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Paper 3: The Effect of Pregnancy and Mode of Delivery on Pelvic Floor Dysfunction: An Epidemiologic Study

Lukacz, E S.*; Lawrence, J M.; Nager, C W.*; Contreras, R; Luber, K M.

Journal of Pelvic Medicine and Surgery: 2005 - Volume 11 - Issue - p S2
doi: 10.1097/01.spv.0000176131.42086.86
Paper Presentations: AUGS Abstracts: 2005 26th Annual Scientific Meeting of The American Urogynecologic Society

*University of California, San Diego, CA; †Kaiser Permanente, Pasadena, CA; ‡Kaiser Permanente, San Diego, CA

Disclosure – Grant/Research Support: None; Consultant: Indevus: E. Lukacz, K. Luber; Watson: K. Luber; Lilly: K. Luber; Ortho McNeil: K. Luber; Pfizer: K. Luber; Speaker's Bureau: Pfizer Inc: E. Lukacz, C. Nager

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To assess the effects of pregnancy and mode of delivery on the development of pelvic floor disorders (PFD).

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A total of 12,200 women from the Southern California Kaiser Permanente Health System ages 25–84 years were surveyed using the validated Epidemiology of Prolapse and Incontinence Questionnaire (EPIQ).1 The presence of stress urinary incontinence (SUI), overactive bladder (OAB), anal incontinence (AI), including flatus, and pelvic organ prolapse (POP) was defined based on previously reported methods.1 Women were categorized into 3 risk exposure groups: nulliparous (NP), vaginally parous (VP), or Cesarean section only (CS). Mantel Haenszel Chi squared analyses were used to explore possible confounding variables and to determine crude odds ratios (OR) with 95% confidence intervals (CI). Multivariate logistic regression models, controlling for age and body mass index, were used for the adjusted OR.

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Mean age of the 4401 respondents was 57 +/- 15.9 years (range 25–84). The overall prevalence of PFD was; SUI=15% (n= 658), OAB=13% (n=572), POP=7% (n=281), mixed SUI & OAB=8% (n=358), AI=25% (n=1060), and any PFD=36% (n=1565). The distribution of women by risk exposure was NP=1079 (25%), VP=2910 (66%), and CS=412 (9%). The crude and adjusted OR and 95% CI for each PFD exposure are presented.

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In this population, the risk of PFD is independently associated with VP but not with pregnancy itself. CS has a protective effect on the development of PFD equal to NP when compared to VP. In counseling patients, the protective effect of cesarean section would have to be balanced against the known risks associated with surgical delivery.

Funding NICHD #R01 HD41113-01A1.



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1. Lukacz ES, et al. AUGS/SGS Joint Scientific Meeting 2004.
© 2005 Lippincott Williams & Wilkins, Inc.