Symptoms Of Pelvic Floor Disorders Research Articles

Urinary Incontinence and Pelvic Organ Prolapse Knowledge, Care-Seeking, and Embarrassment in Women Planning Bariatric Surgery: A Cross-sectional Study.

The objective of this study was to assess whether patients seeking bariatric surgery were at least as proficient in urinary incontinence (UI) and pelvic organ prolapse (POP) knowledge as the general population. Our secondary objective was to determine care-seeking and impact of embarrassment on knowledge of pelvic floor disorders (PFDs). An anonymous survey was administered to adult women who attended a bariatric surgery information session from May 2015 to January 2016. The comprehensive survey included multiple data points and the Prolapse and Incontinence Knowledge Quiz. The study population was compared with a general population described in a previously published study. Three hundred fifteen participants completed the survey (88% response rate). Mean ± SD age was 41.1 ± 11.3 years (range, 18-69 years), and mean body mass index was 47.4 ± 9.6 kg/m (range, 26.7-104.5 kg/m). A total of 196 women (62.2%) had at least one bothersome PFD symptom. The study population was at least as proficient in UI knowledge as the general population (P < 0.0001), but not for POP knowledge (P < 0.946). Among participants with symptomatic PFD, 91.7% of those with UI symptoms and 70% of those with POP symptoms reported that they would seek care. There was a difference in knowledge proficiency between women who were and were not embarrassed to discuss UI (P = 0.77) or POP (P = 0.99). The study population demonstrated less POP knowledge than the general population, but not for UI knowledge. A high proportion of women with UI or POP symptoms would seek care, but embarrassment to discuss UI or POP negatively impacted knowledge.

Prevalence and Awareness of Pelvic Floor Disorders in Female Adolescents Seeking Gynecologic Care.

To determine the prevalence and awareness of pelvic floor disorder symptoms among female adolescents. Cross-sectional study via a written, anonymous survey of adolescents. The survey was composed of validated measures for determination of symptom prevalence. Pediatric and adolescent gynecology clinic in the southeast United States. Female adolescents ages 14-21years. None. We used χ2 analyses for categorical variables and t test for continuous variables. Two hundred sixteen questionnaires were completed. The mean age of respondents was 17.1 (±2.1) years and most respondents had at least heard about urinary (UI) and fecal incontinence (FI; 62.9%). The prevalence of any UI was 31.5%. Urgency UI (UUI) was reported by 15.7% and stress UI was reported by 6.9% of adolescents; 8.8% of participants experienced UUI and stress UI symptoms. FI and pelvic organ prolapse symptoms were reported by 0.9%. There were no differences in reported prevalence rates of UI (31.7% vs 27.9%), FI (1.4% vs 0%), or pelvic organ prolapse (1.4% vs 0%) between younger (14-17years) and older (18-21years) adolescent participants, respectively (all P>.05). Although UI was fairly prevalent among respondents, most stated that it had a minimal effect on daily living. UI symptoms were common among female adolescents, with UUI being the most reported. Early education regarding pelvic floor disorder symptoms might lead to prevention or empowerment to seek treatment as adolescents age.

The short-term outcome of laser in the management of female pelvic floor disorders: Focus on stress urine incontinence and sexual dysfunction

ObjectiveFemale pelvic floor disorders, including female stress urinary incontinence (SUI) or sexual dysfunction are notorious for affecting the quality of women's life. It is reported that laser therapy might result in collagen remodeling and improvement in tissue firmness. The study was conducted to evaluate the short-term outcome of female pelvic floor disorders treated by laser therapy. Materials and methodsWomen with self-reported symptoms of female pelvic floor disorders (limited to SUI and sexual dysfunction) were included in the study. The participants were treated with the Er:YAG laser or the fractional microablative carbon dioxide (CO2) laser system. The therapeutic effect was focused on SUI symptoms and sexual dysfunction. ResultsThere were 31 women underwent laser treatment, including 21 patients treated with Erbium:YAG laser and 10 treated with CO2 laser. In the Erbium:YAG laser group, International Consultation on Incontinence Questionnaire – Urinary Incontinence Short Form (ICIQ- SF) scores were dropped from 8.25 ± 5.66 to 5.00 ± 3.99 (P = 0.007); and in the CO2 laser group, scores were dropped from 11.11 ± 6.85 to 6.44 ± 4.25 (P = 0.035), contributing to the drop of ICI-Q-SF scores from 9.14 ± 6.08 to 5.45 ± 4.05 for all enrolled patients (P = 0.001). However, objective measure using pad test did not show a statistically significant difference between before and after treatment (from 3.20 ± 5.84 g to 1.54 ± 3.18 g, P = 0.224). Sexual dysfunction was improved in 13 patients (44.83%), but Female Sexual Function Index (FSFI) scores were not different before and after laser treatment (44.22 ± 23.36 vs. 44.09 ± 24.51, P = 0.389). ConclusionLaser therapy either by Erbium:YAG laser or CO2 laser seemed to be useful for female pelvic floor disorders, especially on improvement of SUI symptoms; however, the effectiveness needs further confirmation.

Recovery of puborectalis muscle after vaginal delivery: an ultrasound study.

To assess change in levator hiatal dimensions between pregnancy and different timepoints after vaginal delivery, and map recovery of the hiatus in order to contribute to secondary prevention of symptoms of pelvic floor disorders. Twenty nulliparous women with a singleton pregnancy underwent ultrasound assessment of the pelvic floor at rest, on maximum pelvic floor muscle contraction (PFMC) and on Valsalva maneuver at 12 weeks' gestation and at 1 day and 1, 2, 3, 4, 6, 12, 18 and 24 weeks after vaginal delivery. Dimensions of the levator hiatus were measured and contractility and distensibility were calculated. The Wilcoxon signed rank test was used to compare each postpartum value with that at 12 weeks' gestation. Levator hiatal area at rest, on PFMC and on Valsalva maneuver was significantly increased at 1 day and at 1 and 2 weeks after vaginal delivery compared with measurements at 12 weeks' gestation. Hiatal area at rest and on PFMC from 3 weeks postpartum onward, as well as contractility from 6 weeks onward, were comparable to values at 12 weeks' gestation, whereas, a significant difference remained on Valsalva maneuver until 24 weeks after delivery. Moreover, distensibility was still increased at 24 weeks postpartum compared with measurements at 12 weeks' gestation. The puborectalis muscle has the ability to recover anatomically from a first vaginal delivery, and recovery occurs mainly during the first 3 weeks after delivery. Stretching of the puborectalis muscle, as reflected by distensibility, persisted 24 weeks after the first vaginal delivery. The data provide a better understanding of the early 'normal' regeneration process and we hypothesize that the first 3 weeks postpartum is the best window in which to start secondary prevention. Copyright © 2017 ISUOG. Published by John Wiley & Sons Ltd.

Transperineal ultrasound imaging of the pelvic floor muscles in women with pelvic floor dysfunction symptoms: A cross-sectional study

Abstract Objective Transperineal ultrasound (TPUS) assessment of the pelvic floor muscle (morphological and dynamic function) in women with pelvic floor dysfunction symptoms. Study design A cross-section study, 73 women complaining of any of the pelvic floor disorder symptoms. Digital palpation of the puborectalis muscle using modified Oxford score grading system (MOS), 2 D and 3 D TPUS were done at rest, maximum contraction, and at valsalva. Levator ani defects, and/or avulsion were identified. Levator urethral gap (LUG) was measured. Ultrasound measurements were correlated to MOS, and presence of symptoms Results The mean percentage decrease in the antro posterior hiatal diameter (LHap) during contraction was significantly lower in women with UpfmC than those with NpfmC as assessed by MOS. A cut-off percentage decrease in LHap at contraction 2% predicted UpfmC; area under the curve 0.81, sensitivity 38.5%, specificity 81% and accuracy 50.6%. LUG was significantly longer in UpfmC. All cases of ultrasound diagnosed avulsion had an UpfmC by MOS. MOS had a strong positive correlation with percentage decrease LHap (contraction), and a strong negative correlation with the percentage increase in LHap (Valsalva), and LUG. Conclusion Ultrasound is clinically valuable, reasonable, allows morphological and dynamic evaluation of the function of PFM in women with pelvic floor dysfunction symptoms, and correlated well with MOS. LUG increased its validity for diagnosis of levator avulsion.

Obesity in Women: Insights for the Clinician.

As a leading cause of morbidity and mortality in the United States and worldwide, obesity is a disease that is frequently encountered in clinical practice today and requires a range of medical interventions. While obesity affects both men and women across all ages, multiple issues are particularly germane to women's health, particularly as obesity is more prevalent among women than men in the United States and obesity among women of reproductive health relates to the growing issue of childhood obesity. Discussed herein are the epidemiology and pathophysiology of obesity along with the impact of perinatal obesity on fetal programming. Guidance on screening and management of obesity through lifestyle intervention, pharmacologic therapy, and bariatric surgery, as well as avoidance of weight-promoting medications wherever possible, is elaborated. Particular attention is paid to the contribution of these modalities to weight loss as well as their impact on obesity-related comorbidities that affect a woman's overall health, such as type 2 diabetes and hypertension, and her reproductive and gynecologic health. With modest weight loss, women with obesity can achieve notable improvements in chronic medical conditions, fertility, pregnancy outcomes, and symptoms of pelvic floor disorders. Moreover, as children born to women after bariatric surgery-induced weight loss show improved metabolic outcomes, this demonstrates a role for maternal weight loss in reducing risk of development of metabolic disturbances in children. In light of the immense cost burden and mortality from obesity, it is important to emphasize the role of lifestyle intervention, pharmacologic management, and bariatric surgery for weight loss in clinical practice to mitigate the impact of obesity on women's health.

Obesity and pelvic organ prolapse.

The purpose of this review is to review the data on the relationship of obesity and pelvic organ prolapse (POP). This review is timely and relevant as the prevalence of obesity is increasing worldwide, and it is an important risk factor to consider in counseling women on management of prolapse symptoms and outcomes for surgical treatment. The main findings in the literature include: Obesity is increasing worldwide and impacts health, social life, work and healthcare costs. Elevated BMI is an important lifestyle factor affecting pelvic prolapse. The most probable mechanism of POP development among obese women is the increase in intra-abdominal pressure that causes weakening of pelvic floor muscles and fascia. Obesity is associated with significant pelvic floor symptoms and impairment of quality of life (QOL). Weight loss is likely not associated with anatomic improvement, but may be associated with prolapse symptom improvement. Weight loss should be considered a primary option in obese women for its beneficial effects on multiple organ systems and reducing pelvic floor disorder (PFD) symptoms. Although the operation time in obese women is significantly longer than in healthy weight women, the complication rate of surgery has not been shown to be increased compared to nonobese patients, regardless of route of surgery. There are data to support the vaginal approach in obese women. Some studies have shown that women with high body weight are associated with an increase in the risk for both anatomical and functional recurrence, and other studies have shown no difference. Obesity is a prevalent modifiable condition that impacts PFDs including pelvic prolapse. Patients should be counseled using clinical judgment, knowledge of the literature and with the goal of improving QOL.

Longitudinal follow-up of levator ani muscle avulsion: does a second delivery affect it?

To evaluate the morphological outcome of levator ani muscle (LAM) avulsion 3-5 years after a first delivery and to assess the effect of a second delivery on this condition. The impact of LAM avulsion on pelvic floor disorders was also studied. Six hundred and sixty-six women who had been assessed for LAM avulsion 8 weeks after their first delivery were invited for a follow-up examination 3-5 years later. Women completed the Pelvic Floor Distress Inventory including the Urinary Distress Inventory (UDI) and Pelvic Organ Prolapse Distress Inventory (POPDI) questionnaires to explore symptoms of pelvic floor disorders, and the pelvic floor was examined using three-dimensional translabial ultrasound and assessed using the pelvic organ prolapse quantification system. Three hundred and ninety-nine women completed the study, of whom 151 were multiparous. Mean interval between first delivery and follow-up was 42.3 ± 7.6 months. Among 69 women who had LAM avulsion 8 weeks after their first delivery, nine (13.0%) had no LAM avulsion at follow-up. One (0.9%) woman had a new LAM avulsion after her second vaginal delivery. A greater proportion of women with LAM avulsion reported symptoms of stress urinary incontinence (SUI) (adjusted odds ratio, 2.09 (95% CI, 1.18-3.70); P = 0.01) and symptoms of prolapse than did women without avulsion; however, this difference did not reach statistical significance (P = 0.61). Women with LAM avulsion had higher UDI and POPDI scores than did women without avulsion (median UDI score, 17.7 (interquartile range (IQR), 5.0-32.4) vs 9.2 (IQR, 0.0-22.1); P = 0.045 and median POPDI score, 20.8 (IQR, 8.8-40.5) vs 10.7 (IQR, 0.0-32.8); P = 0.021). The risk of developing new LAM avulsion after a second vaginal delivery is low (0.9%). Healing of LAM avulsion was observed in 13% of women who had at least one vaginal delivery. At 3-5 years after delivery, women with LAM avulsion reported symptoms of SUI more often than did those without, and had higher UDI and POPDI scores, implying more bothersome symptoms. Copyright © 2016 ISUOG. Published by John Wiley & Sons Ltd.

Prevalence of Symptomatic Pelvic Floor Disorders among Japanese Women

Objective: There is little epidemiological data regarding pelvic organ prolapse (POP) in Japan, despite it being recognized as a disease can be treated in the outpatient or inpatient settings. Our aim was to estimate the prevalence of symptomatic POP among Japanese women. Methods: This cross-sectional study evaluated 8,407 randomly selected women (20-90 years old) who were employed at the Japanese Agriculture Group. Trained research assistants distributed a Japanese self-administered questionnaire that was specifically designed for this study. The participants were asked to provide information regarding their demographic characteristics and symptoms of POP or urinary incontinence (UI). The potential risk factors included age, body mass index, self-reported conditions or comorbid diseases, parity, heavy lifting at work, perceived health status, and occupation. Results: The weighted prevalence of POP was 5.64% (95% Cl: 5.15-6.13%), the prevalence of UI was 44.25% (95% CI: 43.19-45.31%), and at least one pelvic floor disorder was reported by 46.15% of the women (95% Cl: 45.09-47.22%). The proportion of women who reported having symptomatic POP generally increased with age and peaked at the age of 70-79 years (20-29 years old: 0.86%, 30-39 years old: 3.45%, 40-49 years old: 3.59%, 50-59 years old: 5.79%, 60-69 years old: 6.12%, 70-79 years old: 6.27%, and ≥80 years old: 5.37%; p<0.001). Conclusion: The present study provided the first population-based estimate of the prevalence of POP among Japanese women. The prevalence of symptomatic POP increased with age and peaked at 70–79 years. Approximately half of adult Japanese women reported experiencing symptoms of at least one pelvic floor disorder (POP and/or UI).

The prevalence of symptomatic pelvic floor disorders in women in Bangladesh

Objective: To investigate the prevalence of, and risk factors for, pelvic floor disorders (PFDs) in women in Bangladesh.Methods: A nationally representative sample of 1590 Bangladeshi women, aged 30–59 years, was recruited using a multistage cluster sampling technique, between September 2013 and March 2014. Urinary incontinence (UI), fecal incontinence (FI) and pelvic organ prolapse (POP) were assessed using validated questionnaires. The weighted prevalence and the factors associated with each PFD were investigated using multivariable weighted logistic regression.Results: The weighted prevalence of UI was 23.7% (95% confidence interval (CI) 21.3–26.0%), FI 5.3% (95% CI 4.0–6.6%), POP 16.2% (95% CI 14.2–18.2%), and having at least one PFD 35.3% (95% CI 32.6–37.9%). Women were more likely to have at least one PFD if aged 40–49 years (adjusted odds ratio (AOR) 1.46, 95% CI 1.02–2.08; p = 0.040) or 50–59 years (AOR 2.39, 95% CI 1.59–3.58; p < 0.0001), compared with women aged 30–39 years. Having at least one PFD was positively associated with having three or more versus fewer children (AOR 1.61, 95% CI 1.14–2.27; p = 0.007), being in the middle (AOR 3.05, 95% CI 1.72–5.41; p < 0.0001), second lowest (AOR 2.49, 95% CI 1.39–4.47; p = 0.002) or lowest (AOR 3.13, 95% CI 1.68–5.86; p < 0.0001) wealth quintile compared with the highest, and self-reporting diabetes (AOR 2.55, 95% CI 1.54–4.23; p < 0.0001).Conclusions: One-third of Bangladeshi women aged 30–59 years had at least one symptomatic PFD. Risk factors included greater age, higher parity, lower wealth status and self-reported diabetes. The diagnosis, treatment, and prevention of PFDs in Bangladesh need greater attention, as the prevalence of these disabling conditions is likely to increase with the aging of the population.

Prevalence and degree of bother of pelvic floor disorder symptoms among women from primary care and specialty clinics in Lebanon: an exploratory study.

The prevalence of pelvic floor disorders (PFD) and their impact on quality of life of women vary among different populations. The purpose of this study was to assess the prevalence of symptoms of PFD, and their degree of bother in a convenience sample of Lebanese women, and to evaluate health-care seeking (HCS) behavior related to PFD. Women visiting clinics in a University Medical Center in Beirut, Lebanon, completed the self-filled validated Arabic version of the Global Pelvic Floor Bother Questionnaire (PFBQ). Data covering demographics, comorbidities, and HCS behavior related to PFD were collected. Total individual PFBQ scores, individual PFD symptom scores and HCS behavior were correlated to demographic data and comorbidities. The study participants included 900 women. PFBQ scores were significantly higher in women of older age, women with a lower level of education, women with higher vaginal parity, and women who engaged in heavy lifting/physical activity. BMI >25kg/m2 was the strongest independent risk factor for the presence of PFD symptoms. The overall prevalence of urinary incontinence was 42%. Anal incontinence was the most bothersome PFD. Almost two thirds of the women reported HCS due to any aspect of PFD. Among symptomatic women who believed that their PFD warranted HCS, financial concern was the most common obstacle irrespective of age and educational level. In this convenience sample of Lebanese women, PFD symptoms were common and were significantly correlated with demographic characteristics and self-reported comorbidities. The key reason for not seeking health care related to PFD was financial concern.

Association between pelvic floor disorder symptoms and QoL scores with depressive symptoms among pelvic organ prolapse patients

There is no consensus on the relationship between depressive symptoms (DS) and pelvic organ prolapse (POP) symptoms and quality of life (QoL). Our hypothesis was that women with DS and POP have worse symptoms and QoL than those without DS and POP. Our aim was to compare two groups of POP patients, those with depressive symptoms and those without, and evaluate the association of symptoms and QoL. This planned report is part of a prospective study evaluating the impact of pessary use among symptomatic POP patients. Patients were evaluated by POP quantification (POP-Q), pelvic ultrasound (US), voiding diaries, stress test, pad test, Pelvic Floor Distress Inventory (PFDI-20), Prolapse QoL (P-QoL) and the Goldberg Health Questionnaire (GHQ-12) (psychological health screening for DS when score ≥5). A sample size of 78 patients was required to demonstrate a 50-point difference in the global PFDI-20 score with 80% power and 95% probability. Ninety-one women with POP were included. GHQ-12 was positive in 47 (51.6%) patients. No differences were found in POP-Q, pad and stress test between those with a positive GHQ-12 and those without. However, GHQ-12 was associated with higher PFDI-20 scores and higher scores in seven of nine P-QoL domains. GHQ-12 persisted as an independent risk factor for worse P-QoL scores after multivariable analysis. A 'positive' screening for DS was associated with worse PFDI-20 and P-QoL scores despite no difference in objective measurements. It may be that depressed patients interpret their symptoms differently.

Symptomatic pelvic floor disorders in community-dwelling older Australian women

ObjectivesTo assess the prevalence, and factors associated with, pelvic floor disorders in a representative sample of community-dwelling older Australian women. Methods1548 women, aged 65–79 years, were recruited to this cross-sectional study between April and August 2014. Pelvic floor disorders, including urinary incontinence (UI), fecal incontinence (FI), and pelvic organ prolapse (POP), were assessed using validated questionnaires. Multivariable logistic regression was used to assess factors associated with each, and having one or more pelvic floor disorders. ResultsAmong 1517 women (mean age=71.5±4.1 SD years), 47.2% (95% CI, 44.7–49.7%) of women had one or more pelvic floor disorders, with 36.2% (95% CI, 33.8–38.6%) having UI, 19.8% (95% CI, 17.8–21.9%) having FI, and 6.8% (95% CI, 5.6–8.2%) having POP. Of the women with POP, 53.4% had UI, 33% had FI and 26.2% had both.The proportion of women with one or more pelvic floor disorders increased with parity from 34.6% (95% CI, 7.8–11.7%) for nulliparous women, to 45.3% (95% CI, 40.3–59.1%) for 1–2 births, and 52.1% (95% CI, 48.3–55.8%) for ≥3 births. Obese women were more likely to have at least one pelvic floor disorder (OR=1.77; 95% CI, 1.36–2.31, p<0.01). ConclusionPelvic floor disorders are common in older women. Physicians caring for older women should be mindful that older women presenting with symptoms of one pelvic floor disorder are likely to have another concurrent pelvic floor problem.

Do symptoms of pelvic floor disorders bias maternal recall of obstetrical events up to 10 years after delivery?

The aim of this prospective study was to investigate whether symptoms of incontinence and prolapse bias maternal recall of obstetrical events up to 10 years after delivery. In this secondary analysis of data gathered from the Mothers' Outcomes After Delivery study, we compared obstetrical medical records with maternal recall of delivery events. We calculated the agreement between maternal recall and the medical record across 1821 deliveries from 1011 participants for events including macrosomia, mode of delivery, prolonged second of labor, episiotomy, spontaneous laceration, anal sphincter laceration, and operative delivery. Women with symptomatic pelvic floor disorders were identified through administration of the Epidemiology of Prolapse and Incontinence Questionnaire or a clinical history of therapy for a pelvic floor disorder. We determined whether agreement between maternal recall and the medical record differed for those with or without symptoms using the medical record as a criterion standard. Agreement between maternal recall and the medical record was excellent for macrosomia and forceps deliveries (κ > 0.8), fair to good for episiotomy (κ = 0.61) and anal sphincter laceration (κ = 0.57), and poor for spontaneous perineal laceration (κ = 0.41). Symptomatic pelvic floor disorders did not impact maternal recall of macrosomia, prolonged second stage, episiotomy, spontaneous laceration, or operative delivery. However, recall of anal sphincter lacerations was biased by symptoms of pelvic floor disorders. Specifically, symptomatic women were significantly more likely to report a history of anal sphincter laceration, regardless of whether a sphincter laceration was documented (P = 0.025). Maternal recall of anal sphincter laceration may be biased by symptomatic pelvic floor disorders. In research based on maternal recall of obstetrical events, this could strengthen the apparent association between sphincter laceration and pelvic floor disorders.

Correct performance of pelvic muscle exercises in women reporting prior knowledge.

This study aimed to assess correct performance of pelvic muscle exercises (PMEs) in women presenting for urogynecologic care who express prior PME knowledge and to identify optimal instruction. New patients referred to urogynecology clinic reporting knowledge of PME or Kegels were asked to complete a questionnaire concerning knowledge, prior instruction, and current use of PME. During examination, the participants were asked to perform their PME or Kegel. Initial levator strength was documented by Oxford Scale. Randomized-order instructions were then given to educate women who contracted incorrectly. The participants completed a postexamination questionnaire. Analyses described percentage of women who were able to perform a correct contraction on initial attempt and factors associated with correct performance. Standard statistical methods were used to assess factors associated with correct PME performance and initial strength. Two hundred fifty eligible participants completed the questionnaires. Sixty (24%) participants were unable to correctly perform a PME initially. Of the 83 participants reporting current practice of PME, 23% performed them incorrectly. Prior instruction (odds ratio, 3.0; 95% confidence interval, 1.6-5.7; P < 0.01) and prior feedback (odds ratio, 3.5; 95% confidence interval, 1.0-12.0; P < 0.05) were associated with correct PME performance. In women who performed PME incorrectly at the initial assessment, "Squeeze the vaginal muscles you use to hold your urine" resulted in correct PME performance most often. Women reporting prior knowledge of PME may still perform them incorrectly. Providing instruction and feedback is strongly associated with correct performance and can be easily incorporated into pelvic examination. This may improve PME use and effectiveness to control symptoms of pelvic floor disorders.

Sexual activity and vaginal topography in women with symptomatic pelvic floor disorders.

Pelvic floor disorders affect vaginal anatomy and may affect sexual function. The aims of this study were to explore the relationship between vaginal anatomy and sexual activity in women with symptomatic pelvic floor disorders and to assess whether vaginal measurements (topography) correlate with sexual function. This is a retrospective cohort study comparing sexually active and nonsexually active women planning urogynecologic surgery. Our primary outcome was the difference in vaginal topography based on Pelvic Organ Prolapse Quantification (POP-Q) exam between cohorts. Correlations between POP-Q measurements and Pelvic Organ Prolapse/Urinary Incontinence Sexual Questionnaire short form (PISQ-12) scores were assessed in sexually active women. The POP-Q is a quantitative and standardized examination for prolapse. The PISQ-12 is a condition-specific sexual function questionnaire validated in sexually active women with pelvic floor disorders. Of 535 women, 208 (39%) were sexually active and 327 (61%) were not. Median genital hiatus (GH) and perineal body (PB) measurements and a PB:GH ratio were not significantly different between the two cohorts. Total vaginal length (TVL) was longer in sexually active women (median 9 vs. 8 cm, P<0.001). In a linear regression analysis controlling for potential confounders, sexually active women still had a longer TVL by 0.4 cm (95% confidence interval 0.07, 0.6 cm) compared with those who were not sexually active. Of the 327 nonsexually active women, 28% indicated they avoided sexual activity because of pelvic floor symptoms. There was poor correlation between TVL, GH, PB, and PB : GH ratio with PISQ-12 scores (r=0.10, -0.05, -0.09, -0.03, respectively). In women with pelvic floor disorders, sexual activity is associated with a longer vaginal length. One-quarter of women indicated they avoided sexual activity because of pelvic floor symptoms. Vaginal topography does not correlate with sexual function based on PISQ-12 scores.

Effect of Levator Ani Muscle Injury on Primiparous Women During the First Year After Childbirth

The estimated prevalence of levator ani muscle (LAM) injury after vaginal delivery ranges from 13% to 36%. Levator ani muscle injury is associated with pelvic organ prolapse, but its association with stress incontinence is unclear. Differences have been demonstrated between white and Chinese women in structural and pelvic organ mobility. There are limited data on the effect of LAM injury on health-related quality of life. This prospective observational study evaluated the effect of LAM injury on pelvic floor disorders and health-related quality of life in Chinese primiparous women during the first year after delivery. At 8 weeks and 12 months after delivery, women with and without LAM injury were assessed for symptoms of pelvic floor disorders and quality of life using the standardized questionnaire (Pelvic Organ Prolapse Quantification [POP-Q]); translabial ultrasound was used to detect LAM injury. A total of 442 women were recruited in a tertiary obstetric unit during the first trimester from August 2009 to September 2010. Data were analyzed using descriptive analysis, independent-sample t test, nonparametric testing, χ2 test, and 2-sided Fisher exact test. Of the 442 women enrolled, 328 (74.2%) completed the study. At 8 weeks after delivery, LAM injury was detected in 48 women (19.0% [95% confidence interval, 14.2%–23.8%]) with vaginal delivery; 12 months after delivery, the injury persisted in 38 women (79.2%). Eight weeks after delivery, LAM injury was associated with prolapse symptoms, descent at POP-Q Aa and Ba points, and higher Pelvic Organ Prolapse Distress Inventory and Urinary Distress Inventory Obstructive subscale scores. By 12 months, LAM injury was not associated with prolapse symptoms or with either Pelvic Floor Distress Inventory (PFDI) or Pelvic Floor Impact Questionnaire (PFIQ) scores. At both time points, no association was found between stress urinary incontinence, urge urinary incontinence, mixed urinary incontinence, and fecal incontinence with LAM injury. In this prospective cohort, LAM injury persisted 12 months after vaginal delivery in 79% of women who had LAM injury at 8 weeks. Eight weeks after delivery, LAM injury was associated with prolapse symptoms, lower POP-Q Aa and Ba points, and higher Pelvic Organ Prolapse Distress Inventory general and Urinary Distress Inventory Obstructive subscale scores. However, there was no association between LAM injury and stress urinary incontinence, urge urinary incontinence, mixed urinary incontinence, and fecal incontinence at 8 weeks or 12 months after delivery, or prolapse symptoms, PFDI, or PFIQ scores at 12 months after delivery.

Vitamin D deficiency in postmenopausal women with pelvic floor disorders.

Introduction:The aim of this study is to evaluate the association of vitamin D deficiency and pelvic floor disorders (PFD) including pelvic organ prolapse (POP) and stress urinary incontinence in postmenopausal women.Materials and Methods:This is a prospective case control study on 120 women with or without symptoms of PFD. Relevant history and clinical examination were conducted. Serum 25-hydroxy vitamin D levels were measured in all women. Chi square and student t test were used to test significance of association. Logistic regression was used to adjust for age. Odds ratios and 95% confidence intervals were calculated.Results:Of the 120 postmenopausal women included, 51 had PFD on clinical examination. Of the 51 cases, 28 women had POP and 14 women had stress incontinence (SUI) while nine women had both POP and SUI. The study showed that vitamin D levels were significantly lower in women with PFD than those without PFD. Menopausal status of more than 5 years was also significantly associated with PFD.Conclusion:Findings suggest association of vitamin D deficiency and PFD in postmenopausal women. In addition, postmenopausal women have a high prevalence of vitamin D deficiency indicating a need to evaluate vitamin D levels in these women.

Dynamic cystocolpoproctography is superior to functional pelvic MRI in the diagnosis of posterior pelvic floor disorders: results of a prospective study

The accuracy of dynamic cystocolpoproctography (DCP) and dynamic MRI were compared in diagnosing posterior pelvic floor disorders. Fifty consecutive female patients (mean age 51 years) complaining of posterior compartment pelvic floor disorder and referred to a tertiary centre entered the prospective study. The Institutional Review Board stated that informed consent from the patients was not necessary for this study. Patients underwent a DCP and a supine functional MRI by two different radiologists. Assessment of radiological examinations was prospective and blind. All patients underwent surgery that led to the final diagnosis. Agreement between the operative diagnosis and the diagnoses following DCP and MRI was assessed using the weighted kappa statistic. A matched-pairs McNemar's test was applied to demonstrate whether or not one radiological method was superior to the other. Full-thickness rectal prolapse was best diagnosed by clinical examination. Internal rectal prolapse and peritoneocele were best diagnosed by DCP. A better agreement with the operative diagnosis, which is not true superiority, was observed for DCP compared with functional pelvic MRI for full-thickness rectal prolapse, internal rectal prolapse and peritoneocele. There was no significant difference between DCP and functional pelvic MRI in the diagnosis of internal rectal prolapse (P = 0.125) or peritoneocele (P = 0.10). As full-thickness rectal prolapse, internal rectal prolapse and peritoneocele might be missed by functional pelvic MRI, there should still be a place for DCP in particular cases where the clinical diagnosis is not clear in women with symptomatic posterior pelvic floor disorders.

Concordance Between Hospital Records and Maternal Recall 5–10 Years After Childbirth

INTRODUCTION: This study investigated the agreement between long-term maternal recall and the hospital obstetric record. We examined whether recall differs by parity or birth order and whether recall bias exists for women with symptomatic pelvic floor disorders. METHODS: We compared hospital records with patient questionnaires for 1,821 deliveries (median 6 years postpartum). The κ statistic was used to compare obstetric exposures and assess recall bias for symptomatic pelvic floor disorders. Generalized estimating equations were used to determine agreement between uniparous women, first, and second deliveries of multiparous women. RESULTS: Agreement was excellent for prematurity, macrosomia, labor before cesarean delivery, and operative vaginal deliveries. There was fair agreement for spontaneous lacerations, third- and fourth-degree lacerations, and poor agreement for episiotomies. Some women were unable to report any information about certain variables (eg, duration of the second stage [12%], cervical dilation before cesarean delivery [46%], episiotomy [17%], and anal sphincter laceration [22%]). Multiparous women tended to have more accurate recall of the first birth. Recall bias was observed for anal sphincter laceration, which was more likely to be reported among symptomatic women. CONCLUSIONS: Maternal recall may not provide the information necessary to inform care during subsequent pregnancies and for research purposes. The use of electronic medical records could improve the quality and quantity of information available to health care providers, and maternal recall could be strengthened through the use of clinical summaries. For now, the value of a review of the medical record is clear.