Prevalence of Pelvic Floor Dysfunction in Women After Pelvic Radiotherapy: Systematic Review and Meta-Analysis.

Objective:Pelvic floor dysfunction has a high prevalence among women worldwide. However, in the Kingdom of Saudi Arabia, it is underreported. Thus, we aimed to estimate the prevalence and risk factors of pelvic floor dysfunction in women in the Kingdom of Saudi Arabia.Methods:We conducted a cross-sectional study on literate non-pregnant women aged ⩾18 years who agreed to participate in our survey. We used the validated and translated Australian pelvic floor questionnaire and conducted a multivariate logistic regression analysis to assess the risk factors of pelvic floor dysfunction.Results:A total of 824 participants completed the questionnaire. While 60.2% of the participants had pelvic floor dysfunction, 67.7% reported signs of bowel dysfunction. Urinary dysfunction, prolapse, and sexual dysfunction were present in 44.1%, 67.7%, and 55.4% of the participants, respectively. Age, high body mass index, chronic medical illness, heavy weight lifting, and multiparity were found as the risk factors of bladder function problems. Meanwhile, chronic medical illness, heavy weight lifting, and multiparity were found as the risk factors of bowel dysfunction and prolapse. Age group and marital status were the independent factors associated with sexual dysfunction.Conclusion:We noted a high rate of pelvic floor dysfunction in the Kingdom of Saudi Arabia, which calls for the need to provide holistic approaches for the prevention and management of pelvic floor dysfunction among women.

Background. Pelvic organ prolapse, urinary and fecal incontinence and sexual dysfunction are collectively termed “pelvic floor dysfunction”, the main causes of which are pregnancy and childbirth, which leads to decreased pelvic floor muscle strength and increased frequency of urinary incontinence. Studies show that stress urinary incontinence during pregnancy occurs in a significant proportion of women, and these problems may persist and progress in the postpartum period, especially in those who have suffered injuries during childbirth. In addition, women with complications during pregnancy and childbirth experience more pronounced manifestations of sexual dysfunction and delayed resumption of sexual activity. All these factors indicate the need for early screening and diagnosis of pelvic floor dysfunction in women during pregnancy to improve quality of life and prevent subsequent complications. Objective. To identify predictive ultrasound markers of pelvic floor dysfunction in primiparous women after per vias naturales delivery at the antenatal stage. Material and methods. A prospective cohort comparative study was conducted among 40 women of reproductive age before delivery and 6-8 weeks after delivery per vias naturales in occipital presentation of the fetus. The main group consisted of 18 women who still had symptoms of pelvic floor dysfunction at the end of the late postpartum period; the control group included 22 women without clinical manifestations. All patients underwent a gynecological examination with perineometry and ultrasound examination of the pelvic organs before delivery and 6-8 weeks after delivery. Results. In the group of women who had clinical manifestations of pelvic floor dysfunction, a decrease in pelvic floor muscle tone was noted 6-8 weeks after delivery. These women of ten reported urinary disorders, including frequent urination and stress urinary incontinence. During the instrumental study, it was revealed that already in the third trimester of pregnancy, changes in the urethrovesical angle occurred according to ultrasound examination data, and a decrease in the size of the perineal tendon center and a change in the parameters of the thickness of the bulbospongiosus muscle bundles were observed. Conclusion. Non-invasive diagnostic methods can identify the risks of pelvic floor insufficiency even during pregnancy, which will subsequently allow timely treatment of pelvic dysfunctions in women of reproductive age. Active identification of such patients will help reduce the number of surgical interventions and improve the quality of life of women of reproductive age.

PurposeTo explore the experiences of women with breast cancer and pelvic floor (PF) dysfunction and the perceived enablers and barriers to uptake of treatment for PF dysfunction during their recovery.MethodPurposive sampling was used to recruit 30 women with a past diagnosis of breast cancer and PF dysfunction. Semi-structured interviews were conducted, and data were analysed inductively to identify new concepts in the experiences of PF dysfunction in women with breast cancer and deductively according to the capability, opportunity, motivation and behaviour (COM-B) framework to identify the enablers and barriers to the uptake of treatment for PF dysfunction in women with breast cancer.ResultsParticipants were aged between 31 and 88 years, diagnosed with stages I–IV breast cancer and experienced either urinary incontinence (n = 24/30, 80%), faecal incontinence (n = 6/30, 20%) or sexual dysfunction (n = 20/30, 67%). They were either resigned to or bothered by their PF dysfunction; bother was exacerbated by embarrassment from experiencing PF symptoms in public. Barriers to accessing treatment for PF dysfunction included a lack of awareness about PF dysfunction following breast cancer treatments and health care professionals not focussing on the management of PF symptoms during cancer treatment. An enabler was their motivation to resume their normal pre-cancer lives.ConclusionParticipants in this study reported that there needs to be more awareness about PF dysfunction in women undergoing treatment for breast cancer. They would like to receive information about PF dysfunction prior to starting cancer treatment, be screened for PF dysfunction during cancer treatment and be offered therapies for their PF dysfunction after primary cancer treatment. Therefore, a greater focus on managing PF symptoms by clinicians may be warranted in women with breast cancer.

Female pelvic floor dysfunction (PFD), a common disease affecting women, has attracted a significant amount of attention in the field of obstetrics and gynecology in recent years. Pelvic floor disorders can induce urinary incontinence, vaginal prolapse and other dysfunction, which seriously affect the quality of life of patients. This study aimed to analyze the current status of PFD in urban women in Xi'an City. A total of 1300 women in the urban area of Xi'an City were selected based on a multi-stage sampling method. A face-to-face questionnaire survey and gynecological examination were carried out, and the prevalence rates of stress urinary incontinence (SUI) and pelvic organ prolapse (POP) and PFD were calculated, Multivariate logistic regression analysis was performed to analyze the risk factors of PFD in urban women in Xi'an City. The effective questionnaire recovery rate was 76.69% (997/1,300). The number of patients with SUI, POP, and SUI combined POP were 124 (55.11%), 64 (28.44%) and 37 (16.44%), respectively, and the prevalence of PFD was 22.57% (225/997). Multivariate logistic regression analysis showed that the risk of PFD in women with vaginal delivery, delivery times ≥2, menopause or prolonged labor was higher than that in women with cesarean section, delivery times of 1, no menopause, or no prolonged labor (P<0.05). The prevalence rate of PFD in urban women in Xi'an City cannot be ignored, especially women who have experienced vaginal delivery, delivered ≥2 children, menopause, or prolonged labor. It may be necessary to prioritize these women so as to actively prevent and control PFD.

BackgroundThis study aimed to analyze the effect of obstetric factors on the development of pelvic floor dysfunction (PFD) in women in the early postpartum period.MethodsClinical data of 300 women who were reviewed in our outpatient clinic from July 2016 to December 2019 in the postpartum period were retrospectively analyzed. The occurrence of pelvic organ prolapse (POP) and stress urinary incontinence (SUI) was assessed using the Pelvic Organ Prolapse Quantification System and International Consultation on Incontinence Questionnaire Short Form. Factors affecting the occurrence of PFD in women in the early postpartum period were analyzed using univariate and multifactorial logistic regression models.ResultsA total of 46 cases of POP (15.33%) and 82 of SUI (27.33%) occurred in 300 women at 6–8 weeks after birth. Unconditional logistic regression confirmed that age ≥35 years, vaginal delivery, BMI before delivery ≥ 25 kg/m2, perineal tear, protracted or prolonged second stage of labor, and fetal macrosomia were risk factors influencing the occurrence of POP (OR > 1, P < 0.05), whereas age ≥ 35 years, vaginal delivery, perineal tear, protracted or prolonged second stage of labor, fetal macrosomia, and SUI during pregnancy were risk factors influencing the occurrence of SUI (OR> 1, P< 0.05).ConclusionObstetric factors such as age, mode of delivery, perineal tear, protracted or prolonged second stage of labor, and fetal macrosomia may increase the risk of developing PFD in women in the early postpartum period; hence, these risk factors should be correctly identified and promptly addressed to prevent the development of PFD.

Pelvic floor dysfunction is frequently associated with cervical cancer treatment; however, their baseline prevalence at diagnosis is unknown. This study aimed to investigate pelvic floor dysfunction in newly diagnosed cervical cancer, before oncologic treatment. Cross-sectional analysis of women newly diagnosed with cervical cancer at a single institution in Brazil. Participants answered a structured interview and the FSFI questionnaire and underwent a pelvic floor structured physical examination. Analyses were performed in RStudio. A total of 48 women were included, 19/48 (39.6%) with early-stage and 29/48 (60.4%) with locally advanced cervical cancer. Groups were similar in sociodemographic and reproductive characteristics. Sexual dysfunction was observed in 27/48 (56%) participants. Pelvic floor muscle strength and endurance were comparable between groups, with a median Oxford Scale score of 3 (2-4) and endurance of 5s. Urinary incontinence was present in 25/48 (52%) participants, while fecal incontinence occurred only in 1/48 (5.3%). Pelvic floor dysfunction is common in women newly diagnosed with cervical cancer. Early recognition is crucial to differentiate pre-existing from treatment-induced dysfunction and to guide prehabilitation and rehabilitation strategies that may improve quality of life.

Prevalence of Pelvic Floor Dysfunction in Patients with Interstitial Cystitis

Pelvic floor dysfunction in women includes urinary incontinence and pelvic organ prolapse. In midlife, genitourinary atrophy is commonly associated with these conditions and can practically be considered part of the overall condition. The pelvic floor tissues share a common hormone responsiveness and as such respond collectively to midlife estrogen loss. This review article summarizes the expected consequences of menopause and aging on pelvic floor function and discusses how estrogen deprivation might lead to structural and/or functional failure. A framework for the initial evaluation of pelvic function in midlife women is presented, highlighting the importance of assessing the impact of incontinence, prolapse, and genitourinary atrophy on quality of life.

The aim of the research. To determine the prevalence of symptoms of pelvic floor dysfunction in women of Barnaul and their relationship with socio-demographic and clinical-anamnestic factors.Materials and methods. The study included 400 women aged 18–45 years living in the city of Barnaul. The study was conducted using the questionnaires PFDI 20 (Pelvic Floor Distress Inventory Questionnaire) and FSFI 19 (Female sexual function index). A comparative analysis of socio-demographic and clinical data of patients with symptoms of dysfunction and normal pelvic floor function was carried out.Results. Symptoms of pelvic floor dysfunction are registered in 82% of women. Symptoms of pelvic organ prolapse are noted by 61% of women, urinary disorders – 68%, colorectal-anal symptoms are found in 59,5% of women. Symptoms of sexual dysfunction are registered in 60% of women. A relationship was found between the presence of pelvic floor dysfunction symptoms and a history of vaginal delivery (p = 0,005), a history of precipitous labor (p=0.02), delivery of a large fetus (p=0.000), perineal trauma during childbirth (p=0.000), abortions (p=0.001), adenomyosis (p=0.008), the presence of POP in first-degree relatives (p=0.001), chronic gastritis (p=0.002), constipation (p=0.000) and varicose veins of the lower extremities (p=0.05). Sexual dysfunction is statistically significantly more often recorded in women with a BMI of more than 25 kg/m2 (p=0.02).Conclusions. Symptoms of pelvic floor dysfunction are highly prevalent among women of reproductive age. The relationship between the presence of pelvic floor dysfunction symptoms and socio-demographic and clinical-anamnestic factors women is determined.

As a result of the impairment of the musculoskeletal system, the pelvic floor muscles are likely compromised in women with systemic lupus erythematosus (SLE). We hypothesized that women with SLE would report more symptoms of pelvic floor dysfunction (PFD) and there will be an association between SLE and PFD. An online cross-sectional survey was conducted. Data were collected on demographic and anthropometric characteristics, PFD (urinary incontinence, nocturia, anal incontinence, genital-pelvic pain/penetration disorder and pelvic organ prolapse) and obstetric history using a web-based questionnaire. The groups were compared using the Mann-Whitney test for quantitative variables and the chi-squared test for categorical variables. The association between SLE and PFD was tested using logistic regression analysis. A total of 196 women answered the questionnaire (102 with SLE and 94 healthy controls). Women with SLE reported significantly more urinary incontinence, nocturia, anal incontinence, pelvic organ prolapse and genital-pelvic pain/penetration disorder than the healthy controls (p ≤ 0.05). Women with SLE were 2.8- to 3.0-fold more likely to report genital-pelvic pain/penetration disorder than healthy women. The prevalence of PFD was significantly higher in women with SLE compared to healthy women. Thus, PFD seems to be an important problem in women with this disease. An in-depth investigation of these disorders could contribute to the understanding of how SLE impacts pelvic floor function.

BackgroundPelvic floor dysfunction in women encompasses a wide range of clinical disorders: urinary incontinence, pelvic organ prolapse, fecal incontinence, and pelvic-perineal region pain syndrome. A literature review did not identify any articles addressing the prevalence of all pelvic floor dysfunctions.ObjectiveDetermine the prevalence of the group of pelvic floor disorders and the factors associated with the development of these disorders in women.Material and methodsThis observational study was conducted with women during 2021 and 2022 in Spain. Sociodemographic and employment data, previous medical history and health status, lifestyle and habits, obstetric history, and health problems were collected through a self-developed questionnaire. The Pelvic Floor Distress Inventory (PFDI-20) was used to assess the presence and impact of pelvic floor disorders. Pearson's Chi-Square, Odds Ratio (OR) and adjusted Odds Ratio (aOR) with their respective 95% confidence intervals (CI) were calculated.ResultsOne thousand four hundred forty-six women participated. Urinary incontinence occurred in 55.8% (807) of the women, fecal incontinence in 10.4% (150), symptomatic uterine prolapse in 14.0% (203), and 18.7% (271) reported pain in the pelvic area. The following were identified as factors that increase the probability of urinary incontinence: menopausal status. For fecal incontinence: having had instrumental births. Factors for pelvic organ prolapse: number of vaginal births, one, two or more. Factors for pelvic pain: the existence of fetal macrosomia.ConclusionsThe prevalence of pelvic floor dysfunction in women is high. Various sociodemographic factors such as age, having a gastrointestinal disease, having had vaginal births, and instrumental vaginal births are associated with a greater probability of having pelvic floor dysfunction. Health personnel must take these factors into account to prevent the appearance of these dysfunctions.

The aim was to assess symptoms of pelvic floor dysfunction in women following pelvic trauma. A retrospective questionnaire survey of 24 consecutive women was performed in a tertiary referral orthopaedic centre and urogynaecology unit. Sixteen women had a type B and eight a type C pelvic fracture (Association Osteosynthesis manual classification). The median age was 24 years (11-92). Twenty-one women were nulliparous. Sixteen women reported de novo pelvic floor dysfunction. Bladder symptoms occurred in 12, bowel problems in 11 and sexual dysfunction in 7 of 17 sexually active women. Pelvic fracture seems to be a risk factor for pelvic floor dysfunction.

Pelvic floor dysfunction is one of the most common disorders in women that is associated with social and economic consequences. In general, this disorder imposes direct and indirect costs on the economy of various societies. This review aimed to investigate pelvic floor dysfunction in women with polycystic ovary syndrome (PCOS). In this narrative review, the published articles on pelvic floor dysfunction were examined in PubMed, Scopus, Web of Sciences and Google Scholar. We searched for terms related to polycystic ovary syndrome and pelvic floor dysfunction. Inclusion criteria of this research were observational, experimental, and review studies. In this investigation, the complications associated with polycystic ovary syndrome were examined as risk factors for pelvic floor dysfunction. In this narrative review, we discuss about changes in hormone levels, obesity and overweight, hormonal medications and complications such as diabetes and metabolic disorders and obstetric complications of PCOS can be involved in the pathophysiology of pelvic floor dysfunctions, including stress urinary incontinence and pelvic organ prolapse in women with PCOS. This review highlights knowledge gaps about protective effect of hyperandrogenism on pelvic floor dysfunction as well as destructive effect of metabolic changes on pelvic floor dysfunction in women with PCOS. Further cohort and prospective studies are recommended in women with PCOS to investigate the concept of pelvic organ dysfunction in these women.

Our aim was to identify drivers of and barriers to help-seeking behaviour of older women with pelvic floor dysfunction (PFD) living independently in Australia . Women aged ≥55years were recruited to this cross-sectional study during July and August 2016. Bladder, bowel, pelvic organ prolapse (POP) and sexual dysfunction were assessed with the Australian Pelvic Floor Questionnaire (APFQ). Drivers and barriers were based on the Barriers to Incontinence Care Seeking Questionnaire. Univariate analyses were used to assess any significant relationships between PFD, age, education level, self-reported PFD, barriers and drivers. Of the 376 study participants [mean, standard deviation (SD) age 68.6 (10.5) years], 67% reported symptoms of PFD and 98.7% scored >0 on the APFQ. Women were more likely to seek help if they scored higher on the APFQ (p < 0.001). The main barrier to seeking help was the perception that PFD was a normal part of ageing (22.4%). Of those who did seek help (50%), the main factor was increased level of symptom bother (51.4%). There was no difference in age or education level between women who did and did not seek help. Women are more likely to seek help for PFD if scoring higher on the APFQ or symptoms are becoming more bothersome. They are less likely to seek help if they view their symptoms as normal. Future direction should be taken to raise awareness of normal pelvic floor function as well as the availability of help for PFD.

To describe the principles of pelvic floor physical therapy (PFPT), review the evidence for PFPT as a treatment for pelvic floor dysfunction, and summarize the current recommendations for PFPT as a first-line conservative treatment option for pelvic floor disorders. Pelvic floor dysfunction can cause voiding and defecation problems, pelvic organ prolapse (POP), sexual dysfunction, and pelvic pain. PFPT is a program of functional retraining to improve pelvic floor muscle strength, endurance, power, and relaxation in patients with pelvic floor dysfunction. Based on the available evidence, PFPT with or without supplemental modalities can improve or cure symptoms of urinary incontinence, POP, fecal incontinence, peripartum and postpartum pelvic floor dysfunction, and hypertonic pelvic floor disorders, including pelvic floor myofascial pain, dyspareunia, vaginismus, and vulvodynia. Currently, there is conflicting evidence regarding the effectiveness of perioperative PFPT before or after POP and urinary incontinence surgery. PFPT has robust evidence-based support and clear benefit as a first-line treatment for most pelvic floor disorders. Standards of PFPT treatment protocols, however, vary widely and larger well designed trials are recommended to show long-term effectiveness.