Pelvic floor dysfunction before and after childbirth and preventive strategies in obstetric practice


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Abstract

Objective. To determine the rate of pelvic floor dysfunction (PFD) in women during pregnancy and in postpartum and late periods. Material and methods. The data of 50 foreign and Russian sources found in international databases on this topic were analyzed. Results. PFD (urinary incontinence and pelvic organ prolapse) occurred in 40% of women already during pregnancy and lasted in the majority of them 6-8 weeks postpartum. After one year, the rate of PFD increased by 7-10% and following 10 years, it rose by 25%, amounting 50-77%. The rate of sexual dysfunction was correlated with the manifestations of PFD, increasing from 20% postpartum and up to 50-80% in the late periods. On the contrary, the rate of fecal incontinence decreased, but not in women who had experienced third-to-fourth degree perineal ruptures. Conclusion. The findings suggest that there is a need to screen women who require therapeutic measures, starting just in the postpartum period.

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About the authors

Dmitry M. Kochev

ZAO “Pentkroft Farma”

Email: pentcroft@mail.ru
CEO

Galina B. Dikke

Peoples’ Friendship University of Russia

Email: galadikke@yandex.ru
Honoured Science and Education, MD, professor of obstetrics, gynecology and reproductive medicine, faculty of continuing medical education

References

  1. Memon H.U., Handa V.L. Vaginal childbirth and pelvic floor disorders. Womens Health. 2013; 9(3): 265-77; quiz 276-7. doi: 10.2217/whe.13.17.
  2. Hunskaar S., Burgio K., Diokno A., Herzog A.R., Hjälmäs K., Lapitan M.C. Epid natur hist urinary incontinence in women. Urology. 2003; 62(4, Suppl. 1): 16-23.
  3. Русских А.Н., Самотесов П.А., Горбунов Н.С., Андрейчиков А.В. Конституциональные особенности строения уретры и шейки мочевого пузыря у женщин. Сибирский медицинский журнал (Иркутск). 2010; 92(1): 68-72. [Russkikh A.N., Samotesov P.A., Gorbunov N.S., Andreychikov A.V. Constitutional features of the structure of the urethra and the neck of the bladder in women. Sibirskiy meditsinskiy zhurnal (Irkutsk). 2010; 92(1): 68-72. (in Russian)]
  4. Awwad J., Sayegh R., Yeretzian J., Deeb M.E. Prevalence, risk factors, and predictors of pelvic organ prolapse: a community-based study. Menopause. 2012; 19(11): 1235-41.
  5. Тигиева А.В. Несостоятельность тазового дна у женщин репродуктивного возраста: автореф. дисс.. канд. мед. наук. М.; 2014. [Tigiyeva A.V. The incompetence of the pelvic floor in women of reproductive age: Author’s abstract.. cand. med. sciences. Moscow; 2014. (in Russian)]
  6. Lazarescu A., Turnbull G.K., Vanner S. Investigating and treating fecal incontinence: when and how. Can. J. Gastroenterol. 2009; 23(4): 301-8.
  7. Bharucha A.E., Zinsmeister A.R., Locke G.R., Seide B.M., McKeon K., Schleck C.D., Melton L.J. Prevalence and burden of fecal incontinence: a population-based study in women. Gastroenterology. 2005; 129(1): 42-9.
  8. Norton C., Christianson I., Butler U., Harari D., Nelson R.L. Anal incontinence. In: Abrams P., Cardozo L., Khoury S., Wein A. eds. Incontinence. 2nd International consultation on incontinence. 2nd ed. Plymouth: Health Publication Ltd; 2002: 985-1044.
  9. Simons J., Carey M.P. Prevalence of sexual dysfunctions. Results from a decade of research. Arch. Sex. Behav. 2001; 30(2): 177-219.
  10. Аполихина И.А., Дикке Г.Б., Кочев Д.М. Современная лечебно-профилак тическая тактика при опущении и выпадении половых органов у женщин. Знания и практические навыки врачей. Акушерство и гинекология. 2014; 10: 104-10. [Apolikhina I.A., Dikke G.B., Kochev D.M. Modern therapeutic and preventive tactics for the omission and prolapse of the genital organs in women. Knowledge and practical skills of doctors. Akusherstvo i ginekologiya/ Obstetrics and gynecology. 2014; (10): 104-10. (in Russian)]
  11. Fonti Y., Giordano R., Cacciatore A., Romano M., La Rosa B. Post partum pelvic floor changes. J. Prenat. Med. 2009; 3(4): 57-9.
  12. Bo K., Berghmans B., Morkved S., Van Kampen M. Evidence-based physical therapy for the pelvic floor. Bridging science and clinical practice. Philadelphia, PA: Elsevier Health Sciences; 2007.
  13. Sangsawang B., Sangsawang N. Stress urinary incontinence in pregnant women: a review of prevalence, pathophysiology, and treatment. Int. Urogynecol. J. 2013; 24(6): 901-12.
  14. Morkved S., Bo K. Prevalence of urinary incontinence during pregnancy and postpartum. Int. Urogynecol. J. Pelvic Floor Dysfunct. 1999; 10(6): 394-8.
  15. Lewicky-Gaupp C., Cao D.C., 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.
  16. Liang C.C., Chang S.D., Lin S.J., Lin Y.J. Lower urinary tract symptoms in primiparous women before and during pregnancy. Arch. Gynecol. Obstet. 2012; 285(5): 1205-10.
  17. Ammari A., Tsikouras P., Dimitraki M., Liberis A., Kontomanolis E., Galazios G., Liberis V. Uterine prolapse complicating pregnancy. HJOG. 2014; 13(2): 74-7.
  18. De Vita D., Giordano S. Two successful natural pregnancies in a patient with severe uterine prolapse: A case report. J. Med. Case Reports. 2011; 5: 459.
  19. Büyükbayrak E.E., Yilmazer G., Özyap A.G. et al. Successful management of uterine prolapse during pregnancy with vaginal pessary: a case report. J. Turk. Ger. Gynecol. Assoc. 2010; 11(2): 105-6.
  20. Chen Y., Li F.Y., Lin X., Chen J., Chen C., Guess M.K. The recovery of pelvic organ support during the first year postpartum. BJOG. 2013; 120(11): 1430-7.
  21. Wai C.Y., McIntire D.D., Atnip S.D., Schaffer J.I., Bloom S.L., Leveno K.J. Urodynamic indices and pelvic organ prolapse quantification 3months after vaginal delivery in primiparous women. Int. Urogynecol. J. 2011; 22(10): 1293-8.
  22. Brincat C., Lewicky-Gaupp C., Patel D., Sampselle C., Miller J., Delancey J.O., Fenner D.E. Fecal incontinence in pregnancy and post partum. Int. J. Gynaecol. Obstet. 2009; 106(3): 236-8.
  23. Parés D., Martinez-Franco E., Lorente N., Viguer J., Lopez-Negre J.L., Mendez J.R. Prevalence of fecal incontinence in women during pregnancy: a large cross-sectional study. Dis. Colon Rectum. 2015; 58(11): 1098-103.
  24. Bristol Stool Form Scale. In: Irritable bowel syndrome in adults. Diagnosis and management of irritable bowel syndrome in primary care. NICE Clinical Guidelines, No. 61. London: Royal College of Nursing (UK); 2008. Available at: https://www.ncbi.nlm.nih.gov/
  25. Odar E., Wandabwa J., Kiondo P. Sexual practices of women within 6 months of childbirth in Mulago hospital, Uganda. Afr. Health Sci. 2003; 3(3): 117-23.
  26. Dabiri F., Yabandeh A.P., Shahi A., Kamjoo A., Teshnizi S.H. The effect of mode of delivery on postpartum sexual functioning in primiparous women. Oman Med. J. 2014; 29(4): 276-9.
  27. Barrett G., Pendry E., Peacock J., Victor C., Thakar R., Manyonda I. Women’s sexual health after childbirth. BJOG. 2000; 107(2): 186-95.
  28. Wilson P.D., Herbison R.M., Herbison G.P. Obstetric practice and the prevalence of urinary incontinence three months after delivery. Br. J. Obstet. Gynaecol. 1996; 103: 154-61.
  29. Burgio K.L., Zyczynski H., Locher J.L., Richter H.E., Redden D.T., Wright K.C. Urinary incontinence in the 12-month postpartum period. Obstet. Gynecol. 2003; 102(6): 1291-8.
  30. Brown S., Gartland D., Perlen S., McDonald E., MacArthur C. Consultation about urinary and faecal incontinence in the year after childbirth. BJOG. 2015; 122(7): 954-62.
  31. Altman D., Ekström A., Gustafsson C., Lopez A., Falconer C., Zetterström J. Risk of urinary incontinence after childbirth: a 10-year prospective cohort study. Obstet. Gynecol. 2006; 108(4): 873-8.
  32. Rortveit G., Hannestad Y.S., Daltveit A.K., Hunskaar S. Age- and type-dependent effects of parity on urinary incontinence: the Norwegian EPINCONT Study. Obstet. Gynecol. 2001; 98(6): 1004-10.
  33. Sze E.H., Hobbs G. Relation between vaginal birth and pelvic organ prolapse. Acta Obstet. Gynecol. Scand. 2009; 88(2): 200-3.
  34. Chiarelli P., Murphy B., Cockburn J. Fecal incontinence after high-risk delivery. Obstet. Gynecol. 2003; 102(6): 1299-305.
  35. Brown S.J., Gartland D., Donath S., MacArthur C. Fecal incontinence during the first 12 months postpartum: complex causal pathways and implications for clinical practice. Obstet. Gynecol. 2012; 119(2, Pt 1): 240-9.
  36. Eason E., Labrecque M., Marcoux S., Mondor M. Anal incontinence after childbirth. CMAJ. 2002; 166(3): 326-30.
  37. Macarthur C., Wilson D., Herbison P., Lancashire R.J., Hagen S., Toozs-Hobson P. et al. Faecal incontinence persisting after childbirth: a 12 year longitudinal study. BJOG. 2013; 120(2): 169-78.
  38. Dixon M., Booth N., Powell R. Sex and relationships following childbirth: a first report from general practice of 131 couples. Br. J. Gen. Pract. 2000; 50(452): 223-4.
  39. Kline C.R., Martin D.P., Deyo R.A. Health consequences of pregnancy and childbirth as perceived by women and clinicians. Obstet. Gynecol. 1998; 92(5): 842-8.
  40. Boroumandfar K., Rahmati M.G., Farajzadegan Z., Hoseini H. Reviewing sexual function after delivery and its association with some of the reproductive factors. Iran. J. Nurs. Midwifery Res. 2010; 15(4): 220-3.
  41. Khajehei M. Sexuality after childbirth: Gaps and needs. World J. Obstet. Gynecol. 2012; 1(2): 14-6.
  42. Xu X.Y., Wang H.Y., Su L. et al. Women’s sexual health after delivery and its related influential factors. J. Clin. Rehabil. Tissue Engineer. Res. 2007; 11: 1673.
  43. Sayasneh A., Pandeva I. Postpartum sexual dysfunction: A literature review of risk factors and role of mode of delivery. Br. J. Med. Pract. 2010; 3(2): 316.
  44. Thomas J., Paranjothy S. The National Sentinel Caesarean Section Audit Report. Royal College of Obstetricians and Gynaecologists’ Clinical Effectiveness Support Unit. London: RCOG Press; 2001.
  45. Buhling K.J., Schmidt S., Robinson J.N., Klapp C., Siebert G., Dudenhausen J.W. Rate of dyspareunia after delivery in primiparae according to mode of delivery. Eur. J. Obstet. Gynecol. Reprod. Biol. 2006; 124(1): 42-6.
  46. Marques C. Sexual health in postnatal women: A pilot study. Rev. Psiquiatr. Consiliar e de Ligaçào. 2002; 8: 39-45.
  47. Barrett G., Pendry E., Peacock J., Victor C., Thakar R., Manyonda I. Women’s sexuality after childbirth: A pilot study. Arch. Sex. Behav. 1999; 28(2): 179-91.
  48. Goetsch M.F. Postpartum dyspareunia: An unexplored problem. J. Reprod. Med. 1999; 44(11): 963-8.
  49. Dolan L.M., Hilton P. Obstetric risk factors and pelvic floor dysfunction 20 years after first delivery. Int. Urogynecol. J. 2010; 21(5): 535-44.
  50. Pearl G., Herbert J.H. Assessing pelvic floor during childbearing year. Nurs. Times. 2008; 104(18): 40-4.

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