogle Scholar
  20. 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):91PubMedCrossRefGoogle Scholar
  21. 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 28–33Google Scholar
  22. 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):377–380PubMedCrossRefGoogle Scholar
  23. 23.
    Ashton-Miller JA, Delancey JO (2009) On the biomechanics of vaginal birth and common sequelae. Annu Rev Biomed Eng 11:163–176PubMedCrossRefGoogle Scholar
  24. 24.
    Dougherty MC, Abrams R, McKey PL (1986) An instrument to assess the dynamic characteristics of the circumvaginal musculature. Nurs Res 35(4):202–206PubMedCrossRefGoogle Scholar
  25. 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 9:471–477CrossRefGoogle Scholar
  26. 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):209–214PubMedCrossRefGoogle Scholar
  27. 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):883–887PubMedGoogle Scholar
  28. 28.
    Ashton-Miller JA, DeLancey JO (2007) Functional anatomy of the female pelvic floor. Ann N Y Acad Sci 1101:266–296PubMedCrossRefGoogle Scholar
  29. 29.
    Dietz HP, Lanzarone V (2005) Levator trauma after vaginal delivery. Obstet Gynecol 106(4):707–712PubMedCrossRefGoogle Scholar
  30. 30.
    Shek KL, Dietz HP (2010) Intrapartum risk factors for levator trauma. BJOG 117(12):1485–1492PubMedCrossRefGoogle Scholar
  31. 31.
    Dietz HP, Shek C (2008) Levator avulsion and grading of pelvic floor muscle strength. Int Urogynecol J Pelvic Floor Dysfunct 19(5):633–636PubMedCrossRefGoogle Scholar
  32. 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):967–972PubMedCrossRefGoogle Scholar
  33. 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):130–135PubMedCrossRefGoogle Scholar
  34. 34.
    Wei JT, De Lancey JO (2004) Functional anatomy of the pelvic floor and lower urinary tract. Clin Obstet Gynecol 47(1):3–17PubMedCrossRefGoogle Scholar
  35. 35.
    Sultan AH, Stanton SL (1996) Preserving the pelvic floor and perineum during childbirth—elective caesarean section? Br J Obstet Gynaecol 103(8):731–734PubMedCrossRefGoogle Scholar
  36. 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):615–617PubMedCrossRefGoogle Scholar

Copyright information

© The International Urogynecological Association 2011

Authors and Affiliations

  • Ksena Elenskaia
    • 1
  • Ranee Thakar
    • 1
  • Abdul Hameed Sultan
    • 1
  • Inka Scheer
    • 1
  • Andrew Beggs
    • 1
  1. 1.Croydon University HospitalCroydonUK

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