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Pelvic floor symptoms and quality of life changes during first pregnancy: a prospective cohort study

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Abstract

Introduction and hypothesis

We describe pelvic floor function in nulliparous pregnant women.

Materials and methods

Nulliparous midwifery patients completed the Incontinence Severity Index (ISI), Pelvic Floor Impact Questionnaire (PFIQ-7), Wexner Fecal Incontinence Scale (W), and answered questions about sexual activity and perineal pain at baseline during the first (T1), second (T2), or third trimester (T3) and repeated in late T3. They also underwent a Pelvic Organ Prolapse Quantification (POP-Q) exam at their baseline visit. Data were compared across trimesters. Analysis of variance (ANOVA) and logistic regression accounted for repeated measures and was controlled for age and education.

Results

We recruited 627 women. In T1, 124 women gave baseline data and completed questionnaires; in T2, 403; and in early T3, 96 (496 repeated questionnaires in later T3). Besides an increase in genital hiatus and perineal body (all adjusted p < .05), physical exam measures did not differ between trimesters. As pregnancy progressed, urinary incontinence (UI) (T1 = 33, T2 = 44, T3 = 69% women with ISI >0, all comparisons p < .02) and Incontinence Impact Questionnaire (IIQ-7) scores increased. Fecal incontinence (FI) increased (T1 = 8, T2 = 15, T3 = 16% from T2 to T3, p = .04); the Colorectal–Anal Impact Questionnaire (CRAIQ-7) scores did not. Perineal pain increased (T1 = 17, T2 = 18 and T3 = 40%, all adjusted p < .001), and sexual activity decreased (T1 = 94, T2 = 90, T3 = 77% sexually active, T1 vs T3 and T2 vs T3, p < .001) as pregnancy progressed.

Conclusions

During pregnancy, women experience worsening UI, FI, and perineal pain. UI symptoms are associated with a negative impact on quality of life (QoL). Sexual activity decreased and POP-Q stage did not change.

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References

  1. Solans-Domenech M, Sanchez E, Espuna-Pons M. Urinary and anal incontinence during pregnancy and postpartum: incidence, severity, and risk factors. Obstet Gynecol. 2010;115(3):618–28. doi:10.1097/AOG.0b013e3181d04dff.

    Article  PubMed  Google Scholar 

  2. Lewicky-Gaupp C, Cao DC, Culbertson S. Urinary and anal incontinence in African American teenaged gravidas during pregnancy and the puerperium. J Pediatr Adolesc Gynecol. 2008;21(1):21–6. doi:10.1016/j.jpag.2007.05.003.

    Article  PubMed  Google Scholar 

  3. Chaliha C, Kalia V, Stanton SL, Monga A, Sultan AH. Antenatal prediction of postpartum urinary and fecal incontinence. Obstet Gynecol. 1999;94(5 Pt 1):689–94.

    CAS  PubMed  Google Scholar 

  4. Wijma J, Potters AE, de Wolf BT, Tinga DJ, Aarnoudse JG. Anatomical and functional changes in the lower urinary tract following spontaneous vaginal delivery. BJOG : an international journal of obstetrics and gynaecology. 2003;110(7):658–63.

    Article  Google Scholar 

  5. Eason E, Labrecque M, Marcoux S, Mondor M. Effects of carrying a pregnancy and of method of delivery on urinary incontinence: a prospective cohort study. BMC pregnancy and childbirth. 2004;4(1):4. doi:10.1186/1471-2393-4-4.

    Article  PubMed  PubMed Central  Google Scholar 

  6. Brown SJ, Donath S, MacArthur C, McDonald EA, Krastev AH. Urinary incontinence in nulliparous women before and during pregnancy: prevalence, incidence, and associated risk factors. Int Urogynecol J. 2010;21(2):193–202. doi:10.1007/s00192-009-1011-x.

    Article  PubMed  Google Scholar 

  7. Raza-Khan F, Graziano S, Kenton K, Shott S, Brubaker L. Peripartum urinary incontinence in a racially diverse obstetrical population. Int Urogynecol J Pelvic Floor Dysfunct. 2006;17(5):525–30. doi:10.1007/s00192-005-0061-y.

    Article  PubMed  Google Scholar 

  8. Handa VL, Blomquist JL, Knoepp LR, Hoskey KA, McDermott KC, Munoz A. Pelvic floor disorders 5-10 years after vaginal or cesarean childbirth. Obstet Gynecol. 2011;118(4):777–84. doi:10.1097/AOG.0b013e3182267f2f.

    Article  PubMed  PubMed Central  Google Scholar 

  9. Brincat C, Lewicky-Gaupp C, Patel D, Sampselle C, Miller J, Delancey JO, Fenner DE. Fecal incontinence in pregnancy and post partum. International journal of gynaecology and obstetrics: the official organ of the International Federation of Gynaecology and Obstetrics. 2009;106(3):236–8. doi:10.1016/j.ijgo.2009.04.018.

    Article  Google Scholar 

  10. van Brummen HJ, Bruinse HW, van de Pol G, Heintz AP, van der Vaart CH. Defecatory symptoms during and after the first pregnancy: prevalences and associated factors. Int Urogynecol J Pelvic Floor Dysfunct. 2006;17(3):224–30. doi:10.1007/s00192-005-1351-0.

    Article  PubMed  Google Scholar 

  11. King VG, Boyles SH, Worstell TR, Zia J, Clark AL, Gregory WT. Using the Brink score to predict postpartum anal incontinence. Am J Obstet Gynecol. 2010;203(5):486.e1–5. doi:10.1016/j.ajog.2010.07.032.

    Article  Google Scholar 

  12. Pauls RN, Occhino JA, Dryfhout V, Karram MM. Effects of pregnancy on pelvic floor dysfunction and body image; a prospective study. Int Urogynecol J Pelvic Floor Dysfunct. 2008;19(11):1495–501. doi:10.1007/s00192-008-0670-3.

    Article  PubMed  Google Scholar 

  13. Erol B, Sanli O, Korkmaz D, Seyhan A, Akman T, Kadioglu A. A cross-sectional study of female sexual function and dysfunction during pregnancy. J Sex Med. 2007;4(5):1381–7. doi:10.1111/j.1743-6109.2007.00559.x.

    Article  PubMed  Google Scholar 

  14. Rogers RG, Leeman LM, Borders N, Qualls C, Fullilove AM, Teaf D, Hall RJ, Bedrick E, Albers LL. Contribution of the second stage of labour to pelvic floor dysfunction: a prospective cohort comparison of nulliparous women. BJOG : an international journal of obstetrics and gynaecology. 2014;121(9):1145–53. discussion 54 doi:10.1111/1471-0528.12571.

    Article  CAS  Google Scholar 

  15. Ninivaggio C, Rogers RG, Leeman L, Migliaccio L, Teaf D, Qualls C. Sexual function changes during pregnancy. Int Urogynecol J. 2016; doi:10.1007/s00192-016-3200-8.

    PubMed  Google Scholar 

  16. Leeman L, Rogers R, Borders N, Teaf D, Qualls C. The effect of perineal lacerations on pelvic floor function and anatomy at 6 months postpartum in a prospective cohort of nulliparous women. Birth (Berkeley, Calif). 2016;43(4):293–302. doi:10.1111/birt.12258.

    Article  Google Scholar 

  17. Komorowski LK, Leeman LM, Fullilove AM, Bedrick EJ, Migliaccio LD, Rogers RG. Does a large infant head or a short perineal body increase the risk of obstetrical perineal trauma? Birth (Berkeley, Calif). 2014;41(2):147–52. doi:10.1111/birt.12101.

    Article  Google Scholar 

  18. Meriwether KV, Hall RJ, Leeman LM, Migliaccio L, Qualls C, Rogers RG. Postpartum translabial 2D and 3D ultrasound measurements of the anal sphincter complex in primiparous women delivering by vaginal birth versus cesarean delivery. Int Urogynecol J. 2014;25(3):329–36. doi:10.1007/s00192-013-2215-7.

    Article  PubMed  Google Scholar 

  19. Meriwether KV, Hall RJ, Leeman LM, Migliaccio L, Qualls C, Rogers RG. The relationship of 3-D translabial ultrasound anal sphincter complex measurements to postpartum anal and fecal incontinence. Int Urogynecol J. 2015;26(8):1191–9. doi:10.1007/s00192-015-2676-y.

    Article  PubMed  PubMed Central  Google Scholar 

  20. Meriwether KV, Hall RJ, Leeman LM, Migliaccio L, Qualls C, Rogers RG. Anal sphincter complex: 2D and 3D endoanal and translabial ultrasound measurement variation in normal postpartum measurements. Int Urogynecol J. 2015;26(4):511–7. doi:10.1007/s00192-014-2524-5.

    Article  PubMed  Google Scholar 

  21. Haylen BT, de Ridder D, Freeman RM, Swift SE, Berghmans B, Lee J, Monga A, Petri E, Rizk DE, Sand PK, Schaer GN. An international Urogynecological association (IUGA)/international continence Society (ICS) joint report on the terminology for female pelvic floor dysfunction. Int Urogynecol J. 2010;21(1):5–26. doi:10.1007/s00192-009-0976-9.

    Article  PubMed  Google Scholar 

  22. Bump RC, Mattiasson A, Bo K, Brubaker LP, DeLancey JO, Klarskov P, Shull BL, Smith AR. The standardization of terminology of female pelvic organ prolapse and pelvic floor dysfunction. Am J Obstet Gynecol. 1996;175(1):10–7.

    Article  CAS  PubMed  Google Scholar 

  23. Brink CA, Sampselle CM, Wells TJ, Diokno AC, Gillis GL. A digital test for pelvic muscle strength in older women with urinary incontinence. Nurs Res. 1989;38(4):196–9.

    Article  CAS  PubMed  Google Scholar 

  24. Hanley J, Capewell A, Hagen S. Validity study of the severity index, a simple measure of urinary incontinence in women. BMJ (Clinical research ed). 2001;322(7294):1096–7.

    Article  CAS  Google Scholar 

  25. Bradley CS, Rovner ES, Morgan MA, Berlin M, Novi JM, Shea JA, Arya LA. A new questionnaire for urinary incontinence diagnosis in women: development and testing. Am J Obstet Gynecol 2005;192(1):66–73. doi: 10.1016/j.ajog.2004.07.037. PubMed

  26. Jorge JM, Wexner SD. Etiology and management of fecal incontinence. Dis Colon rectum. 1993;36(1):77–97.

  27. Boyles SH, Li H, Mori T, Osterweil P, Guise JM. Effect of mode of delivery on the incidence of urinary incontinence in primiparous women. Obstet Gynecol 2009;113(1):134–141. doi: 10.1097/AOG.0b013e318191bb37. PubMed

  28. Corbacioglu Esmer A, Akca A, Akbayir O, Goksedef BP, Bakir VL. Female sexual function and associated factors during pregnancy. J Obstet Gynaecol Res. 2013;39(6):1165–72. doi:10.1111/jog.12048.

    Article  PubMed  Google Scholar 

  29. Aslan G, Aslan D, Kizilyar A, Ispahi C, Esen A. A prospective analysis of sexual functions during pregnancy. Int J Impot Res. 2005;17(2):154–7. doi:10.1038/sj.ijir.3901288.

    Article  CAS  PubMed  Google Scholar 

  30. Yildiz H. The relation between prepregnancy sexuality and sexual function during pregnancy and the postpartum period: a prospective study. Journal of sex & marital therapy. 2015;41(1):49–59. doi:10.1080/0092623x.2013.811452.

    Article  Google Scholar 

  31. Galazka I, Drosdzol-Cop A, Naworska B, Czajkowska M, Skrzypulec-Plinta V. Changes in the sexual function during pregnancy. J Sex Med. 2015;12(2):445–54. doi:10.1111/jsm.12747.

    Article  PubMed  Google Scholar 

  32. Seven M, Akyuz A, Gungor S. Predictors of sexual function during pregnancy. Journal of obstetrics and gynaecology : the journal of the Institute of Obstetrics and Gynaecology. 2015;35(7):691–5. doi:10.3109/01443615.2015.1006596.

    Article  CAS  Google Scholar 

  33. O’Boyle AL, O’Boyle JD, Ricks RE, Patience TH, Calhoun B, Davis G. The natural history of pelvic organ support in pregnancy. Int Urogynecol J Pelvic Floor Dysfunct 2003;14(1):46–49; discussion 9. doi: 10.1007/s00192-002-1006-3

  34. Sze EH, Sherard 3rd GB, Dolezal JM. Pregnancy, labor, delivery, and pelvic organ prolapse. Obstet Gynecol. 2002;100(5 Pt 1):981–6.

    PubMed  Google Scholar 

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Correspondence to Rebecca G. Rogers.

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Funding

This project was supported (in part or in full) by the Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD), 1R01HD049819-01A2, and by the National Center for Research Resources and the National Center for Advancing Translational Sciences of the National Institutes of Health, grant 8 UL1TR001449.

Conflicts of interest

RG Rogers: UptoDate royalties, travel, lodging and stipends from IUGA, ABOG and ACOG. C Ninivaggio: Travel and lodging, food and beverage for AUGS Fellows’ course, travel and lodging for course sponsored by Medtronic. K Gallagher, AN Borders, C Qualls, and LM Leeman declare no conflicts of interest.

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Rogers, R.G., Ninivaggio, C., Gallagher, K. et al. Pelvic floor symptoms and quality of life changes during first pregnancy: a prospective cohort study. Int Urogynecol J 28, 1701–1707 (2017). https://doi.org/10.1007/s00192-017-3330-7

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  • DOI: https://doi.org/10.1007/s00192-017-3330-7

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