Childbirth and
Pelvic Floor Consequences

Can Childbirth Cause Incontinence?

The short answer is “yes, absolutely.” Our providers see several women each month who have suffered birth injuries leading to urinary incontinence, fecal incontinence, pelvic organ prolapse, and even urinary and fecal fistulae. How does it happen? Take a look at the following picture. This is a great representation of how a fetal head moving through the birth canal disrupts and damages the pelvic structures. 

 

Birth Injuries and Urinary Incontinence

A large percentage of women who have a vaginal birth never develop incontinence. The reason for this is that damage created by childbirth, mainly to the pubovaginal fascia, does have the ability to heal and repair itself over time. Unfortunately, not all women experience this type of healing. For them, the likelihood of developing urinary incontinence in the future is more common. 

Birth Injuries and Fecal Incontinence

Fecal incontinence may develop after birth due to either direct injuries (such as sphincter muscle tears or the development of a rectovaginal fistula) or may be due to more indirect factors such as nerve stretching and nerve injury. Some studies have indicated that more than a third of women who deliver vaginally have at least some damage to the anal sphincter complex, while around 80% of women who undergo operative deliveries with forceps will have damage to the sphincter complex.

Sometimes, in order to facilitate delivery of the fetal head, the obstetrician will cut an episiotomy at the posterior portion of the vaginal opening. Due to the location of these episiotomies, particularly midline episiotomies, the anal sphincter is much more likely to be damaged with subsequent delivery of the infant. Mediolateral and “J-hook” or “hockey-stick” episiotomies decrease the chance of damage to the anal sphincter, but are generally more painful and are more difficult to heal. 

Due to the likelihood of sphincter damage and subsequent fecal incontinence, our view is that episiotomies should ONLY be cut to facilitate delivery and that the use of “routine episiotomies” should be discontinued.

Is Cesarean Delivery Protective Against Prolapse And Incontinence?

Since elective Cesarean delivery avoids the stretching and overall damage to the nerves and muscles of the pelvis, women undergoing Cesarean should have less risk of developing urinary and fecal incontinence, as well as pelvic organ prolapse. This has been shown in several studies. However, one must keep in mind that many women undergo vaginal delivery and never develop these problems, so it would be completely void of evidence to suggest elective Cesarean deliveries for all women. That being said, our view is that women should have a choice between vaginal delivery and elective Cesarean barring any unforeseen circumstances. They should be made aware of all the risks, benefits, and alternatives and then be given the opportunity to make an informed, intelligent decision.




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