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Pelvic floor damage and childbirth: a neurophysiological study.
R E Allen1, G L Hosker, A R Smith
1Saint Mary's Hospital, Manchester Department of Urological Gynaecology, Manchester.
British Journal of Obstetrics and Gynaecology
|September 1, 1990
Summary
Childbirth can cause pelvic floor nerve damage in most first-time mothers, with 80% showing muscle re-innervation. Severe damage may lead to incontinence and prolapse.
Area of Science:
- Obstetrics and Gynecology
- Neuroscience
- Pelvic Floor Medicine
Background:
- Childbirth is a significant physiological event for nulliparous women.
- The pelvic floor's striated muscles and nerve supply are crucial for continence and support.
- Potential childbirth-related damage to the pelvic floor requires thorough investigation.
Purpose of the Study:
- To investigate childbirth-induced damage to the pelvic floor's striated muscles and nerve supply.
- To assess the extent of denervation and re-innervation following vaginal delivery.
- To identify factors associated with pelvic floor nerve damage.
Main Methods:
- Conducted electromyography (EMG) on pelvic floor muscles.
- Performed pudendal nerve conduction tests.
- Assessed pelvic floor muscle contraction using a perineometer in 96 nulliparous women.
Main Results:
- EMG indicated re-innervation in 80% of women post-vaginal delivery.
- Longer active second stage of labor and heavier babies correlated with more EMG evidence of nerve damage.
- Forceps delivery and perineal tears did not significantly affect the degree of nerve damage.
Conclusions:
- Vaginal delivery frequently causes partial denervation and subsequent re-innervation of the pelvic floor muscles in women.
- Severe cases of pelvic floor denervation can result in urinary and fecal incontinence.
- This damage may be an initial step towards developing pelvic organ prolapse or stress incontinence.