Search

Significant associations between perineal descent and pudendal nerve latency have previously been described in fecally incontinent patients. This has led to the hypothesis that pelvic floor muscle and nerve injury initiated by childbirth might progress and cause fecal incontinence.The study contained herein was undertaken to test whether changes in perineal position and pudendal nerve latency were associated in a population of healthy middle-aged women.A cross-sectional study of 144 women were selected randomly from the Danish National Register; they had a mean age of 50 (range, 45-57) years and a mean parity of 2 (range, 0-6). Perineal position at rest and during simulated defecation and pudendal nerve terminal motor latency were measured. All examinations were performed by one of the authors (AMR) and without the knowledge of parity.The perineal position both at rest and during straining was significantly lowered, and the pudendal nerve terminal motor latency was significantly prolonged with increasing numbers of vaginal deliveries (data not shown). There was, however, no association between pudendal nerve terminal motor latency and perineal position at rest (correlation coefficient, r=-0.15, P=0.1) or during simulated defecation (r=-0.08, P=0.4).Small but significant effects of vaginal deliveries were detected in a random population of healthy perimenopausal women. However, because perineal descent and pudendal nerve latency were not associated, our findings do not support the hypothesis that damage induced by vaginal delivery to the pudendal nerves and pelvic floor will progress. [ABSTRACT FROM AUTHOR]

This study was undertaken to determine the long-term effects of vaginal deliveries on anorectal function in healthy perimenopausal women.An observational study of 144 perimenopausal women living in the county of Aarhus, Denmark, aged 45 to 57 (mean, 50) years were randomly selected from the National Register. All women had delivered 0 to 6 (mean, 2) times 10 to 34 years before the investigation. Examinations describing pelvic floor function were measurements of perineal position at rest and descent during straining, anal mucosa electrosensitivity, maximum resting pressure and maximum squeeze pressure of the anal sphincters, and pudendal nerve terminal motor latency. All tests were performed by one of the authors (AMR) and without knowledge of parity. Data were analyzed using the multiple regression technique, and all associations between anorectal function and parity were corrected for age and hysterectomy status.Increasing parity correlated with a lowered perineal position at rest (correlation coefficient (r)=0.26;P=0.003), an increased descent during straining (r=0.24;P=0.006), an increased threshold of anal mucosa electrosensitivity (r=0.22, P=0.008), and an increased pudendal nerve terminal motor latency on both sides (r=0.27;P=0.002). No effect of parity on the maximum resting pressure (r=0.06;P=0.70) and maximum squeeze pressure (r=0.06;P=0.36) was found. The number of vaginal deliveries account for only a minor fraction of the total variability seen in the tests of pelvic floor function (between 1.6 and 5.7 percent).Repeated vaginal deliveries have a long-term adverse effect on anorectal physiology in a population of randomly selected healthy perimenopausal women. [ABSTRACT FROM AUTHOR]

This study was undertaken to evaluate the risk of permanent flatus or urinary incontinence after repeated vaginal deliveries.In 1989 a questionnaire on obstetric history and urinary and fecal incontinence was sent to a sample of 304 women selected from the birth records from 1976 to 1988; 242 responded (80 percent).Participants had one, two, or three vaginal deliveries, all without an obstetric tear of the anal sphincter. After the first, second, and third deliveries, 1.2, 1.5, and 8.3 percent developed permanent flatus incontinence. The risk was significantly increased after the third delivery compared with the first and second deliveries (odds ratio, 6.6; confidence interval, 2.4-18.3). Permanent urinary incontinence after the first, second, and third delivery developed in 3.3, 1.0, and 6.8 percent. The risk was significantly increased after the third delivery compared with the first and second (odds ratio, 3.2; confidence interval, 1.1-9.1).These results indicate that repeated vaginal deliveries increase the risk of minor anal and urinary incontinence, which were found to be a common problem in premenopausal women. [ABSTRACT FROM AUTHOR]