Association between breastfeeding and pelvic floor dysfunction: a systematic review
Related Experiment Video
Updated: Nov 3, 2026

Quantification of Levator Ani Hiatus Enlargement by Magnetic Resonance Imaging in Males and Females with Pelvic Organ Prolapse
Published on: April 17, 2019
Claudia Manzini1, Mart Christiaan Paul Kortman2, Nienke Bosschaart3
1Multi-Modality Medical Imaging, Faculty of Science and Technology, Technical Medical Centre, University of Twente, Enschede, The Netherlands. c.manzini@utwente.nl.
Background:
This systematic review evaluates the association between breastfeeding and pelvic floor (dys)function. Since breastfeeding has well-known positive effects, exclusive breastfeeding is recommended for the first 6 months after birth. At the same time, the postpartum period is the period in which mothers recover from pregnancy and delivery. It has been hypothesized that breastfeeding can negatively affect pelvic floor regeneration by sustaining a hypoestrogenic state. Considering the health benefits of both breastfeeding and optimal pelvic floor recovery, the association between the two was assessed.
Methods:
PubMed and Cochrane CENTRAL library were searched on the 29th of November 2023. Studies on the association between breastfeeding and pelvic floor (dys)function were included. The results were grouped into five domains: (1) dyspareunia, (2) urinary incontinence (UI), (3) pelvic organ prolapse (POP), (4) anal incontinence (AI), and (5) pelvic floor muscles function (PFMF). A qualitative synthesis of the results was performed.
Results:
Nineteen studies were retrieved for dyspareunia, eight for UI, two for POP and AI, and three for PFMF. Fourteen studies showed a significant association between breastfeeding and dyspareunia, with a greater risk of dyspareunia in the breastfeeding group. The studies on UI, POP and AI, and PFMF reported conflicting results. A meta-analysis was not performed due to heterogeneity among studies.
Conclusions:
The available literature shows an association between breastfeeding and postpartum dyspareunia. However, no causal relation can be inferred. In the case of symptoms, women should be informed of the multifactorial nature of dyspareunia and of the benefits of breastfeeding. The association of breastfeeding with UI, POP and AI has not been established. Any advice to discontinue breastfeeding because of these symptoms is not supported by scientific evidence.
Related Concept Videos
Muscles of the Pelvic Floor and Perineum
Perineal Layer
The perineum is a diamond-shaped area below the pelvic diaphragm, divided into an anterior urogenital triangle that contains the external genitals and a posterior anal triangle housing the anus. The urogenital...
Development of the Oral Microbiota
Development of Human Microbiota