Dysfunction, activity limitations, participation restriction and contextual factors in South African women with pelvic organ prolapse.

Corlia Brandt,Elizabeth C Janse Van Vuuren

doi:10.4102/sajp.v75i1.933

Abstract

BackgroundPelvic organ prolapse (POP) is a multifactorial, poorly understood condition impacting quality of life (QOL). The pathology and aetiology might imply population-specific differences in domains of the International Classification of Function, Disability and Health (ICF). There is, however, a lack of research in this regard in South Africa.ObjectivesTo describe the dysfunction, activity limitations, participation restrictions and contextual factors in South African women with POP.MethodOne hundred women were conveniently sampled in a primary health care setting. They completed a self-compiled medical and exercise history questionnaire, the standardised Prolapse-Quality of Life (P-QOL) questionnaire and the Visual Faces Scale. The stage of prolapse was determined by the Pelvic Organ Prolapse Quantification (POP-Q) Scale. Means, medians, standard deviations, percentages and frequencies were calculated.ResultsEighty-six per cent had a stage III POP, 57% had overactive bladder, 50% had constipation, 37% had stress urinary incontinence, 31% had urge urinary incontinence, 32% had incomplete emptying and 30% had anal incontinence. Comorbidities included cardiovascular disease (65%), depressive symptoms (12%) and hypothyroidism (18%). Other contextual factors included limited physical activity (80%), an increased body mass index (29 kg/m2), older age (59 years) and unemployment (80%). Quality of life was affected in the severity, social, emotional and sleep/energy domains (median scores were 66.7% – 33.3%).ConclusionThe dysfunction domain of the ICF was similar to other populations with POP. Activity and participation restrictions included social, emotional and sleep/energy aspects. Contextual factors seem to be population-specific, possibly leading to differences comparing QOL amongst different populations.Clinical implicationsActivity and participation restrictions, as well as contextual factors, may differ in different populations with POP. Interactions between contextual factors and movement impairment should be considered during management and be further investigated.

Highlights

Pelvic organ prolapse (POP) can be defined as a multifactorial condition which presents as the downward displacement of the pelvic organs from their anatomical position and is associated with bladder and/or bowel dysfunction, and/or sexual dysfunction
Results of the P-quality of life (QOL) questionnaire are depicted as the median values for each domain owing to the non-parametric distribution of data
The participants in this study were characterised by the presence of overlapping risk factors for POP and lifestyle diseases, disability in the form of symptoms and signs owing to pelvic floor dysfunction and activity and participation restrictions (Figure 2)

Summary

Introduction

Pelvic organ prolapse (POP) can be defined as a multifactorial condition which presents as the downward displacement of the pelvic organs from their anatomical position and is associated with bladder and/or bowel dysfunction, and/or sexual dysfunction. Increasing evidence shows that women with POP seek treatment primarily to improve their quality of life (QOL) (Srikrishna et al 2008). It is a debilitating condition, patients are reluctant to talk about their problems and many times have symptoms for years. The International Classification of Functioning, Disability and Health (ICF) classifies health and health-related states. According to this system, the causes of the dysfunctional pelvic floor are classified as the pathophysiological component of the ICF. Pelvic organ prolapse (POP) is a multifactorial, poorly understood condition impacting quality of life (QOL). There is, a lack of research in this regard in South Africa

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