Though vaginal birth is considered the most natural means of having a baby, the associated pelvic floor dysfunctions that women could suffer as a result often go unrecognised. It is estimated that as many as 60% of women will suffer some degree of pelvic floor dysfunction following vaginal birth. These problems are often related to difficult vaginal births from: prolonged second stage of labour, large babies, multiple vaginal births and the use of forceps to facilitate vaginal birth among others. Some of the problems women complain about as result include the following:
Some of the complaints listed above could take as much as 20 years or more to become bothersome. (Reference: See Dr Ben’s published paper below).
“The prevalence of urinary incontinence 20 years after childbirth: a national cohort study in singleton primiparae after vaginal or caesarean delivery.” Onyeka BA……British journal of obstetrics and gynaecology. 2013 Aug; 120(9):1150.
The pelvic floor muscles and tissues are made up of materials that are elastic and therefore stretch to accommodate the baby during its passage through the birth canal and vagina. Following vaginal birth however, the vagina/pelvic floor tissues may become hyper stretched and not fully spring back to their original state. In addition to the over-stretching of pelvic floor and vaginal tissues, the process of vaginal birth which includes pressure from the baby, may compress and compromise the function of the main pelvic floor nerve (pudendal nerve) during the baby’s passage along the birth canal. This happens with or without any associated tear or physical injury during vaginal birth.
These problems are sometimes amenable to conservative care: pelvic floor exercise, insertion of vaginal pessaries and other life style changes. However when these measures fail to control the symptoms, surgical repair could be an option for women to consider. Some women however do not take further action following failure of conservative measures, in part due to lack of awareness in regards to what surgery might entail or what to expect from such surgery.
Most of these surgical repairs have become simple procedures that can be performed through the vagina and with good results. The type of surgery would depend on the concern(s) of the patient. The surgery includes: reduction of excessive vaginal tissue, tightening of the vaginal tissue, lifting up the central aspects of the urethral with sling to stop leakage of urine, supporting of the top (apex) of the vagina amongst other procedures. Dr Ben has pioneered a successful and simple method of vaginal repair as a one-day procedure, with high patients’ satisfaction rate (100%) (see reference below).
The Onyeka haemostatic suture technique: A novel technique of vaginal and perineal skin closure that facilitates pelvic floor repair as a day-case procedure. Onyeka B et al Presented at the ICS/IUGA international scientific conference Toronto Canada 25th August 2010.
Before surgery, it may be necessary to perform an initial test called urodynamics, especially where urinary incontinence is present. This is a computerised bladder function test that takes around 40 mins to complete. It is not a painful procedure and involves filling up the bladder with fluid (saline) through the urethra. It helps to determine the reason(s) behind the incontinence and also the best operation or combination of operations that would best benefit the patient. Dr Ben is a certified urodynamicist and has published research papers in urodynamics investigation. He received additional training in urodynamics, urology and surgery during his training years in the UK and was a trainer of specialist doctors in urodynamics on behalf of the RCOG (London, UK).
There is no reason why any woman should put up with these symptoms if conservative management has failed.