Credit: Lead women’s health physiotherapist Mary O’Dwyer newsletter
A high rate of pelvic floor dysfunction (PFD) in nulliparous women with clinically significant symptoms and associated bother has been reported in a cross sectional study (part of the SCOPE study) in Ireland.
A total of 1484 women completed the validated Australian Pelvic Floor Questionnaire at 15 weeks gestation. Urinary dysfunction was present in 61%, faecal dysfunction in 41%, prolapse in 5% and sexual dysfunction in 41%. The dysfunction was perceived as bothersome by 37%.
In the urinary section, 61% of participants reported at least one primary symptom and 35% showed clinically significant symptoms. In those who reported urinary incontinence (UI), stress urinary incontinence was present in 50%, urge urinary incontinence alone in 20% and mixed urinary incontinence in 30%. The overall prevalence of UI in this study was 24%.
In the faecal dysfunction (FD) section, 41% of all women were symptomatic for primary symptoms. Within this affected group, 5.3% reported faecal incontinence, 36.8% reported flatal incontinence and 5.5% reported obstructed defecation. The authors explain the high rates of FD could be partially explained by 11% of women having a medical history of irritable bowel syndrome, celiac disease or inflammatory bowel disease.
Pelvic organ prolapse symptoms were reported by 4.8% of all women and 26% of symptomatic women commonly reported symptoms of vaginal pressure or heaviness. The authors state these results should be interpreted with caution as some bowel or bladder related symptoms might resemble prolapse.
Sexual dysfunction symptoms were reported by 41% of all women. Within this group 31% reported dyspareunia (painful intercourse), 25% reported vaginal tightness/vaginismus, 4.8% reported vaginal laxity and coital incontinence was reported by 1.2%. Regarding dyspareunia, the authors believe it is due to endometriosis, which is more prevalent in nulliparous women.
The study demonstrates that in the majority of nulliparous women with PFD, the disorder affects more than one pelvic floor compartment simultaneously. The authors stated the ‘high prevalence of PFD and multi-compartment involvement in nulliparous women could possibly suggest that congenital factors play an important role in PFD development. In order to understand the real role of childbearing in pelvic floor morbidity it is important to know the natural history of PFD by studying women before and after their first delivery.’
The authors believe the strength of this study is the large number of nulliparous women with extensive, detailed demographic characteristics and medical history of the participants. The study can be considered representative of an entire population from a statistical point of view. The main limitation of this study is that the women were not clinically examined to verify the questionnaires findings. As women completed the questionnaire in early pregnancy, they cannot rule out the potential for confusion or recall bias, as questions related only to pre-pregnancy status.
Due to the high prevalence of PDF in pregnant nulliparous women, the authors say that a comprehensive approach to investigating this group is needed to determine their history of PFD. Postpartum follow up will detect the role of pre-pregnancy PFD in the structure of postpartum pathology and determine the women who could be at a higher risk of severe postpartum PFD.
Durnea CM, Khashan AS, Kenny LC, Tabirca SS, O’Reilly BA. An insight in pelvic floor status in nulliparous women. Int Urogyn Journal. Vol 25: 3, 337-345. March 2014.
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