Ante- and postpartum alterations to the female
pelvic floor and its clinical relevance
Pelvic floor disorders have become a major field of research.
Devastating conditions, such as urinary or fecal incontinence
and pelvic organ prolapse, have a huge impact on
quality of life; initiating the idea to focus on options for
»pelvic floor protection« in obstetrics. Anatomic landmarks
and relevant structures such as the M. levator ani with
its connective tissue especially along the anterior vaginal
wall and their interactions between the urethral and anal
sphincters have been identified using MRI and ultrasound.
Little data exists about pelvic floor disorders during pregnancy.
However, postpartum, there is evidence of a putative
protective effect of cesarean section regarding urinary
incontinence in the short term. Due to the fact that this
»advantage« seems to become weaker with increasing
age, the rising use of cesarean should not be justified.
The definition of an »ideal mode of delivery« must be
Regarding anal incontinence, the mode of delivery seems
to be less relevant, as long as there is no anal sphincter
laceration during delivery. The use of instrument-assisted
delivery, especially forceps, is associated with increased
trauma to the female pelvic floor as is the routine use
of episiotomy. Long term disorders such as pelvic organ
prolapse or urinary and anal incontinence can be the
CME Prakt Fortbild Gynakol Geburtsmed Gynakol Endokrinol
2011; 7(3): 228-241
Pelvic floor disorders
Universitäts-Frauenklinik Tübingen, Tübingen
Reviewer: Markus Grebe, Dresden
und Rainer Lange, Alzey
Hübner M. Prä- und peripartale ... Gynakol Geburtsmed Gynakol Endokrinol 2011; 7(3): 228-241 publiziert 30.11.11 www.akademos.de/gyn ©akademos Wissenschaftsverlag 2011 ISSN 1614-8533