The prevalence of pelvic floor disorders and their relationship to gender, age, parity and mode of delivery

BJOG: An International Journal of Obstetrics and Gynaecology - Tập 107 Số 12 - Trang 1460-1470 - 2000
Alastair H. MacLennan1, Anne Taylor2, David Wilson1, Don Wilson3
1Department of Obstetrics and Gynaecology, The University of Adelaide, Australia
2Centre for Population Studies in Epidemiology, South Australian Department of Human Services, Adelaide, Australia
3Department of Obstetrics and Gynaecology, University of Otago, Dunedin, New Zealand

Tóm tắt

Objectives To define the prevalence of pelvic floor disorders in a non‐institutionalised community and to determine the relationship to gender, age, parity and mode of delivery.Design A representative population survey using the 1998 South Australian Health Omnibus Survey.Sample Random selection of 4400 households; 3010 interviews were conducted in the respondents'homes by trained female interviewers. This cross sectional survey included men and women aged 15–97 years.Results The prevalence of all types of self‐reported urinary incontinence in men was 4.4% and in women was 35.3% (P < 0.001). Urinary incontinence was more commonly reported in nulliparous women than men and increased after pregnancy according to parity and age. The highest prevalence (51.9%) was reported in women aged 70–74 years. The prevalence of flatus and faecal incontinence was 6.8% and 2.3% in men and 10.9% and 3.5% in women, respectively. Pregnancy (> 20 weeks), regardless of the mode of delivery, greatly increased the prevalence of major pelvic floor dysfunction, defined as any type of incontinence, symptoms of prolapse or previous pelvic floor surgery. Multivariate logistic regression showed that, compared with nulliparity, pelvic floor dysfunction was significantly associated with caesarean section (OR 2.5, 95% CI 1.5–4.3), spontaneous vaginal delivery (OR 3.4, 95% CI 2.4–4.9) and at least one instrumental delivery (OR 4.3, 95% CI 2.8–6.6). The difference between caesarean and instrumental delivery was significant (P < 0.03) but was not for caesarean and spontaneous delivery. Other associations with pelvic floor morbidity were age, body mass index, coughing, osteoporosis, arthritis and reduced quality of life scores. Symptoms of haemorrhoids also increased with age and parity and were reported in 19.9% of men and 30.2% of women.Conclusion Pelvic floor disorders are very common and are strongly associated with female gender, ageing, pregnancy, parity and instrumental delivery. Caesarean delivery is not associated with a significant reduction in long term pelvic floor morbidity compared with spontaneous vaginal delivery.

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Tài liệu tham khảo

10.1136/bmj.281.6250.1243

Holst K, 1988, The prevalence of female urinary incontinence and reasons for not seeking treatment, N Z Med J, 101, 756

10.1136/bmj.296.6632.1300

10.1111/j.1532-5415.1998.tb06009.x

10.1097/00006254-199812000-00005

Cardozo L. Prolapse, 1995, Dehurst's Textbook of Obstetrics and Gynaecology for Postgraduates, 642

10.1111/j.1471-0528.1991.tb15386.x

10.1111/j.1471-0528.1996.tb09668.x

Wilson DH, 1992, The South Australian Health Omnibus Survey, Health Promotion Journal of Australia, 2, 47

10.1016/S0140-6736(96)91271-4

10.1016/0378-5122(93)90063-N

10.5694/j.1326-5377.1995.tb139971.x

10.5694/j.1326-5377.1993.tb137666.x

10.1111/j.1479-828X.1996.tb02718.x

1997, What is the right number of caesarean sections? [editorial], Lancet, 349, 815, 10.1016/S0140-6736(97)21012-3

1997, Estimated Resident Population by Sex and Age: States and Territories of Australia

10.1093/ije/28.2.247

10.1111/j.1467-842X.1998.tb01177.x

Ware JE., 1993, The SF‐36 Health Survey. Manual and Interpretation Guide

Hosmer DW, 1989, Applied Logistic Regression

1981, BMDP Statistical Software

10.1111/j.1471-0528.1990.tb02570.x

10.1016/S0140-6736(84)90766-9

10.1016/S0301-2115(96)02692-9

10.1016/S0140-6736(86)92068-4

MacLennan AH., 1991, The role of the hormone relaxin in human reproduction and pelvic girdle relaxation, Scand J Rheumatol, 7

MacLennan AH., 1995, Progress in Relaxin Research, 263

10.1111/j.1523-536X.1998.t01-2-.x

10.1136/bmj.295.6601.749

Carroli B, 1997, Episiotomy policies in vaginal births, 1

10.1046/j.1464-410X.1998.00730.x

10.1093/ageing/21.3.211

Borrie MJ, 1992, Incontinence in institutions: costs and contributing factors, Can Med Assoc, 147, 322

10.1016/0029-7844(96)00013-0

10.1097/00006254-199812000-00005

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BJOG: An International Journal of Obstetrics and Gynaecology

Tập 107 Số 12

1460-1470

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