Pelvic floor dysfunction one year after first childbirth in relation to perineal tear severity

The aims of this study were to evaluate pelvic floor dysfunction symptoms one year after delivery and investigate whether adverse functional outcomes after childbirth were related to the degree of perineal injury. A prospective cohort of 776 primiparas were included. Self-reported pelvic floor function data were obtained using a web-based questionnaire. Women with no/first-degree injuries, second-degree injuries, third-/fourth-degree injuries (obstetric anal sphincter injury, OASI) and cesarean section were compared. A total of 511 women (66%) responded. Second-degree tears were a risk factor for stress incontinence (aOR 2.6 (95% CI 1.3-5.1)). Cesarean section was protective against stress incontinence (aOR 0.2 (95% CI 0.1-0.9)). OASI was a risk factor for urge incontinence (aOR 4.8 (95% CI 1.6-15)), prolapse (aOR 7.7 (95% CI 2.1-29)) and pelvic pain (OR 3.3 (95% CI 1.1-10)). Dyspareunia was reported by 38% of women, 63% of women in the OASI group (aOR 3.1 (95% CI 1.1-9.0)). Women with OASI reported that the injury affected daily life (OR 18 (95% CI 5.1-59)). Pelvic floor dysfunction is common after childbirth, even in women with moderate injury. Women with OASI had significantly higher risks of symptoms of prolapse, urge urinary incontinence, pain, dyspareunia and impacts on daily life.