Muscle damage during childbirth is linked to later prolapse

A new study from the University of Michigan Health System establishes one of the strongest connections yet discovered between muscle damage that can occur during vaginal deliveries and pelvic organ prolapse, the authors say.

Even so, the researchers caution against using these findings as support for more elective cesarean sections because that would result in numerous women having an operation they do not need. Rather, they say, the study results should be used to help determine how to prevent these injuries in the first place.

The study found major defects of the levator ani among 55% of women with prolapse and just 16% of women who do not have prolapse (Obstet Gynecol 2007; 109:295-302). MRI was used to determine the extent of damage to the levator ani muscles. When women were asked to contract their muscles, the muscles were 40% weaker in women with prolapse. In addition, about 52% of the women in the study with prolapse recalled having forceps used during childbirth.

"Our findings are an important step forward in the search to identify what causes pelvic organ prolapse and subsequent difficulties with other problems, such as incontinence," said lead author John O.L. DeLancey, MD. "The next step is for researchers to look at ways of preventing and treating these injuries of the levator ani muscle in order to reduce the rate of pelvic organ prolapse later in life."