From the Guidelines
Having a cesarean section (C-section) provides some protection to the pelvic floor compared to vaginal delivery, but this protection is not complete and diminishes over time. During vaginal delivery, the pelvic floor muscles, nerves, and connective tissues stretch significantly to allow the baby to pass through the birth canal, which can lead to weakening and damage 1. C-sections bypass this process, reducing the immediate trauma to these structures. However, pregnancy itself places considerable strain on the pelvic floor regardless of delivery method, as the weight of the growing uterus and hormonal changes affect these tissues.
Some key factors to consider in the context of pelvic floor health include:
- The risk of pelvic organ prolapse, which can occur in women after both vaginal and cesarean deliveries, with studies indicating that increasing age, high BMI, and various comorbidities are associated with a higher incidence of pelvic floor disorders 1.
- The importance of preventive measures, such as practicing pelvic floor exercises (Kegels) during and after pregnancy, maintaining a healthy weight, and avoiding chronic constipation and heavy lifting during the postpartum period.
- The potential long-term consequences of mechanical injury during childbirth, including levator ani muscle injury and tissue laxity, which can lead to pelvic organ prolapse or incontinence 1.
It is essential to weigh the benefits and risks of C-sections in the context of pelvic floor health, considering that while they may reduce the risk of certain pelvic floor disorders in the short term, they carry their own risks, including surgical complications and potential complications in future pregnancies. Ultimately, the decision to have a C-section should be based on individual circumstances and medical necessity, rather than solely for the purpose of protecting the pelvic floor.
From the Research
Pelvic Floor Protection with C-Section
- Having a c-section may offer some protection to the pelvic floor, as elective cesarean section carries diminished risk for stress urinary incontinence 2.
- However, the protective effect of c-section seems to weaken with time, and older age at first delivery may be associated with a higher likelihood of trauma and subsequent symptoms 3.
- Vaginal childbirth appears to be strongly associated with stress urinary incontinence and pelvic organ prolapse, suggesting that c-section may be beneficial in preventing these conditions 4.
Comparison of Vaginal Delivery and C-Section
- Studies have shown that vaginal delivery is associated with a larger hiatal area, levator ani muscle defects, and increased bladder neck mobility compared to c-section 5.
- However, c-section is not without risks, and the decision to undergo elective cesarean section should be made after weighing the risks and benefits, particularly for women without prior risk of pelvic organ disorder 2.
Additional Factors
- Pelvic floor muscle training, such as Kegel exercises, can be beneficial in restoring postpartum pelvic floor muscle function and preventing pelvic floor disorders 6.
- The identification of women at high risk for delivery-related pelvic floor trauma should be a priority for future research in this field 3.