International Urogynecology Journal

, Volume 25, Issue 3, pp 337–345 | Cite as

An insight into pelvic floor status in nulliparous women

  • C. M. Durnea
  • A. S. Khashan
  • L. C. Kenny
  • S. S. Tabirca
  • B. A. O’Reilly
Original Article


Introduction and hypothesis

Few studies have comprehensively investigated the prevalence of various types of pelvic floor Dysfunction (PFD) in women before their first pregnancy. However, no previous studies have investigated in detail all four compartments of PFD and the correlation between them.


This was a cross-sectional study nested within a parent prospective study Screening for Pregnancy Endpoints (SCOPE) performed in a tertiary referral teaching hospital with approximately 9,000 deliveries per annum. Nulliparous women completed the validated Australian Pelvic Floor Questionnaire at 15 weeks’ gestation, at the time of recruitment to the SCOPE study. The questionnaire contained four sections, with questions about urinary, faecal, prolapse and sexual dysfunction in the prepregnancy period.


A total of 1,484 participants completed the prenatal questionnaire. Urinary dysfunction was present in 61 % of participants, faecal in 41 %, prolapse in 5 % and sexual in 41 %; in 37 %, dysfunction was perceived as bothersome . At least one clinically significant symptom, defined as severity grade 2 or 3, or grade 1 associated with being bothersome, was reported by 58.2 % of participants. More than one type of PFD was present in 57.6 % of cases. The severity score of each symptom within a PFD section was associated with total section score.


We confirmed a high rate of PFD in nulliparous women. Clinically significant symptoms and associated bother were very common among symptomatic participants. The majority of affected women had more than one type of PFD. Postnatal follow-up is needed in order to elucidate the role of prepregnancy symptoms in the aetiology of postnatal pelvic floor pathology.


4P-Study Incontinence Nulliparous PFD Prolapse Urge 



We thank all SCOPE Ireland participants, the Continence Foundation Ireland and Anu Research Centre for their input into this research project.


SCOPE Ireland is funded by Health Research Board of Ireland (grant reference CSA 2007/2). The study was supported by Continence Foundation Ireland and Anu Research Centre, UCC.

Financial disclaimer/Conflicts of interest


Supplementary material

192_2013_2225_MOESM1_ESM.bmp (839 kb)
Appendix A1(BMP 839 kb)
192_2013_2225_MOESM2_ESM.pdf (797 kb)
Appendix A2(PDF 797 kb)
192_2013_2225_MOESM3_ESM.pdf (197 kb)
Appendix A3(PDF 197 kb)


  1. 1.
    Bump RC, Norton PA (1998) Epidemiology and natural history of pelvic floor dysfunction. Obstet Gynecol Clin N Am 25(4):723–746CrossRefGoogle Scholar
  2. 2.
    MacArthur C, Lewis M, Knox EG (1991) Health after childbirth. Br J Obstet Gynaecol 98(12):1193–1195PubMedCrossRefGoogle Scholar
  3. 3.
    MacLennan AH et al (2000) The prevalence of pelvic floor disorders and their relationship to gender, age, parity and mode of delivery. BJOG 107(12):1460–1470PubMedCrossRefGoogle Scholar
  4. 4.
    Skoner MM, Thompson WD, Caron VA (1994) Factors associated with risk of stress urinary incontinence in women. Nurs Res 43(5):301–306PubMedCrossRefGoogle Scholar
  5. 5.
    Rortveit G et al (2003) Urinary incontinence after vaginal delivery or cesarean section. N Engl J Med 348(10):900–907PubMedCrossRefGoogle Scholar
  6. 6.
    Nygaard I et al (2008) Prevalence of symptomatic pelvic floor disorders in US women. JAMA 300(11):1311–1316PubMedCentralPubMedCrossRefGoogle Scholar
  7. 7.
    King JK, Freeman RM (1998) Is antenatal bladder neck mobility a risk factor for postpartum stress incontinence? Br J Obstet Gynaecol 105(12):1300–1307PubMedCrossRefGoogle Scholar
  8. 8.
    Dietz HP et al (2005) Bladder neck mobility is a heritable trait. BJOG 112(3):334–339PubMedCrossRefGoogle Scholar
  9. 9.
    Hendrix SL et al (2002) Pelvic organ prolapse in the Women’s Health Initiative: gravity and gravidity. Am J Obstet Gynecol 186(6):1160–1166PubMedCrossRefGoogle Scholar
  10. 10.
    Persson J, Wolner-Hanssen P, Rydhstroem H (2000) Obstetric risk factors for stress urinary incontinence: a population-based study. Obstet Gynecol 96(3):440–445PubMedCrossRefGoogle Scholar
  11. 11.
    Ekstrom A et al (2008) Planned cesarean section versus planned vaginal delivery: comparison of lower urinary tract symptoms. Int Urogynecol J Pelvic Floor Dysfunct 19(4):459–465PubMedCrossRefGoogle Scholar
  12. 12.
    Cacciatore A et al (2010) Putative protective effects of cesarean section on pelvic floor disorders. J Perinat Med 4(1):1–4Google Scholar
  13. 13.
    Chaliha C (2009) Postpartum pelvic floor trauma. Curr Opin Obstet Gynecol 21(6):474–479PubMedCrossRefGoogle Scholar
  14. 14.
    Stanton SL, Kerr-Wilson R, Harris VG (1980) The incidence of urological symptoms in normal pregnancy. Br J Obstet Gynaecol 87(10):897–900PubMedCrossRefGoogle Scholar
  15. 15.
    Chan SS et al (2012) Prevalence of urinary and fecal incontinence in Chinese women during and after their first pregnancy. Int Urogynecol J 24(9):1473–1479Google Scholar
  16. 16.
    Viktrup L et al (1992) The symptom of stress incontinence caused by pregnancy or delivery in primiparas. Obstet Gynecol 79(6):945–949PubMedGoogle Scholar
  17. 17.
    Baessler K et al (2009) Australian pelvic floor questionnaire: a validated interviewer-administered pelvic floor questionnaire for routine clinic and research. Int Urogynecol J Pelvic Floor Dysfunct 20(2):149–158PubMedCrossRefGoogle Scholar
  18. 18.
    Vaughan CP et al (2011) The prevalence of clinically meaningful overactive bladder: bother and quality of life results from the population-based FINNO study. Eur Urol 59(4):629–636PubMedCrossRefGoogle Scholar
  19. 19.
    O’Halloran T et al (2012) Urinary incontinence in young nulligravid women: a cross-sectional analysis. Ann Intern Med 157(2):87–93PubMedCrossRefGoogle Scholar
  20. 20.
    Rortveit G et al (2001) Age- and type-dependent effects of parity on urinary incontinence: the Norwegian EPINCONT study. Obstet Gynecol 98(6):1004–1010PubMedCrossRefGoogle Scholar
  21. 21.
    Hannestad YS et al (2000) A community-based epidemiological survey of female urinary incontinence: the Norwegian EPINCONT study. Epidemiology of Incontinence in the County of Nord-Trondelag. J Clin Epidemiol 53(11):1150–1157PubMedCrossRefGoogle Scholar
  22. 22.
    Lam GW et al (1992) Social context, social abstention, and problem recognition correlated with adult female urinary incontinence. Dan Med Bull 39(6):565–570PubMedGoogle Scholar
  23. 23.
    Bellelis P et al (2010) Epidemiological and clinical aspects of pelvic endometriosis-a case series. Rev Assoc Med Bras 56(4):467–471PubMedCrossRefGoogle Scholar
  24. 24.
    Dalpiaz O et al (2008) Female sexual dysfunction: a new urogynaecological research field. BJU Int 101(6):717–721PubMedCrossRefGoogle Scholar
  25. 25.
    Monz B et al (2007) Patient characteristics associated with quality of life in European women seeking treatment for urinary incontinence: results from PURE. Eur Urol 51(4):1073–1081, discussion 1081–2PubMedCrossRefGoogle Scholar
  26. 26.
    Gil KM et al (2009) Distress and quality of life characteristics associated with seeking surgical treatment for stress urinary incontinence. Health Qual Life Outcomes 7:8PubMedCentralPubMedCrossRefGoogle Scholar
  27. 27.
    Brown SJ et al (2010) Urinary incontinence in nulliparous women before and during pregnancy: prevalence, incidence, and associated risk factors. Int Urogynecol J 21(2):193–202PubMedCrossRefGoogle Scholar
  28. 28.
    Gay LR (1987) Educational research: Competencies for analysis and application, 3rd edn. Merrill Publishing Company, Columbus, pp 114–115Google Scholar
  29. 29.
    Thom DH et al (2006) Differences in prevalence of urinary incontinence by race/ethnicity. J Urol 175(1):259–264PubMedCentralPubMedCrossRefGoogle Scholar
  30. 30.
    Githens PB et al (1993) Maternal recall and medical records: an examination of events during pregnancy, childbirth, and early infancy. Birth 20(3):136–141PubMedCrossRefGoogle Scholar

Copyright information

© The International Urogynecological Association 2013

Authors and Affiliations

  • C. M. Durnea
    • 1
    • 2
    • 4
  • A. S. Khashan
    • 1
  • L. C. Kenny
    • 1
  • S. S. Tabirca
    • 3
  • B. A. O’Reilly
    • 1
    • 2
  1. 1.Anu Research Centre, Department of Obstetrics and GynaecologyUniversity College Cork (UCC)CorkIreland
  2. 2.Department of UrogynaecologyCork University Maternity Hospital (CUMH)CorkIreland
  3. 3.School of MedicineUniversity College CorkCorkIreland
  4. 4.Anu Research Centre, Department of Obstetrics and GynaecologyCork University Maternity HospitalCorkIreland

Personalised recommendations