64: Pelvic floor disorders and psychiatric diagnoses: Are they related?

Abstract

To identify the prevalence of psychiatric diagnoses in a Female Pelvic Medicine and Reconstructive Surgery (FPMRS) clinic population and to determine if associations exist between these diagnoses and pelvic floor disorders (PFDs). We retrospectively reviewed de-identified medical records for all new patients who presented to the FPMRS clinic from 2007-2013. Urogynecologic and psychiatric diagnoses were identified by ICD-9 codes. Statistical analysis of patients with various PFDs was performed comparing those patients with and without psychiatric diagnoses. Chi-square was used for categorical data and Student’s t-test or Mann-Whitney U test were utilized for continuous data. Backwards multivariate logistic regression was also performed to identify those variables related to PFDs significantly correlated with having a psychiatric diagnosis. A total of 6,461 women were seen in the FPMRS clinic during this time. Patients had a mean age of 60.8 ± 16.3 years and most were white (58%). Half (50%) carried at least one comorbid psychiatric diagnosis. The number of psychiatric diagnoses in those affected ranged from 1-11 with a median of 3. The majority (75%) of patients had more than one PFD diagnosed with a median of 3 (range = 1-14). High-tone pelvic floor/painful bladder syndrome (PBS), overactive bladder (OAB), fecal incontinence (FI), and neurogenic bladder were each associated with having a psychiatric diagnosis on multivariate logistic regression. Each PFD had a different constellation of associated comorbid psychiatric disorders, however, anxiety disorders were linked to every PFD correlated with having a psychiatric diagnosis (Table). PFDs that were not associated with psychiatric comorbidities were stress urinary incontinence, acute/recurrent urinary tract infection, nocturia, mesh complications, vulvovaginal atrophy, care for obstetric anal sphincter injury after delivery, and genitourinary or rectovaginal fistula. Patients were more likely to receive a referral to pelvic floor physical therapy for treatment of PFD if they were white and younger, had an anxiety disorder, psychosis, or sexual disorder. They were less likely to be referred if they were Black/African American, had post-traumatic stress disorder or dementia. White or Hispanic race were correlated with undergoing a urogynecologic surgery, while patients of Black/African American race were less likely to undergo surgery for their PFD. Patients with comorbid anxiety or dementia were also less likely to have surgery. Comorbid psychiatric diagnoses are found in half of the FPMRS patient population and often correlate with common PFDs. Anxiety disorders correlated highly with all PFDs associated with having a psychiatric disorder. As psychiatric diagnoses may have an effect on clinical practice patterns, clinicians should take this into account when counseling and treating patients with PFDs.