Uterine Prolapse

Delivery method associated with pelvic floor disorders after childbirth: Decade-long study identifies women at highest risk for incontinence

Uterine Prolapse | Johns Hopkins Medicine

Research completed at Johns Hopkins and the Greater Baltimore Medical Center has demonstrated that vaginal childbirth substantially increases the probability a woman will develop a pelvic floor disorder later in life. Pelvic floor disorders, including urinary incontinence and uterine prolapse, afflict millions of women in the United States.

However, until now little was known about who will develop these conditions and how they progress over time.

In this week's Journal of the American Medical Association, Johns Hopkins and Greater Baltimore Medical Center researchers report results of a 10-year study showing that some delivery modes, including spontaneous vaginal delivery, are associated with higher risk of some types of pelvic floor disorders.

“We knew that these disorders are more common after childbirth, but now after following these women for 10 years, we have a good sense of how delivery mode impacts a woman's risk of developing a pelvic floor disorder,” says Victoria Handa, M.D., M.H.S., professor of gynecology and obstetrics at the Johns Hopkins University School of Medicine and director of gynecology and obstetrics at Johns Hopkins Bayview Medical Center.

This study considered a woman's risk of developing one of four pelvic floor disorders: stress urinary incontinence (urine leakage during with activities that increase abdominal pressure), overactive bladder (frequent and urgent urination), anal incontinence (involuntary loss of solid stool, liquid stool or gas) and pelvic organ prolapse (when the uterus and vaginal walls fall downward into the vagina, protruding beyond the vaginal opening when bearing down).

The research team enrolled 1,528 women within five to 10 years of their first birth. These women were followed annually for up to nine years.

Of the women, 778 delivered all of their children via cesarean birth, 565 had at least one spontaneous vaginal delivery and 185 had at least one delivery involving forceps or vacuum-assistance, also called operative vaginal delivery. The median age at enrollment was 38.

3 — the youngest study participant at enrollment was 22.7 years old and the oldest participant at the end of the study was age 61.7.

The team collected information from the women at the time of enrollment, including date of first birth, age at first birth, body mass index, whether they had developed any pelvic floor disorder already, birth delivery mode, and genital hiatus size — the distance between the urethra and the posterior hymen.

The team then collected information at follow-up visits — the cesarean birth group made 4,039 visits, the spontaneous vaginal delivery group made 2,817 visits and the operative vaginal delivery group made 948 visits.

Some women already had developed pelvic floor disorders at the time of study enrollment while others developed the conditions over the course of the study.

In all, the researchers found that cesarean delivery substantially reduced the risk of pelvic floor disorders, most notably pelvic organ prolapse, while operative delivery increased the risk. And for pelvic organ prolapse, the magnitude of these differences grew over time.

For example, by 15 years after a first delivery, prolapse of the uterus or vaginal wall beyond the vaginal opening was seen in 9 percent (7-12 percent) of women who had delivered by cesarean, 30 percent (25-35 percent) who had at least one vaginal delivery and 45 percent (37-53 percent) of those who had at least one operative delivery.

The researchers also found that a large percentage of new cases of urinary and bowel incontinence developed in the first five years after delivery, while pelvic organ prolapse tended to develop many more years after childbirth.

A third discovery was that the genital hiatus size is significantly associated with all pelvic floor disorders but most significantly with pelvic organ prolapse. This suggests that the genital hiatus size is a marker that might identify women at high risk of developing pelvic floor disorders with aging.

“While this study was limited to one community hospital and might not accurately reflect populations nation- or world-wide, it is the first time we have been able to gather data over a significant period of time,” says Handa.

“These data help us understand which women might be at highest risk to develop these conditions.

Ultimately this research will help us identify which women should be targeted for prevention strategies, and will hopefully improve our ability to deliver the right type of care to the right person.”

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Source: https://www.sciencedaily.com/releases/2018/12/181219093903.htm

Delivery method associated with pelvic floor disorders after childbirth

Uterine Prolapse | Johns Hopkins Medicine

Vaginal childbirth substantially increases the probability a woman will develop a pelvic floor disorder later in life, a new study has found.

Pelvic floor disorders, including urinary incontinence and uterine prolapse, afflict millions of women in the U.S., and until now, little was known about who will develop these conditions and how they progress over time.

In this week's Journal of the American Medical Association, researchers from Johns Hopkins and the Greater Baltimore Medical Center report results of a 10-year study that show some delivery modes, including spontaneous vaginal delivery, are associated with higher risk of some types of pelvic floor disorders.

“We knew that these disorders are more common after childbirth, but now after following these women for 10 years, we have a good sense of how delivery mode impacts a woman's risk of developing a pelvic floor disorder,” says Victoria Handa, professor of gynecology and obstetrics at the Johns Hopkins University School of Medicine and director of gynecology and obstetrics at Johns Hopkins Bayview Medical Center.

This study considered a woman's risk of developing one of four pelvic floor disorders: stress urinary incontinence, when urine leaks during activities that increase abdominal pressure; overactive bladder, marked by frequent and urgent urination; anal incontinence, which is the involuntary loss of solid stool, liquid stool, or gas; and pelvic organ prolapse, when the uterus and vaginal walls fall downward into the vagina, protruding beyond the vaginal opening when bearing down.

The research team enrolled 1,528 women within five to 10 years of their first birth. These women were followed annually for up to nine years.

Of the women, 778 delivered all of their children via cesarean birth, 565 had at least one spontaneous vaginal delivery and 185 had at least one delivery involving forceps or vacuum-assistance, also called operative vaginal delivery. The median age at enrollment was 38.

3—the youngest study participant at enrollment was 22.7 years old and the oldest participant at the end of the study was age 61.7.

The team collected information from the women at the time of enrollment, including date of first birth, age at first birth, body mass index, whether they had developed any pelvic floor disorder already, birth delivery mode, and genital hiatus size—the distance between the urethra and the posterior hymen.

The team then collected information at follow-up visits. The cesarean birth group made 4,039 visits, the spontaneous vaginal delivery group made 2,817 visits, and the operative vaginal delivery group made 948 visits.

Some women already had developed pelvic floor disorders at the time of study enrollment while others developed the conditions over the course of the study.

In all, the researchers found that cesarean delivery substantially reduced the risk of pelvic floor disorders, most notably pelvic organ prolapse, while operative delivery increased the risk. And for pelvic organ prolapse, the magnitude of these differences grew over time.

For example, by 15 years after a first delivery, prolapse of the uterus or vaginal wall beyond the vaginal opening was seen in 9 percent (7–12 percent) of women who had delivered by cesarean, 30 percent (25–35 percent) who had at least one vaginal delivery and 45 percent (37–53 percent) of those who had at least one operative delivery.

The researchers also found that a large percentage of new cases of urinary and bowel incontinence developed in the first five years after delivery, while pelvic organ prolapse tended to develop many more years after childbirth.

A third discovery was that the genital hiatus size is significantly associated with all pelvic floor disorders but most significantly with pelvic organ prolapse. This suggests that the genital hiatus size is a marker that might identify women at high risk of developing pelvic floor disorders with aging.

“While this study was limited to one community hospital and might not accurately reflect populations nation- or world-wide, it is the first time we have been able to gather data over a significant period of time,” says Handa.

“These data help us understand which women might be at highest risk to develop these conditions.

Ultimately this research will help us identify which women should be targeted for prevention strategies, and will hopefully improve our ability to deliver the right type of care to the right person.”

Posted in Health

obstetrics, pregnancy, maternal health

Source: https://hub.jhu.edu/2019/01/10/childbirth-method-pelvic-floor-disorder/

Uterine Prolapse

Uterine Prolapse | Johns Hopkins Medicine

Linkedin Pinterest Gynecological Conditions Pelvic Floor Disorders What You Need to Know

  • When pelvic muscle, tissue and ligaments weaken, the uterus can drop down into the vaginal canal, causing uterine prolapse.
  • Nearly one-half of all women between ages 50 and 79 have some degree of uterine or vaginal vault prolapse, or some other form of pelvic organ prolapse.
  • Factors that increase your risk of uterine prolapse include childbirth, age, obesity, chronic constipation and having a hysterectomy.
  • Many women with uterine prolapse have no symptoms. If symptoms are present, they may include bulging in the vagina, feeling pressure in the pelvis or vagina, and lower back pain accompanied by bulging in the vagina.
  • There is no definitive way to prevent uterine prolapse.

    Losing weight, eating a fiber-rich diet, quitting smoking and performing pelvic floor exercises can help to reduce the risk of this condition.

Uterine prolapse occurs when the muscles and tissue in your pelvis weaken. The weakness lets the uterus drop down into your vagina.

Sometimes, it comes out through your vaginal opening. Nearly half of all women between ages 50 and 79 have this condition.

What causes uterine prolapse?

Uterine prolapse is caused when the muscles and tissue of the pelvic floor are weakened and can’t support the weight of the uterus. This lets it drop into your vagina.

What are the risk factors for uterine prolapse?

Risk factors include:

  • Giving birth (highest risk)

  • Vaginal delivery (vs. C-section)

  • Menopause

  • Being Caucasian

  • Being overweight

  • Smoking

What are the symptoms of uterine prolapse?

Many women with this condition have no symptoms. However, if symptoms start, they may include:

  • Leakage of urine

  • Inability to completely empty your bladder

  • Feeling of heaviness or fullness in your pelvis

  • Bulging in your vagina

  • Lower-back pain

  • Aching, or the feeling of pressure, in your lower abdomen or pelvis

  • Constipation

How is uterine prolapse diagnosed?

If your healthcare provider thinks that you have a prolapsed uterus, he or she will probably do a physical exam to check your pelvis. If you also have urinary incontinence or a feel you can’t empty your bladder, your doctor may do a procedure called a cystoscopy to examine your bladder and urethra.

Your healthcare provider might also order an MRI (magnetic resonance imaging). This procedure uses a magnet and radio waves to create images. This will allow your healthcare provider to get a good look at your kidneys and other pelvic organs.

If your symptoms bother you or you’re not comfortable during everyday activities, talk with your healthcare provider about treatment options. Lifestyle changes, such as losing weight, may help.

So can doing Kegel exercises. These strengthen your pelvic floor muscles. To do this exercise, you squeeze the muscles you use to control the flow of urine, and hold for up to 10 seconds then release.

Repeat 50 times a day.

A pessary can also relieve symptoms. This is a device your healthcare provider inserts into your vagina to support your pelvic organs.

A hysterectomy is a surgery to remove your uterus. This can be done through your vagina. The healing time is faster than with surgery that requires an abdominal incision. There also are fewer complications.

Can uterine prolapse be prevented?

There is no certain way to prevent uterine prolapse. However, the following can help lower your risk:

  • Lose weight, if you’re overweight

  • Follow a diet rich in fiber and fluids to prevent constipation and straining

  • Avoid heavy lifting

  • Quit smoking, if you smoke

  • Seek prompt treatment for a chronic cough, which can place extra pressure on your pelvic organs

  • Do Kegel exercises to strengthen your pelvic floor muscles

These actions may also help if you already have uterine prolapse.

See your healthcare provider when symptoms first start to bother you. Don’t wait until your discomfort becomes severe. Regular pelvic exams can help detect uterine prolapse in its early stages.

Key points for uterine prolapse

  • Uterine prolapse occurs when the muscles and tissue in your pelvis weaken.

  • This allows your uterus to drop down into your vagina.

  • Common symptoms include leakage of urine, fullness in your pelvis, bulging in your vagina, lower-back pain, and constipation.

  • Treatment for uterine prolapse includes lifestyle changes, a pessary, or surgery to remove the uterus.

  • You may be able to prevent this condition with weight loss, a high fiber diet, not smoking, and doing Kegel exercises.

Next steps

Tips to help you get the most from a visit to your healthcare provider:

  • Know the reason for your visit and what you want to happen.

  • Before your visit, write down the questions you want to be answered.

  • Bring someone with you to help you ask questions and remember what your provider tells you.

  • At the visit, write down the name of a new diagnosis, and any new medicines, treatments, or tests. Also, write down any new instructions your provider gives you.

  • Know why a new medicine or treatment is prescribed, and how it will help you. Also, know what the side effects are.

  • Ask if your condition can be treated in other ways.

  • Know why a test or procedure is recommended and what the results could mean.

  • Know what to expect if you do not take the medicine or have the test or procedure.

  • If you have a follow-up appointment, write down the date, time, and purpose for that visit.

  • Know how you can contact your provider if you have questions.

Dr. Victoria Handa and her team at the Johns Hopkins Women's Center for Pelvic Health and Reconstructive Surgery study how childbirth leads to long-term physical and functional changes in a woman’s body. Watch to learn more.

Source: https://www.hopkinsmedicine.org/health/conditions-and-diseases/uterine-prolapse