Association between pelvic floor muscle trauma and pelvic organ prolapse 20 years after delivery

It is known that pelvic floor muscle trauma (PFMT) after vaginal delivery is associated with pelvic organ prolapse (POP) symptoms (sPOP) and signs (POP-Q a parts per thousand yen2) in patient populations. Our aims were to establish the prevalence and investigate a possible association between PFMT and sPOP and POP-Q a parts per thousand yen2 in healthy women 20 years after their first delivery. During 2013 and 2014 we conducted a cross-sectional study among 847 women who delivered their first child between 1990 and 1997. Women responded to a postal questionnaire and were offered a clinical examination including prolapse grading and pelvic floor ultrasonography. The main outcome measures were sPOP, POP-Q a parts per thousand yen2 and PFMT, defined by levator avulsion or a levator hiatal area on Valsalva manoeuvre of > 40 cm(2) on ultrasonography. Of the 847 eligible women, 608 (72 %) were examined. Data on POP symptoms, POP-Q stage, levator avulsion and levator hiatal area were available in 598, 608, 606 and 554 women, respectively, and of these 75 (13 %) had sPOP, 275 (45 %) had POP-Q a parts per thousand yen2, 113 (19 %) had levator avulsion and 164 (30 %) had a levator hiatal area > 40 cm(2). Levator avulsion was associated with POP-Q a parts per thousand yen2 with an odds ratio (OR) of 9.91 and a 95 % confidence interval (CI) of 5.73 - 17.13, and with sPOP (OR 2.28, 95 % CI 1.34 - 3.91). Levator hiatal area > 40 cm(2) was associated with POP-Q a parts per thousand yen2 (OR 6.98, 95 % CI 4.54, - 10.74) and sPOP (OR 3.28, 95 % CI 1.96 - 5.50). Many healthy women selected from the general population have symptoms and signs of POP 20 years after their first delivery, and PFMT is associated with POP-Q a parts per thousand yen2 and sPOP.