(646) 355-8777

Herman & Wallace Blog

Role of Prepregnancy Pelvic Floor Dysfunction and in Postpartum Issues

Blog by Holly Tanner

An important survey completed in Australia asked if prenatal pelvic floor function and dysfunction relates to postnatal pelvic floor dysfunction (PFD). Interestingly, the authors propose that "…damage to the pelvic floor is probably made before first pregnancy due to congenital intrinsic weakness of pelvic floor structures." Many of the patients involved in the study had dysfunction in more than one domain of pelvic health, with the authors recommending a comprehensive approach to the evaluation of pelvic floor dysfunction.

As part of the large study called the Screening for Pregnancy Endpoints study, or SCOPE, a prospective cohort study called Prevalence and Predictors of Pelvic floor dysfunction in Prenips, or 4P, was also completed. The 4P research (n = 858) contained 2 different studies including a questionnaire-based survey and a detailed clinical assessment. The survey utilized the Australian pelvic floor questionnaire which was administered at 15 weeks gestation and at 1 year postpartum. The Australian questionnaire scores items on domains of urinary dysfunction, fecal dysfunction, pelvic organ prolapse, and sexual dysfunction. When the participants answered the questionnaire the first time, all answers were directed to be answered for symptoms they experienced prior to being pregnant.

The results indicated that at 1 year postpartum, 90% of the women in this study reported pelvic floor dysfunction. Regarding the domains of bladder, bowel, prolapse and sexual symptoms, 71% of the participants reported symptoms from more than 1 of these domains, 31% from 2 domains, 24% from 3 sections of the survey, and 8% from all four sections. Other interesting statistics are as follows:

-of the 73% of participants reporting urinary dysfunction, 67% had these symptoms persisting from the prenatal period

-pre-pregnancy urinary dysfunction symptoms persisted in postpartum in 61% of participants

-for new onset bowel symptoms in the postpartum period, fecal incontinence or obstructed defecation were more likely to occur, while incontinence of gas (flatus) was more likely to occur as persisting symptoms

-prolapse symptoms were reported by 14% of women, with 20% of participants describing symptoms as severe and most common symptoms being vaginal pressure, heaviness, or a sensation of a lump being present

-symptoms of sexual dysfunction such as dyspareunia persisted postnatally in 59% and worsened in 12% compared to prenatal period

In women who delivered vaginally, the risk of pelvic floor dysfunction was increased, yet the authors caution against stating that c-sections are protective against pelvic floor dysfunction. They do theorize based on survey results that c-section may reduce the persisting PFD. Ideally, research such as this can help can assist in creating predictions for postpartum pelvic floor symptoms based on prenatal symptom history. Certainly it may be helpful to be aware of a patient's prenatal symptoms and include any new onset or persisting postpartum symptoms in her rehabilitation. If you are interested in learning more about pelvic floor dysfunction in pregnancy or postpartum, these topics are included in our Pregnancy and Postpartum course series that you can find on our main course page. The Care of the Pregnant Patient is happening in mid-March in Seattle, with a few seats still available! Care of the Postpartum Patient happens next in May in Boston. If you are interested in hosting Peripartum Special Topics, send us an email or give us a call!

Resurfacing after Hip Labral Surgery
Jaime Sepulveda - Featured Certified Pelvic Rehabi...

Upcoming Continuing Education Courses

Jun 28, 2019 - Jun 30, 2019
Location: Mount Carmel Health

Jun 28, 2019 - Jun 30, 2019
Location: Mizzou Physical Therapy-Rangeline

Jun 29, 2019 - Jun 30, 2019
Location: Advantage Physical Therapy

Jun 29, 2019 - Jun 30, 2019
Location: Vertex Physical Therapy Specialists

Jul 12, 2019 - Jul 14, 2019
Location: The Virginian

Jul 13, 2019 - Jul 14, 2019
Location: Johns Hopkins Medicine

Jul 19, 2019 - Jul 21, 2019
Location: Loyola University Stritch School of Medicine

Jul 20, 2019 - Jul 21, 2019
Location: East Sacramento Physical Therapy

Jul 21, 2019 - Jul 23, 2019
Location: Rutgers University - Doctoral Programs in Physical Therapy

Jul 26, 2019 - Jul 28, 2019
Location: Bon Secours St. Francis Health System

Jul 27, 2019 - Jul 28, 2019
Location: Providence Healthcare

Aug 9, 2019 - Aug 11, 2019
Location: Robert Wood Johnson Medical Associates

Aug 9, 2019 - Aug 11, 2019
Location: Metro West Medical Center

Aug 9, 2019 - Aug 11, 2019
Location: Providence Holy Cross Medical Center of Mission Hills

Aug 16, 2019 - Aug 18, 2019
Location: WakeMed Health & Hospitals

Aug 16, 2019 - Aug 18, 2019
Location: BodyWorx Vitality

Aug 16, 2019 - Aug 18, 2019
Location: Piedmont Healthcare

Aug 16, 2019 - Aug 18, 2019
Location: Dignity Health Care of Stockton, CA

Aug 17, 2019 - Aug 18, 2019
Location: Ochsner Health System

Aug 23, 2019 - Aug 25, 2019
Location: PeaceHealth Southwest Medical Center

Aug 23, 2019 - Aug 25, 2019
Location: Inova Physical Therapy Center

Aug 23, 2019 - Aug 25, 2019
Location: The Sage Colleges

Aug 23, 2019 - Aug 25, 2019
Location: Loyola University Stritch School of Medicine

Aug 23, 2019 - Aug 24, 2019
Location: Mizzou University of Missouri

Aug 23, 2019 - Aug 25, 2019
Location: Mizzou University of Missouri

Sep 6, 2019 - Sep 8, 2019
Location: Advanced Physical Therapy of Little Rock

Sep 6, 2019 - Sep 8, 2019
Location: Bon Secours St. Francis Health System

Sep 7, 2019 - Sep 8, 2019
Location: Franklin Pierce University

Sep 7, 2019 - Sep 8, 2019
Location: Spooner Physical Therapy

Sep 13, 2019 - Sep 15, 2019
Location: Huntington Hospital