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The following is a summary of “Association between enlarged genital hiatus and prolapse with overactive bladder 1 year after vaginal delivery,” published in the April 2025 issue of American Journal of Obstetrics & Gynecology by Hendrickson et al. 

The association between genital hiatus enlargement, pelvic organ prolapse, and overactive bladder 5-10 years after the first delivery was established, but whether this relationship existed earlier in the postpartum period remained unknown.   

Researchers conducted a retrospective study to explore the association between overactive bladder within 1 year after the first vaginal delivery and enlarged genital hiatus, anatomic pelvic organ prolapse, and bulge symptoms.   

They analyzed data from primiparous women with singleton term vaginal deliveries who completed symptom questionnaires and physical exams at the 3rd trimester, 8 weeks, and 1 year postpartum. Overactive bladder was defined as the presence of urinary urgency, plus urinary frequency, nocturia, or urgency incontinence (Epidemiology of Prolapse and Incontinence Questionnaire (EPIQ)). Genital hiatus was considered enlarged if > 4 cm, and pelvic organ prolapse was defined as vaginal descent at or beyond the hymen. Poisson regression was used to assess associations between overactive bladder, genital hiatus, and pelvic organ prolapse at 1 year postpartum.   

The results showed that among 579 participants with a mean age of 29 years and 17% Hispanic, both enlarged genital hiatus and pelvic organ prolapse at 1 year postpartum were linked to a higher prevalence of overactive bladder (genital hiatus: adjusted risk ratio 1.5, 95% CI 1.1-2.1; pelvic organ prolapse: adjusted risk ratio 1.8, 95% CI 1.2-2.6). These associations were more pronounced in women older than 30 years (genital hiatus: adjusted risk ratio 2.1, 95% CI 1.3-3.4; pelvic organ prolapse: adjusted risk ratio 2.2, 95% CI 1.3-3.7) and were not significant in women younger than 30 years.   

Investigators concluded that an enlarged genital hiatus and pelvic organ prolapse at 1 year postpartum was associated with an overactive bladder at the same time point, especially in women older than 30, suggesting that genital hiatus size might indicate impaired pelvic floor function that elevates the risk of both conditions early after delivery. 

Source: ajog.org/article/S0002-9378(25)00226-1/abstract