A new study published in Female Pelvic Medicine & Reconstructive Surgery found that decreased pelvic floor strength after childbirth is 2.5 times more likely to affect women over age 25 years than younger women (Female Pelvic Med Reconstr Surg 2017; 23: 136-140).
“In multivariate analysis, age alone was a predisposing factor for pelvic floor weakness after childbirth, even though we also assessed variables such as race, BMI, length of second stage labor, vacuum delivery, and episiotomy,” said lead author Lieschen Quiroz, MD, of the University of Oklahoma Health Sciences Center, Oklahoma City.
“The issue of pelvic floor weakness is important, because one in five women are affected by pelvic floor dysfunction during their lifetime-often in the fifth or sixth decade of life-but the event that puts them at risk may have occurred years before at the time of vaginal delivery,” Dr. Quiroz said.
Since older women are at increased risk for pelvic floor weakness after vaginal delivery, it’s important that clinicians assess the pelvic floor strength of women over age 25 or 30 before childbirth, Dr. Quiroz noted. “If pelvic floor weakness is found, women can be referred to physical therapy to improve their pelvic floor strength,” she added.
In the study, 68 women with a singleton pregnancy planning a vaginal delivery were assessed for pelvic floor strength at 24 to 37 weeks and between 4 weeks and 6 months postpartum. The median follow-up time was 7 weeks postpartum. Sixty-six percent of the women experienced a vaginal delivery while 34% went into labor but had a Cesarean delivery. Pelvic floor strength was evaluated with a Peritron perineometer during pelvic floor contractions, and the women also underwent physical exams and 3D vaginal ultrasounds during pregnancy and postpartum clinical visits.
Next: What the authors found
The results indicated that 25% of women under age 25 years showed a decrease in pelvic floor strength after delivery, compared to 70% of those between age 25-29 years and 62% of those over age 30 years (p=.03). In univariate analysis, decreased pelvic floor strength was also observed more frequently in the vaginal delivery group-occurring in 68% of women who delivered via vaginal birth versus 42% of women who experienced a Cesarean delivery (p=.03).
Overall, 59% of women were found to have decreased pelvic floor strength after delivery while 41% had similar or increased strength postpartum. The clinical implications of this finding are that clinicians should assess pelvic floor strength before and after delivery, but also reassure patients that vaginal delivery will not necessarily result in pelvic floor weakness, Dr. Quiroz noted.
Dr. Quiroz acknowledged that the follow-up time in the study may not have been sufficient to determine the long-term clinical impact of labor and vaginal delivery on pelvic floor strength. Recent research indicates that the pelvic floor continues to recover for up to 6 months postpartum. The authors are also working on a secondary analysis of their data, and will publish a study later this year that assesses the effects of the women’s pregnancies on their pelvic floor muscles, as assessed by ultrasound.
“The good news is that an assessment of women’s pelvic floor strength is minimally invasive, and pelvic floor weakness can be corrected with the right kind of therapy. If women with pelvic floor weakness are referred for physical therapy and followed regularly, we can help prevent further pelvic floor dysfunction down the line,” Dr. Quiroz said.
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