Association between pelvic floor muscle trauma and pelvic organ prolapse 20 years after delivery
Introduction and hypothesis
It is known that pelvic floor muscle trauma (PFMT) after vaginal delivery is associated with pelvic organ prolapse (POP) symptoms (sPOP) and signs (POP-Q ≥2) in patient populations. Our aims were to establish the prevalence and investigate a possible association between PFMT and sPOP and POP-Q ≥2 in healthy women 20 years after their first delivery.
During 2013 and 2014 we conducted a cross-sectional study among 847 women who delivered their first child between 1990 and 1997. Women responded to a postal questionnaire and were offered a clinical examination including prolapse grading and pelvic floor ultrasonography. The main outcome measures were sPOP, POP-Q ≥2 and PFMT, defined by levator avulsion or a levator hiatal area on Valsalva manoeuvre of >40 cm2 on ultrasonography.
Of the 847 eligible women, 608 (72 %) were examined. Data on POP symptoms, POP-Q stage, levator avulsion and levator hiatal area were available in 598, 608, 606 and 554 women, respectively, and of these 75 (13 %) had sPOP, 275 (45 %) had POP-Q ≥2, 113 (19 %) had levator avulsion and 164 (30 %) had a levator hiatal area >40 cm2. Levator avulsion was associated with POP-Q ≥2 with an odds ratio (OR) of 9.91 and a 95 % confidence interval (CI) of 5.73 – 17.13, and with sPOP (OR 2.28, 95 % CI 1.34 – 3.91). Levator hiatal area >40 cm2 was associated with POP-Q ≥2 (OR 6.98, 95 % CI 4.54, – 10.74) and sPOP (OR 3.28, 95 % CI 1.96 – 5.50).
Many healthy women selected from the general population have symptoms and signs of POP 20 years after their first delivery, and PFMT is associated with POP-Q ≥2 and sPOP.
KeywordsLevator avulsion Levator hiatus area Pelvic floor muscle trauma Pelvic organ prolapse
We thank Christine Østerlie and Tuva K. Halle for help with identifying potential study participants, Johan Morten Dreier and Berit Marianne Bjelkaasen for help with questionnaires, and Guri Kolberg for help with coordination of clinical examinations.
This project was financially supported by the Norwegian Women’s Public Health Association/the Norwegian Extra Foundation for Health and Rehabilitation through EXTRA funds, St. Olavs Hospital, Trondheim University Hospital and the Norwegian University of Science and Technology. The funders played no role in the study design, in the collection, analysis and interpretation of data, or in the writing of the report and the decision to submit the article for publication. All researchers were independent of the funders.
Conflicts of interest
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