Among the conditions that can compromise physically and emotionally women, during pregnancy and post-partum, are urinary incontinence (UI) and fecal incontinence (FI) [1] [2] [3].
In addition to pregnancy and vaginal birth, multiparity, prolonged or obstructive labor and history of stress urinary incontinence (SUI), during pregnancy, are recognized risk factors for a woman becoming incontinent after childbirth [2]. These factors are deeply researched and discussed in the international literature. One of these factors that can contribute to prolong labor and delivery is the use of analgesia, which has not yet been investigated so deeply.
Due to the impacts that labor analgesia may have on the female pelvic floor, and to the inconsistency on the subject in the literature, it is necessary to investigate its real impact on the most prevalent emergence of Pelvic Floor Dysfunctions (PFD), during the postpartum period, UI and FI. Labor analgesia has benefits and its use must be based on scientific evidence. Therefore, it is necessary to investigate the impact of its use not only at the time of birth, but also after it.
Thus, the objective was to verify the existence of an association between the use of analgesia during vaginal birth and the prevalence of complaints of urinary and/or fecal incontinence within three months after birth.

These are the preliminary results (3 months) of a prospective cohort, prepared according to the STROBE initiative guideline. The study was carried out in the shared accommodation of a public maternity hospital, in which primiparous women with full-term vaginal birth in cephalic presentation and over 18 years of age were included in the sample. Those who complained of antepartum urinary or fecal incontinence were excluded. The sample size calculation estimated that it was necessary to evaluate 50 exposed women (Group with analgesia, GCA) and 150 women not exposed to analgesia (Group without analgesia, GSA). Patient recruitment took place between March 2022 and February 2023, during which the following instruments were applied: Colorectal Anal Distress Inventory (CRADI-8) and Urinary Distress Inventory (UDI-6), which are subscales of the Pelvic Floor Distress Inventory (PFDI-20). Those women, who answered “yes” to questions numbered 2, 3 and 4 on the UDI-6 scale and 3, 4 and 5 on the CRADI-8 scale, were excluded from the study, were related to symptoms of UI and FI, respectively. The others continued the research and other data were collected, such as sociodemographic, gynecological, obstetric and neonatal data. In order to investigate the impact of UI and FI symptoms on quality of life (QoL), during the postpartum period, the Urinary Impact Questionnaire (UIQ-7) and the Colorectal Anal Impact Questionnaire (CRAIQ-7) were used, respectively, for being subscales of the Pelvic Floor Impact Questionnaire (PFIQ-7). In addition to these, data were collected from the patient's medical records and contact details for follow-up in three months after birth. Data were tabulated in Microsoft Excel and analyzed using SPSS v20.0. In order to respect the ethical precepts of research involving human beings, this project was approved by the Research Ethics Committee. All study participants were clarified the objectives and guaranteed anonymity, as well as ensuring the freedom to continue or not participate in the research, by signing the Free and Informed Consent Form in two copies, one remaining with the participant and the other , with the researcher.

159 eligible primiparous women were recruited: 63 (39.6%) reported complaints of UI and FI symptoms; 55 (34.5%) complained of SUI; four (2.5%), of UUI; three (1.8%), of MUI; and one (0.6%), of FI (loss of liquid feces). Therefore, such patients were excluded from the study. 96 eligible patients continued in the research, 73 (76%) in the GSA and 23 (24%) in the GCA.
Sociodemographic, gynecological and obstetric data were homogeneous in both groups.
The sample was mostly composed of young women (Md=23.47±4.95), with some fixed partnership (n=83/86.5%), literate (Md=11.55±1.72), who did not perform any paid activity (n =56/59.6%), with monthly family income varying between one and two minimum wages (Md=1792.14±925.53) and with a predominance of self-reported brown color/race (n=71/74%).
The GCA showed higher percentages of instrumental births (p<0.05), with variations in the position of the fetal head, in the detachment of the cephalic pole of the posterior and transverse types (p = 0.027) and prolonged duration of the second stage of labor (p = 0.001). Furthermore, when together, third and fourth degree lacerations occurred in a greater proportion in the GCA (p = 0.032).
During the three-month follow-up, 25 losses occurred for the following reasons: four (n=4/16%) did not wish to continue in the research; it was not possible to contact 21 (84%) by telephone. Thus, 71 participants remained in the research, 19 (n=19/26.8%) belonging to the GCA and 52 (n=52/73.2%), to the GSA.
During this period, it was observed that there was no difference in the intergroup assessment; the incidence of UI and AI were similar in both groups (p = 0.491 and p = 1.00), regarding the types; and SUI (n=9/12.7%) and loss of flatus (n=7/9.9%) were the most prevalent. Similarly, there was no difference between the UDI-6 and CRADI-8 subscale scores in the two groups. Furthermore, the impact of PAD symptoms on the quality of life of the follow-up participants was similar in both groups, with the vast majority responding that the symptoms had “minimum” impact on the ability to perform activities of daily living, in both subscales. UIQ-7 (n=9/36%) and CRAIQ-7 (n=11/52.4%).

Although the risk factors for pelvic floor dysfunction, in the postpartum period, were more identified in the GCA (p<0.05), it was not possible to perceive, in the short term, their effects on the presence of symptoms, as well as their impact on women. This can be explained by the fact that, within three months, women may experience temporary incontinence, what may have contributed to the increase in complaints among women in the GSA.

The increased presence of risk factors for PFD in women, who gave birth vaginally under analgesia, is undeniable. However, for a more accurate assessment of its effects on the female pelvic floor, a follow-up must be carried out for more than three months.

LÓPEZ-LÓPEZ, Ana Isabel et al. Pelvic floor: vaginal or caesarean delivery? A review of systematic reviews. International Urogynecology Journal, [s. l.], v. 32, n. 7, p. 1663–1673, 2021. Available at: https://doi.org/10.1007/s00192-020-04550-8
ABRAMS, P. et al. Incontinence. 6th ed. Paris: Health Publication; 2017.
SULTAN, Abdul H. et al. An International Urogynecological Association (IUGA)/International Continence Society (ICS) joint report on the terminology for female anorectal dysfunction. International Urogynecology Journal, [s. l.], v. 28, n. 1, p. 5–31, 2017. Available at: https://doi.org/10.1007/s00192-016-3140-3