Self-reported pelvic floor dysfunction 12 months after an obstetric anal sphincter injury in relation to maternal...

The aim of this study was to evaluate self-reported pelvic floor symptoms 12 months postpartum, in women after a first-time vaginal delivery complicated by an obstetric anal sphincter injury, according to body mass index. The hypothesis was that dyspareunia, urinary incontinence, and anal incontinence would be more common in overweight and obese women compared with normal weight women 12 months postpartum.

This is a population-based cohort study. Altogether, 6595 primiparous women with a first-time vaginal delivery complicated by an obstetric anal sphincter injury in Sweden between 2014 and 2019 were included in the Swedish Perineal Laceration Registry. Self-reported pre-pregnancy data and data from the 12-month follow-up questionnaire were retrieved from the Perineal Laceration Registry. Uni- and multivariate analyses were used to compare normal weight (BMI ≤ 24.9), overweight (25.0-29.9), and obese (≥30) women in regard to the self-reported prevalence of dyspareunia, urinary incontinence, and anal incontinence 12 months postpartum.

Overweight and obese women had a decreased risk of dyspareunia compared with normal weight women, aOR 0.82 (CI = 0.68-0.98) and aOR 0.71 (CI = 0.54-0.93), respectively. The absolute rate of dyspareunia was 41% among normal weight women, 38% among overweight women, and 33% among the obese group. In the univariate analyses, episiotomy and the grade of anal sphincter injury did not affect the risk of dyspareunia. There was an increased risk of urinary incontinence among overweight (aOR = 1.51, CI = 1.11-2.04) and obese women (aOR = 2.82, CI = 1.94-4.12) compared with normal weight women. The risk of anal incontinence did not differ between the BMI groups.

Dyspareunia 12 months after an obstetric anal sphincter injury was less common among overweight and obese women than in normal-weight women. Self-reported anal incontinence one year after an obstetric anal sphincter injury was equally distributed over the BMI groups 12 months after delivery, which is a new finding and clinically relevant.