International Urogynecology Journal

, Volume 26, Issue 8, pp 1115–1121 | Cite as

Clustering of pelvic floor disorders 20 years after one vaginal or one cesarean birth

  • Maria GyhagenEmail author
  • Sigvard Åkervall
  • Ian Milsom
Original Article


Introduction and hypothesis

The objective was to assess the prevalence and risk factors for co-occurring pelvic floor disorders (PFDs): urinary incontinence (UI), symptomatic pelvic organ prolapse (sPOP), and fecal incontinence (FI), 20 years after one vaginal (VD) or one cesarean (CS) delivery.


We carried out a registry-based national cohort study of primiparae who delivered during the period 1985–1988 and had no further deliveries. Medical Birth Registry data were linked to data from postal questionnaires distributed 20 years post-partum (response rate 65.2 %, n = 5,236). Main outcome measures were prevalence and risk factors for combined and isolated PFDs.


The prevalence of any PFD was 46.5; 31.7 % had one symptom and 14.8 % had two or more. Co-occurring symptoms doubled after VD (17.1 %) compared with CS (8.4 %) (adjOR 2.26; 95 % CI 1.84–2.79). The strongest association was observed between VD and having all three symptoms (adjOR 5.20; 95 % CI 2.73–9.91), followed by the combination of sPOP and UI (adjOR 3.38; 95 % CI 2.24–5.10). The degree of frustration perceived by the women because of pelvic floor dysfunction increased with each additional co-occurring PFD (p < 0.001). The strongest risk factors for clustering of PFDs were: VD (OR 2.19; 95 % CI 1.75–2.73), family history (OR 2.03; 95 % CI 1.73–2.34), and ≥2 degree tear (OR 1.78; 95 % CI 1.24–2.55). Vacuum extraction and episiotomy were not risk factors.


The prevalence of co-occurring PFDs was high and was doubled in women after VD compared with CS. Women with UI most likely had it as an isolated symptom, whereas FI and sPOP more often occurred in combination.


Epidemiology Cesarean section Combinations Long-term Pelvic floor dysfunction Vaginal delivery 



The study was supported by a National LUA/ALF grant no. 11315 and the Region of Västra Götaland, grants from The Göteborg Medical Society and Hjalmar Svenssons Fund. The funding source played no role in the study design, data analysis, data interpretation or writing of the report. MG and IM had full access to all study data and had final responsibility for the decision to submit for publication.

Authors’ contributions

M. Gyhagen, S. Åkervall, I. Milsom all contributed to protocol/project development, data collection, data analysis, manuscript writing, and editing.

Conflict of interest


Supplementary material

192_2015_2663_MOESM1_ESM.doc (144 kb)
ESM 1 (DOC 143 kb)


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Copyright information

© The International Urogynecological Association 2015

Authors and Affiliations

  1. 1.Department of Obstetrics and GynecologySahlgrenska Academy at Gothenburg UniversityGothenburgSweden
  2. 2.Department of Obstetrics and GynecologySödra Älvsborgs HospitalBoråsSweden
  3. 3.Department of SurgerySödra Älvsborgs HospitalBoråsSweden

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