Does breastfeeding affect the pelvic floor?
Claudia Manzini, MD PhD (TNW-M3i, Women’s Health), Mart Kortman, MSc (TNW-M3i), Nienke Bosschaart, PhD Prof (BMPI, Women’s Health), Anique Grob, PhD Asst Prof (TNW-M3i, Women’s Health).
Abstract
Introduction Vaginal delivery is a major risk factor for pelvic floor disorders (PFD) including urinary incontinence (UI), pelvic organ prolapse (POP), anal incontinence (AI) and dyspareunia (painful sexual intercourse). PFD recovery is known to occur during the postpartum period, however the factors influencing the recovery are not known. A study in mice showed that an insufficiency of the female hormone estrogen (hypoestrogenic state) affects muscle strength and regeneration. Our hypothesis is that breastfeeding negatively influences the pelvic floor recovery process.
Objective Summarize through a systematic review the available literature on the effect of breastfeeding on PFD.
Methods PubMed and Cochrane CENTRAL library were searched in November 2023. The studies retrieved were screened by title, abstract and full text by two authors independently from each other. Studies on the effect of breastfeeding on PFD were included and the risk of bias was assessed using the Newcastle-Ottawa Scale (NOS). A qualitative synthesis of the results was made.
Results Twenty-eight studies were included. The mean NOS score was 5.7, which indicate a fair to good quality. Nineteen papers assessed the effect of breastfeeding on dyspareunia and the majority showed a significant correlation. Very few studies were retrieved on UI, POP and AI with varying results.
Conclusion Breastfeeding has a negative impact on postpartum dyspareunia. Knowledge on the effect of breastfeeding on UI, POP and AI is lacking. Based on the current evidence and the significant benefits of breastfeeding for maternal and infant health, women with postpartum PFD should not be discouraged to breastfeed.