Vaginal descent and pelvic floor symptoms in postmenopausal women: a longitudinal study.
ABSTRACT To determine whether vaginal descent changes are associated with pelvic floor symptoms in postmenopausal women.
This 4-year prospective study included 260 postmenopausal women with an intact uterus enrolled at one Women's Health Initiative (WHI) clinical trial site. All completed at least two annual pelvic organ prolapse quantification (POP-Q) examinations and symptom questionnaires (30 bladder, bowel, and prolapse symptom items, modified from the Pelvic Floor Distress Inventory). Symptoms were grouped, and group scores categorized into two or three evenly distributed levels. Year 4 data collection was incomplete because the overall WHI study halted. Generalized logistic linear models and generalized estimating equation methods were used to measure associations between vaginal descent and a symptom or symptom score, controlling for time, age, and body mass index (BMI).
Mean age was 68+/-5 years, BMI 30+/-6 kg/m(2), and median parity 4. Ninety-five percent of women had POP-Q stages I-II prolapse. Increasing maximal vaginal descent was associated with "see/feel a bulge" and "sensation of protrusion or bulging," and with obstructive bladder, prolapse, and obstructive bowel scores. Increasing apical descent (POP-Q point C) was associated with "see/feel a bulge," increasing anterior descent (POP-Q point Ba) with bladder pain and obstructive bladder scores, and increasing posterior descent (POP-Q point Bp) with the bowel incontinence score.
Although previous work showed that most pelvic floor symptoms correlated poorly with levels of early prolapse, longitudinal analysis suggests that vaginal descent progression over time is positively associated with various bladder, bowel, and prolapse symptoms in postmenopausal women with stages I-II prolapse.
- Journal of Minimally Invasive Gynecology 04/2014; · 1.58 Impact Factor
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ABSTRACT: The aim of the study was to estimate whether POP severity is related to lower urinary tract symptoms (LUTS) and symptoms of sexual difficulties, when evaluated with validated questionnaires. Multicentric cross-sectional study of 521 women seeking care for PFD in 35 specialized urogynecological clinics. Patients answered the EPIQ to detect symptoms of PFD. The severity of urinary incontinence and the OAB symptoms were measured by ICIQ-UI SF and BSAQ. POP anatomic severity was measured by the anatomic stage of each compartment, determined in pelvic examination in accordance with the IUGA-ICS terminology. A maximum POP stage (M-POP-S) was assigned to each patient: Group A, patients with no POP (stage 0-I); group B, M-POP-S stage II; and group C, M-POP-S stage III-IV. Pelvic examination demonstrated anatomic POP in 224 patients (stage from II to IV). 288 women (56.25%) were classified in group A (no prolapse); 102 (19.92%) group B (stage II); and 122 (28.83%) group C (stage III-IV). Several associations were found between studied variables and M-POP-S (age<55 years, menopause, number of vaginal deliveries, symptom of vaginal bulge, feeling of a bulge makes it difficult to have sexual relations, symptoms of stress urinary incontinence, nocturia and voiding difficulties), but the only variables independently associated were age, symptom of vaginal bulge and difficulty in having sexual relations due to feeling of a bulge. In patients seeking care for PFD, LUTS are not independently associated to the prolapse stage.European journal of obstetrics, gynecology, and reproductive biology 04/2014; · 1.97 Impact Factor
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ABSTRACT: Although a variety of the health benefits have been attributed to regular physical activity, some studies suggested that strenuous exercise may be considered as an independent risk factor for the onset of urinary incontinence in young women. The aim of this article is to provide a review of the scientific literature concerning the role of physiotherapy in the prevention and treatment of urinary incontinence in sport women. Stress urinary incontinence is defined as a leakage of urine during elevated intra-abdominal pressure that can occur during exercise. This dysfunction may affect the quality of life, carrying negative implications on psychological, social and athletic performance. Pelvic floor muscle training has been shown to be an effective treatment in women in general population. However, few studies have been conducted showing the effects of the pelvic floor training in sportswomen. In addition, there are no randomized clinical trials studying this subject. Evidence suggests that stress urinary incontinency may be related to delays in pelvic floor muscles contraction in response to sudden increase of intra-abdominal pressure. Further research is necessary to determine the pelvic floor muscles function in women that perform physical activity with different levels of exigency.Current Women s Health Reviews 02/2013; 9:77-84.