Pregnancy, and in particular vaginal delivery, are main risk factors for bothersome pelvic floor disorders in younger and older women (1,2). The aims of the Early Intervention of Pelvic Floor Disorder After Delivery trial (E-PAD) were to investigate the prevalence of pelvic floor dysfunctions postpartum through a first prospective study design in Germany. We analyzed bladder dysfunction and pelvic organ prolapse symptoms until 12 months postpartum identify significant risk factors for the development of pelvic floor disorders after delivery and to improve health care system for those patients in Germany.

This is a first prospective cohort study (n=409) of primi- and multiparous women using standardized questionnaire to assess pelvic floor dysfunctions from pre-pregnancy state to three timepoints after delivery until 12 months postpartum (three, six, and twelve months postpartum). Women who delivered at the Cologne University Hospital from 2021 to 2022 were recruited for the trial. Symptoms of pelvic floor disorders were assessed by using the validated German Pelvic Floor Questionnaire: prevalence and intensity of bladder, bowel, prolapse and sexual symptoms, along with the resulting subjective impact on quality of daily life. Data were analyzed using IBM Statistical Package for Social Sciences (SPSS) Version 29 (NewYork, NY, USA). We conducted a descriptive analysis, as well as an examination of relevant factors influencing pelvic floor disorders.

261 women answered the questionnaire 3 months postpartum, after 12 months we were able to interview 136 patients. Out of the bladder dysfunctions considered, stress urinary incontinence was the most prevalent and increased from prepartum to postpartum (26% prepartum, 31% 6 months postpartum, 38.2% 12 months postpartum). Significant risk factors for bladder dysfunctions were urinary incontinence during pregnancy (p <0.001), multiparity with previous vaginal deliveries (p 0.001), vaginal delivery of the index  pregnancy (p 0.001), associated birth injuries (perineal tears, vaginal tears; p 0.004), nicotine abuse (only 3 months postpartum; p 0.002), blood sugar issues (p 0.017) and obesity (p 0.018), as well as fetal characteristics. 
Furthermore, pelvic organ prolapse symptoms were analyzed. Most relevant and influencing factor for quality of life was vaginal delivery and multiparity with previous vaginal deliveries. Prevalence of symptoms increased from timepoint before pregnancy (8.8%) until 6 months postpartum ( 21.3%) and decreased until 12 months postpartum (14.7%). 85% of patients with symptoms 12 months postpartum answered that the prolapse symptoms had an impact on their quality of life.

Pelvic floor dysfunction symptoms increased comparing the timepoint before pregnancy and 12 months postpartum. While stress urinary incontinence symptoms was described by most of the patients 12 months postpartum, prolapse symptoms were most prevalent 6 months postpartum. Pelvic floor disorders after deliveries are prevalent and relevant in our German collective. Significant risk factors are concordant with previous international studies (2). Nevertheless, these results are the first of this kind in Germany.

Pelvic floor dysfunctions after delivery have an impact on persisting symptoms and quality of life of women. Routine diagnostic concerning pelvic floor dysfunctions should be part of peripartal maternal health care. Guidelines for patients with early symptoms and relevant risk factors should be initialized.

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Gyhagen M, Bullarbo M, Nielsen TF, Milsom I. (2013). The prevalence of urinary incontinence 20 years after childbirth: A national cohort study in singleton primiparae after vaginal or caesarean delivery. BJOG An Int J Obstet Gynaecol. 120(2):144–51.

Continence 12S (2024) 101389
DOI: 10.1016/j.cont.2024.101389