Factors Associated With Symptoms of Pelvic Floor Dysfunction Six Years After Primary Operation of Genital Prolapse

Abstract

Postoperative symptoms after surgical correction of pelvic floor dysfunction (PFD) are relatively unpredictable. Previous studies have shown that correction of pelvic organ prolapse (POP) can lead to adverse effects such as urinary incontinence and sexual dysfunction. Predictive factors of PFD symptoms have not been well investigated. This cross-sectional observational study assessed the prevalence of symptoms of PFD in 240 Swedish women 6 years after primary surgery for POP and analyzed predictive factors for these symptoms. Only women with no subsequent prolapse surgery during the following 6 years were included. The study was based on patient records and a questionnaire concerning symptoms of PFD and other data completed in 1999. One or more weekly episodes of urinary incontinence were reported by 41% of the participants. Eighteen percent reported a feeling of vaginal bulging; 15% had solid stool incontinence, and 38% gas incontinence. Thirty-nine percent stated they were sexually active; 15% were sexually inactive because of discomfort or pain; 46% refrained from sexual activity due to lack of or sick partner; and 42% experienced discomfort or pain during sexual activity. Urinary incontinence preoperatively and prior surgery for urinary incontinence were highly predictive for significant urinary incontinence following primary POP surgery. Anterior repair was a predictive protective factor for the postoperative symptoms of incomplete bladder and bowel emptying and vaginal protrusion, but had no impact on urinary incontinence. In contrast, posterior repair was strongly associated with feeling of incomplete bowel emptying and solid stool incontinence. No significant association was found between posterior repair and sexual discomfort and pain. This study shows that women experience substantial symptoms of PFD 6 years after POP surgery. In accordance with prior studies, anterior repair was shown to improve symptoms and discomfort.