The Extent of Incurred Pelvic Floor Damage during a Vaginal Birth and Pelvic Floor Complaints

Background: Pelvic floor damage through vaginal birth exists in approximately half the women postpartum.
Through this damage, complaints like urinary incontinence, faecal incontinence, flatus, pelvic organ prolapse,
dyspareunia and pain in the pelvic floor area whilst sitting may occur. However, these complaints are also seen in
women who do not encounter pelvic floor damage after childbirth, and in women who never experienced childbirth.
Aim: The purpose of this study was to examine how far the extent of pelvic floor damage during a vaginal birth is
responsible for the development of pelvic floor complaints. Findings could help improve information for pregnant
women, stimulate preventative measures before and at the time of birth and provide better-tailored care postpartum.
Methods: This study was set up in a cross sectional design in The Netherlands. 379 women filled out an online
questionnaire. 239 women between the ages of 18 and 45 met the inclusion criteria. 177 parous women who had a
vaginal birth in the past two years and 62 nulliparous women were divided in five groups: no childbirth (control
group), no reported damage, episiotomy, 1st and 2nd degree, and 3rd and 4th degree perineal laceration. Six pelvic
floor complaints were investigated: urinary incontinence, faecal incontinence, flatus, pelvic organ prolapse,
dyspareunia and pain in the pelvic floor area whilst sitting were subject of this study. It was expected that more
severe pelvic floor damage would result in more or more severe pelvic floor complaints. Hypotheses were tested
using multivariate analyses of variance, followed by contrast analysis.
Results: Only dyspareunia occurs significantly more often after vaginal birth with 3rd and 4th degree perineal
laceration in comparison with the control group. No significant differences between the five groups were found on
urinary incontinence, faecal incontinence, pelvic organ prolapse and pain in the pelvic floor area whilst sitting.
Conclusion: Dyspareunia is most likely to occur after vaginal birth with 3rd and 4th degree perineal lacerations