Urinary Incontinence:  Urinary incontinence affects 30-50% of mothers before age 40.  Among women experiencing stress incontinence after childbearing, up to 63% report that it began during pregnancy.  And whereas 18% of women report some incontinence before pregnancy, by their 3rd trimester over 50% have complaints.  So even before giving birth, pregnancy alone can be enough to cause the problem.  And if you already had incontinence before pregnancy, during those nine months your symptoms are likely to become worse.

Anal Incontinence:  Loss of control over gas or stool affects up to 25% of women who have given birth.  Not all cases of anal incontinence are caused in the labor room, but childbirth injuries are indeed the key factor predisposing women to this problem.

Sexual Dysfunction:  Physical changes caused by childbirth affect female sexuality more often than most women are aware – manifested as pain, loss of sensation, or problems with orgasm.  Six months after childbirth, roughly one quarter of women after a first vaginal birth experience diminished sexual function, and higher rates are seen following forceps or vacuum delivery compared to ‘spontaneous’ vaginal birth.

Pelvic Prolapse:  After childbirth, the vast majority ofwomen will develop some degree of weakening around the vagina, uterus and pelvic floor, at least enough to be visible to a doctor during a pelvic exam.  Although a minority of women with mild changes to their pelvic supports will be bothered by symptoms, by age 80 up to 11% of the overall female population will undergo major surgery for prolapse or incontinence.  Common types of prolapse include cystocele (‘dropped bladder’), rectocele (‘bulging rectum’), and uterine prolapse (‘dropped uterus’).

Which Key Body Parts Might Be Affected?
The ‘perineum’ is the span of tissue between the opening of the vagina and the anus. It represents the connection point for several muscles that form the opening of the vulva and vagina. The perineum is visible externally, and represents the tissue intentionally cut during an episiotomy.

The levator muscles provide much of the foundation of your pelvic floor. Their condition can strongly influence the way you feel and function, as they provide the major support for the uterus, vagina, bladder and other pelvic organs – and are important for maintaining control over the bladder and bowels. After childbirth, loss of strength and detachment from their supports are commonly seen.

Pelvic nerves are responsible for maintaining pelvic floor muscle strength – as the levator muscles depend upon a healthy nerve supply to maintain their strength, position and tone. One nerve called the ‘pudendal’ is particularly important – and injuries to this nerve are associated with incontinence and pelvic floor symptoms after childbirth, and especially after difficult deliveries.

Pelvic “connective tissues” and ‘ligaments’ are tissues that help to secure the pelvic organs to their proper locations in the pelvis. During childbirth they routinely stretch, tear and weaken.

Adapted From:  “Ever Since I Had My Baby: Understanding, Treating and Preventing the Most Common Physical Aftereffects of Pregnancy and Childbirth”, by Roger P. Goldberg, MD MPH

(Crown Publishers, Random House, NY 2003)