Body image and pelvic floor dysfunction in pregnancy and postpartum: A prospective one-year follow-up cohort study

ObjectiveTo determine the prevalence of pelvic floor dysfunction (PFD) among pregnant women, their clustering and their association with body image disturbance (BID) up to 1 year postpartum.DesignMonocentric prospective cohort study.SettingUniversity Hospitals Leuven.PopulationPregnant women attending for pregnancy care, first assessed prior to 14 weeks of gestation and agreeing to follow-up until 1 year postpartum.MethodsStandardised questionnaires reporting on PFD and BID at 12-14 and 28-32 weeks of gestation, and again at 6-8 weeks and 1 year postpartum. We calculated the prevalence of PFD, how the cases clustered and how the cases correlated with BID using a linear mixed-model analysis. A minimum of 174 women with complete follow-up were required.Main Outcome MeasuresThe questionnaires used were the International Consultation on Incontinence Questionnaire - Urinary Incontinence Short Form (ICIQ-UI SF), St. Mark's Incontinence Score (SMIS), Patient Assessment of Constipation Symptoms (PAC-SYM), Pelvic Organ Prolapse Distress Inventory (POPDI), Pelvic Organ Prolapse/Incontinence Sexual Questionnaire IUGA Revised (PISQ-IR) and the Body Image Disturbance Questionnaire (BIDQ).ResultsOut of 208 women, 92.8% reported one or multiple symptoms of PFD at 28-32 weeks of gestation, dropping to 73.6% by 1 year postpartum. The most common symptoms were constipation (65.3% at 28-32 weeks of gestation and 42.8% at 1 year postpartum) and urinary incontinence (56.8% at 28-32 weeks of gestation and 35.1% at 1 year postpartum). After correcting for body mass index, parity and mode of delivery, the severity of BID was associated with the ICIQ-UI SF score (beta = 0.016, range 0.007-0.024), the PAC-SYM score (beta = 0.006, range 0.002-0.011) and the POPDI score (beta = 0.009, range 0.005-0.012), but not with the SMIS score (beta = 0.015, range -0.001 to 0.031) or the PISQ-IR score, in sexually active women.ConclusionsUrinary incontinence, constipation and symptoms of prolapse have a measurable impact on BID.