Pelvic floor disorders up with vaginal delivery: risk increased twofold in large study.(News)

MONTREAL -- Vaginal delivery is associated with a nearly twofold increased odds of pelvic floor disorders, compared with cesarean delivery and nulliparity, according to results of a large epidemiologic study.

"This study finally gives us some numbers to hang our hat on, with respect to pelvic floor dysfunction, when we are counseling patients about vaginal versus cesarean delivery," the study's principal investigator, Emily Lukacz, M.D., commented during the annual meeting of the International Continence Society.

"A twofold increased odds of a pelvic floor disorder sounds like a lot, but surgical delivery is not without its own risks," she said in an interview, adding that the protective effects of cesarean section must be balanced against the known risks of surgical delivery.

She cautioned that although the study shows an association between vaginal delivery and pelvic floor disorders, it does not prove causality.

"We are really still in the infancy of understanding the role of mode of delivery on the development of pelvic floor disorders until we can have a randomized, controlled trial of vaginal versus cesarean delivery, which will likely never happen," said Dr. Lukacz of the University of California, San Diego Medical Center.

Still, she said that she suspects it's hard not to link the trauma caused by vaginal delivery to many of these disorders. "There are not many things that can cause that kind of damage," she said. "However, not all women who deliver vaginally develop pelvic floor disorders. Therefore, future research should be aimed at identifying women at risk for developing pelvic floor disorders due to vaginal delivery."

The Kaiser Permanente continence-associated risk epidemiology study was a population-based study of 12,200 randomly selected women between the ages of 25 and 84. Using the validated Epidemiology of Prolapse and Incontinence Questionnaire, researchers assessed participants for symptoms and signs of stress urinary incontinence, overactive bladder (with or without leakage), and anal incontinence (leakage of solid, liquid, or gas), as well as pelvic organ prolapse.