Pelvic floor disorders (PFDs) include pelvic organ prolapse, urinary incontinence, and fecal incontinence. The burden of disease related to PFDs is substantial. These disorders affect one-third of adult women in the United States, with considerable impact on their quality of life [1-4]. As many as 12 percent of women undergo surgical treatment for PFDs and approximately 17 percent of these women require reoperation [5-7]. The scope of this clinical issue is even greater than the surgical treatment rate suggests, because many women are managed conservatively with pessaries, pads, or no therapy.
An area of intense investigation is the effect of pregnancy and childbirth on a woman's risk of developing PFDs and whether this risk can be reduced by modifications to obstetric care. Some women have requested cesarean delivery for this reason.
This review will focus on urinary incontinence and pelvic organ prolapse. The data are more comprehensive for incontinence, because prolapse is difficult to study . Many women with prolapse are asymptomatic and measurement of the true prolapse rate requires pelvic examination. Measurement of symptomatic prolapse is more clinically relevant, since asymptomatic prolapse does not require treatment. Even this presents a research challenge because prolapse symptoms may take longer to develop than symptoms of incontinence and the symptoms (eg, vaginal bulge or pressure, urinary retention, constipation) are less specific. Thus, even symptomatic prolapse is not well measured by symptom questionnaires . Further, use of surgery as a surrogate measure for the prevalence of prolapse does not detect the number of women with symptomatic prolapse who have not had surgical treatment [10-12].
The association of urinary incontinence and pelvic organ prolapse with pregnancy and childbirth and selected management issues are reviewed here. The role of pregnancy and childbirth in the development of fecal incontinence is discussed separately. (See "Fecal incontinence associated with pregnancy and childbirth".)
General principles of the diagnosis and treatment of urinary incontinence and pelvic organ prolapse are also discussed separately. (See "Approach to women with urinary incontinence" and "Treatment and prevention of urinary incontinence in women" and "An overview of the epidemiology, risk factors, clinical manifestations, and management of pelvic organ prolapse in women" and "Pelvic organ prolapse in women: Diagnostic evaluation".)