Cesarean delivery; Childbirth; Fecal incontinence; Pelvic floor dysfunction; Pelvic organ prolapse; Urinary incontinence; Vaginal delivery

Objective: To compare the prevalence of pelvic floor dysfunction symptoms, including pelvic organ prolapse (POP), urinary incontinence (UI), and fecal incontinence (FI) among primiparous women after vaginal and cesarean delivery.Methods: In a prospective cohort study at a University hospital in the Czech Republic, singleton primiparas with cephalic presentation who delivered at term were enrolled between 2002 and 2007. In 2013, 5-10 years after delivery, women who had not delivered again completed an internet-based survey about current symptoms of POP, UI, and FI, which were evaluated using validated questionnaires. The relative risk (RR) of POP, UI, and FI symptoms was calculated.Results: Complete questionnaire data were obtained from 641 women who delivered vaginally and 224 who delivered by cesarean. The mean UI score (ICIQ-SF) was 2.3 +/- 3.6 in the vaginal group and 1.0 +/- 2.7 in the cesarean group (P= 0.005). The mean POP scores (POPDI-6) were 2.2 +/- 2.3 and 2.1 +/- 2.0, respectively (P= 0.944). The mean Wexner scores to evaluate FI were 1.3 +/- 1.7 and 1.0 +/- 1.5, respectively (P= 0.220). The RR of pelvic floor dysfunction after vaginal delivery was highest for women with UI symptoms (RR 1.15, 95% confidence interval 0.92-1.42).Conclusion: Significant differences in the occurrence of symptoms of UI were observed after vaginal delivery as compared with cesarean delivery.