DELIVERY AND PELVIC FLOOR DYSFUNCTION

Year 2021, Volume: 84 Issue: 2, 269 - 274, 25.04.2021

Nezihe Kızılkaya Beji , Elif Zahide Çelebi , Nilgün Avcı

https://doi.org/10.26650/IUITFD.2020.0032

Abstract

Urinary incontinence, anal incontinence, pelvic organ prolapse and sexual dysfunction are included in the definition of pelvic floor dysfunction. Pregnancy and childbirth play a major role in the emergence of pelvic floor dysfunction, which is seen in 41%-65% of women worldwide. Studies have suggested that childbirth causes damage to the pelvic floor due to damage to nerves, muscles and connective tissue. Particularly, obstetric factors related to labor, episiotomy, second stage of labor, interventions and lacerations have been suggested to be associated with pelvic floor dysfunction. It is seen that vaginal delivery increases pelvic floor dysfunction, and there are controversial results in studies on cesarean delivery. In this review, the effects of childbirth on the pelvic floor were examined and discussed in the light of current literature.

Keywords

Birth, Pelvic floor, Pelvic floor disorders

DOĞUM VE PELVİK TABAN DİSFONKSİYONU

Abstract

Üriner inkontinans, anal inkontinans, pelvik organ prolapsusu ve cinsel disfonksiyon pelvik taban disfonksiyonu kapsamında yer almaktadır. Dünya genelindeki kadınların %41-%65’inde görülmekte olan pelvik taban disfonksiyonunun ortaya çıkışında gebelik ve doğum büyük rol oynamaktadır. Yapılan çalışmalarda doğumun sinirlere, kaslara ve bağ dokusuna zarar vererek pelvik taban hasarına neden olduğu ileri sürülmektedir. Özellikle doğuma bağlı obstetrik faktörlerin, epizyotominin, doğumun ikinci evresinin, müdahaleli doğumların ve laserasyonların pelvik taban disfonksiyonları ile ilişkili olduğu düşünülmektedir. Vajinal doğumların pelvik taban disfonksiyonunu arttırdığı, sezaryen doğumlar ile ilgili çalışmalarda ise tartışmalı sonuçların olduğu görülmektedir. Bu derlemede, doğumun pelvik taban üzerindeki etkileri incelenerek, güncel literatür doğrultusunda tartışıldı.

Keywords

Doğum, pelvik taban, Pelvik taban kusurları

References

• 1. Kepenekci I, Keskinkilic B, Akinsu F, Cakir P, Elhan AH, Erkek AB, et al. Prevalence of pelvic floor disorders in the female population and the impact of age, mode of delivery and parity. Dis Colon Rectum 2011;54(1):85-94. [CrossRef]
• 2. Bozkurt M, Ender Yumru A, Şahin L. Pelvic floor dysfunction, and effects of pregnancy and mode of delivery on pelvic floor. Taiwan J Obstet Gynecol 2014;53(4):452-458. [CrossRef]
• 3. Lipschuetz M, Cohen SM, Libergall-Wischnitzer M, Zbedat K, Hochner-Celnikier D, Lavy Y, et al. Degree of bother from pelvic floor dysfunction in women one year after first delivery. Eur J Obstet Gynecol Reprod Biol 2015;191:90-4. [CrossRef]
• 4. Kahyaoğlu Süt H. Gebelik ve doğumun pelvik taban yetersizlikleri üzerine etkisi: önlenmesi ve korunmada hemşirenin rolü. GUSBD 2015;4(2):292-304.
• 5. Kızılkaya Beji N, Satır G, Çayır G. Effect of pregnancy process on urinary system and pelvic floor and nursing approach. Bezmialem Science 2020;8(2):206-11. [CrossRef]
• 6. Torrisi G, Gianfranco M, Bernasconi F, Perrone A, Trezza G, Guardabasso V, et al. A prospective study of pelvic floor dysfunciton related to delivery. Eur J Obstet Gynecol Reprod Biol 2012;160(1):110-5. [CrossRef]
• 7. Bilgiç Çelik D, Kızılkaya Beji N. Pelvik taban fonksiyon bozuklukları ve yaşam kalitesi. İ.Ü.F.N. Hem. Derg 2012;20(1):69-79.
• 8. Walker GJA, Gunasekera P. Pelvic organ prolapse and incontinence in developing counties: review of prevalence and risk factors. Int Urogynecol J 2011;22(2):127-35. [CrossRef]
• 9. Kömürcü Ö, Uğur G. Doğuma bağlı ortaya çıkan pelvik taban değişiklikleri. Kontinans ve Nöroüroloji Bülteni 2017;4:25-34.
• 10. Rortveit G, Hannestad YS, Daltveit AK, Hunskaar S. Age-and type-dependent effects of parity on urinary incontinence: the Norwegian EPINCONT study. Obstet Gynecol 2001;98(6):1004-10. [CrossRef]
• 11. Nygaard I, Barber MD, Burgio KL, Kenton K, Meikle S, Schaffer J, et al. Prevalence of symptomatic pelvic floor disorders in US women. JAMA 2008;300(11):1311-6. [CrossRef]
• 12. Friedman S, Blomquist JL, Nugent JM, McDermott KC, Munoz A, Handa VL. Pelvic muscle strength after childbirth. Obstet Gynecol 2012;120(5):1021-8. [CrossRef]
• 13. Hilde G, Staer-Jensen J, Siafarikas F, Engh ME, Braekken IH, Bo K. Impact of childbirth and mode of delivery on vaginal resting pressure and on pelvic foor muscle strength and endurance. Am J Obstet Gynecol MFM 2013;208(1):50.e1- 7. [CrossRef]
• 14. Akagündüz N. Primiparlarda doğum şeklinin mesane boynu ve pelvik tabana anatomik ve fonksiyonel etkisinin değerlendirilmesi (uzmanlık tezi). İstanbul: TC. Sağlık Bakanlığı Kanuni Sultan Süleyman E.A.H. Kadın Hastalıkları ve Doğum Kliniği. 2011.
• 15. Albrich SB, Laterza RM, Skala C, Salvatore S, Koelbl H, Naumann G. Impact of mode of delivery on levator morphology: a prospective observational study with threedimensional ultrasound early in the postpartum period. BJOG 2012;119(1):51-61. [CrossRef]
• 16. Dietz HP, Wilson PD. Childbirth and pelvic floor trauma. Best Pract Res Clin Obstet Gynaecol 2005;19(6):913-24. [CrossRef]
• 17. Memon H, Handa VL. Pelvic floor disorders following vaginal or cesarean delivery. Curr Opin Obstet Gynecol 2012;24(5):349-54. [CrossRef]
• 18. Martelucci J, Bergamini C, Palla G, Simoncini T, Naldini G, Valeri A. Functional anatomy of the pelvic floor. In: Martellucci J, editors. Electrical Stimulation for Pelvic Floor Disorders. New York Dordrecht London: Springer Cham Heidelberg; 2015.p.19-42. [CrossRef]
• 19. Memon HU, Handa VL. Vaginal childbirth and pelvic floor disorders. Women’s Health 2013;9(3):265-77. [CrossRef]
• 20. Falkert A, Endress E, Weigl M, Seelbach-Göbel B. Threedimensional ultrasound of the pelvic floor 2 days after first delivery: influence of constitutional and obstetric factors. Ultrasound Obstet Gynecol 2010;35(5):583-8. [CrossRef]
• 21. DeLancey JOL, Morgan DM, Fenner DE, Kearney R, Guire K, Miller JM, et al. Comparison of levator ani muscle defects and function in women with and without pelvic organ prolapse. Obstet Gynecol 2007;109(2):295-302. [CrossRef]
• 22. Dietz HP, Simpson JM. Levator trauma is associated with pelvic organ prolapse. BJOG 2008;115(8):979-984. [CrossRef]
• 23. DeLancey J, Kearney R, Chou Q, Speights S, Binno S. The appearance of levator ani muscle abnormalities in magnetic resonance images after vaginal delivery. Obstet Gynecol 2003;101(1):46-53. [CrossRef]
• 24. Kudish BI, Iglesia CB, Gutman RE, Sokol AI, Rodgers AK, Gass M, et al. Risk factors for prolapse development in white, black and hispanic women. Female Pelvic Med Reconstr Surg 2011;17(2):80-90. [CrossRef]
• 25. Vergeldt TFM, Weemhoff M, IntHout J, Kluivers KB. Risk factors for pelvic organ prolapse and its recurrence: a systematic review. Int Urogynecol J 2015;26:1559-73. [CrossRef]
• 26. Handa VL, Bloomquist JL, Knoepp LR, Hoskey KA, McDermott KC, Munoz A. Pelvic floor disorders 5-10 years after vaginal or cesarean childbirth. Obstet Gynecol 2011;118(4):777-84. [CrossRef]
• 27. Quiroz LH, Munoz A, Shippey SH, Gutman RE, Handa VL. Vaginal parity and pelvic organ prolapse. J Reprod Med 2010;55(3-4):93-98.
• 28. D‘Ancona C, Haylen B, Oelke M, Abranches-Monteiro L, Arnold E, Goldman H, et al. The International Continence Society (ICS) report on the terminology for adult male lower urinary tract and pelvic floor symptoms and dysfunction. Neurourol Urodyn 2019;38(2):433-77. [CrossRef]
• 29. Basak T, Kok G, Guvenc G. Prevalence, risk factors and quality of life in Turkish women with urinary ıncontinence: a synthesis of the literature. Int Nurs Rev 2013;60(4):448-60. [CrossRef]
• 30. Tahtinen RM, Carwright R, Tsui JF, Aaltonen RL, Aoki Y, Cardenas JL, et al. Long-term impact of mode of delivery on stress urinary incontinence and urgency urinary incontinence: a systematic review and meta-analysis. Eur Urol 2016;70(1):148-58. [CrossRef]
• 31. Kuismanen K, Nieminen K, Karjalainen K, Lehto K, Uotila J. Outcomes of primary anal sphincter repair after obstetric injury and evaluation of a novel three choice assessment. Tech Coloproctol 2018;22:209-214. [CrossRef]
• 32. Shin GH, Toto EL, Schey R. Pregnancy and postpartum bowel changes: constipation and fecal incontinence. Am J Gastroenterol 2015;110(4):521-9. [CrossRef]
• 33. Yalçın Ö. Ürojinekoloji ve pelvik rekonstrüktif cerrahi. 1. baskı, Ankara: Ortadoğu Reklam Tanıtım Yayıncılık; 2007.
• 34. Fitzpatrick M, O’Brien C, O’Connel PR, O’Herlihy C. Patterns of abnormal pudendal nerve function that are associated with postpartum fecal incontinence. Am J Obstet Gynecol 2003;189(3):730-5. [CrossRef]
• 35. Pretlove SJ, Thompson PJ, Toozs-Hobson PM, Radley S, Khan KS. Does the mode of delivery predispose women to anal incontinence in the first year postpartum? a comparative systematic review. BJOG 2008;115(4):421-34. [CrossRef]
• 36. Balachandran AA, Thakar R. Risk factors for and management of obstetric anal sphincter injury. Obstetrics, Gynaecology and Reproductive Medicine 2019;29(4):93-7. [CrossRef]
• 37. Shek KL, Dietz HP. Intrapartum risk factors for levator trauma. BJOG 2010;117(2):1485-92. [CrossRef]
• 38. Herbert J. Pregnancy and childbirth: the effects on pelvic foor muscles. Nurs Times 2009;105(7):38-41.
• 39. Brown SJ, Gartland D, Donath S, MacArthurc C. Effects of prolonged second stage, method of birth, timing of caesarean section and other obstetric risk factors on postnatal urinary incontinence: an Australian nulliparous cohort study. BJOG 2011;118(8):991-1000. [CrossRef]
• 40. Krofta L, Otcenasek M, Kasíkova E, Feyereisl J. Pubococcygeus–puborectalis trauma after forceps delivery: evaluation of the levator ani muscle with 3D/4D ultrasound. Int Urogynecol J 2009;20:1175-81. [CrossRef]
• 41. Memon HU, Blomquist JL, Dietz HP, Pierce CB, Weinstein MM, Handa VL. Comparison of levator ani muscle avulsion injury after forceps-assisted and vacuum-assisted vaginal childbirth. Obstet Gynecol 2015;125(5):1080-7. [CrossRef]
• 42. Coşkun AM. Kadın sağlığı ve hastalıkları hemşireliği el kitabı. İstanbul: Koç Üniversitesi Yayınları; 2012.
• 43. Carroli G, Mignini L. Episiotomy for vaginal birth. Cochrane Database Syst Rev 2014;1:1-51. [CrossRef]
• 44. Ejegard H, Ryding EL, Sjögren B. Sexuality after delivery with episiotomy: a long-term follow-up. Gynecol Obstet Invest 2008;66:1-7. [CrossRef]
• 45. Torkestani F, Zafarghandi N, Davati A, Hadavand SH, Garshasbi M. Case-controlled study of the relationship between delivery method and incidence of post-partum urinary incontinence. J Int Med Res 2009;37(1):214-9. [CrossRef]
• 46. Sartore A, De Seta F, Maso G, Pregazzi R, Grimaldi E, Guaschino S. The effects of mediolateral episiotomy on pelvic floor function after vaginal delivery. Obstet Gynecol 2004;103(4):669-73. [CrossRef]
• 47. Kokabi R, Yazdanpanah D. Effects of delivery mode and sociodemographic factors on postpartum stress urinary incontinency in primipara women: a prospective cohort study. J Chin Med Assoc 2017;80(8):498-502. [CrossRef]
• 48. Soligo M, Livio S, De Ponti E, Scebba I, Carpentieri F, Serati M, et al. Pelvic floor assessment after delivery: how should women be selected? Eur J Obstet Gynecol Reprod Biol 2016;206:153-7. [CrossRef]
• 49. Verghese TS, Champaneria R, Kapoor DS, Latthe PM. Obstetric anal sphincter injuries after episiotomy: systematic review and meta-analysis. Int Urogynecol J 2016;27:1459- 67. [CrossRef]
• 50. Lukacz ES, Lawrence JM, Contreras R, Nager CW, Luber KM. Parity, mode of delivery, and pelvic floor disorders. Obstet Gynecol 2006;107(6):1253-60. [CrossRef]
• 51. Zizzi PT, Trevisan KF, Leister N, Cruz CS, Riesco MLG. Women’s pelvic floor muscle strength and urinary and anal incontinence after childbirth: a cross-sectional study. Rev Esc Enferm USP 2017;51:e03214. [CrossRef]
• 52. Van Geelen H, Ostergard D, Sand P. A review of the impact of pregnancy and childbirth on pelvic floor function as assessed by objective measurement techniques. Int Urogynecol J 2018;29:327-38. [CrossRef]
• 53. Nelson RL, Furner SE, Westercamp M, Farguhar C. Cesarean delivery for the prevention of anal incontinence (Review). Cochrane Database Syst Rev 2010;2010(2):CD006756. [CrossRef]
• 54. Barbosa AMP, Marini G, Piculo F, Rudge CVC, Calderon IMP, Rudge MVC. Prevalence of urinary incontinence and pelvic floor muscle dysfunction in primiparae two years after cesarean section: cross-sectional study. Sao Paulo Med J 2013;131(2):95-9. [CrossRef]
• 55. Crane AK, Geller EJ, Bane H, Ju R, Myers E, Matthews CA. Evaluation of pelvic floor symptoms and sexual function in primiparous women who underwent operative vaginal delivery versus cesarean delivery for second-stage arrest. Female Pelvic Med Reconstr Surg 2013;19(1):13-16. [CrossRef]