Study design, materials and methods
This is a descriptive cross-sectional study. Norwegian speaking postpartum women who gave birth between 6 weeks and 12 months prior to inclusion were eligible. They were recruited from May to October 2023, primarily through social media, and were invited to complete an anonymously and web-based questionnaire. This included questions regarding demographic variables, pregnancies, deliveries and current postpartum symptoms of pelvic floor disorders. Women were asked if they had symptoms (yes/no) of eleven specified pelvic floor disorders (urinary incontinence, flatal incontinence, fecal incontinence, pelvic organ prolapse, increased urinary frequency, dysuria, urgency or fecal urgency, obstipation, anorectal pain symptoms, pelvic pain and dyspareunia). If yes, they further reported severity (NRS 0-10) of each symptom. Descriptive statistics were used to assess prevalence and severity of symptoms. Kruskal-Wallis Test for between-group analysis of variance were used to assess difference according to time since delivery (6-12 weeks, 13-26 weeks and 27-52 weeks) and according to coexistence of symptoms (1-2, 3-4 and 5-9 pelvic floor symptoms). Multinominal logistic regression analysis was used to assess the association between number of pelvic floor disorders and selected background and pregnancy and delivery-related variables.
Results
In total, 1371 women completed the questionnaire and were eligible for analysis. Women from all over the country responded. Of these 41% were primiparous, 15% gave birth with cesarean delivery, 85% were currently breastfeeding, and 83% had attended the recommended 6-weeks postnatal check with general practitioner or midwife. Responders were categorized according to time since delivery; 6-12 weeks, 13-16 weeks and 27-52 weeks since delivery.
A total of 1291 women (94%) reported at least one PFD with urinary incontinence being the most frequently reported symptom (n=701; 51%), followed by obstipation (n=684; 50%), increased urinary frequency (n=600; 44%), anorectal pain symptoms (n=601; 44%), pelvic organ prolapse (n=593; 43%), dyspareunia (n=592; 43%), flatal incontinence (n=564; 41%), pelvic pain (n=566; 41%), urgency or fecal urgency (n=549, n=40%), dysuria (n=140; n=10%) and fecal incontinence (n=115; 8.4%). There were only minor insignificant differences in prevalence and severity of symptoms between time since delivery-groups. More than half (57%) reported 2-5 symptoms. Severity of pelvic floor disorders increased with increasing number om pelvic floor disorders reported. Experiencing other musculoskeletal symptoms or postnatal mental health disorders were strongly associated with having three or more PFDs. In general, women with highest symptom burden had lowest satisfaction of postnatal care.
Interpretation of results
Pregnancy and delivery is demanding for the pelvic floor. This study found that a high number of postnatal women reported pelvic floor disorders, also up to one year postpartum. Most women have coexisting pelvic floor disorders and experiencing more symptoms increases the severity. This study strongly emphasize the importance of a holistic postnatal care, including the substantial physical and mental transformations associated with giving birth.