***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: OBJECTIVE : This study aim ed to assess the associations between parity , mode of delivery , and pelvic floor disorders . METHODS : The prevalence of pelvic organ prolapse , stress urinary incontinence , overactive bladder , and anal incontinence was assessed in a r and om sample of women aged 25–84 years by using the vali date d Epidemiology of Prolapse and Incontinence Question naire . Women were categorized as  nulliparous , vaginally parous , or only delivered by cesarean .  Adjusted odds ratios and 95 % confidence intervals ( CIs ) for each disorder were calculated with logistic regression , controlling for age , body mass index , and parity . RESULTS : In the 4,458 respondents the prevalence of each disorder was as follows : 7 % prolapse , 15 % stress urinary incontinence , 13 % overactive bladder , 25 % anal incontinence , and 37 % for any one or more pelvic floor disorders . There were no significant differences in the prevalence of disorders between the cesarean delivery and nulliparous groups . The adjusted odds of each disorder increased with vaginal parity compared with cesarean  delivery : prolapse = 1.82 ( 95 % CI 1.04–3.19 ) , stress urinary incontinence = 1.81 ( 95 % CI 1.25–2.61 ) , overactive bladder = 1.53 ( 95 % CI 1.02–2.29 ) , anal incontinence = 1.72 ( 95 % CI 1.27–2.35 ) , and any one or more pelvic floor disorders = 1.85 ( 95 % CI 1.42–2.41 ) . Number-needed-to-treat analysis revealed that 7 women would have to deliver only by cesarean delivery to prevent one woman from having a pelvic floor disorder . CONCLUSION : The risk of pelvic floor disorders is independently associated with vaginal delivery but not with parity alone . Cesarean delivery has a protective effect , similar to nulliparity , on the development of pelvic floor disorders when compared with vaginal delivery . LEVEL OF EVIDENCE : OBJECTIVES : To investigate whether postpartum fecal incontinence is less common in women who had a cesarean delivery  and more common in women who had an operative vaginal birth  compared with women who had a spontaneous vaginal birth for their first newborn , and whether postpartum fecal incontinence is more common in women who report intimate-partner violence . METHODS : This was a multicenter , prospect i ve , nulliparous pregnancy cohort ( n=1,507 ) using st and ardized measures to assess frequency and severity of fecal incontinence in pregnancy and at 3 , 6 , 9 , and 12 months postpartum . RESULTS : Approximately 17 % reported fecal incontinence at some point in the first 12 months postpartum , with 12.8 % reporting fecal incontinence beyond the first 3 months postpartum . Fecal incontinence at 4 to12 months postpartum was significantly more common among women who had experienced emotional violence , physical violence , or both in the first 12 months postpartum ( 18.8 % compared with 11.5 % , adjusted odds ratio [ OR ] 1.62 , 95 % confidence interval [ CI ] 1.05–2.50 ) . Compared with  spontaneous vaginal birth , cesarean delivery  ( 13.1 % compared with 11.3 % , adjusted OR 0.99 , 95 % CI 0.65–1.53 ) , and  operative vaginal birth ( 15.0 % compared with 11.3 % , adjusted OR 1.33 , 95 % CI 0.86–2.07 ) did not significantly alter the likelihood of fecal incontinence beyond the first 3 months postpartum . CONCLUSION : Underst and ing causal pathways for postpartum fecal incontinence requires attention to the interplay of pregnancy and birth events and upstream factors such as intimate-partner violence . This has implication s for how clinicians present evidence and discuss risks associated with vaginal birth and cesarean delivery . In this nulliparous cohort , method of birth was not a major determinant of fecal incontinence status beyond 3 months postpartum . LEVEL OF EVIDENCE : Background This study was carried out to identify risk factors associated with urinary incontinence in women three months after giving birth . Methods Urinary incontinence before and during pregnancy was assessed at study enrolment early in the third trimester . Incontinence was re-assessed three months postpartum . Logistic regression analysis was used to assess the role of maternal and obstetric factors in causing postpartum urinary incontinence . This prospect i ve cohort study in 949 pregnant women in Quebec , Canada was nested within a r and omised controlled trial of prenatal perineal massage . Results Postpartum urinary incontinence was increased with prepregnancy incontinence ( adjusted odds ratio [ adj0R ] 6.44 , 95 % CI 4.15 , 9.98 ) , incontinence beginning during pregnancy ( adjOR 1.93 , 95 % CI 1.32 , 2.83 ) , and higher prepregnancy body mass index ( adjOR 1.07/unit of BMI , 95 % CI 1.03,1.11 ) .  Caesarean section  was highly protective ( adjOR 0.27 , 95 % CI 0.14 , 0.50 ) . While there was a trend towards increasing incontinence with forceps delivery ( adjOR 1.73 , 95 % CI 0.96 , 3.13 ) this was not statistically significant . The weight of the baby , episiotomy , the length of the second stage of labour , and epidural analgesia were not predictive of urinary incontinence . Nor was prenatal perineal massage , the r and omised controlled trial intervention . When the analysis was limited to women having their first vaginal birth , the same risk factors were important , with similar adjusted odds ratios . Conclusions Urinary incontinence during pregnancy is extremely common , affecting over half of pregnant women . Urinary incontinence beginning during pregnancy roughly doubles the likelihood of urinary incontinence at 3 months postpartum , regardless whether delivery is vaginal or by Caesarean section STUDY OBJECTIVE : To investigate the prevalence and lifetime risk factors for  urinary incontinence in middle aged women . DESIGN : Nationally representative birth cohort study with prospect i ve data on childhood enuresis , measured adult height and weight , childbearing histories and measures of socioeconomic status up date d at regular contacts , and measures of menopausal status , symptomatology and health care in midlife . SETTING : Engl and , Scotl and and Wales . PARTICIPANTS : General population sample of 1333 women aged 48 years . MAIN RESULTS : Fifty per cent reported symptoms of stress incontinence and 22 % reported symptoms of urge incontinence in the previous year . Eight per cent had severe symptoms . Women who at age 6 years had wet in the day or several nights a week were more likely to suffer severe incontinence and report urge symptoms but occasional bedwetting was not associated with an increased risk in adult life . Those who were older at the birth of their children and who had vaginal deliveries had an excess risk of stress symptoms . Heavier adult body weight was also a risk factor for these symptoms and for severe incontinence . Postmenopausal women were less likely to report stress symptoms . These risk factors remained significant after taking account of the increased reporting of incontinence among women with high levels of general symptomatology and general practitioner visits , and of stress symptoms among better educated women . CONCLUSIONS : Urinary incontinence is a common problem among middle aged women . This is the first prospect i ve study of a general population sample to support the postulated link between childhood enuresis and adult incontinence . Child-bearing has long term adverse effects , particularly for older mothers . Overweight is a common risk factor The purpose of this study was to evaluate pelvic organ support during pregnancy and following delivery . This was a prospect i ve observational study .  Pelvic organ prolapse quantification ( POPQ ) examinations  were performed during each trimester of pregnancy and in the postpartum . Statistical comparisons of POPQ stage and of the nine measurements comprising the POPQ between the different time intervals were made using Wilcoxon ’s signed rank and the paired t-test . Comparison of POPQ stage by mode of delivery was made using Fisher ’s exact test . One hundred thirty-five nulliparous women underwent 281 pelvic organ support evaluations .  During both the third trimester and postpartum , POPQ stage was significantly higher compared to the first trimester ( p<0.001 ) . In the postpartum , POPQ stage was significantly higher in women delivered vaginally compared to women delivered by cesarean ( p=0.02 ) . In nulliparous pregnant women , POPQ stage appears to increase during pregnancy and does not change significantly following delivery . In the postpartum , POPQ stage may be higher in women delivered vaginally compared to women delivered by cesarean OBJECTIVE This study was undertaken to compare maternal outcomes at 2 years postpartum after planned cesarean section and planned vaginal birth for the singleton fetus in breech presentation at term . STUDY DESIGN In selected centers in the Term Breech Trial , mothers completed a structured question naire at 2 or more years postpartum to determine their health in the previous 3 to 6 months . RESULTS A total of 917 of 1159 ( 79.1 % ) mothers from 85 centers completed a follow-up question naire at 2 years postpartum . There were no differences between groups in breast feeding , relationship with child or partner , pain , subsequent pregnancy , incontinence , depression , urinary , menstrual or sexual problems , fatigue , or distressing memories of the birth experience . Planned cesarean section was associated with a higher risk of constipation ( P = .02 ) . CONCLUSION Maternal outcomes at 2 years postpartum are similar after planned cesarean section and planned vaginal birth for the singleton breech fetus at term OBJECTIVE The purpose of this study was to determine the relative effects of pregnancy and mode of delivery on the prevalence of urinary and fecal incontinence . STUDY DESIGN This was a prospect i ve , observational multicenter study of women presenting to 6 gynecology clinics . Demographic data collected included : height , weight , gravidity , parity , and number of vaginal deliveries . Patients were diagnosed with incontinence by question naire . St and ard univariate logistic regression analyses ' were performed to determine the contribution of pregnancy , mode of delivery , and BMI on the prevalence of urinary and fecal incontinence . RESULTS One thous and and four women were enrolled over an 18-month period . Two hundred and thirty-seven and 128 subjects had urinary and fecal incontinence , respectively . Odds ratio ( 95 % CI ) calculated for the prevalence of urinary incontinence by pregnancy and mode of delivery were : any term pregnancy vs no term pregnancy was 2.46 ( 1.53 - 3.95 ) , any term pregnancy but no vaginal deliveries ( cesarean section only ) vs no term pregnancy was 1.95 ( 0.99 - 3.80 ) , any term pregnancy and at least 1 vaginal delivery vs no term pregnancy was 2.53 ( 1.57 - 4.07 ) , and any term pregnancy but no vaginal delivery ( cesarean section only ) vs any term pregnancy , and at least 1 vaginal delivery was 1.30 ( 0.77 - 3.95 ) . Odds ratio ( 95 % CI ) calculated for the prevalence of fecal incontinence by pregnancy and mode of delivery were : any term pregnancy vs no term pregnancy was 2.26 ( 1.22 - 4.19 ) , any term pregnancy but no vaginal deliveries ( cesarean section only ) vs no term pregnancy was 1.13 ( 0.43 - 2.96 ) , any term pregnancy and at least 1 vaginal delivery vs no term pregnancy was 2.41 ( 1.30 - 4.49 ) , and any term pregnancy but no vaginal deliveries ( cesarean section only ) vs any term pregnancy , and at least 1 vaginal delivery was 2.15 ( 0.97 - 4.77 ) . BMI and age did not impact these results . CONCLUSION Pregnancy increases the risk of urinary and fecal incontinence . Cesarean section does not decrease the risk of urinary or fecal incontinence compared to pregnancy with a vaginal delivery Objective To evaluate the long term effect of a postpartum pelvic floor muscle training course in prevention and treatment of urinary incontinence We compared the prevalence and risk of lower urinary tract symptoms in healthy primiparous women in relation to vaginal birth or elective cesarean section  9 months after delivery . We performed a prospect i ve controlled cohort study including 220 women delivered by elective cesarean section and 215 by vaginal birth .  All subjects received an identical question naire on lower urinary tract symptoms in late pregnancy , at 3 and 9 months postpartum . Two hundred twenty subjects underwent elective cesarean section , and 215 subjects underwent vag 
    Output:
    
RESULTS Compared to vaginal delivery , caesarean section appears to protect against urinary incontinence , but the effect decreases after patients reach their fifties .
The risk of pelvic organ prolapse increases ( dose-response effect ) with the number of vaginal deliveries compared to caesarean sections .
There are few reliable studies on the association between mode of delivery and anal incontinence , but meta-analyses may indicate that caesarean section does not offer protection after the postpartum period .
Women with previous anal sphincter rupture during vaginal delivery are a sub-group with an elevated risk of anal incontinence .
The degree of severity of pelvic floor dysfunction is frequently unreported in the literature .
INTERPRETATION The prevalence of urinary incontinence and pelvic organ prolapse is lower in women who have only delivered by caesarean section  than in those who have delivered vaginally .
For urinary incontinence this difference appears to level out with increasing age .
There is no basis for identifying sub-groups with a high risk of pelvic floor injury , with the exception of women who have previously had an anal sphincter rupture .
Caesarean section will have a limited primary preventive effect on pelvic floor dysfunction at a population level