Frequency of pelvic floor disorders and related socio-demographic and obstetric determinants in reproductive aged women in Tabriz city, 2021-2022

Document Type : Original Article

Authors

1 M.Sc. of Midwifery, Student Research Committee, School of Nursing and Midwifery, Tabriz University of Medical Sciences, Tabriz, Iran.

2 PhD of Reproductive Health, Social Determinants of Health Research Center, School of Nursing and Midwifery, Tabriz University of Medical Sciences, Tabriz, Iran.

Abstract

Introduction: Pelvic floor disorders are one of the most common morbidities in women, which have negative consequences on women's daily life. Since the total prevalence of this disorder among Iranian′s women has not been reported by appropriate tools, this study was conducted with aim to determine the prevalence of pelvic floor disorder and its risk factors.
Methods: This cross-sectional study was conducted in 2021-2022 on 400 non-pregnant women of reproductive age referring to Tabriz health centers. Data related to pelvic floor disorders were collected through the Australian Pelvic Floor Questionnaire and the Sociodemographic and Obstetric Characteristics Questionnaire. Data were analyzed using SPSS software (version 26) and Chi-square test and multivariate logistic regression. P<0.05 was considered significant.
Results: In this study, 264 participants (66.0%) had pelvic floor disorder.  Also, 191 participants (47.8%) had urinary incontinence, 235 (58.8%) had fecal incontinence, 52 (13.0%) had pelvic organ prolapse, and 271 (67.8%) had sexual dysfunction. The odds of pelvic floor disorder was lower in women with primary education (odds ratio (OR): 0.46; 95% confidence interval (95% CI): 0.24 to 0.86; P=0.016) and women who exercised (OR: 0.55; 95% CI: 0.35 to 0.86; P=0.009). History of vaginal delivery (OR: 2.37; 95% CI: 1.41 to 3.96; P=0.001) and having constipation (OR: 3.37; 95% CI: 1.62 to 7.00; P<0.001) significantly increased the odds of pelvic floor disorders.
Conclusion: Pelvic floor disorders were common among participated women. The results of the study highlight specific risk factors in the management and prevention of pelvic floor disorders. Therefore, screening and preventive measures are suggested by health workers considering its risk factors.

Keywords

Main Subjects

References

  1. Memon HU, Handa VL. Vaginal childbirth and pelvic floor disorders. Women’s health 2013; 9(3):265-77.
  2. Bozkurt M, Yumru AE, Şahin L. Pelvic floor dysfunction, and effects of pregnancy and mode of delivery on pelvic floor. Taiwanese Journal of Obstetrics and Gynecology 2014; 53(4):452-8.
  3. Beketie ED, Tafese WT, Assefa ZM, Berriea FW, Tilahun GA, Shiferaw BZ, et al. Symptomatic pelvic floor disorders and its associated factors in South-Central Ethiopia. Plos one 2021; 16(7):e0254050.
  4. Dheresa M, Worku A, Oljira L, Mengiste B, Assefa N, Berhane Y. One in five women suffer from pelvic floor disorders in Kersa district Eastern Ethiopia: a community-based study. BMC women's health 2018; 18:1-8.
  5. Eftekhar T, Ghanbari Z, Kalantari F, Shariat M, Haghollahi F. The frequency of pelvic floor dysfunctions and their risk factors in women aged 40-55. Journal of Family and Reproductive Health 2012; 6(2):59-64.
  6. Sigurdardottir T, Bø K, Steingrimsdottir T, Halldorsson TI, Aspelund T, Geirsson RT. Cross-sectional study of early postpartum pelvic floor dysfunction and related bother in primiparous women 6–10 weeks postpartum. International Urogynecology Journal 2021; 32(7):1847-55.
  7. Memon H, Handa VL. Pelvic floor disorders following vaginal or cesarean delivery. Current Opinion in Obstetrics and Gynecology 2012; 24(5):349-54.
  8. Boyle R, Hay‐Smith EJ, Cody JD, Mørkved S. Pelvic floor muscle training for prevention and treatment of urinary and fecal incontinence in antenatal and postnatal women: a short version Cochrane review. Neurourology and urodynamics 2014; 33(3):269-76.
  9. Hage‐Fransen MA, Wiezer M, Otto A, Wieffer‐Platvoet MS, Slotman MH, Nijhuis‐van der Sanden MW, et al. Pregnancy‐and obstetric‐related risk factors for urinary incontinence, fecal incontinence, or pelvic organ prolapse later in life: a systematic review and meta‐analysis. Acta obstetricia et gynecologica Scandinavica 2021; 100(3):373-82.
  10. Bols EM, Hendriks EJ, Berghmans BC, Baeten CG, Nijhuis JG, De Bie RA. A systematic review of etiological factors for postpartum fecal incontinence. Acta obstetricia et gynecologica Scandinavica 2010; 89(3):302-14.
  11. Tähtinen RM, Cartwright R, Tsui JF, Aaltonen RL, Aoki Y, Cardenas JL, et al. Long-term impact of mode of delivery on stress urinary incontinence and urgency urinary incontinence: a systematic review and meta-analysis. European urology 2016; 70(1):148-58.
  12. Kokabi R, Yazdanpanah D. Effects of delivery mode and sociodemographic factors on postpartum stress urinary incontinency in primipara women: A prospective cohort study. Journal of the Chinese Medical Association 2017; 80(8):498-502.
  13. Barca JA, Bravo C, Pintado-Recarte MP, Asúnsolo Á, Cueto-Hernández I, Ruiz-Labarta J, et al. Pelvic floor morbidity following vaginal delivery versus cesarean delivery: systematic review and meta-analysis. Journal of Clinical Medicine 2021; 10(8):1652.
  14. Blomquist JL, Muñoz A, Carroll M, Handa VL. Association of delivery mode with pelvic floor disorders after childbirth. Jama 2018; 320(23):2438-47.
  15. López-López AI, Sanz-Valero J, Gómez-Pérez L, Pastor-Valero M. Pelvic floor: vaginal or caesarean delivery? A review of systematic reviews. International Urogynecology Journal 2021; 32:1663-73.
  16. Meyer I, Richter HE. Impact of fecal incontinence and its treatment on quality of life in women. Women’s Health 2015; 11(2):225-38.
  17. Mazloomdoost D, Crisp CC, Kleeman SD, Pauls RN. Primary care providers’ experience, management, and referral patterns regarding pelvic floor disorders: A national survey. International urogynecology journal 2018; 29:109-18.
  18. Verbeek M, Hayward L. Pelvic floor dysfunction and its effect on quality of sexual life. Sexual medicine reviews 2019; 7(4):559-64.
  19. Swenson CW, DePorre JA, Haefner JK, Berger MB, Fenner DE. Postpartum depression screening and pelvic floor symptoms among women referred to a specialty postpartum perineal clinic. American journal of obstetrics and gynecology 2018; 218(3):335-e1.
  20. Fritel X, Fauconnier A, Bader G, Cosson M, Debodinance P, Deffieux X, et al. Diagnosis and management of adult female stress urinary incontinence: guidelines for clinical practice from the French College of Gynaecologists and Obstetricians-European Journal of Obstetrics & Gynecology and Reproductive Biology 2010; 151(1):14-19.
  21. Woodley SJ, Lawrenson P, Boyle R, Cody JD, Mørkved S, Kernohan A, et al. Pelvic floor muscle training for preventing and treating urinary and faecal incontinence in antenatal and postnatal women. Cochrane Database of Systematic Reviews 2020(5).
  22. Hay-Smith J, Mørkved S, Fairbrother KA, Herbison GP. Pelvic floor muscle training for prevention and treatment of urinary and faecal incontinence in antenatal and postnatal women. Cochrane Database Syst Rev 2008; 4:CD.
  23. Damghanian M, Pakgohar M, Tavousi M, Dehghan Nayeri N, Najafi M, Kharaghani R, et al. Psychometric analysis of the Broome pelvic floor muscle exercise self-efficacy scale in women with urinary incontinence. Hayat 2018; 23(4):307-17.
  24. Toye F, Barker KL. A meta-ethnography to understand the experience of living with urinary incontinence:‘is it just part and parcel of life?’. BMC urology 2020; 20:1-25.
  25. Meekins AR, Siddiqui NY. Diagnosis and Management of Postpartum Pelvic Floor Disorders. Obstetrics and Gynecology Clinics of North America 2020; 47(3):477-86.
  26. Good MM, Solomon ER. Pelvic floor disorders. Obstetrics and gynecology clinics of North America 2019; 46(3):527-40.
  27. Sanchez-Sanchez B, Torres-Lacomba M, Yuste-Sánchez MJ, Navarro-Brazalez B, Pacheco-da-Costa S, Gutierrez-Ortega C, et al. Cultural adaptation and validation of the pelvic floor distress inventory short form (PFDI-20) and pelvic floor impact questionnaire short form (PFIQ-7) Spanish versions. European Journal of Obstetrics & Gynecology and Reproductive Biology 2013; 170(1):281-5.
  28. Barber MD. Questionnaires for women with pelvic floor disorders. International Urogynecology Journal 2007; 18:461-5.
  29. Saudi RA, Tosson EE. Prevalence and the degree of distress of pelvic floor disorders symptoms in women seeking primary health care at Ismailia governorate. Egypt Urogynaecologia 2022; 34:291.
  30. Baessler K, O’Neill SM, Maher CF, Battistutta D. Australian pelvic floor questionnaire: a validated interviewer-administered pelvic floor questionnaire for routine clinic and research. International Urogynecology Journal 2009; 20:149-58.
  31. Mashayekh-Amiri S, Asghari Jafarabadi M, Rashidi F, Mirghafourvand M. Psychometric evaluation and cross-cultural adaptation of the Australian Pelvic Floor Questionnaire (APFQ-IR) in Iranian reproductive age women. Scientific Reports 2023; 13(1):23015.
  32. Malaekah H, Al Medbel HS, Al Mowallad S, Al Asiri Z, Albadrani A, Abdullah H. Prevalence of pelvic floor dysfunction in women in Riyadh, Kingdom of Saudi Arabia: a cross-sectional study. Women's Health 2022; 18:17455065211072252.
  33. Zeleke BM, Bell RJ, Billah B, Davis SR. Symptomatic pelvic floor disorders in community-dwelling older Australian women. Maturitas 2016; 85:34-41.
  34. Saudi RA, Tosson EE. Prevalence and the degree of distress of pelvic floor disorders symptoms in women seeking primary health care at Ismailia governorate. Egypt Urogynaecologia 2022; 34:291.
  35. Rashidi F, Hajian S, Darvish S, Alavi Majd H. Prevalence of urinary incontinence in Iranian women: systematic review and meta-analysis. The Iranian Journal of Obstetrics, Gynecology and Infertility 2019; 21(12):94-102.
  36. Taimoori B, Roudbari M. The prevalence of symptoms of pelvic floor disorders in women that referred to the clinic of gynecology in Ali-ebn-Abitaleb hospital, Zahedan, Iran. Zahedan Journal of Research in Medical Sciences 2006; 8(3).
  37. Dieter AA, Wilkins MF, Wu JM. Epidemiological trends and future care needs for pelvic floor disorders. Current Opinion in Obstetrics and Gynecology 2015; 27(5):380-4.
  38. Islam RM, Oldroyd J, Rana J, Romero L, Karim MN. Prevalence of symptomatic pelvic floor disorders in community-dwelling women in low and middle-income countries: a systematic review and meta-analysis. International urogynecology journal 2019; 30:2001-11.
  39. Kepenekci I, Keskinkilic B, Akinsu F, Cakir P, Elhan AH, Erkek AB, et al. Prevalence of pelvic floor disorders in the female population and the impact of age, mode of delivery, and parity. Diseases of the Colon & Rectum 2011; 54(1):85-94.
  40. Peinado-Molina RA, Hernández-Martínez A, Martínez-Vázquez S, Rodríguez-Almagro J, Martínez-Galiano JM. Pelvic floor dysfunction: prevalence and associated factors. BMC Public Health 2023; 23(1):2005.
  41. McGrother CW, Donaldson MM, Hayward T, Matthews R, Dallosso HM, Hyde C. Urinary storage symptoms and comorbidities: a prospective population cohort study in middle-aged and older women. Age and Ageing 2006; 35(1):16-24.
  42. Sobhgol SS, Charandabee SM. Related factors of urge, stress, mixed urinary incontinence and overactive bladder in reproductive age womenin Tabriz, Iran: a cross-sectional study. International Urogynecology Journal 2008; 19:367-73.
  43. Wu JM, Vaughan CP, Goode PS, Redden DT, Burgio KL, Richter HE, et al. Prevalence and trends of symptomatic pelvic floor disorders in US women. Obstetrics & Gynecology 2014; 123(1):141-8.
  44. Brown H, Roberts J. Exercising choice: the economic determinants of physical activity behaviour of an employed population. Social science & medicine 2011; 73(3):383-90.
  45. Ekenga CC, Parks CG, Wilson LE, Sandler DP. Leisure-time physical activity in relation to occupational physical activity among women. Preventive medicine 2015; 74:93-6.
  46. Handa VL, Blomquist JL, Knoepp LR, Hoskey KA, McDermott KC, Muñoz A. Pelvic floor disorders 5–10 years after vaginal or cesarean childbirth. Obstetrics & Gynecology 2011; 118(4):777-84.
  47. Abedian S, Iravani M. Childbirth and the pelvic floor muscles and strategies to prevent the disorder: A review article. Nursing And Midwifery Journal 2020; 18(6):486-95.
  48. Afshari P, Dabagh F, Iravani M, Abedi P. Comparison of pelvic floor muscle strength in nulliparous women and those with normal vaginal delivery and cesarean section. International urogynecology journal 2017; 28:1171-5.
  49. Navarro-Brazález B, Prieto-Gómez V, Prieto-Merino D, Sánchez-Sánchez B, McLean L, Torres-Lacomba M. Effectiveness of hypopressive exercises in women with pelvic floor dysfunction: a randomised controlled trial. Journal of clinical medicine 2020; 9(4):1149.
  50. Bø K, Nygaard IE. Is physical activity good or bad for the female pelvic floor? A narrative review. Sports medicine 2020; 50(3):471-84.
  51. de Mattos Lourenco TR, Matsuoka PK, Baracat EC, Haddad JM. Urinary incontinence in female athletes: a systematic review. International urogynecology journal 2018; 29:1757-63.
  52. Nygaard IE, Shaw JM. Physical activity and the pelvic floor. American journal of obstetrics and gynecology 2016; 214(2):164-71.
  53. Amselem C, Puigdollers A, Azpiroz F, Sala C, Videla S, Fernandez‐Fraga X, et al. Constipation: a potential cause of pelvic floor damage?. Neurogastroenterology & Motility 2010; 22(2):150-e48.
  54. Zareian MA, Nejatbakhsh F, Tabarrai Arani M. Importance and methods of treating pregnancy constipation in conventional medicine and comparison with traditional medicine. The Iranian Journal of Obstetrics, Gynecology and Infertility 2017; 19(40):19-32.
The Iranian Journal of Obstetrics, Gynecology and Infertility
Volume 27, Issue 2
April 2024
Pages 36-46

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