Obstetric risk factors and pelvic floor dysfunction 20 years after first delivery.

INTRODUCTION AND HYPOTHESIS

Intrapartum events at first delivery and subsequent childbearing are associated with long-term pelvic floor dysfunction (PFD).

METHODS

Primigravidae delivered between 1983-1986 were identified; current addresses traced through the UK National Health Service database (N = 3002). Women completed screening and Sheffield Pelvic Floor Questionnaires (Sheffield-PAQ). Maternity data were obtained from Standard Maternity Information System. Primary outcomes were urinary incontinence (UI), anal incontinence (AI), and prolapse (POP).

RESULTS

Primary response was 62.1%; 53.8% (n = 985) had >or=1 PFD symptom and in 71.5% symptoms were bothersome. UI (OR 0.47 95% CI 0.28, 0.81) and fecal incontinence (FI; OR 0.32 95% CI 0.13, 0.77) risks were lower after first delivery by cesarean section (CS). However, 25% had UI and 12% had FI after delivering exclusively by CS. Obesity was a risk factor independent of obstetric history.

CONCLUSIONS

CS provides incomplete or poorly sustained pelvic floor protection by middle age. Obese women were at highest risk and had the most severe symptoms.