Pelvic floor function during and after first pregnancy

Abstract

This study evaluated the effects the first pregnancy and childbirth on the pelvic floor. Pregnancy and vaginal delivery can negatively affect pelvic floor function. Micturition symptoms, defecation symptoms and sexual dysfunction are all signs of an impaired pelvic floor function. These symptoms are known to have a high prevalence during and after pregnancy. In a non-pregnant population these symptoms are often experienced as bothersome. Efforts should be made to identify risk factors for different pelvic floor symptoms and the consequences of these symptoms on the quality of life. The studies in this thesis were all performed on a large cohort of healthy nulliparous women with a singleton pregnancy. The aims of this thesis was: 1. to report on the prevalence of pelvic floor symptoms during and after first pregnancy 2. to investigate the effect of pregnancy and childbirth on pelvic floor symptoms 3. to study the consequence of pelvic floor symptoms on the quality of life during and after first pregnancy 4. to determine what factors can be of influence on the sexual function after first childbirth Urogenital symptoms occurred in almost all women during pregnancy. Whereas the prevalence of frequency and urgency symptoms was high from 12 weeks gestation onwards and remained stable during pregnancy, the prevalence of urinary incontinence symptoms increased with gestational age. Despite the high prevalence of symptoms the majority of women reported not to be bothered by it. The prevalence of bothersome symptoms is the highest at 36 weeks gestation, and they are probably part of a normal pregnancy. After childbirth SUI was significantly more prevalent in women who delivered vaginally. Besides the mode of delivery, we did found another risk factor for SUI postpartum. The presence of SUI in early pregnancy gave an increased risk for experiencing SUI one year postpartum both in women after a vaginal delivery and in women who underwent a caesarean delivery. Overactive bladder symptoms are common during pregnancy. Dry OAB had no negative effect on the quality of life whereas wet OAB negatively affected the quality of life both during and after pregnancy, mainly on the mobility and embarrassment domain. The urge urinary incontinence symptom in wet OAB seems to have a profound negative effect on the quality of life. Apparently, in young mothers with wet OAB limitations in mobility are especially stressful and these symptoms can be embarrassing. Defecation symptoms that are already present in early pregnancy are highly predictive for reporting symptoms at 12 months postpartum. The only exception is fecal incontinence, which is mainly related to anal sphincter lesion. An important prognostic factor for a dissatisfied sexual relationship one year postpartum is not being sexual active in early pregnancy. Satisfaction with the sexual relationship seemed not to depend on pregnancy and parturition associated factors.