Pelvic floor dysfunction including urinary incontinence, anal incontinence, urogenital prolapse and sexual dysfunction are common and distressing sequela to pregnancy and childbirth. Large epidemiological studies have demonstrated that urinary incontinence affects 1 in 3 women following vaginal delivery and around 1 in 6 following caesarean section. When compared to caesarean section, vaginal delivery and instrumental delivery are associated with a 9 fold and 20 fold increased risk of urogenital prolapse respectively. In addition, the long-term risks of anal incontinence have been shown to be approximately 6%.
Whilst caesarean section is generally thought to be protective the epidemiological evidence is mixed and the risks associated with delivery by caesarean section need to be carefully balanced with the risks of pelvic floor injury. There is also increasing evidence to suggest that pregnancy also has an important role in pelvic floor dysfunction and therefore operative delivery is not fully protective.
This lecture will explore the latest epidemiological evidence supporting the role of both pregnancy and delivery in the aetiology of pelvic floor dysfunction as well as looking at the possibility of using predictive modelling to identify those women who are most at risk.