Veränderungen des Beckenbodens durch Schwangerschaft und Geburt

O. Preyer; E. Hanzal; W. Umek; T. Laml

doi:10.1055/s-2005-873082

Subscribe to RSS

Please copy the URL and add it into your RSS Feed Reader.

https://www.thieme-connect.de/rss/thieme/en/10.1055-s-00000020.xml

Share / Bookmark

Facebook Linkedin Weibo

Download PDF

Geburtshilfe Frauenheilkd 2006; 66(5): 450-454
DOI: 10.1055/s-2005-873082

Übersicht

Georg Thieme Verlag KG Stuttgart · New York

Veränderungen des Beckenbodens durch Schwangerschaft und Geburt

The Impact of Pregnancy and Childbirth on the Pelvic FloorO. Preyer¹ , E. Hanzal¹ , W. Umek¹ , T. Laml¹

¹Medizinische Universität Wien, Universitätsklinik für Frauenheilkunde, Wien, Österreich

Further Information

Publication History

Eingang Manuskript: 22.8.2005 Eingang revidiertes Manuskript: 10.11.2005

Akzeptiert: 22.11.2005

Publication Date:
23 May 2006 (online)

Also available at

Abstract
Full Text
References

Buy Article Permissions and Reprints

Zusammenfassung

Das Bewusstsein, dass durch eine vaginale Geburt ein Schaden am Beckenboden entstehen kann, ist in den letzten Jahren durch ein besseres Verständnis der Konsequenzen, verbesserte Methoden der präzisen neurophysiologischen Untersuchung und einer zunehmend verbesserten Datenlage über die Prognose, deutlich gestiegen. Schwangerschaft und vaginale Geburt sind oft verantwortlich für den Beginn einer Belastungsharninkontinenz und eines Beckenbodenschadens. Die Mehrzahl der publizierten Daten basiert auf einer Analyse, die von Fragebögen stammt. Nur eine kleine Anzahl prospektiver Studien ist derzeit verfügbar, um die Einflüsse der Schwangerschaft und Geburt auf den Beginn einer Harn- oder Stuhlinkontinenz oder Störungen des Beckenbodens zu untersuchen. Longitudinale Studien wären notwendig, um die Langzeitfolgen der Schwangerschaft und Geburt auf den unteren Harntrakt und die Beckenbodenfunktion zu erheben.

Abstract

In the last years, due to a better understanding of consequences, better and more precise neurophysiological examinations and more conclusive clinical data on prognosis, the awareness increased that a vaginal delivery may result in damage to the pelvic floor. Pregnancy and vaginal delivery are mostly responsible for the beginning of stress urinary incontinence and injury to the pelvic floor. The majority of published data is based on analyses of questionnaires. Only few prospective studies are available which examine the influence of pregnancy and delivery on the beginning of urinary or stool incontinence or disturbances of the pelvic floor. Longitudinal studies are required to evaluate the long-term effects of pregnancy and delivery on the lower urinary tract and function of the pelvic floor.

Schlüsselwörter

Beckenboden - Schwangerschaft - Geburtsmodus - Prävention

Key words

Pelvic floor - pregnancy - mode of delivery - prevention

Literatur

1 Gainey H L. Postpartum observation of pelvic tissue damage. Am J Obstet Gynecol. 1943; 45 457-466

PubMed Search in Google Scholar
2 Foldspang A, Mommsen S, Lam G W, Elving L. Parity as a correlate of adult female urinary incontinence prevalence. J Epidemiol Community Health. 1992; 46 595-600

PubMed Search in Google Scholar
3 Chaliha C, Stanton S L. Urological problems in pregnancy. BJU Int. 2002; 89 469-476

Crossref PubMed Search in Google Scholar
4 Iosif S, Ingemarsson I, Ulmsten U. Urodynamic studies in normal pregnancy and in puerperium. Obstet Gynecol. 1980; 137 696-700

PubMed Search in Google Scholar
5 Tong Y, Wein A J, Levin R M. Effects of pregnancy and adrenergic function in the rabbit urinary bladder. Neurourol Urodyn. 1992; 11 525-533

PubMed Search in Google Scholar
6 Brown A DG. The effects of pregnancy on the lower urinary tract. Clin Obstet Gynaecol. 1978; 5 151-168

PubMed Search in Google Scholar
7 Francis W JA. Disturbances of bladder function in relation of pregnancy. J Obstet Gynecol Br Emp. 1960; 67 353-366

PubMed Search in Google Scholar
8 Schulman A, Herlinger H. Urinary tract dilatation in pregnancy. Br J Radiol. 1975; 48 638-645

PubMed Search in Google Scholar
9 Myers D L, Scotti R J. Acute urinary retention and incarcered, retroverted, gravid uterus. J Reprod Med. 1995; 40 487-490

PubMed Search in Google Scholar
10 Cutner A, Cardozo L D, Benness C J. Assessment of urinary symptoms in early pregnancy. Br J Obstet Gynaecol. 1991; 98 1283-1286

PubMed Search in Google Scholar
11 Sommer P, Bauer T, Nielsen K K, Kristensen E S, Hermann G G, Steven K, Nordling J. Voiding patterns and prevalence of incontinence in women. A questionnaire survey. Br J Urol. 1990; 66 12-15

PubMed Search in Google Scholar
12 Elving L B, Foldspang A, Lam G W, Mommsen S. Descriptive epidemiology of urinary incontinence in 3100 women age 30 - 59. Scand J Urol Nephrol. 1989; 125 37-43

PubMed Search in Google Scholar
13 Harrison G L, Memel D S. Urinary incontinence in women: its prevalence and its management in a health promotion clinic. Br J Gen Pract. 1994; 44 149-152

PubMed Search in Google Scholar
14 Burgio K L, Locher J L, Zyczynski H, Hardin J M, Singh K. Urinary incontinence during pregnancy in a racially mixed sample: characteristics and predisposing factors. Int Urogynecol J Pelvic Floor Dysfunct. 1996; 7 69-73

Crossref PubMed Search in Google Scholar
15 Simeonova Z, Bengtsson C. Prevalence of urinary incontinence among women at a Swedish primary health care centre. Scand J Prim Health Care. 1990; 8 203-206

PubMed Search in Google Scholar
16 Jolleys J V. Reported prevalence of urinary incontinence in women in a general practice. BMJ. 1988; 296 1300-1302

PubMed Search in Google Scholar
17 Yarnell J W, Voyle G J, Sweetnam P M, Milbank J, Richards C J, Stephenson T P. Factors associated with urinary incontinence in women. J Epidemiol Community Health. 1982; 36 58-63

PubMed Search in Google Scholar
18 Crist T, Shingleton H M, Koch G G. Stress incontinence and the nulliparous patient. Obstet Gynecol. 1972; 40 13-17

PubMed Search in Google Scholar
19 Thomas T M, Plymat K R, Blannin J, Meade T W. Prevalence of urinary incontinence. BMJ. 1980; 281 1243-1245

PubMed Search in Google Scholar
20 Faundes A, Guarisi T, Pinto-Neto A M. The risk of urinary incontinence of parous women who delivered only by cesarean section. Int J Gynaecol Obstet. 2001; 72 41-46

Crossref PubMed Search in Google Scholar
21 Kuh D, Cardozo L, Hardy R. Urinary incontinence in middle aged women: childhood enuresis and other lifetime risk factors in a British prospective cohort. J Epidemiol Community Health. 1999; 53 453-458

PubMed Search in Google Scholar
22 Rortveit G, Daltveit A K, Hundskaar S. Vaginal delivery parameters and urinary incontinence: the Norwegian EPINCONT study. Am J Obstet Gynecol. 2003; 189 1268-1274

Crossref PubMed Search in Google Scholar
23 Iosif C S, Ingemarsson I. Prevalence of stress incontinence among women delivered by elective cesarean section. Int J Gynaecol Obstet. 1982; 20 87-89

Crossref PubMed Search in Google Scholar
24 Hojberg K E, Salvig J D, Winslow N A, Lose G, Secher N J. Urinary incontinence: prevalence and risk factors at 16 weeks of gestation. Br J Obstet Gynaecol. 1999; 106 842-850

PubMed Search in Google Scholar
25 Danso K A, Martey J O, Wall L L, Elkins T E. The epidemiology of genitourinary fistulae in Kumasi, Ghana, 1977 - 1992. Int Urogynecol J Pelvic Floor Dysfunct. 1996; 7 117-120

Crossref PubMed Search in Google Scholar
26 Cardozo L, Cutner A. Lower urinary tract symptoms in pregnancy. Br J Urol. 1997; 80 14-23

PubMed Search in Google Scholar
27 Stanton S L, Kerr-Wilson R, Harris V G. The incidence of urological symptoms in normal pregnancy. Br J Obstet Gynaecol. 1980; 87 897-900

PubMed Search in Google Scholar
28 Hong P L, Leong M, Selzer V. Uroflowmetric observation in pregnancy. Neurourol Urodynam. 1988; 7 61-70

PubMed Search in Google Scholar
29 Parboosingh J, Doig A. Studies in nocturia in normal pregnancy. J Obstet Gynaecol Br Comw. 1973; 80 888-895

PubMed Search in Google Scholar
30 Abrams P, Cardozo L, Khoury S, Wein A. Incontinence. 3rd International Consultation on Incontinence. Plymouth, Mass; Health Publication Ltd 2005: 432-434

Search in Google Scholar
31 Peschers U M, Schaer G N, Delancey J O, Schuessler B. Levator ani function before and after childbirth. Br J Obstet Gynaecol. 1997; 104 1004-1008

PubMed Search in Google Scholar
32 Meyer S, Bachelard O, De G P. Do bladder neck mobility and urethral sphincter function differ during pregnancy compared with during the non-pregnant state?. Int Urogynecol J Pelvic Floor Dysfunct. 1998; 9 397-404

PubMed Search in Google Scholar
33 Jeffcoate T N, Roberts H. Observations on stress incontinence of urine. Am J Obstet Gynecol. 1952; 64 721-738

PubMed Search in Google Scholar
34 Schloßberger A, Liebemann A, Anthuber C, Hepp H. Morphologische und funktionelle Veränderungen des weiblichen Beckenbodens nach primärer und sekundärer Sectio caesarea. Geburtsh Frauenheilk. 2005; 65 383-388

Thieme Connect PubMed Search in Google Scholar
35 Green T H. Urinary stress incontinence: differential diagnosis, pathophysiology and management. Am J Obstet Gynecol. 1975; 122 368-400

PubMed Search in Google Scholar
36 Wijma J, Weis Potters A E, de Wolf B T, Tinga D J, Aarnoudse J G. Anatomical and functional changes in the lower urinary tract during pregnancy. Br J Obstet Gynecol. 2001; 108 726-732

Crossref PubMed Search in Google Scholar
37 Peschers U, Schaer G, Anthuber C, Delancey J O, Schuessler B. Changes in vesical neck mobility following vaginal delivery. Obstet Gynecol. 1996; 88 1001-1006

Crossref PubMed Search in Google Scholar
38 King J K, Freeman R M. Is antenatal bladder neck mobility a risk faktor for postpartum stress incontinence?. Br J Obstet Gynecol. 1998; 105 1300-1307

PubMed Search in Google Scholar
39 Reilly E T, Freeman R M, Waterfield M R, Waterfield A E, Steggles P, Pedlar F. Prevention of postpartum stress incontinence in primigravidae with increased bladder neck mobility: a randomised controlled trial of antenatal pelvic floor exercises. Br J Obstet Gynecol. 2002; 109 68-76

PubMed Search in Google Scholar
40 Delancey J OL. Structural support of the urethra as it relates to stress urinary incontinence: the Hammock hypothesis. Am J Obstet Gynecol. 1994; 170 1713-1723

PubMed Search in Google Scholar
41 Lange R, Walther D, Hundertmark S. Veränderungen des Beckenbodens in gravididate: Blasenhalstopografie und Muskelfunktionalität. Eine Longitudinalstudie. Geburtsh Frauenheilk. 2001; 61 970-976

Thieme Connect PubMed Search in Google Scholar
42 Howell C J. Epidural versus non-epidural analgesia for pain relief in labour (Cochrane Review). The Cochrane Library. Vol. 3. Oxford; Update Software 2003: CD000331

Search in Google Scholar
43 Sultan A H, Kamm M A, Hudson C N, Thomas J M, Bartram C I. Anal-sphincter disruption during vaginal delivery. New Engl J Med. 1993; 329 1905-1911

Crossref PubMed Search in Google Scholar
44 MacArthur C, Bick D E, Keighley M R. Faecal incontinence after childbirth. British Journal of Obstet Gynaecol. 1997; 104 46-50

PubMed Search in Google Scholar
45 Brown S, Lumley J. Maternal health after childbirth: results of an Australian population based survey. Br J Obstet Gynaecol. 1998; 105 156-161

PubMed Search in Google Scholar
46 Johanson R B, Heycock E, Carter J, Sultan A H, Walklate K, Jones P W. Maternal and child health after assisted vaginal delivery: five-year follow-up of a randomised controlled study comparing forceps and ventouse. Br J Obstet Gynaecol. 1999; 106 544-549

PubMed Search in Google Scholar
47 Eason E, Labrecque M, Wells G, Feldman P. Preventing perineal trauma during childbirth: a systematic review. Obstet Gynecol. 2000; 95 464-471

Crossref PubMed Search in Google Scholar
48 Abitbol M M. Birth and human evolution: anatomical and obstetrical mechanics in primates. Westport, CT; Bergin and Garvey 1997

Search in Google Scholar
49 Moerman M L. Growth of the birth canal in adolescent girls. Am J Obstet Gynecol. 1982; 143 528-532

PubMed Search in Google Scholar
50 Myers-Helfgott M G, Helfgott A W. Routine use of episiotomy in modern obstetrics. Should it be performed?. Obstet Gynecol Clin North Am. 1999; 26 305-325

Crossref PubMed Search in Google Scholar
51 Iosif S, Henriksson L, Ulmsten U. Postpartum incontinence. Urol Int. 1981; 36 53-58

PubMed Search in Google Scholar
52 Iosif S. Stress incontinence during pregnancy and in puerperium. Int J Gynaecol Obstet. 1981; 19 13-20

Crossref PubMed Search in Google Scholar
53 Viktup L, Lose G, Rolff M, Barfoed K. The symptom of stress incontinence caused by pregnancy or delivery in primiparas. Obstet Gynecol. 1992; 79 945-949

PubMed Search in Google Scholar
54 David M, Pachaly J, Vetter K. Die Episiotomie: Protektiv- oder Risikofaktor beim schweren Dammriss?. Geburtsh Frauenheilk. 2005; 65 604-611

Thieme Connect PubMed Search in Google Scholar
55 Sampselle C M, Miller J M, Mims B L, Delancey J O, Ashton-Miller J A, Antonakos C L. Effect of pelvic muscle exercise on transient incontinence during pregnancy and after birth. Obstet Gynecol. 1998; 91 406-412

Crossref PubMed Search in Google Scholar
56 Morkved S, Bo K. Effect of postpartum pelvic floor muscle training in prevention and treatment of urinary incontinence: a one-year follow-up. BJOG. 2000; 107 1022-1028

PubMed Search in Google Scholar
57 Salvesen K A, Morkved S. Randomised controlled trial of pelvic floor muscle training during pregnancy. BMJ. 2004; 329 378-380

Crossref PubMed Search in Google Scholar

Dr. Oliver Preyer

Medizinische Universität Wien
Universitätsklinik für Frauenheilkunde

Währinger Gürtel 18 - 20

1090 Wien

Österreich

Email: oliver.preyer@gmx.net