A holistic view of the effects of episiotomy on pelvic floor

Abstract

Vaginal delivery is commonly accepted as a risk factor in pelvic floor dysfunction; however, other obstetric procedures (episiotomy) are still controversial. In this work, to analyze the relationship between episiotomy and pelvic floor function, a finite element model of the pelvic cavity is used considering the pelvic floor muscles (PFMs) with damaged regions from spontaneous vaginal delivery and from deliveries with episiotomy. Common features assessed at screening of pelvic floor dysfunction are evaluated during numerical simulations of both Valsalva maneuver and contraction. As stated in literature, a weakening of the PFM, represented by damaged regions in the finite element model, would lead to a bladder neck hypermobility measured as a variation between the α angle (angle between the bladder neck and the symphysis pubis line and the midline of the symphysis) during straining and withholding. However, the present work does not associate bladder neck hypermobility to a more damaged muscle, suggesting that other supportive structures also play an important role in the stabilization of the pelvic organs. Furthermore, considering passive behavior of the PFM, independently of the amount of damage considered, the resultant displacements of the pelvic structures are the same. Regarding the PFM contraction, the less the muscle is damaged, the greater the movements of the pelvic organs. Furthermore, the internal organs of the female genital system are the most affected by the unhealthy of the PFM. Additionally, the present study shows that the muscle damage affects more the active muscle component than the passive.

In vivo assessment of the levator ani muscles using shear wave elastography: a feasibility study in women

“…The first limitation of this study is that it deals with parous women, who potentially have existing pelvic floor damage. Thus, the shear modulus that we reported for the levator ani muscle may not be representative of the elastic properties of the levator ani muscle in nulliparous women, because a damaged levator ani muscle probably exhibits different biomechanical behavior than an undamaged one [27]. Nevertheless, this limitation did not bias our analysis because our main objective was to assess the feasibility of the procedure and not to describe the elastic properties of the levator ani muscle.…”

The Most Common Functional Disorders and Factors Affecting Female Pelvic Floor

“…During contraction, PFM contract inward to close the body's orifices. On the other hand, when a muscle is damaged, the inward movement is minimal, which causes ineffective closure of the holes, leading to incontinence [38].…”