A prospective cohort study was undertaken to evaluate the impact of pregnancy and the first delivery on the defecatory symptoms and to identify associated factors. Included were 487 nulliparous pregnant women who completed four questionnaires. Flatus and fecal incontinence, constipation, and painful defecation are already present in early pregnancy and are significantly predictive for reporting symptoms after delivery, except for fecal incontinence. A third or fourth degree sphincter tear was significantly associated with fecal incontinence 12 months postpartum and with de novo fecal incontinence, while other factors associated with de novo onset of symptoms were of borderline significance. Defecation symptoms already present in early pregnancy are highly predictive for reported symptoms at 12 months postpartum except for fecal incontinence that is mainly related to anal sphincter lesion. Therefore, investigating the effects of childbirth in general on the anorectal function is not justified without knowledge of this function during pregnancy.

A prospective cohort study was undertaken to evaluate the effect of pregnancy and childbirth in nulliparous pregnant women. The focus of this paper is on the difference in the prevalences and risk factors for lower urinary tract symptoms (LUTS) between woman who delivered vaginally or by cesarean and secondly the effect of LUTS on the quality of life between these two groups was analyzed. Included were 344 nulliparous pregnant women who completed four questionnaires with the Urogenital Distress Inventory and the Incontinence Impact Questionnaire (IIQ). Two groups were formed: vaginal delivery group (VD), which included spontaneous vaginal delivery and an instrumental vaginal delivery and cesarean delivery group (CD). No statistical significant differences were found in the prevalences of LUTS during pregnancy between the two groups. Three months after childbirth, urgency and urge urinary incontinence (UUI) are less prevalent in the CD group, but no statistical difference was found 1 year postpartum. Stress incontinence was significantly more prevalent in the VD group at 3 and 12 months postpartum. The presence of stress urinary incontinence (SUI) in early pregnancy is predictive for SUI both in the VD as in CD group. A woman who underwent a CD and had SUI in early pregnancy had an 18 times higher risk of having SUI in year postpartum. Women were more embarrassed by urinary frequency after a VD. After a CD, 9% experienced urge urinary incontinence. Urge incontinence affected the emotional functioning more after a cesarean, but the domain scores on the IIQ were low, indicating a minor restriction in lifestyle. In conclusion, after childbirth, SUI was significantly more prevalent in the group who delivered vaginally. Besides a vaginal delivery, we found both in the VD and in the CD group that the presence of SUI in early pregnancy increased the risk for SUI 1 year after childbirth. Further research is necessary to evaluate the effect of SUI in early pregnancy on SUI later in life. Women were more embarrassed by urinary frequency after a vaginal delivery. UUI after a CD compared to a vaginal birth limited the women more emotionally; no difference was found for the effect of SUI on the quality of life between the two groups.

RESULTSOf the 344 women, 83 (24.2%) reported having a moderate to greatly bothersome frequency symptom at 36 weeks of gestation. After childbirth there was a statistically significant decline in the prevalence of bothersome frequency to 38 (9.6%) women ( P < 0.001).Bothersome SUI was present in 53 (15.4%) women at 36 weeks of gestation, and in 36 (10.5%) at 1 year after childbirth. Fifty-eight (16.9%) women reported having moderate to greatly bothersome urge UI (UUI) and at 1 year after childbirth, 51 (14.8%) were still bothered by it. After univariate and multivariate analysis, the predictive factors for the presence of bothersome SUI were greater maternal age (32.5 vs 30.3 years old at delivery) and the presence of bothersome SUI at 12 weeks of gestation. Bothersome UUI was significantly associated with a lower educational level (odds ratio 0.08, 95% confidence interval 0.02-0.36). Women after a Caesarean delivery had more bothersome UUI and women after a spontaneous vaginal delivery developed more bothersome SUI (neither statistically significant, possibly because there were too few samples). During pregnancy, all UDI subscale scores increased significantly and after childbirth all scores decreased significantly vs 36 weeks of gestation. However, the score on the UI subscale remained significantly higher at 1 year after birth than at 12 weeks of gestation, whereas the scores on the OAB and obstructive voiding subscales were lower at 1 year after birth than at 12 weeks of gestation. Nevertheless, the scores for UI and obstructive voiding were low, indicating little bother. CONCLUSIONMost women are not bothered by their LUTS after their first delivery. As the prevalence of bothersome symptoms was highest at 36 weeks of gestation, they are probably part of a normal pregnancy. However, OAB symptoms can be perceived as bothersome. Physiotherapy and bladder training can be offered to women with bothersome LUTS. Bothersome SUI in early pregnancy and a greater maternal age were predictive of bothersome SUI at 1 year after first childbirth. A Caesarean delivery seemed to be protective for bothersome SUI at 1 year after birth, but bothersome UUI was more prevalent after a Caesarean than a vaginal delivery. More research with a larger sample is needed to allow definite statements about the effect of the mode of delivery and bothersome UI symptoms.

Normal obstetric procedures can be followed in women reporting pregnancy-related pelvic girdle pain. Prognosis is generally good, however, women reporting pelvic girdle pain 3 months after delivery need extra consideration. Attention needs to be given to psychosocial factors, in particular depressive symptoms.

One hundred and three women underwent sacrospinous hysteropexy (n=54) or vaginal hysterectomy with a vaginal vault suspension (n=49) for the management of descensus uteri. They were sent a postal questionnaire. Logistic regression analysis was used to obtain crude and adjusted odds ratios. Seventy-four (72%) women responded. The adjusted odds ratios for urge incontinence is 3.4 (1.0-12.3) and for overactive bladder 2.9 (0.5-16.9) greater after vaginal hysterectomy. The women recovered significantly more quickly after sacrospinous hysteropexy. There were no differences in anatomical outcome or recurrence rate. When performed to correct a descensus uteri of grade 2 or more we found that vaginal hysterectomy is associated with a three times higher risk for urge incontinence and overactive bladder symptoms. In addition, the women who underwent sacrospinous hysteropexy also reported a quicker recovery from surgery. Sacrospinous hysteropexy, therefore, appears to be promising for the correction of descensus uteri.