Pelvic floor trauma following vaginal delivery

Recent years have seen a steady increase in the information available regarding pelvic floor trauma in childbirth. A review of this information is timely in view of the ongoing discussion concerning elective caesarean section.

In addition to older evidence regarding pudendal nerve injury, it has recently been shown that inferior aspects of the levator ani and fascial pelvic organ supports such as the rectovaginal septum can be disrupted in childbirth. Such trauma is associated with pelvic organ prolapse, bowel dysfunction, and urinary incontinence. Elective caesarean section seems to have a limited protective effect that appears to weaken with time. Older age at first delivery may be associated with a higher likelihood of trauma and subsequent symptoms.

Pelvic floor trauma is a reality, not a myth. It is currently not possible, however, to advise patients as to whether avoidance of potential intrapartum pelvic floor trauma is worth the risk, cost, and effort of elective caesarean section. In some women this may well be the case. The identification of women at high risk for delivery-related pelvic floor trauma should be a priority for future research in this field.