Pelvic and urinary system disorders following delivery

Aim. To investigate pelvic and urodynamic disorders in women after spontaneous vaginal delivery complicated by perineal trauma.

Materials and methods. The study included 200 women of reproductive age (18–35 years): the main group comprised 100 patients with perineal trauma (first- and second-degree tears, episiotomy), and the control group consisted of 100 patients after vaginal delivery without trauma. Six months postpartum, all participants underwent a comprehensive examination, including medical history collection, gynecological and physical examinations, perineometry, pelvic floor ultrasound, uroflowmetry, and questionnaires (International Conférence on Incontinence Questionnaire – Short Form, King’s Health Questionnaire). Pelvic floor muscle tone was assessed by palpation using the Oxford 5-point scale, while contractile strength was measured with perineometry (iEASE XFT-0010, China) using biofeedback (three 10-second trials). Pelvic ultrasound was performed on a Voluson E8 system with convex and transvaginal probes, both at rest and during the Valsalva maneuver, with evaluation of pelvic diaphragm morphometry, urethra, bladder, and α, β angles. Uroflowmetry was used to analyze urinary flow rate and voided volume.

Results. The study groups were comparable in age, height, fetal head circumference, and labor duration (p >0.05). Neonatal weight was slightly higher in the main group (3479.3 ± 442.0 g vs. 3340.2 ± 381.4 g, p >0.05). Birth trauma distribution included first-degree tears (36.9 %), second-degree tears (31.0 %), and mediolateral episiotomy (32.1 %). Lower urinary tract symptoms were more frequent in the main group: increased voiding frequency (71 % vs. 42 %), stress urinary incontinence (38 % vs. 21 % with exertion; 45 % vs. 32 % with cough / sneeze), and urgency (17 % vs. 12 %). King’s Health Questionnaire responses indicated more pronounced impact on quality of life (anxiety, self-esteem, daily activity, work performance). Perineometry demonstrated reduced pelvic floor muscle strength (all three measurements p <0.05), with no significant difference in maximal contraction duration. Ultrasound revealed greater urethral length during Valsalva (31.71 ± 4.8 mm vs. 28.02 ± 2.5 mm, p <0.05) and wider urethra at rest and during straining (p <0.05). Although mean α and β angles did not differ (p >0.05), their displacement was significantly higher in the main group (α: 4.51 ± 2.5° vs. 2.49 ± 1.0°; β: 11.77 ± 7.0° vs. 6.94 ± 4.6°, p <0.05), suggesting increased urethral mobility. Uroflowmetry showed reduced mean and peak flow rates (11.65 ± 3.7 and 20.57 ± 6.9 ml / s vs. 17.86 ± 2.0 and 25.18 ± 3.0 ml / s, p <0.05) and a non-significant trend toward longer voiding time (p >0.05).

Conclusion. The results of the study demonstrate that perineal birth trauma is a significant risk factor for the development of pelvic and urodynamic disorders in the early postpartum period. Women with perineal tears and episiotomy were found to have a statistically higher prevalence of urinary frequency, stress urinary incontinence, and urgency six months after delivery, accompanied by decreased pelvic floor muscle strength on perineometry and greater urethral hypermobility during functional tests. These changes were associated with a deterioration in quality-of-life indicators according to questionnaires, including increased anxiety, reduced self-esteem, and social maladaptation. Instrumental assessment (ultrasound and uroflowmetry) confirmed the presence of functional and morphometric changes, such as urethral elongation and widening, increased displacement of angles α and β, and reduced mean and peak urinary flow rates. The findings highlight the need for active screening and early correction of pelvic floor disorders in the postpartum period to prevent chronicity, reduce the risk of progression of urodynamic dysfunction, and improve patients’ quality of life.

1. Ilyina I.Yu., Dobrokhotova Yu.E., Chikisheva A.A. et al. Urination disorders after childbirth: treatment methods. Consilium Medicum 2018;20(6):66–9. (In Russ.). DOI: 10.26442/2075-1753_2018.6.66-69

2. Chechneva M.A., Rebrova T.V., Klimova I.V. Effect of episiotomy on the state of the pelvic floor after vaginal delivery. Rossiysky vestnik akushera-ginekologa = Russian Bulletin of ObstetricsGynecology 2020;20(2):47–54. (In Russ.). DOI: 10.17116/rosakush20202002147

3. Mikhelson A.A., Malgina G.B., Lukyanova K.D. et al. Early diagnosis and prevention of pelvic and urodynamic dysfunctions in women after childbirth. Ginekologiya = Gynecology 2022; 24(4):295–301. (In Russ.). DOI: 10.26442/20795696.2022.4.201782

4. Kochev D.M., Dikke G.B. Pelvic floor dysfunction before and after childbirth and preventive strategies in obstetric practice. Akusherstvo i ginekologiya = Obstetrics and Gynecology 2017;(5):9–15. DOI: 10.18565/aig.2017.5.9-15

5. Thom D.H., Rortveit G. Prevalence of postpartum urinary incontinence: a systematic review. Acta Obstet Gynecol Scand 2010;89(12):1511–22. DOI: 10.3109/00016349.2010.526188

6. Suar G., Cevik F., Yavuz N.S., Özerdoğan N. Urinary incontinence in the postpartum 1-year period: its prevalence and effect on psychosocial status of women. Low Urin Tract Symptoms 2023;15(5):191–9. DOI: 10.1111/luts.12495

7. Giugale L., Moalli P., Canavan T. et al. Prevalence and Predictors of Urinary Incontinence at 1 Year Postpartum. Female Pelvic Med Reconstr Surg 2021;27(2):e436–41. DOI: 10.1097/SPV.0000000000000955