Multidisciplinary UroGyneProcto Editorial Comment
We studied the pelvic floor dysfunction symptoms in pregnancy and early postpartum and its association with parity and gestational age. Women who had been referred to low risk obstetric clinic for prenatal and early postpartum care, between January 2005 and August 2006 were recruited to the study. Women were invited to complete an anonymous, self-report questionnaire regarding pelvic floor symptoms (PFDI-20). Dataset of 733 women were available for analysis. Only in nulliparous women, urinary
... equency (58.8% vs 80.8%, P 0.005) and stress incontinence (20.5% vs 50.6%, P 0.001) were significantly more prevalent in second half of pregnancy in contrast to first half. All symptoms except painful defecation and urge urinary incontinence were significantly more prevalent in antepartum period than early postpartum. Logistic regression analyses revealed that increase in number of previous vaginal delivery was independently associated with presence of painful void, urge urinary incontinence and urinary frequency in early postpartum period. Pelvic floor dysfunction symptoms are significantly more frequent during pregnancy in comparison with early postpartum period. Additionally, prevalence of most symptoms was the same during first and second half of pregnancy. Parity and history of prior vaginal delivery did not affect the frequency of most symptoms during pregnancy. Reporting the results of an observational study in 733 women on pelvic floor dysfunction symptoms in pregnancy and early postpartum and their association with parity and gestational age, the authors conclude that urinary frequency and urinary stress incontinence are more prevalent in the second half of pregnancy in nulliparous women compared to multiparous women, and that in the latter changes of PFD symptoms during pregnancy are not observed. We know that different connective tissues are associated with various pelvic floor symptoms 1,2 , and periurethral biopsies in nulliparous women with and without urodynamic stress incontinence have shown significantly less collagen in the tissues of those without urinary stress incontinence. Probably in nulliparous women the changes in the connective tissue that occur in the second part of the pregnancy are reversible and they disappear after childbirth. In multiparous women however connective tissue changes are likely to be permanent and this could explain the absence of a significant difference in PFD symptoms during all the stages of pregnancy. From an anatomical point of view this finding justifies the association between pelvic prolapse and multiparity. Procto... About half of pregnant women have to deal with constipation, but only few need medical attention, the problem usually beginning at the 11-12 th week to become more pronounced after the sixth month and it may be cause and consequence of symptomatic hemorrhoids (prolapse, edema) and anal fissures. These quite annoying conditions often have a triggering moment in the effort required for a difficult evacuation. Among of the numerous factors affecting defecation (and likewise fecal continence) i.e. sphincters' relaxation, pelvic ligaments integrity, peristalsis, stool consistency, anorectal sensitivity, emotions) also the intestinal bacterial flora seems to play a very important role. Furthermore in pregnancy-constipation we must consider several causes of bowel malfunctioning: progesterone, that prevents uterus contractions, favors the growth of the myometrium and promotes placental activity , it slows down the intestinal motor activity and the transit, worsening a pre-existing constipation or causing a new problem; the compression from the pregnant uterus; an increased water demand reducing the amount needed to soften intestinal contents; a frequent intake of iron supplements often necessary during pregnancy; a reduced physical movement, variations in diet. All the above conditions need to be considered and in pregnancy the type of constipation should always be analyzed for an appropriate treatment.