Prolapse, Urinary Incontinence, Childbirth Injuries

Unfortunately, many feel that childbirth injuries are difficult to talk about or that others may not understand their concerns. However, it is important to emphasize that there are treatments that can alleviate the problems. Seeking help and advice from specialists is crucial to accurately assess the symptoms and subsequently recommend the right treatment.

During a vaginal delivery, approximately 8 out of 10 women experience some form of childbirth tear, but most heal on their own and do not cause any lasting issues. If the childbirth tear heals with defects, it can lead to a childbirth injury that may cause problems.

Tears are common and are usually classified into four different degrees.

Grade 1 involves a tear in the skin and mucous membrane.

Grade 2 is a tear in the mucous membrane and the underlying muscle attachment in the perineum.

Grade 3 and 4 occur in approximately 3.5 percent of vaginal deliveries and describe different degrees of damage to the anal sphincter and surrounding tissues.

Injuries to the levator muscles, side muscles in the pelvic floor, are also relatively common.

Levator injuries occur in approximately 10-15% of vaginal deliveries in first-time mothers. The levator muscle is stretched to three times its own length during a vaginal delivery, and sometimes there is a tearing of the muscle's attachment from the pubic bone, known as an avulsion injury.

A levator injury can occur on one side or both, and the injury is classified into microtraumas, meaning stretches/small tears, or macrotraumas, which involve a complete tear of the muscle. Those with small tears often heal within a year, while others may experience lasting damage, with or without symptoms. A levator injury is often challenging to assess immediately after childbirth because it is not visible to the naked eye.

Risk factors for a levator injury are the same as for significant tearing, including the use of vacuum extraction, a large baby, and a prolonged second stage of labor. However, a levator injury can also occur when the delivery is too fast. With a levator injury, one may experience pain in the pelvic floor, especially during pelvic floor exercises.

Prolapse involves a weakening of the vaginal support tissue, resulting in something bulging out of the vaginal opening.

It can be the uterus and/or vaginal walls. Symptoms of prolapse may also include difficulty emptying the bladder, urinary urgency, difficulty emptying the bowels, constipation, or discomfort in the pelvic area. Often, the sensation is less noticeable upon waking and increases later in the day when the body has been subjected to gravity and various forms of stress.

A constant bulging/heaviness sensation usually gradually decreases after a few months postpartum. Sometimes, a tense pelvic floor can cause various symptoms such as a heavy feeling and pain, leading one to interpret it as a prolapse sensation. However, unlike prolapse, which is influenced by exertion and rest, a tense pelvic floor tends to feel more constant and can be aggravated by stress/anxiety/fear, as the pelvic floor muscles quickly respond to these emotions.

Some injuries that occur during childbirth require more than pelvic floor exercises for the pelvic floor to regain its previous function. In such cases, surgery may be considered. The procedure is typically performed in day surgery, under local anesthesia or general anesthesia. If you require surgical treatment, you can undergo surgery in our operating department in Stockholm.

It is common to feel unwell if you have issues that persist long after childbirth. Often, it can be sensitive to talk about these problems.

It can also be challenging to get understanding for your issues. Many hear from various sources that this is how giving birth is, that the pelvic area changes. You may hear that it's natural to leak urine or that everyone who has given birth farts when they cough. But it doesn't have to be this way.