Peripartum Pelvic Floor Disorders

This review summarizes the pathophysiology, clinical presentation, and evidence-based management of pelvic floor disorders (PFDs) during pregnancy, birth, and the postpartum period. It highlights current knowledge on prevention, diagnosis, treatment, and long-term outcomes, with particular focus on urinary incontinence, fecal incontinence, pelvic organ prolapse, and perineal wound-related complications. Pregnancy induces hormonal and mechanical changes that predispose to PFDs, including urinary incontinence, fecal incontinence, and pelvic organ prolapse. Vaginal birth, especially with operative assistance and/or resulting in obstetric anal sphincter injury (OASI), significantly increases the risk of long-term pelvic floor dysfunction. Preventative strategies—such as antenatal perineal massage, pelvic floor muscle training (PFMT), perineal application of warm compresses in labor, manual perineal protection during birth, and restricted use of episiotomy—can reduce severe lacerations and future PFDs. Conservative postpartum management of PFDs includes PFMT, biofeedback, pessaries; and newer digital tools may improve adherence and outcomes. Although surgical interventions are typically delayed until after childbearing, emerging evidence supports select procedures even if future childbearing is desired. Myofascial pain and wound complications require tailored management with physical therapy and, in some cases, local injections. Counseling on subsequent mode of birth after prior OASI remains individualized. Pelvic floor disorders are common and often underrecognized sequelae of pregnancy and childbirth. Optimizing prevention and early postpartum care can reduce symptom burden and improve quality of life. Individualized counseling, shared decision-making, and multidisciplinary management are essential to address the complex interplay of delivery-related injury, pelvic floor dysfunction, and patient goals.