Abstract
Purpose
Pregnancy and childbirth are the most common risk factors leading to pelvic floor disorders including pelvic organ prolapse (POP). POP is caused by the descent of pelvic organs due to increased intra-abdominal pressure and load on the birth canal. POP presents various symptoms. Therefore, it is difficult to diagnose through interview. If the relationship between the prevalence of specific POP symptoms and risk factors including habits that increase intra-abdominal pressure can be determined, the incidence of POP in women after childbirth may be prevented. This study aimed to clarify the prevalence of POP symptoms for each postpartum period during 5 years after childbirth and to determine the risk factors of these symptoms.
Methods
This cross-sectional study included participants who underwent vaginal delivery at the University of Tokyo Hospital in Japan. We used the Japanese version of the Pelvic Floor Distress Inventory – short form 20, which includes the Prolapse Distress Inventory, to assess POP. The rate of women experiencing POP symptoms was calculated every 6 months after childbirth. Participants’ characteristics including lifestyle, delivery records, and other variables were obtained from the questionnaire or medical records. The participants were divided into two groups: group with and without symptoms. Logistic regression analysis was performed using variables that showed a significant difference between the two groups. The research procedures were approved by the Research Ethics Committee of the University of Tokyo.
Results
Questionnaires were distributed to 3776 women, and 1056 (28.0%) were returned. The number of valid responses was 681. Approximately 36% and 43% of women had POP symptoms during 5 years and 6 months after childbirth, respectively. There was no significant difference in the rate of POP symptoms in each postpartum period. Women with POP symptoms were significantly more likely to experience incontinence, hard stools before and after pregnancy, and straining habits during defecation before pregnancy than those without.
Conclusion
Lifestyle habits before pregnancy and defecation conditions during the postpartum period were related to POP symptoms after childbirth. The study suggested the need for care to prevent the onset and worsening of POP symptoms, including advice on daily living behaviors such as early postpartum monitoring for the presence or absence of symptoms, voiding care, and avoiding increased intra-abdominal pressure that could stress the pelvic floor.
