Women have the highest risks for stress urinary incontinence (SUI) surgery and pelvic organ prolapse (POP) surgery after their first vaginal childbirth, according to new study findings presented at the International Continence Society’s 2022 annual meeting (ICS 2022) in Vienna, Austria.  

Using the 2010-2017 Swedish National Quality Register of Gynecological Surgery, investigators identified 59,415 women aged 45 years and older who had SUI or POP surgery. The vast majority of women who underwent SUI surgery (93.1%) had 1 or more vaginal deliveries, whereas just 2.6% had C-sections, and 4.3% were never pregnant. POP surgery showed a similar pattern: 97.8% of patients had 1 or more vaginal deliveries, whereas 0.4% had C-sections, and 1.9% were never pregnant.

The vaginal delivery group had a significant 22% and 28% higher risk for SUI and POP surgery, respectively, compared with the age-matched general female population, Jennie Larsudd-Kåverud, MD, of Gothenberg Continence Research Center at the University of Gothenberg in Sweden reported on behalf of her team. In contrast, the never-pregnant and C-section groups had significant 69% and 74% lower risks for SUI surgery and 26% and 99.6% lower risks for POP surgery, respectively.

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In absolute terms, the risk for POP surgery was highest in the vaginal delivery group (2.1%) and lowest in the C-section group (0.09%) – a 23-fold difference.

The first vaginal delivery carried the highest absolute risks: a 6.0-fold increased risk for POP surgery and a 3.0-fold risk of SUI surgery. Compared with the first vaginal delivery, the second vaginal birth carried a quarter of the risk for POP surgery and a tenth of the risk for SUI surgery.

“The result of the present study did not support the assumption that one or more pregnancies in themselves may cause long-term effects on the pelvic floor leading to POP and SUI surgery,” Dr Larsudd-Kåverud concluded in a study abstract.

Disclosure: Some study authors declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of authors’ disclosures.


Larsudd-Kåverud J, Gyhagen J, Åkervall S, et al. The influence of pregnancy, parity, and mode of delivery on the risk of urinary incontinence and prolapse surgery – a national register study. Presented at ICS 2022; September 7-10, Vienna, Austria. Abstract 71.