Vaginal Delivery and Organ Prolapse:
Is There a Connection?

Some women are encouraged to deliver their baby by an elective Caesarean section, because their doctors worry that a vaginal delivery will lead, later in life, to a condition called pelvic organ prolapse.

Prolapse occurs when the bladder, uterus or lower bowel falls from its normal position in the body into the vaginal area. A common effect of the condition is urinary incontinence. Every year, more than 200,000 women have surgery to correct prolapse and other pelvic floor disorders.

Whether vaginal delivery actually causes this condition has been hotly debated in the medical community. In a recent study, Medical School researchers found a strong connection between muscle damage that can occur during vaginal deliveries and pelvic organ prolapse. Rates of muscle injury were particularly high when forceps were used to assist delivery, according to John O.L. DeLancey, M.D., the Norman F. Miller Professor of Obstetrics and Gynecology.

Fifty-five percent of women in the study with prolapse were found to have major damage to the levator ani muscle, which supports the bladder and uterus, compared to just 16 percent of women without prolapse. When women were asked to contract their pelvic muscles, the muscles were 40 percent weaker in women with prolapse.

However, DeLancey cautions against using the findings to support more elective C-sections. He says study results should be used to help identify how women are injured during vaginal birth in an effort to make it safer.

—Katie Gazella

For an expanded version of the story:
www.med.umich.edu/opm/newspage/2007/prolapse.htm

For patient information on pelvic organ prolapse:
www.med.umich.edu/1libr/aha/umpelvicpro.htm