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Sigurdardottir T1,2, Steingrimsdottir T1,2, Geirsson RT1,2, Bø K3,4
1University of Iceland, Faculty of Medicine, School of Health Sciences, Reykjavik, Iceland, 2Landspitali University Hospital, Department of Obstetrics and Gynecology, Reykjavík, Iceland, 3Norwegian School of Sports Sciences, Department of Sports Medicine, Oslo, Norway, 4Akershus University Hospital, Department of Obstetrics and Gynecology, Lørenskog, Norway
Background: Studies on postpartum pelvic floor dysfunctions, such as urinary incontinence is well established but less knowledge is available on bowel symptoms and sexual conserns after chidbirth and how it affects women.
Purpose: To study prevalence of self-reported postpartum pelvic floor dysfunction and related bother in first time mothers giving singleton births.
Methods: Prospective observational study where women answered the Australian Pelvic Floor Questionnaire through email link six to ten weeks after first childbirth. The questions were in four domains; bladder-, bowel-, prolapse- and sexual. Each domain also enquired about how bothersome the symptoms were for each section. Information from the Icelandic Medical Birth Registry was linked to answers from questionnaire.
Results: Of the 858 primiparous women who initially agreed to participate, 721 returned their answers between April 2015 to March 2017 (84% respones rate). All had given birth at the Landspitali University Hospital in Reykjavik, Iceland. Mean maternal age at first childbirth was 27 years (SD 4.8, range 18-47). Vaginal births were 599 (83%), thereof 114 instrumental deliveries, 100 (14%) women had emergency cesarean sections and 22 (3%) went through elective cesarean section. Thirty six percent of the women reported stress urinary incontinence, 40% reported urgency and 29% urgency urinary incontinence. Only 27% considered this bothersome. In the bowel section 59% reported flatus incontinence, 4% had liquid fecal and 1% solid fecal incontinence. Bothersome bowel symptoms were reported in 55% of the women . In the prolapse domain 15% experienced vaginal tissue protrusion and 25% vaginal pressure/heaviness or a sagging sensation. Only 13% reported symptoms of pelvic organ prolapse to be bothersome. In the sexual domain, 44% of the women reported not being sexually active six to ten weeks postpartum, with16% not interested in sex, 1% due to vaginal dryness, 10.5% considered intercourse too painful, 2% reported embarassment due to bladder, bowel or prolapse symptoms and 60% of women not sexually active chose to cite other reasons in an open-ended question, such as short time since childbirth, partner not interested, not ready, too tired, pain related to episiotomy or cesarean section. Sixty four percent of sexually active women reported some degree of pain during intercourse. In all 47% of the participants considered sexual concerns to be bothersome.
Conclusion(s): Symptoms of pelvic floor dysfunction in the early postpartum period are common with bowel and sexual concerns being the most bothersome.
Implications: Pregnancy and childbirth may cause physical changes that affect women and their quality of life. Health care providers including physiotherapists have a responsibility to educate women regarding all aspects of their health during pregnancy and in the puerperium. Bowel symptoms and sexual matters should not be overlooked.
Keywords: Postpartum sexual dysfunction, Bothersome pelvic floor dysfunction, Bowel symptoms
Funding acknowledgements: University of Iceland Research Fund,
Public Health Fund, Iceland,
Icelandic Physiotherapy Association Science Fund,
Landspitali University Hospital Science Fund.
Purpose: To study prevalence of self-reported postpartum pelvic floor dysfunction and related bother in first time mothers giving singleton births.
Methods: Prospective observational study where women answered the Australian Pelvic Floor Questionnaire through email link six to ten weeks after first childbirth. The questions were in four domains; bladder-, bowel-, prolapse- and sexual. Each domain also enquired about how bothersome the symptoms were for each section. Information from the Icelandic Medical Birth Registry was linked to answers from questionnaire.
Results: Of the 858 primiparous women who initially agreed to participate, 721 returned their answers between April 2015 to March 2017 (84% respones rate). All had given birth at the Landspitali University Hospital in Reykjavik, Iceland. Mean maternal age at first childbirth was 27 years (SD 4.8, range 18-47). Vaginal births were 599 (83%), thereof 114 instrumental deliveries, 100 (14%) women had emergency cesarean sections and 22 (3%) went through elective cesarean section. Thirty six percent of the women reported stress urinary incontinence, 40% reported urgency and 29% urgency urinary incontinence. Only 27% considered this bothersome. In the bowel section 59% reported flatus incontinence, 4% had liquid fecal and 1% solid fecal incontinence. Bothersome bowel symptoms were reported in 55% of the women . In the prolapse domain 15% experienced vaginal tissue protrusion and 25% vaginal pressure/heaviness or a sagging sensation. Only 13% reported symptoms of pelvic organ prolapse to be bothersome. In the sexual domain, 44% of the women reported not being sexually active six to ten weeks postpartum, with16% not interested in sex, 1% due to vaginal dryness, 10.5% considered intercourse too painful, 2% reported embarassment due to bladder, bowel or prolapse symptoms and 60% of women not sexually active chose to cite other reasons in an open-ended question, such as short time since childbirth, partner not interested, not ready, too tired, pain related to episiotomy or cesarean section. Sixty four percent of sexually active women reported some degree of pain during intercourse. In all 47% of the participants considered sexual concerns to be bothersome.
Conclusion(s): Symptoms of pelvic floor dysfunction in the early postpartum period are common with bowel and sexual concerns being the most bothersome.
Implications: Pregnancy and childbirth may cause physical changes that affect women and their quality of life. Health care providers including physiotherapists have a responsibility to educate women regarding all aspects of their health during pregnancy and in the puerperium. Bowel symptoms and sexual matters should not be overlooked.
Keywords: Postpartum sexual dysfunction, Bothersome pelvic floor dysfunction, Bowel symptoms
Funding acknowledgements: University of Iceland Research Fund,
Public Health Fund, Iceland,
Icelandic Physiotherapy Association Science Fund,
Landspitali University Hospital Science Fund.
Topic: Women's & men's pelvic health
Ethics approval required: Yes
Institution: Landspitali University Hospital, Reykjavik, Iceland.
Ethics committee: Icelandic National Bioethics Committee
Ethics number: 13-189
All authors, affiliations and abstracts have been published as submitted.
