PELVIC FLOOR DYSFUNCTION IN THE POSTPARTUM PERIOD  PREVENTION MANAGEMENT

Pelvic floor dysfunction is a disorder in the physiologic function of the pelvic floor muscles around the bladder, vagina and anal canal that affects the ability of the pelvic floor muscles to control and coordinate. Pelvic floor dysfunction includes urinary incontinence, fecal incontinence, pelvic organ prolapse and sexual dysfunction. Age, ethnicity, history of pelvic surgery, chronic cough, obesity, spinal cord disorders, family history and genetics are among the most common identifiable risk factors for the development of pelvic floor dysfunction.

One of the factors negatively affecting pelvic floor dysfunction is obstetric history. Pregnancy and labor are the most important risk factors for pelvic floor dysfunction. Parity, labor, episiotomy and perineal tear, prolonged second stage of labor and fetus-related factors are among the factors affecting pelvic floor dysfunction. 

Considering that pregnancy and obstetric conditions are risk factors for pelvic floor dysfunction, it is very important for pregnant women to receive prenatal care to prevent pelvic floor dysfunction. When the prevention management of urinary incontinence, fecal incontinence, pelvic organ prolapse and sexual dysfunction as pelvic floor dysfunction is evaluated separately; in urinary incontinence, the trauma management of the head pressing on the urethra should be done very well and the second stage should not be kept too long. As lifestyle interventions, attention should be paid to fluid intake, weight gain and smoking. In the management of fecal incontinence prevention, obstetric interventions such as episiotomy, perineal trauma, instrumental delivery, especially during the delivery process may cause the development of fecal incontinence in the postpartum period. In the management of fecal incontinence, restrictive application of episiotomy, support of the perineum, massage and warm application to the perineum, pelvic floor muscle exercise at the end of labor, smoking, and prevention of constipation are recommended. The birth process affects sexual dysfunction the most. Correct birth management, postpartum family planning and pelvic floor muscle exercises are among the interventions to prevent sexual dysfunction. In the management of prevention of pelvic organ prolapse, heavy lifting should be avoided and exercise should be performed at low to moderate intensity. If postpartum POP develops, a waiting period of several months is recommended due to the healing and tissue remodeling process.  Pelvic floor dysfunction in the postpartum period can be prevented with adequate prenatal care, interventions in the intrapartum period and lifestyle changes in the postpartum period. In this review, interventions to prevent pelvic floor dysfunction in the postpartum period were examined in line with the literature.