Highlights
- •Compared to nulliparas, women delivered exclusively by Caesarean Section (CS) show increased pelvic organ descent on Valsalva.
- •Greater tissue displacement on pelvic floor muscle contraction is observed in women who delivered exclusively by CS, compared to nulliparas.
- •Increased tissue elasticity/ compliance or reduced stiffness may be a result of permanent hormonal and/or mechanical effect of pregnancy.
Abstract
Objective
Vaginal childbirth is an established main aetiological factor in the pathogenesis
of female pelvic floor dysfunction. However, pregnancy itself is also likely to have
an effect. This study investigated the effect of pregnancy on pelvic floor functional
anatomy.
Study design
This was a retrospective observational study involving vaginally nulliparous women
who presented to a tertiary urogynaecology unit with symptoms and signs of pelvic
floor dysfunction between 2006 and 2014. Nulliparous women were compared with those
who delivered exclusively by Caesarean Section (CS). All had undergone a standardised
clinical interview, ICS POP-Q assessment and 3D/4D translabial pelvic floor ultrasound.
Main outcome measures included sonographically determined pelvic organ position and
hiatal dimensions on Valsalva and pelvic floor muscle contraction (PFMC).
Results
Of 2930 women seen during the study period, 242 had never given birth vaginally. One
hundred and twenty-nine (53 %) were nulliparous, and 113 (47 %) were delivered by
CS only. The CS group demonstrated significantly higher pelvic organ mobility in the
anterior compartment (all P < 0.05) and a larger hiatal area on Valsalva (P = 0.004).
All sonographic measures of pelvic floor muscle function demonstrated greater tissue
displacement on PFMC in the CS group (all P < 0.05).
Conclusions
Compared to nulliparas, women who delivered exclusively by CS showed increased pelvic
organ descent on Valsalva and tissue displacement on PFMC, implying increased tissue
elasticity/ compliance or reduced stiffness, consistent with a small permanent hormonal
and/or mechanical effect of pregnancy.
Abbreviations:
CS (Caesarean Section), LAM (Levator ani muscle), PFMC (pelvic floor muscle contraction), POP (pelvic organ prolapse), SP (symphysis pubis)Keywords
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Article info
Publication history
Published online: January 27, 2021
Accepted:
January 23,
2021
Received in revised form:
January 15,
2021
Received:
August 25,
2020
Identification
Copyright
© 2021 Elsevier B.V. All rights reserved.
