In cooperation with

Abstract

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 made carefully.

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 consequence.

CME Prakt Fortbild Gynakol Geburtsmed Gynakol Endokrinol 2011; 7(3): 228-241

Keywords
Pelvic floor disorders

Markus Hübner
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