Maternal Pelvic Floor Trauma

Childbirth and Pelvic Floor Trauma

Pregnancy and childbirth are exceptional experiences in the lives of women. Although delivery usually goes smoothly, sometimes childbirth is complicated. Obstetrical perineal lacerations are tears to the skin and tissue between the vagina and anus that occur during vaginal delivery. They occur to some degree in over 90 percent of women having their first vaginal delivery. The majority of women have relatively minor lacerations that are repaired and heal easily. However, about two percent of women experience severe lacerations that involve not only the vaginal skin and underlying tissue, but also the anal sphincter muscles and even the rectum.

Risk factors for severe lacerations include:

• Need for delivery with obstetrical forceps or vacuum assistance
• Very large babies (over 8 pounds, 13 ounces)
• Prolonged duration of pushing

Usually, even these severe lacerations can be repaired in the delivery room after the birth of a woman’s baby. To repair the damaged tissue, an obstetrician will use stitches that dissolve.

Most women fully recover from perineal lacerations. Unfortunately, about 20 percent of women that experience a severe perineal laceration suffer from complications that include:

• Leaking urine (urinary incontinence), especially when exercising, coughing, laughing, or sneezing, is the most well recognized bothersome urinary symptom following delivery. Other problems include urinary frequency (eight or more times per day) or bothersome need to urinate after going to bed.
• Bowel problems including accidental leakage of stool may result from direct injury to the anal sphincter muscles or from neurologic damage to the rectum that results in needing to rush to the toilet or conversely having trouble completely emptying your bowels.
• Sexual problems including pain during or following intercourse may result from damage to the pelvic floor muscles.
• Pelvic organ prolapse, the condition in which the pelvic organs herniate into the vagina. Women become aware of this problem when they can feel (with their fingers) a lump or bulge near the entrance of the vagina (for example, during toileting or showering).

Specialized physical therapy that focuses on the pelvic floor muscles can effectively address these problems. However, in rare cases, surgery may be required to treat these conditions.

Mikio Nihira, MD is a UCR Health urogynecologist, board-certified in both Obstetrics/Gynecology and Female Pelvic Medicine and Reconstructive Surgery.