The impact of breastfeeding on pelvic floor recovery from pregnancy and labor

Objective: Pelvic floor dysfunction (PFD) symptoms are prevalent during pregnancy and are mostly reversible thereafter. The pelvic floor muscles and their surrounding connective tissue support are estrogen-responsive. Breastfeeding is a condition of estrogen deficiency. We hypothesized that in breastfeeding women there may be a slower spontaneous recovery of PFD symptoms following birth. We aimed to determine the impact of breastfeeding on recovery from gestational PFD symptoms.

Methods: We conducted a prospective cohort study of women who gave birth at the Soroka University Medical Center, Beer-Sheva, Israel. Those who have consented completed the Pelvic Floor Distress Inventory-20 (PFDI-20), after delivery and three months postpartum. Breastfeeding status was evaluated three months after delivery. Clinical and obstetrical characteristics were retrieved from the participants' medical records.

Results: A total of 119 women had completed the PFDI-20 after delivery and three months postpartum. We found a significant difference between PFD during pregnancy, and PFD three months postpartum (P < 0.001). The overall PFDI-20 score was significantly decreased from a scale score of 64 to 27 (delta 36, P < 0.001), and this decrease remained significant for all components of the PFDI-20: pelvic organ prolapse distress (delta 14, P < 0.001); colorectal and anal dysfunction (delta 3.9, P = 0.01); and urinary dysfunction (delta 18, P < 0.001). No significant differences were noted in the extent of recovery of PFD symptoms between women who did and did not breastfeed (P = 0.59).

Conclusions: There is a clinical and statistically significant spontaneous recovery from gestational PFD symptoms at three months postpartum. Women with PFD symptoms prior to or during pregnancy can be reassured that breastfeeding probably does not delay the pelvic floor recovery.