Pelvic organ support, symptoms and quality of life during pregnancy: a prospective study.

INTRODUCTION AND HYPOTHESIS: Prevalence studies show an increase in lower urinary tract and pelvic floor symptoms during pregnancy. The aim of our prospective study was to evaluate changes in pelvic organ support, pelvic floor symptoms and their effect on quality of life (QOL) during the first pregnancy using validated measures. We hypothesised that pregnancy is associated with worsening of pelvic floor function. METHODS: Objective assessment of pelvic organ support using the Pelvic Organ Prolapse Quantification (POP-Q) system and subjective evaluation of symptoms of pelvic floor disorders and related QOL with the electronic Personal Assessment Questionnaire-Pelvic Floor (ePAQ-PF) were performed in the second trimester and then repeated at 36 weeks gestation. RESULTS: A total of 182 nulliparae attended the first visit at 20 weeks and 150 (82.4%) women returned for follow-up at 36 weeks gestation. There were no significant changes in POP-Q points or stage between the two visits except for a significant increase in genital hiatus (p = 0.0001) and perineal body length (p = 0.0001). The vaginal symptoms did not show any changes. Symptoms and bother with voiding difficulties and stress urinary incontinence increased during pregnancy. Constipation (p = 0.02) and evacuation subdomains improved significantly (p = 0.009). In the sexual domain, the only subdomain that worsened significantly (p = 0.03) was "sex and vaginal symptoms". None of the pelvic floor symptoms impacted the QOL. CONCLUSIONS: In our group of nulliparae, pelvic floor-related QOL and prolapse stage did not change significantly from the second to the third trimester of pregnancy.

Effect of childbirth on pelvic organ support and quality of life: a longitudinal cohort study.

INTRODUCTION AND HYPOTHESIS: Although childbirth is known to be a major risk factor for pelvic floor disorders, there is a paucity of prospective, long-term data addressing this issue. The aim of our study was to evaluate the changes of pelvic organ support, symptoms and quality of life (QOL) after childbirth. METHODS: Pelvic organ support was objectively assessed using the Pelvic Organ Prolapse Quantification method (POP-Q) and pelvic floor symptoms were subjectively evaluated using a validated questionnaire performed in the second trimester, 14 weeks, 1 and 5 years after delivery. RESULTS: We recruited 182 nulliparae and 97 (53.3 %) returned for follow-up at 5 years. POP-Q stage after vaginal delivery (VD) worsened at all time points. After caesarean the worsening in POP-Q stage was temporary at 14 weeks. Prolapse symptoms worsened at 14 weeks (p<0.001) and 1 year (p=0.006) after VD but not at 5 years. No changes in prolapse symptoms occurred after caesarean. Significant increase in faecal incontinence was observed in both delivery groups 5 years after delivery. For all pelvic floor disorder domains there were no significant changes in QOL irrespective of mode of delivery, except for worsening in general sexual QOL after VD. CONCLUSIONS: Five years after childbirth the stage of prolapse worsened after VD but not after caesarean. However, there was no impact on prolapse symptoms or QOL. After VD women were more likely to experience a worsening in general sex score, but no other difference in QOL measures.

The effect of pregnancy and childbirth on pelvic floor muscle function.

INTRODUCTION AND HYPOTHESIS: The effect of pregnancy and mode of delivery on pelvic floor muscle function (PFMF) is unclear. Our aim was to prospectively evaluate the effect of pregnancy and childbirth on PFMF. METHODS: Subjective (Oxford scale) and objective (perineometry) assessments of PFMF were performed at 20 and 36 weeks gestation and at 14 weeks and 12 months after delivery. The resting pressure (RP) and the maximum squeeze pressure (MSP) were recorded. RESULTS: Four hundred three women (182 nulliparous and 221 multiparous) were recruited. Two hundred ninety-four (73%) delivered vaginally and 92 (23%) by caesarean section. RP and MSP improved significantly (p < 0.01) during pregnancy. After childbirth, a significant decrease in PFMF was demonstrated, which recovered completely by 1 year in majority of women. CONCLUSIONS: There appears to be a physiological increment in PFMF during pregnancy. The pelvic floor weakens temporarily after childbirth but contractility appears to recover by 1 year irrespective of the mode of delivery.

Mode of delivery after previous obstetric anal sphincter injuries (OASIS)--a reappraisal?

INTRODUCTION AND HYPOTHESIS: To prospectively evaluate anorectal symptoms, quality of life (QoL), sphincter integrity and function after subsequent childbirth following previous obstetric anal sphincter injuries (OASIS). METHODS: A validated Manchester Health Questionnaire, endoanal sonography and manometry were performed during the third trimester and 13 weeks postpartum. Women without objective compromise of anal function were recommended a vaginal delivery and the others a caesarean section. RESULTS: Seventy-three consecutive women with previous OASIS were seen during a subsequent pregnancy of whom 59 were reviewed 13 weeks following delivery. Anal manometry findings did not change significantly following a subsequent vaginal delivery or caesarean section. Only one new defect (internal sphincter) occurred after a vaginal delivery. There was no significant change in symptoms or QoL. Three (6.8%) sustained repeat OASIS. CONCLUSIONS: Women who have no antenatal evidence of objective compromise of anal sphincter function can be reassured that a vaginal delivery is not associated with any significant deterioration in function or QoL.

Female sexual dysfunction: are urogynecologists ready for it?

The aim of this study was to assess the practice of members of the British Society of Urogynaecology (BSUG) with respect to female sexual dysfunction (FSD) and compare it to members of the American Urogynecologic Society (AUGS). A web-based anonymous electronic questionnaire was sent to all (n = 150) BSUG members. Frequencies of responses and chi-square test for association with demographics were calculated. One hundred questionnaires were returned of which 95 were sufficiently filled. Fifty percent regularly screened for FSD at clinic visits and 49.5% after surgery, compared to 77% and 76% of AUGS members, respectively. The most important barrier was lack of time. Only 2% said FSD was not an important problem. Seventy-six percent found training for FSD unsatisfactory. FSD is not part of normal practice for half of BSUG members. There is, therefore, a need for better implementation of education and training at both undergraduate and postgraduate levels.

Sexual function following pelvic floor surgery.

OBJECTIVE: To prospectively evaluate sexual function in women who underwent surgery for incontinence and/or prolapse using the Pelvic Organ Prolapse-Urinary Incontinence Sexual Questionnaire (PISQ), and to provide a preliminary evaluation of the PISQ's psychometric properties for a population of women in the United Kingdom. METHODS: Women who underwent surgery for pelvic organ prolapse and/or urinary incontinence completed the PISQ, the Sheffield Prolapse Symptoms Questionnaire, and the King's Health Questionnaire preoperatively and 4 months postoperatively. Rates of item completion were assessed to evaluate the performance of the PISQ, and Cronbach alpha values and item-total correlations were calculated for the full scale and each of the 3 domains (behavioral-emotive, physical, and partner-related). RESULTS: Thirty-five women responded to the questionnaire. Postoperatively an improvement was demonstrated for overall score (P=0.002), and for physical (P<0.001) and partner-related domains (P=0.004). CONCLUSION: Women reported a significant improvement in sexual function 4 months after surgery for incontinence and prolapse.

Urinary incontinence after obstetric anal sphincter injuries (OASIS)--is there a relationship?

This study aimed to compare urinary symptoms and its impact on women's quality of life after obstetric anal sphincter injuries (OASIS) with a matched control group in the short term. The study group consisted of 100 primiparous women with OASIS and 104 controls who sustained a second-degree tear or had a mediolateral episiotomy performed. All women completed a validated International Consultation on Incontinence Questionnaire-Short Form (ICIQ-SF) questionnaire 10 weeks after delivery. Compared to controls, significantly more women with OASIS reported overall urinary incontinence (21.2 vs 38%, p = 0.005) and had significantly worse quality of life score (incontinence score: 2.42 vs 1.2; p = 0.008). Significantly more women with OASIS suffered from stress urinary incontinence (33 vs 14%; p = 0.002; OR 3.06; CI = 1.54-6.07) than controls. Logistic regression analysis revealed that OASIS and a prolonged (>50 min) second stage of labour were independent risk factors for the development of stress urinary incontinence. This study highlights the importance of inquiring about urinary incontinence in women with OASIS.

Physical and sexual abuse in patients with overactive bladder: is there an association?

The known sequelae of sexual abuse include acute and chronic injury. The purpose of this study was to evaluate the association of overactive bladder symptoms (OABs) with a history of physical or sexual abuse. Two hundred and forty-three women who attended the gynaecological out-patient clinic or the urogynaecological clinic were recruited for our study. Based on their clinical examination, they were assigned to three groups of patients with either OAB or with stress urinary incontinence (SUI) without concomitant urgency symptoms (SUI), or without history of incontinence (control group). Afterwards, they completed an anonymous questionnaire about bladder function and physical/sexual violence. Significantly more women (30.6%, 26/85) with OAB had previously been physically or sexually abused than women with SUI (17.8%, 18/101) and of the control group (17.5%, 10/57). Our study showed that significantly more women with OAB report physical and sexual abuse than subjects with stress incontinence or no urinary complaints. Women with stress incontinence had the same rate of self-reported physical/sexual abuse as continent controls.

Voiding dysfunction after abdominoplasty--an unusual complication.

Abdominoplasty is an electively undertaken aesthetic operation mostly performed on patients after massive weight reduction. Previous case reports have demonstrated an improvement of incontinence symptoms after abdominoplasty. We report a case where urinary dysfunction occurred after refashioning of an abdominoplasty. The stress urinary incontinence got worse but what was of greater concern to her was a noticeable change of her urinary stream in an upward direction. A urethrolysis combined with an insertion of a tension-free vaginal tape and an anterior colporrhaphy was performed. After the operation, stress urinary incontinence improved and she reported that her urine stream reverted towards a normal direction.