Association between breastfeeding and pelvic floor dysfunction: a systematic review

This systematic review evaluates the association between breastfeeding and pelvic floor (dys)function. Since breastfeeding has well-known positive effects, exclusive breastfeeding is recommended for the first 6 months after birth. At the same time, the postpartum period is the period in which mothers recover from pregnancy and delivery. It has been hypothesized that breastfeeding can negatively affect pelvic floor regeneration by sustaining a hypoestrogenic state. Considering the health benefits of both breastfeeding and optimal pelvic floor recovery, the association between the two was assessed. PubMed and Cochrane CENTRAL library were searched on the 29th of November 2023. Studies on the association between breastfeeding and pelvic floor (dys)function were included. The results were grouped into five domains: (1) dyspareunia, (2) urinary incontinence (UI), (3) pelvic organ prolapse (POP), (4) anal incontinence (AI), and (5) pelvic floor muscles function (PFMF). A qualitative synthesis of the results was performed. Nineteen studies were retrieved for dyspareunia, eight for UI, two for POP and AI, and three for PFMF. Fourteen studies showed a significant association between breastfeeding and dyspareunia, with a greater risk of dyspareunia in the breastfeeding group. The studies on UI, POP and AI, and PFMF reported conflicting results. A meta-analysis was not performed due to heterogeneity among studies. The available literature shows an association between breastfeeding and postpartum dyspareunia. However, no causal relation can be inferred. In the case of symptoms, women should be informed of the multifactorial nature of dyspareunia and of the benefits of breastfeeding. The association of breastfeeding with UI, POP and AI has not been established. Any advice to discontinue breastfeeding because of these symptoms is not supported by scientific evidence.