Women whose babies are delivered via Cesarean section are less likely to suffer from long-term pelvic floor disorders such as stress urinary incontinence, according to NIH-funded research.
The study built on earlier research linking pelvic floor disorders to childbirth by tracking more than 1,500 women for up to nine years after the birth of their children.
Linking spontaneous vaginal delivery to certain pelvic floor disorders could lead to better, more proactive treatment of these common conditions.
Pelvic floor disorders affect around one-in-four women in the U.S. but little is known about how these conditions progress over time. To address that knowledge gap, NIH-funded research led by Victoria Handa of Johns Hopkins Bayview Medical Center enrolled women five to 10 years after their first delivery and assessed whether they suffered from an array of pelvic floor disorders.
Among the 778 women who had given birth via C-section, 13% had stress urinary incontinence. The rate of the condition among the 565 women who delivered babies via spontaneous vaginal birth was 26%, suggesting that procedure has long-term effects on muscles that control the bladder.
The researchers identified differences in the rates of other pelvic floor disorders, too. While 10% of women who had C-sections suffered from overactive bladder, the figure rose to 16% in the vaginal birth cohort. Similarly, the rates of pelvic organ prolapse in the C-section and vaginal birth arms were 5% and 17%, respectively.
In a third cohort of women who had operative vaginal deliveries — a procedure involving forceps or other devices to extract the fetus — 30% of subjects suffered from pelvic organ prolapse. The operative procedure was associated with a 31% rate or anal incontinence, compared to 19% and 23% in the C-section and spontaneous birth cohorts.
The findings shed some light on the biological mechanisms that may underpin pelvic floor disorders. Earlier epidemiological studies correlated pelvic floor disorders to childbirth and suggested women who have C-sections are less prone to the conditions than those who have vaginal births. However, the literature on maternal and obstetrical characteristics and their association with different pelvic floor disorders was lacking.
With the NIH-funded study providing evidence that certain groups of women are at particular risk of developing pelvic floor conditions, physicians may be able to make more targeted interventions. Pelvic floor disorders are treated using muscle-strengthening exercises, medication and surgery.