There is no end to the debate on postpartum pelvic floor changes. A vaginal birth and the development of subsequent pelvic floor dysfunction is a hot topic of discussion among expectant moms. Do you believe that pelvic floor disorders are associated with vaginal births?
Many experts and studies on the subject point out that stress urinary incontinence and pelvic organ prolapse are strongly associated with vaginal childbirth. At the same time, others argue that childbirth cannot be the sole reason for such disorders. Well, let’s get the facts right.
Understanding Pelvic Floor
A pelvic floor is a group of muscles, nerves, and other tissues in the pelvic area. Pelvic floor muscles extend from the pubic bone at the front to the base of your spine at the back.
Imagine a sling or hammock carrying you. The pelvic floor works in the same way. It supports your organs like a sling would. It holds your bladder, uterus, bowel, and other pelvic organs in place so that they can work properly.
Thus, a weak pelvic floor is not good for you. Your bladder will not be in your control, which makes it difficult for you to squeeze the muscles. The chances of urine leakage will be, thus, very high. Moreover, the strength of the pelvic floor will have an impact on your vaginal muscles too. With a weak pelvic floor, you will have a less satisfying sexual experience.
During pregnancy, the pelvic floor has a greater role to play by supporting your uterus. The expanding uterus puts extra pressure on the pelvic floor and it stretches accordingly.
Vaginal Birth And Pelvic Floor Dysfunction
It is a common belief among women that vaginal birth is associated with pelvic floor damage. Pelvic floor dysfunction is reported in 58% of women who had spontaneous vaginal delivery, compared with 43% of those who underwent a cesarean section.
During a vaginal delivery, the baby’s passage through vagina puts growing pressure on the tissues. And it causes the pelvic floor to stretch with possible damage to the muscle or connective tissue.
Vaginal delivery is associated with a high rate of postpartum urinary incontinence. Even harder labors and big babies could lead to a weak pelvic floor.
Another aftereffect is pelvic organ prolapse. It occurs when a pelvic organ shifts from its normal place and ends up pushing against the walls of your vagina. The way you carry the baby’s weight, different stages of labor, and the final push to deliver the baby – all these factors weaken your pelvic floor, creating conditions for pelvic organ prolapse.
‘Operative vaginal delivery’ or the ‘instrumental vaginal delivery’ is another risk factor for pelvic floor disorder. Forceps and vacuums are often used when there is a prolonged second stage of labor. Hence, it is an indication of difficult labor. The odds of surgical intervention for stress urinary incontinence is 20-times higher for those who have experienced forceps-assisted delivery compared with women who gave birth via cesarean. Curbing the overuse of these practices will result in better pelvic-floor functioning in women.
According to a research published in a thesis from Sahlgrenska Academy, University of Gothenburg, Sweden, women are more likely to experience urinary incontinence, prolapse, and fecal incontinence 20 years after one vaginal delivery rather than one cesarean section. As part of the study, researchers sent a questionnaire to different women.
It is found that vaginal delivery was associated with a 67% increased odds of urine incontinence (UI). The prevalence of fecal incontinence was higher after vaginal delivery when compared to a c-section. Also, it is seen that perineal tear of the 2nd degree almost doubled the risk of fecal incontinence. The research also added that the single most important risk factor for symptomatic prolapse was delivery via the vaginal route.
However, irrespective of vaginal birth, pregnancy itself could contribute to pelvic floor disorders. So, experts say that there is no point in going for an elective c-section fearing pelvic floor disorders. The decision should be made on the health status of the baby and mother.
And pregnancy is not the only factor. Older age, obesity, smoking, accidents, and chronic disease could damage your pelvic floor.
Pelvic floor exercises can help you regain the strength of pelvic floor muscles. Even daily pelvic floor exercises during pregnancy will keep the muscles strong.