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Zhou Q, Guo Y, Li L, Lu M, Li GS, Peng GL. Female genital prolapse and risk of psychiatric disorders: A two-sample Mendelian randomization analysis. J Affect Disord 2024; 367:8-17. [PMID: 39218317 DOI: 10.1016/j.jad.2024.08.196] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Revised: 03/29/2024] [Accepted: 08/29/2024] [Indexed: 09/04/2024]
Abstract
BACKGROUND There is a growing body of evidence suggests a strong link between female genital prolapse (FGP) and mental health. However, the causal relationship between FGP and psychological disorders remains unclear. OBJECTIVES Bidirectional Mendelian Randomization (MR) analysis has been applied to investigate the potential impact of FGP on the risk of seven common psychiatric disorders. METHODS The two-sample MR analysis was conducted using genetic instruments such as Inverse variance weighted (IVW), MR Egger, weighted median, simple mode, and weighted mode from the genome-wide association study (GWAS) summary data in European populations. In addition, the Cochrane's Q test, MR-Egger intercept test, MR pleiotropy residual sum and outliers (MR-PRESSO) test and leave-one-out analysis were employed to assess the sensitivity and heterogeneity. RESULTS The MR results revealed that FGP exhibited a potential marginal protective effect on bipolar disorder (BD) (odds ratio(OR) = 0.92, 95%confidence interval (95%CI: 0.85-0.99, P = 0.03) as well as schizophrenia(OR = 0.91, 95%CI:0.85-0.98, P = 0.01). Nevertheless, there was no causal correlation between genetically predicted FGP and obsessive compulsive disorder (OCD) (OR = 0.98, 95%CI:0.80-1.20, P = 0.84),depression (broad) (OR = 1.00, 95%CI:0.99-1.01, P = 0.76), major depression(OR = 0.98, 95%CI:0.94-1.03, P = 0.43), anxiety disorders (OR = 1.00, 95%CI:0.94-1.07,P = 0.97) and post-traumatic stress disorder(PTSD) (OR = 1.18, 95%CI:0.88-1.57,P = 0.27),respectively. In addition, BD was found to have a potential significant influence on FGP in the inverse MR analysis (OR = 0.83, 95%CI:0.72-0.97, P = 0.02). No significant heterogeneity or horizontal pleiotropy detected, and the results were deemed stable based on sensitivity analysis and leave-one-out test . LIMITATIONS There are shortcomings such as data limitations, population bias, potential pleiotropy, and stratified analysis. CONCLUSIONS While there is potential causal relationship between FGP and BD or schizophrenia, it does not exhibit any correction with OCD, depression (broad), major depression, anxiety disorders and PTSD among European populations.
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Affiliation(s)
- Quan Zhou
- Department of Gynecology, Fujian Provincial Hospital, Fuzhou University Affiliated Provincial Hospital, Fuzhou, Fujian Province, China.
| | - Yan Guo
- Department of Pathology, Qinghai Provincial People's Hospital, Xining, Qinghai Province 810007, PR China
| | - Lu Li
- Department of Gynecology and Obstetrics, The First College of Clinical Medical Science, China Three Gorges University/Yichang Central People's Hospital, Yichang 443000, PR China
| | - Man Lu
- Department of Gynecology and Obstetrics, The First College of Clinical Medical Science, China Three Gorges University/Yichang Central People's Hospital, Yichang 443000, PR China
| | - Guo-Sheng Li
- Department of Gynecology and Obstetrics, The First College of Clinical Medical Science, China Three Gorges University/Yichang Central People's Hospital, Yichang 443000, PR China
| | - Gan-Lu Peng
- Department of Gynecology and Obstetrics, The First College of Clinical Medical Science, China Three Gorges University/Yichang Central People's Hospital, Yichang 443000, PR China
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Peinado Molina RA, Martínez Vázquez S, Martínez Galiano JM, Rivera Izquierdo M, Khan KS, Cano-Ibáñez N. Prevalence of depression and anxiety in women with pelvic floor dysfunctions: A systematic review and meta-analysis. Int J Gynaecol Obstet 2024. [PMID: 38859723 DOI: 10.1002/ijgo.15719] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2024] [Accepted: 05/23/2024] [Indexed: 06/12/2024]
Abstract
BACKGROUND Female pelvic floor dysfunction (PFD) is a common condition affecting the emotional well-being of women. OBJECTIVE To estimate the prevalence of depressive and anxiety symptoms in women with PFD. SEARCH STRATEGY, SELECTION CRITERIA, DATA COLLECTION AND ANALYSIS: Following prospective registration (PROSPERO CRD42022362095) we conducted a search of three electronic databases (PubMed, Web of Science and Scopus) from inception to April 2023 without language restriction to capture studies reporting the prevalence of depression/anxiety among women with PFD (chronic pelvic pain [CPP], urinary incontinence [UI], pelvic organ prolapse [POP], and/or fecal incontinence [FI]). Only studies with validated tools were included. Data extraction and study quality assessment were performed by two independent reviewers. Stratifying by type of PFD, rates of depression and anxiety were pooled using random effects model computing 95% confidence interval (CI) and assessing heterogeneity using the I2 statistic. Funnel plots were used to detect potential reporting biases and small-study effects. MAIN RESULTS The search yielded 767 articles, from which 54 studies containing 632 605 women were included. All the studies were high quality. The prevalence of depression was: CPP 26.8% (95% CI: 19.2-34.4, I2 = 98.7%; 12 studies, 4798 participants with 491 cases; Egger's P value = 0.009); UI 26.3% (95% CI: 19.4-33.2, I2 = 99.9%; 26 studies, a total of 346 114 participants with 25 050 cases; Egger's P value = 0.944); POP 34.9% (95% CI: 24.3-45.6, I2 = 68%; three studies, 297 participants with 104 cases; Egger's P value = 0.973); and FI 25.3% (95% CI: 0.68-49.9, I2 = 99.7%; six studies, 14 663 participants with 1773 cases; Egger's P value = 0.780). The prevalence of anxiety was: CPP 29.5% (95% CI: 16.3-42.7, I2 = 97.7%; nine studies, 2483 participants with 349 cases; Egger's P value = 0.001); UI 46.91% (95% CI: 39.1-54.6, I2 = 99.6%; 11 studies, 198 491 participants with 40 058 cases; Egger's P value = 0.337); and POP 28% (95% CI: 13.6-42.4, I2 = 89%; three studies with 355 participants with 90 cases; Egger's P value = 0.306). CONCLUSION The prevalence of mental health illness was variable in the different types of PFDs. This meta-analysis helps quantify the burden of depression and anxiety in PFD and will help inform the policies regarding screening of emotional well-being by healthcare professionals engaged in care of women with PFD.
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Affiliation(s)
| | | | - Juan Miguel Martínez Galiano
- Department of Nursing, University of Jaen, Jaén, Spain
- Consortium for Biomedical Research in the Epidemiology and Public Health Network (CIBERESP), Madrid, Spain
| | - Mario Rivera Izquierdo
- Consortium for Biomedical Research in the Epidemiology and Public Health Network (CIBERESP), Madrid, Spain
- Department of Preventive Medicine and Public Health, Faculty of Medicine, University of Granada, Granada, Spain
- Instituto de Investigación Biosanitaria (ibs. Granada), Granada, Spain
| | - Khalid Saeed Khan
- Consortium for Biomedical Research in the Epidemiology and Public Health Network (CIBERESP), Madrid, Spain
- Department of Preventive Medicine and Public Health, Faculty of Medicine, University of Granada, Granada, Spain
| | - Naomi Cano-Ibáñez
- Consortium for Biomedical Research in the Epidemiology and Public Health Network (CIBERESP), Madrid, Spain
- Department of Preventive Medicine and Public Health, Faculty of Medicine, University of Granada, Granada, Spain
- Instituto de Investigación Biosanitaria (ibs. Granada), Granada, Spain
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Abebe SA, Gashaw ZM, Ayichew Z, Angaw DA, Kindie EA. Prevalence and associated factors of depression among women with advanced pelvic organ prolapse in Northwest Ethiopia: cross-sectional study. BMC Womens Health 2024; 24:313. [PMID: 38816695 PMCID: PMC11137946 DOI: 10.1186/s12905-024-03162-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2023] [Accepted: 05/27/2024] [Indexed: 06/01/2024] Open
Abstract
BACKGROUND Depression is a symptom characterized by sadness, loss of interest or pleasure, feelings of guilt or low self-worth, disturbed sleep or appetite, feelings of tiredness and poor concentration. One of the most common mental illnesses in the world and a major contributor to morbidity and mortality is depression. The purpose of this study was to ascertain the prevalence of depression and the risk factors associated with it in women who had advanced pelvic organ prolapse. METHODS A facility-based cross-sectional study was conducted to determine depression among advanced pelvic organ prolapse women at Gondar University Comprehensive Specialized Hospital. All women who have advanced pelvic organ prolapse were consecutively included till it reached a total of 367 participants over four months. A structured questionnaire was used to obtain the sociodemographic characteristics, clinical characteristics and depression status of the participants. Depression measures were obtained by using the Patient Health Questionnaire tool, which is validated in the Ethiopian local language for chronic illnesses including pelvic organ prolapse using a cut point of five and above, which is considered to indicate depression. Women who screened positive were linked to a psychiatric clinic for further evaluation and treatment. Data was entered into a computer using Epi Info version 3.5.3 and then exported to STATA version 14 for analysis. Multivariable logistic regressions were fitted and odds ratios with 95% confidence intervals with a P value less than 0.05 were used to identify statistically significant factors. RESULTS The prevalence of depression was found to be 47.1% (95% CI: 43-52%). Being rural (AOR = 4.8; CI: 1.11-16.32), having a history of divorce because of pelvic organ prolapse (AOR = 5.5; CI: 1.85-16.32) and having a history of urinary symptoms (AOR = 3.1; CI: 1.12-8.59) were found to be independently associated with depression. CONCLUSIONS The prevalence of depression among women with advanced pelvic organ prolapse in this study is high as compared to other studies. Depression screening strategies should be designed for the early identification and treatment of depression among women with advanced pelvic organ prolapse.
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Affiliation(s)
- Sileshi Ayele Abebe
- Department of Gynecology and Obstetrics, School of Medicine, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia.
| | - Zelalem Mengistu Gashaw
- Department of Gynecology and Obstetrics, School of Medicine, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Zelalem Ayichew
- Department of Gynecology and Obstetrics, School of Medicine, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Dessie Abebaw Angaw
- Department of Public Health, School of Medicine, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Endeshaw Asaye Kindie
- Department of Pathology, School of Medicine, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
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Graziottin A, Di Simone N, Guarano A. Postpartum care: Clinical considerations for improving genital and sexual health. Eur J Obstet Gynecol Reprod Biol 2024; 296:250-257. [PMID: 38484617 DOI: 10.1016/j.ejogrb.2024.02.037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2023] [Revised: 02/15/2024] [Accepted: 02/20/2024] [Indexed: 04/19/2024]
Abstract
The postpartum period encompasses the biological and psychoaffective transition to motherhood. However, it remains a most neglected phase in a woman's life. Furthermore, the transition to parenthood is a critical and potentially disrupting factor in a couple's relationship, which can be complicated by undiagnosed biological and psychosexual difficulties. Lack of recognition of the many biological and medical factors that can affect women's health and sexuality in the postpartum period is a common and persistent clinical omission worldwide. Communication difficulties exist between healthcare professionals and women and there are wording biases in describing female genitalia. This can further contribute to the diagnostic lack of attention and timely diagnosis and treatment of even very bothersome symptoms. Early diagnosis and treatment of common postpartum conditions is vital and quality care for new mothers should include psychological and emotional support, lactation assistance, early diagnosis and treatment of genital and sexual pain symptoms, pelvic floor rehabilitation and sexual health guidance. The inclusion of correct genital hygiene practices is a critical element of postpartum gynaecological counselling and can help improve overall genital and sexual health. In this review, we summarise the variability in global professional guidelines for postpartum care, identify common health problems faced by postpartum women and discuss appropriate postpartum care. We pay specific attention to prominent biological or medical factors that can impact the emotional and psychosexual wellbeing of women and couples. The aetiology, diagnosis and treatment of sexual dysfunction, in particular sexual pain disorders, is therefore discussed with a pragmatic approach. Finally, the role of intimate hygiene care is discussed with special attention given to cleanser ingredients with solid scientific evidence to help clinicians adopt a more tailored approach with their clinical recommendations.
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Affiliation(s)
- Alessandra Graziottin
- Centre of Gynaecology and Medical Sexology, Department of Obstetrics and Gynaecology, San Raffaele Resnati Hospital, 20122 Milan, Italy; Department of Obstetrics and Gynaecology, University of Verona, 37129 Verona, Italy; Specialty School, Endocrinology and Metabolic Diseases Department, Federico II University, 80131 Naples, Italy; Alessandra Graziottin Foundation for the Cure and Care of Pain in Women, NPO, Italy
| | - Nicoletta Di Simone
- Department of Biomedical Sciences, Humanitas University, 20072 Milan, Italy; IRCCS Humanitas Research Hospital, Via Manzoni 56, 20089 Rozzano, Italy
| | - Alice Guarano
- Department of Biomedical Sciences, Humanitas University, 20072 Milan, Italy.
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Mínguez-Esteban I, De-la-Cueva-Reguera M, Romero-Morales C, Martínez-Pascual B, Navia JA, Bravo-Aguilar M, Abuín-Porras V. Physical manifestations of stress in women. Correlations between temporomandibular and pelvic floor disorders. PLoS One 2024; 19:e0296652. [PMID: 38626037 PMCID: PMC11020383 DOI: 10.1371/journal.pone.0296652] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2023] [Accepted: 12/15/2023] [Indexed: 04/18/2024] Open
Abstract
INTRODUCTION Stress is characterized as a challenging occurrence that triggers a physiological and/or behavioral allostatic response, alongside the demands typically encountered throughout the natural course of life. A sustained state of stress gives rise to secondary effects, including insomnia and neck pain. Also, the risk of musculoskeletal problems in the cervical and lumbar spine can be increased due to a sustained state of stress. The present study main objective is to study the association between orofacial and pelvic floor muscles in women in Spain. METHODOLOGY An observational, cross-sectional, retrospective analytical study was designed and carried out in the laboratories of the European University of Madrid. Sixty-five participants were recruited with a mean age of 29.9 ± 7.69. Measurements were taken by myotonometry on natural oscillation frequency (Hz), dynamic stiffness (N/m), elasticity (N/m2), mechanical stress relaxation time (ms) and creep, for the following muscles: right and left masseter, right and left temporalis and central fibrous nucleus of the perineum (CFPF). On the other hand, the subjects completed the following questionnaires: perceived stress scale (PSS-14), anxiety scale (STAI), self-reported bruxism questionnaire (CBA), Fonseca Anamnestic Index and the Pittsburgh Sleep Quality Scale (PSQI). RESULTS Significant correlations were found in several parameters between the right temporalis and CFPF (p<0.05). Highlighting the correlation between TMDs and lubrication r = -0.254 (p = 0.041) and bruxism with pain in sexual intercourse r = 0.261 (p = 0.036). CONCLUSION The results support the proposed hypothesis. To the author's knowledge, this is the first study which relates both locations, and it is suggested to continue with the research and expand the knowledge of it.
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Affiliation(s)
- Isabel Mínguez-Esteban
- Faculty of Sport Sciences, Universidad Europea de Madrid, Villaviciosa de Odón, Madrid, Spain
- Musculoskeletal Pain and Motor Control Research Group, Faculty of Sport Sciences, Universidad Europea de Madrid, Madrid, Spain
- OnelifeCentre, Multidisciplinary Centre for the Prevention and Treatment of Pain, Alcorcón, Spain
| | | | - Carlos Romero-Morales
- Faculty of Sport Sciences, Universidad Europea de Madrid, Villaviciosa de Odón, Madrid, Spain
| | | | - Jose A. Navia
- Faculty of Sport Sciences, Universidad Europea de Madrid, Villaviciosa de Odón, Madrid, Spain
- Facultad de Educación, Universidad de Alcalá, Alcalá de Henares, España
| | - María Bravo-Aguilar
- Faculty of Sport Sciences, Universidad Europea de Madrid, Villaviciosa de Odón, Madrid, Spain
| | - Vanesa Abuín-Porras
- Faculty of Sport Sciences, Universidad Europea de Madrid, Villaviciosa de Odón, Madrid, Spain
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Smith AR, Mansfield SA, Bradley CS, Kenton KS, Helmuth ME, Cameron AP, Kirkali Z, Emi Bretschneider C, Andreev V, Sarma A, Lane G, Collins SA, Cella D, Henry Lai H, Harte SE, Griffith JW. Relationships Between Urinary and Nonurinary Symptoms in Treatment-Seeking Women in LURN. UROGYNECOLOGY (PHILADELPHIA, PA.) 2024; 30:123-131. [PMID: 37428882 PMCID: PMC10751379 DOI: 10.1097/spv.0000000000001388] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/12/2023]
Abstract
IMPORTANCE Physical health and psychological health represent modifiable factors in the causal pathway of lower urinary tract symptoms (LUTS). OBJECTIVES Understand the relationship between physical and psychological factors and LUTS over time. STUDY DESIGN Adult women enrolled in the Symptoms of Lower Urinary Tract Dysfunction Research Network observational cohort study completed the LUTS Tool and Pelvic Floor Distress Inventory, including urinary (Urinary Distress Inventory), prolapse (Pelvic Organ Prolapse Distress Inventory), and colorectal anal (Colorectal-Anal Distress Inventory) subscales at baseline, 3 months, and 12 months. Physical functioning, depression, and sleep disturbance were measured using the Patient-Reported Outcomes Measurement Information System (PROMIS) questionnaires; relationships were assessed using multivariable linear mixed models. RESULTS Of 545 women enrolled, 472 had follow-up. Median age was 57 years; 61% and 78% reported stress urinary incontinence and overactive bladder, respectively; and 81% reported obstructive symptoms. The PROMIS depression scores were positively associated with all urinary outcomes (range, 2.5- to 4.8-unit increase per 10-unit increase in depression score; P < 0.01 for all). Higher sleep disturbance scores were associated with higher urgency, obstruction, LUTS Total Severity, Urinary Distress Inventory, and Pelvic Floor Distress Inventory (1.9- to 3.4-point increase per 10-unit increase, all P < 0.02). Better physical functioning was associated with less severe urinary symptoms except stress urinary incontinence (2.3- to 5.2-point decrease per 10-unit increase, all P < 0.01). All symptoms decreased over time; however, no association was detected between baseline PROMIS scores and trajectories of LUTS over time. CONCLUSIONS Nonurologic factors demonstrated small to medium cross-sectional associations with urinary symptom domains, but no significant association was detected with changes in LUTS. Further work is needed to determine whether interventions targeting nonurologic factors reduce LUTS in women.
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Affiliation(s)
| | | | | | | | | | | | - Ziya Kirkali
- National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, MD
| | | | | | | | | | - Sarah A. Collins
- Northwestern University, Feinberg School of Medicine, Chicago, IL
| | - David Cella
- Northwestern University, Feinberg School of Medicine, Chicago, IL
| | - H. Henry Lai
- Washington University in St. Louis, St. Louis, MO
| | - Steven E. Harte
- Department of Anesthesiology, University of Michigan Medical School, Ann Arbor, MI
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Sun ZJ, Tian Z, Xu T, Wang ZM, Zhu XH, Luo J, Cheng F, Gong L, Zhang J, Wang LH, Zhu WP, Qu XL, Lin Z, Ge WP, Wang BN, Zhu L. Pelvic floor muscle strength and influencing factors based on vaginal manometry among healthy women at different life stages: A multicentre cross-sectional study. BJOG 2024. [PMID: 38168494 DOI: 10.1111/1471-0528.17736] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Revised: 11/03/2023] [Accepted: 12/02/2023] [Indexed: 01/05/2024]
Abstract
OBJECTIVE To assess pelvic floor muscle (PFM) strength and influencing factors among healthy women at different life stages. DESIGN Multicentre cross-sectional study. SETTING Fourteen hospitals in China. POPULATION A total of 5040 healthy women allocated to the following groups (with 1680 women per group): premenopausal nulliparous, premenopausal parous and postmenopausal. METHODS The PFM strength was evaluated by vaginal manometry. Multivariate logistic regression was used to determine the influencing factors for low PFM strength. MAIN OUTCOME MEASURES Maximum voluntary contraction pressure (MVCP). RESULTS The median MVCP values were 36, 35 and 35 cmH2 O in premenopausal nulliparous (aged 19-51 years), premenopausal parous (aged 22-61 years), and postmenopausal (aged 40-86 years) women, respectively. In the premenopausal nulliparous group, physical work (odds ratio, OR 2.05) was the risk factor for low PFM strength, which may be related to the chronic increased abdominal pressure caused by physical work. In the premenopausal parous group, the number of vaginal deliveries (OR 1.28) and diabetes (OR 2.70) were risk factors for low PFM strength, whereas sexual intercourse (<2 times per week vs. none, OR 0.55; ≥2 times per week vs. none, OR 0.56) and PFM exercise (OR 0.50) may have protective effects. In the postmenopausal group, the number of vaginal deliveries (OR 1.32) and family history of pelvic organ prolapse (POP) (OR 1.83) were risk factors for low PFM strength. CONCLUSIONS Physical work, vaginal delivery, diabetes and a family history of POP are all risk factors for low PFM strength, whereas PFM exercises and sexual life can have a protective effect. The importance of these factors varies at different stages of a woman's life.
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Affiliation(s)
- Zhi-Jing Sun
- Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, National Clinical Research Center for Obstetric & Gynecologic Diseases, Beijing, China
| | - Zhao Tian
- Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, National Clinical Research Center for Obstetric & Gynecologic Diseases, Beijing, China
| | - Tao Xu
- Department of Epidemiology and Biostatistics, Institute of Basic Medical Sciences, Chinese Academy of Medical Sciences and School of Basic Medicine, Peking Union Medical College, Beijing, China
| | - Zhong-Min Wang
- Department of Obstetrics and Gynecology, Dalian Municipal Women and Children's Medical Center (Group), Dalian, Liaoning, China
| | - Xi-Hui Zhu
- Department of Obstetrics and Gynecology, The Fourth Hospital of Shijiazhuang, Shijiazhuang, Hebei, China
| | - Jun Luo
- Department of Obstetrics and Gynecology, Hunan Maternal and Child Health Hospital, Changsha, Hunan, China
| | - Fang Cheng
- Department of Obstetrics and Gynecology, Huaian Maternal and Child Health Hospital, Huaian, Jiangsu, China
| | - Lin Gong
- Department of Obstetrics and Gynecology, Shenzhen Maternity and Child Healthcare Hospital, Shenzhen, Guangdong, China
| | - Jie Zhang
- Department of Obstetrics and Gynecology, Maternal and Child Health Care Hospital of Qinhuangdao, Qinhuangdao, Liaoning, China
| | - Li-Hui Wang
- Department of Obstetrics and Gynecology, Women and Children's Health Care Hospital of Luohu, Shenzhen, Guangdong, China
| | - Wei-Pei Zhu
- Department of Obstetrics and Gynecology, The Second Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China
| | - Xue-Ling Qu
- Department of Obstetrics and Gynecology, Changjianglu Pelvic Floor Repair Center, Dalian Maternity and Child Healthcare Center (Group), Dalian, Liaoning, China
| | - Zhong Lin
- Department of Obstetrics and Gynecology, Liuzhou Maternity and Child Healthcare Hospital, Liuzhou, Guangxi, China
| | - Wei-Ping Ge
- Department of Obstetrics and Gynecology, Qingdao Municipal Hospital, Qingdao, Shandong, China
| | - Bi-Nan Wang
- Department of Obstetrics and Gynecology, Changsha Hospital for Maternal and Child Health Care Affiliated to Hunan Normal University, Changsha, Hunan, China
| | - Lan Zhu
- Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, National Clinical Research Center for Obstetric & Gynecologic Diseases, Beijing, China
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Duca I, Boja R, Dumitrascu DL. Assessment of defecation disorders using high-resolution MRI-defecography. Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub 2023; 167:357-361. [PMID: 35582728 DOI: 10.5507/bp.2022.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2022] [Accepted: 05/03/2022] [Indexed: 11/23/2022] Open
Abstract
AIMS The aim of this retrospective study was to try to find correlations between different diagnoses established by clinical examination, anorectal manometry and MRI-defecography and, the association with psychiatric disorders. METHODS 44 patients (median age 53.81 years) presenting with intestinal motility disorders and who underwent clinical, biological and psychiatric examination, dynamic defecographic-MRI (resting, squeezing, straining, defecation and evacuation phases), anorectal manometry, colonoscopy. MRI was performed using the 1,5 T. RESULTS MRI-defecography revealed the following changes: anismus (16), rectocele (12), pelvic floor dysfunction (6), peritoneocele (2), cervical-cystic-ptosis (1), rectal prolapse (6), and in 1 case the examination was normal. Hypertonic anal sphincter (16) and lack of defecation reflex (12) at anorectal manometry correlated with anismus in all patients at MRI-defecography. Lack of inhibitor anal reflex (6) was associated with rectocele (4), cervix-cysto-ptosis (1) and peritoneocele (2). Anxiety (11), depression (6) and anxiety-depressive disorders (10) were found in 27/44, somatization disorders in 9/44 and no psychiatric changes in 8/44 cases. CONCLUSION As multiparous women are at risk for outlet obstruction constipation, MRI-defecography is suggested in this category. There is good correlation between diagnosis using anorectal manometry and MRI-defecography in patients with terminal constipation and anismus. Lower defecation dysfunction is often associated with psychiatric disorders.
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Affiliation(s)
- Ioana Duca
- 2nd Medical Clinic, Department of Internal Medicine, "Iuliu Hatieganu" University of Medicine and Pharmacy Cluj-Napoca, Romania
| | | | - Dan Lucian Dumitrascu
- 2nd Medical Clinic, Department of Internal Medicine, "Iuliu Hatieganu" University of Medicine and Pharmacy Cluj-Napoca, Romania
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Tian Z, Wang X, Hu X, Sun Z. Effect of Surgically Induced Weight Loss on Pelvic Organ Prolapse: A Meta-analysis. Obes Surg 2023; 33:3402-3410. [PMID: 37804469 PMCID: PMC10602998 DOI: 10.1007/s11695-023-06867-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2023] [Revised: 09/19/2023] [Accepted: 09/25/2023] [Indexed: 10/09/2023]
Abstract
INTRODUCTION Bariatric surgery alleviates certain aspects of pelvic floor disorder, but the effect on pelvic organ prolapse (POP) is unclear. To assess the effect of bariatric surgery on POP we conducted the present meta-analysis and firstly performed a subgroup analysis based on the duration of follow-up. METHODS Four databases including PubMed, The Cochrane Library, Web of Science, and Embase were searched to identify relevant studies published before February 24, 2023. The main outcome was the prevalence and severity of POP symptoms before and after bariatric surgery. Then we assessed the heterogeneity, publication bias and performed subgroup analyses based on follow-up time, study quality and region. RESULTS Eleven studies with a total of 696 participants met the inclusion criteria. The results showed that the prevalence of POP decreased after bariatric surgery (odds ratio[OR] = 2.29, 95% confidence interval[CI]: 1.05, 5.01; P = 0.04, I2 = 78%), with significant differences observed both at 3-6 months (OR = 2.24, 95% CI: 1.25, 4.01; P = 0.007, I2 = 59%) and 12 months (OR = 4.64, 95% CI: 2.83, 7.58; P < 0.0001, I2 = 0%) of follow-up compared with pre-surgery. Pelvic Organ Prolapse Distress Inventory scores 6-item also decreased after bariatric surgery (mean difference [MD] = 2.11, 95% CI: 0.32, 3.89; P = 0.02, I2 = 55%) with significant differences observed both at 3-6 months (MD = 3.72; 95% CI: [0.10, 7.34], P = 0.04, I2 = 70%) and ≥ 12 months (MD = 3.24; 95% CI: [0.56, 5.91], P = 0.02, I2 = 56%) of follow-up. CONCLUSION Bariatric surgery alleviated POP symptoms in women with obesity both during short-term (3-6 months) and long-term (≥ 12 months) follow-up.
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Affiliation(s)
- Zhao Tian
- Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, National Clinical Research Center for Obstetric & Gynecologic Diseases, Beijing, China
| | - Xiuqi Wang
- Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, National Clinical Research Center for Obstetric & Gynecologic Diseases, Beijing, China
| | - Xiaopeng Hu
- Department of Structural Heart Disease, National Center for Cardiovascular Disease, China & Fuwai Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China.
| | - Zhijing Sun
- Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, National Clinical Research Center for Obstetric & Gynecologic Diseases, Beijing, China.
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UGWU EO, DIM CC, ELEJE GU. Urinary and anal incontinence in pregnancy in a Nigerian population: A prospective longitudinal study. SAGE Open Med 2023; 11:20503121231206927. [PMID: 37900970 PMCID: PMC10612434 DOI: 10.1177/20503121231206927] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2023] [Accepted: 09/25/2023] [Indexed: 10/31/2023] Open
Abstract
Objectives There are several studies from sub-Saharan Africa on postpartum urinary incontinence and anal incontinence, but very rare in pregnancy. Such data will guide obstetric caregivers in providing appropriate counseling to the women as well as in minimizing the risk factors. This study aimed to determine the comparative effects of different trimesters of pregnancy on urinary incontinence and anal incontinence, and their possible risk factors. Methods The study was longitudinal in design, and the study population consisted of 223 pregnant women receiving care at the two largest tertiary health institutions in Enugu, South-East Nigeria. The recruitment was in the first trimester and the women were followed up to term. Interviews were conducted at specific times in the three trimesters and data regarding urinary incontinence and anal incontinence symptoms were obtained using validated questionnaires. Results The incidence of urinary incontinence increased across the trimesters: 22%, 30.5%, and 48% in the first trimester, second, and third trimesters, respectively, with a cumulative incidence rate of 50.2%. The incidence of anal incontinence also increased across the trimesters but not as high as urinary incontinence: 1.7%, 3.6%, and 5.8%, respectively, with a cumulative incidence rate of 6.7%. The risk factors for urinary incontinence were maternal age >35 years, multiparity, previous prolonged second-stage labor, and previous history of neonatal macrosomia, while that of anal incontinence were previous instrumental vaginal delivery and previous prolonged second stage of labor. Conclusion Our study demonstrated an increase in the incidence of urinary incontinence and anal incontinence as pregnancy advances. Obstetricians are therefore encouraged to discuss these pelvic floor issues during antenatal care services and make more efforts toward reducing the modifying obstetric risk factors.
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Affiliation(s)
- Emmanuel Onyebuchi UGWU
- Institute of Maternal and Child Health, College of Medicine, University of Nigeria Ituku-Ozalla Campus, Enugu, Nigeria
- Department of Obstetrics and Gynaecology, College of Medicine, University of Nigeria Ituku- Ozalla, Enugu, Nigeria
| | - Cyril Chukwudi DIM
- Institute of Maternal and Child Health, College of Medicine, University of Nigeria Ituku-Ozalla Campus, Enugu, Nigeria
- Department of Obstetrics and Gynaecology, College of Medicine, University of Nigeria Ituku- Ozalla, Enugu, Nigeria
| | - George Uchenna ELEJE
- Institute of Maternal and Child Health, College of Medicine, University of Nigeria Ituku-Ozalla Campus, Enugu, Nigeria
- Department of Obstetrics and Gynaecology, College of Health Sciences, Nnamdi Azikiwe University, Nnewi Campus, Anambra State, Nigeria
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Brand AM, Waterink W, Stoyanov S, van Lankveld JJDM. Restrictions and distress in daily, social, and sexual functioning, and intimate relationships in women with pelvic floor complaints: A mixed-method study. Health Care Women Int 2023; 44:1178-1191. [PMID: 35471120 DOI: 10.1080/07399332.2022.2062758] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Revised: 04/02/2022] [Accepted: 04/03/2022] [Indexed: 10/18/2022]
Abstract
Women with pelvic floor complaints experience restrictions and distress in their daily, social, and sexual functioning, and their intimate relationships. We interviewed forty-eight women to unravel differences between women receiving and not receiving pelvic physical therapy and between pregnant, parous, and nulliparous women in preparation for theory development. We analyzed data in a mixed-method design using NVivo and Leximancer. Sexual dysfunction, relationship dynamics, the nature and severity of restrictions and distress, and coping strategies appear to vary between women receiving and not receiving therapy. Specific combinations of restrictions and distress are present in pregnant, parous, and nulliparous women, and might influence women's decision to seek help.
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Affiliation(s)
- A M Brand
- Faculty of Psychology, Open University of the Netherlands, Heerlen, The Netherlands
| | - W Waterink
- Faculty of Psychology, Open University of the Netherlands, Heerlen, The Netherlands
| | - S Stoyanov
- Faculty of Educational Sciences, Open University of the Netherlands, Heerlen, The Netherlands
| | - J J D M van Lankveld
- Faculty of Psychology, Open University of the Netherlands, Heerlen, The Netherlands
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12
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Reed P, Whittall CM, Emery S, Osborne LA. Relationship between depression, anxiety, and attendance at pelvic-floor muscle training sessions. Physiotherapy 2023; 120:10-16. [PMID: 37354825 DOI: 10.1016/j.physio.2023.06.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2021] [Revised: 04/23/2023] [Accepted: 06/04/2023] [Indexed: 06/26/2023]
Abstract
OBJECTIVES Psychological comorbidities are associated with non-attendance for pelvic-floor muscle training (PFMT) appointments and non-engagement with ongoing treatment. However, little direct work has examined the precise relationship between these variables. DESIGN A prospective observational study of consecutively referred women patients with Pelvic-floor Dysfunction. Patients were assessed at intake for age, BMI, pelvic symptoms (measured by the Queensland Pelvic Symptom Scale), and anxiety and depression (measured by the Hospital Anxiety and Depression Scales). SETTING A women's health physiotherapy outpatient unit of a metropolitan hospital. PARTICIPANTS 433 consecutively-referred women with pelvic-floor dysfunction (PFD). INTERVENTIONS Six sessions of PFMT, lasting over a period of 6 months. MAIN OUTCOME MEASURES Attendance at PFMT sessions was the outcome, and was related to intake patient age, BMI, pelvic symptoms, as well as anxiety and depression. RESULTS Psychological symptoms of depression and anxiety predicted attendance at PFMT sessions, over and above physical symptoms. Depression was the key predictor of non-attendance, with anxiety having a more complex relationship with attendance. There were few differences between these psychological variables and the different types of PFD, or between type of PFD and PFMT attendance. CONCLUSIONS The findings add to the literature suggesting that consideration of patients' psychological state is important when designing treatment-regimes. CONTRIBUTION OF THE PAPER.
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Affiliation(s)
| | | | | | - Lisa A Osborne
- Swansea Bay University Health Board, UK; The Open University, UK
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De La Ossa AMP, Catai CC, Lopes S, Pena CC, De Paula NA, Fernandes ACNL, Jorge CH. Do patients undergoing physical therapy in a rehabilitation center have a high prevalence of pelvic floor dysfunction and psychological disorders? A cross-sectional study. Braz J Phys Ther 2023; 27:100536. [PMID: 37639944 PMCID: PMC10470286 DOI: 10.1016/j.bjpt.2023.100536] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2023] [Accepted: 08/16/2023] [Indexed: 08/31/2023] Open
Abstract
BACKGROUND Prevalence of pelvic floor dysfunction (PFD) and its relationship with anxiety in a population undergoing physical therapy treatment in Rehabilitation Centers seems to have been little investigated in the literature. OBJECTIVE 1) to investigate the prevalence of PFD, anxiety, depression; 2) to assess quality of life (QoL) in patients undergoing physical therapy in a Rehabilitation Center, 3) to compare the results by sex; and 4) to assess the relationship between PFD and anxiety, depression, and QoL. METHODS This cross-sectional study included participants receiving physical therapy care in a Rehabilitation Center. Validated questionnaires were used to assess PFD, QoL, depression, and anxiety. The Chi-square test, Pearson's correlation coefficient, and a binary logistic regression model were used for data analysis. RESULTS 253 participants (56.9% female) were included, 45% of them reported at least one PFD symptom. Females had higher prevalence of urinary incontinence (UI) (28% vs 14%); constipation (25% vs 10%); sexual dysfunction (75% vs 9%); anxiety (47% vs 35%); and depression (34% vs 17%) than males. A weak correlation was found between anxiety and depression with UI and sexual dysfunction for females. For all participants, poor QoL was found in physical functioning, physical role, bodily pain and emotional role. Being elderly (OR: 2.58 [1.24, 5.37]), partnered (OR: 1.82 [1.04, 3.17]), female (OR: 3.38 [1.91, 5.99]), and anxious (OR: 2.03 [1.14, 3.62]) were risk factors for reporting PFD. CONCLUSION This study found a high prevalence of PFD symptoms in patients attending a Rehabilitation Center. All symptoms except fecal incontinence were more prevalent in females than in males. There was a weak correlation between UI with QoL and psychological disorders among females.
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Affiliation(s)
| | - Camila Chizuto Catai
- Department of Health Sciences, Ribeirão Preto Medical School, Universidade de São Paulo, Ribeirão preto, SP, Brazil
| | - Samuel Lopes
- Hospital das Clínicas da Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão preto, SP, Brazil
| | - Caroline Caetano Pena
- Department of Health Sciences, Ribeirão Preto Medical School, Universidade de São Paulo, Ribeirão preto, SP, Brazil
| | - Nicole Arantes De Paula
- Department of Health Sciences, Ribeirão Preto Medical School, Universidade de São Paulo, Ribeirão preto, SP, Brazil
| | | | - Cristine Homsi Jorge
- Department of Health Sciences, Ribeirão Preto Medical School, Universidade de São Paulo, Ribeirão preto, SP, Brazil.
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Wu K, Little RD, Long A, Khera A, Kamm MA, Basnayake C. Clinical features and outcomes of adult idiopathic megarectum. Eur J Gastroenterol Hepatol 2023; 35:550-552. [PMID: 36966769 DOI: 10.1097/meg.0000000000002545] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/30/2023]
Abstract
OBJECTIVE Idiopathic megarectum is characterized by abnormal, pronounced rectal dilatation in the absence of identifiable organic pathology. Idiopathic megarectum is uncommon and under-recognized. This study aims to describe the clinical features and management of idiopathic megarectum. METHODS A retrospective review was undertaken on patients diagnosed with idiopathic megarectum with or without idiopathic megacolon over a 14-year period until 2021. Patients were identified from the hospital's International Classification of Diseases codes, and pre-existing clinic patient databases. Patient demographics, disease characteristics, healthcare utilization and treatment history data were collected. RESULTS Eight patients with idiopathic megarectum were identified; half of the patients were female, with the median age of symptom onset being 14 years (interquartile range [IQR] 9-24). The median rectal diameter measured was 11.5 cm (IQR 9.4-12.1). The most common presenting symptom was constipation, bloating and faecal incontinence. All patients required prior sustained periods of regular phosphate enemas and 88% were using ongoing oral aperients. Concomitant anxiety and or depression were found in 63% of patients and 25% were diagnosed with an intellectual disability. Healthcare utilization was high with a median of three emergency department presentations or ward admissions related to idiopathic megarectum per patient over the follow-up period; 38% of patients required surgical intervention during the period of follow-up. CONCLUSION Idiopathic megarectum is uncommon and associated with significant physical and psychiatric morbidity and high healthcare utilization.
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Affiliation(s)
- Kyle Wu
- St Vincent's Hospital Melbourne, Melbourne, Australia
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Baruch Y, Manodoro S, Barba M, Cola A, Re I, Frigerio M. Prevalence and Severity of Pelvic Floor Disorders during Pregnancy: Does the Trimester Make a Difference? Healthcare (Basel) 2023; 11:healthcare11081096. [PMID: 37107930 PMCID: PMC10137441 DOI: 10.3390/healthcare11081096] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2023] [Revised: 04/05/2023] [Accepted: 04/11/2023] [Indexed: 04/29/2023] Open
Abstract
(1) Background: Women experience pelvic floor dysfunction symptoms during pregnancy. This study is the first to investigate and compare variances in the prevalence and severity of pelvic floor symptoms between trimesters using a valid pregnancy-targeted questionnaire. (2) Methods: A retrospective cohort study was conducted between August 2020 to January 2021 at two university-affiliated tertiary medical centers. Pregnant women (n = 306) anonymously completed the Pelvic Floor Questionnaire for Pregnancy and Postpartum with its four domains (bladder, bowel, prolapse, and sexual). (3) Results: Thirty-six women (11.7%) were in the 1st trimester, eighty-three (27.1%) were in the 2nd trimester, and one hundred and eighty-seven (61.1%) were in the 3rd trimester. The groups were similar in age, pregestational weight, and smoking habits. A total of 104 (34%) had bladder dysfunction, 112 (36.3%) had bowel dysfunction, and 132 (40.4%) reported sexual inactivity and/or sexual dysfunction. Least prevalent (33/306; 10.8%) were prolapse symptoms. Increased awareness of prolapse and significantly higher rates of nocturia and the need to use pads due to incontinence were recorded in the 3rd trimester. Sexual dysfunction or abstinence were equally distributed in all three trimesters. (4) Conclusions: Bladder and prolapse symptoms, equally frequent throughout pregnancy, significantly intensified in the 3rd trimester. Bowel and sexual symptoms, equally frequent throughout pregnancy, did not intensify in the third trimester.
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Affiliation(s)
- Yoav Baruch
- Urogynecology and Pelvic Floor Unit, Department of Obstetrics and Gynecology, Tel Aviv Medical Center, Tel Aviv University, Tel Aviv 6997801, Israel
| | - Stefano Manodoro
- Department of Obstetrics and Gynecology, ASST Santi Paolo e Carlo, San Paolo Hospital, 20132 Milano, Italy
| | - Marta Barba
- Department of Obstetrics and Gynecology, Fondazione IRCCS San Gerardo dei Tintori, University Milano Bicocca, 20900 Monza, Italy
| | - Alice Cola
- Department of Obstetrics and Gynecology, Fondazione IRCCS San Gerardo dei Tintori, University Milano Bicocca, 20900 Monza, Italy
| | - Ilaria Re
- Department of Obstetrics and Gynecology, Fondazione IRCCS San Gerardo dei Tintori, University Milano Bicocca, 20900 Monza, Italy
| | - Matteo Frigerio
- Department of Obstetrics and Gynecology, Fondazione IRCCS San Gerardo dei Tintori, University Milano Bicocca, 20900 Monza, Italy
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16
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Notenboom-Nas FJM, Knol-de Vries GE, Slieker-Ten Hove MCP, Dekker JH, Keuken DG, van Koeveringe GA, Blanker MH. Comparing male and female pelvic floor muscle function by the number and type of pelvic floor symptoms. Neurourol Urodyn 2023; 42:875-885. [PMID: 36811502 DOI: 10.1002/nau.25149] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Revised: 12/06/2022] [Accepted: 01/31/2023] [Indexed: 02/24/2023]
Abstract
AIMS Pelvic floor symptoms (PFS), including lower urinary tract symptoms, defecation problems, sexual dysfunction, and pelvic pain, are common in males and females. Comparing pelvic floor musculature (PFM) function between sexes may reveal important differences relevant to clinical care. This study aimed to compare male and female PFM function and to assess the function of both sexes with the number and type of PFS. METHODS We purposively enrolled males and females aged ≥ 21 years with 0-4 PFS based on questionnaire responses in an observational cohort study. Participants then underwent PFM assessment, and muscle function in the external anal sphincter (EAS) and puborectal muscle (PRM) were compared between sexes. The relationships between muscle function and the number and type of PFS were explored. RESULTS Of the invited 400 males and 608 females, 199 and 187 underwent PFM assessment, respectively. Compared with females, males more often showed increased EAS and PRM tone during assessments. Compared with males, females more often showed weaker maximum voluntary contraction (MVC) of the EAS and dysfunctional endurance of both muscles; additionally, those with zero or one PFS, sexual dysfunction, and pelvic pain more often showed a weak MVC of the PRM. CONCLUSIONS Despite a few similarities between males and, females we found differences in muscle tone, MVC, and endurance between male and female PFM function. These findings provide useful insights into the differences in PFM function between males and females.
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Affiliation(s)
- Françoise J M Notenboom-Nas
- Department of General Practice and Elderly Care Medicine, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Grietje E Knol-de Vries
- Department of General Practice and Elderly Care Medicine, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Marijke C P Slieker-Ten Hove
- Department of General Practice and Elderly Care Medicine, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Janny H Dekker
- Department of General Practice and Elderly Care Medicine, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Debby G Keuken
- Netherlands Society of Cardiology, Utrecht, the Netherlands
| | | | - Marco H Blanker
- Department of General Practice and Elderly Care Medicine, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
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Polypharmacy and Multimorbidity in the Urogynecology Population and Their Effect on Pelvic Floor Symptoms. UROGYNECOLOGY (HAGERSTOWN, MD.) 2023; 29:80-87. [PMID: 36548108 DOI: 10.1097/spv.0000000000001262] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
IMPORTANCE Polypharmacy and multimorbidity are common in older adults but has not been well studied in the urogynecologic patient population. OBJECTIVES The objective of this study was to determine the prevalence of polypharmacy and multimorbidity in a diverse outpatient urogynecologic population and to examine whether polypharmacy and/or multimorbidity were associated with lower urinary tract symptoms, pelvic organ prolapse, defecatory distress, and/or female sexual dysfunction. STUDY DESIGN This is a secondary analysis of a dual-center cross-sectional study of new patients presenting for evaluation of pelvic floor disorders at 2 urban academic outpatient urogynecology clinics. Baseline demographics and clinical characteristics were obtained from the electronic medical record. Validated surveys were administered to determine severity of lower urinary tract symptoms (Overactive Bladder Validated 8-Question Screener, Urogenital Distress Inventory-6), pelvic floor dysfunction (Pelvic Organ Prolapse Distress Inventory-6, Colorectal-Anal Distress Inventory-8), and sexual dysfunction (6-item Female Sexual Function Index). Standard statistical techniques were used. RESULTS One hundred ninety-seven women with mean age 58.8 years (SD, 13.4 years) were included, and most were of minority race/ethnicity (Black, 34.0%; Hispanic, 21.8%). The majority of participants met criteria for polypharmacy (58.4%) and multimorbidity (85.8%), with a mean prescription number of 6.5 (SD, ± 4.9) and mean number of medical comorbidities of 4.9 (SD, ± 3.3). Polypharmacy and multimorbidity were significantly associated with higher CRADI-8 scores. Specifically, polypharmacy was associated with straining with bowel movements and painful stools, whereas multimorbidity was associated with incomplete emptying and fecal urgency. There was no significant association between polypharmacy and multimorbidity with urinary symptoms, prolapse, or sexual dysfunction. CONCLUSIONS Polypharmacy and multimorbidity are common in the urogynecologic population. There is a relationship between greater defecatory distress and polypharmacy and multimorbidity.
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Ferrari L, Cuinas K, Igbedioh C, Hainsworth A, Solanki D, Williams A, Sahai A, Kelleher C, Schizas A. Patient pathway in a tertiary referral pelvic floor unit: Telephone triage assessment clinic. Neurourol Urodyn 2023; 42:168-176. [PMID: 36317396 DOI: 10.1002/nau.25063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Revised: 08/31/2022] [Accepted: 10/09/2022] [Indexed: 12/30/2022]
Abstract
BACKGROUND To meet the increasing demands for colorectal pelvic floor services, a dedicated telephone triage assessment clinic (TTAC) was set up to establish a more efficient pathway, and reduce waiting times and patient's visits to the hospital. The primary aim of this study was to review TTAC in patients suffering from pelvic floor dysfunction and assess its feasibility. Secondary aims include measurement of waiting times for TTAC, main presenting complaints, and main treatment outcomes, including the need for review by a consultant surgeon. METHODS Review of data collected retrospectively in a single tertiary referral center collected from an institutional database. KEY RESULTS Between January 2016 and October 2017, 1192 patients referred to our pelvic floor unit were suitable for TTAC. Of these, 694 patients had complete records. There were 66 without follow-up after the initial TTAC, leaving 628 patients for analysis. In all, 86% were females and 14% were males, with a mean age of 52 years (range: 18-89). The median waiting time for TTAC was 31 days (range: 0-184). The main presenting complaint during the TTAC was obstructive defecation in 69.4%, fecal incontinence in 28.5%, and rectal prolapse in 2.1%. In our study, 611 patients had conservative management (97.3%), with a median of three sessions per patient (range: 1-16), while 82 patients (13.1%) needed a surgical intervention. Only 223 patients (35.5%) were reviewed by a consultant at some stage during the study period. CONCLUSIONS AND INFERENCES To optimize resources, an adequate triage system allowed us to streamline the pathway for each individual patient with pelvic floor dysfunction according to their symptoms and/or test results with the aim of reducing waiting times and expediting treatment.
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Affiliation(s)
- Linda Ferrari
- Pelvic Floor Unit, Guy's and St Thomas NHS foundation Trust, London, UK
| | - Karina Cuinas
- Pelvic Floor Unit, Guy's and St Thomas NHS foundation Trust, London, UK
| | - Carlene Igbedioh
- Pelvic Floor Unit, Guy's and St Thomas NHS foundation Trust, London, UK
| | - Alison Hainsworth
- Pelvic Floor Unit, Guy's and St Thomas NHS foundation Trust, London, UK
| | - Deepa Solanki
- Pelvic Floor Unit, Guy's and St Thomas NHS foundation Trust, London, UK
| | - Andrew Williams
- Pelvic Floor Unit, Guy's and St Thomas NHS foundation Trust, London, UK
| | - Arun Sahai
- Pelvic Floor Unit, Guy's and St Thomas NHS foundation Trust, London, UK
| | | | - Alexis Schizas
- Pelvic Floor Unit, Guy's and St Thomas NHS foundation Trust, London, UK
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Osborne LA, Mair Whittall C, Emery S, Reed P. Change in depression predicts change in bladder symptoms for women with urinary incontinence undergoing pelvic-floor muscle training. Eur J Obstet Gynecol Reprod Biol 2023; 280:54-59. [PMID: 36402023 DOI: 10.1016/j.ejogrb.2022.11.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2022] [Revised: 11/06/2022] [Accepted: 11/10/2022] [Indexed: 11/16/2022]
Abstract
INTRODUCTION To examine the relationship between depression and bladder symptoms, especially the impact of change in depression on changes in bladder symptoms, for women with urge and stress urinary incontinence undergoing a course of PFMT. METHOD 106 adult females with pelvic-floor dysfunction (PFD), consecutively referred to an outpatient pelvic-floor muscle training (PFMT) programme for either urge, stress, or mixed incontinence, participated in a prospective observational study. Participants reported subjective views of their pelvic floor problems (Queensland), and their levels of depression (HADS_D), and data relating to age and BMI were collected. The trial was registered on clinicaltrials.gov (NCT02549157). RESULTS There was a positive relationship between depression and bladder symptoms at intake. Levels of initial depression significantly predicted levels of bladder symptoms at completion of PFMT, and ability to complete the PFMT programme. Change in depression significantly predicted change in bladder symptoms, over and above intake patient characteristics and symptoms. DISCUSSION These data imply a multidisciplinary focus, including psychological input, for PFD may be a highly effective strategy for its management.
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Affiliation(s)
- Lisa A Osborne
- Swansea Bay University Health Board, UK; The Open University, UK
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Alborzi Avanaki F, Rafiee S, Aldin Varpaei H, Taher M, Aletaha N, Allameh F. Biofeedback Treatment Can Improve Clinical Condition and Quality of Life in Patients with Pelvic Floor Dyssynergy with Irritable Bowel Syndrome: A Prospective Cohort Study. Middle East J Dig Dis 2023; 15:45-52. [PMID: 37547159 PMCID: PMC10404073 DOI: 10.34172/mejdd.2023.319] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Accepted: 12/02/2022] [Indexed: 08/08/2023] Open
Abstract
Background: Chronic constipation is a common health concern. Defecatory disorders are considered one of the mechanisms of chronic idiopathic constipation. This study aimed to evaluate the effect of concurrent irritable bowel syndrome (IBS) on the success rate and response to biofeedback therapy in patients with chronic constipation and pelvic floor dyssynergia (PFD). Methods: This prospective cohort study was performed at the Imam Khomeini Hospital Complex in Tehran from October 2020 to July 2021. Patients aged 18-70 years with chronic constipation and PFD confirmed by clinical examination, anorectal manometry, balloon expulsion test, and/or defecography were included. All patients failed to respond to treatment with lifestyle modifications and laxative use. The diagnosis of IBS was based on the ROME IV criteria. Biofeedback was educated and recommended to all patients. We used three different metrics to assess the patient's response to biofeedback: 1) constipation score (questionnaire), 2) lifestyle score (questionnaire), and 3) manometry findings (gastroenterologist report). Results: Forty patients were included in the final analysis, of which 7 men (17.5%) and 21 (52.2%) had IBS. The mean age of the study population was 37.7 ± 11.4. The average resting pressure decreased in response to treatment; however, this decrease was statistically significant only in non-IBS patients (P = 0.007). Patients with and without IBS showed an increase in the percentage of anal sphincter relaxation in response to treatment, but this difference was not statistically significant. Although the first sensation decreased in both groups, this decrease was not statistically significant. Overall, the clinical response was the same across IBS and non-IBS patients, but constipation and lifestyle scores decreased significantly in both groups of patients with and without IBS (P < 0.001). Conclusion: Biofeedback treatment appears to improve the clinical condition and quality of life of patients with PFD. Considering that a better effect of biofeedback in correcting some manometric parameters has been seen in patients with IBS, it seems that paying attention to the association between these two diseases can be helpful in deciding on treatment.
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Affiliation(s)
- Foroogh Alborzi Avanaki
- Department of Gastroenterology, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran
| | - Sara Rafiee
- Department of Internal Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | | | - Mohammad Taher
- Department of Gastroenterology, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran
| | - Najmeh Aletaha
- Department of Gastroenterology, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran
| | - Farshad Allameh
- Department of Gastroenterology, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran
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The impact of anxiety on postoperative pain following pelvic reconstructive surgery. Int Urogynecol J 2022:10.1007/s00192-022-05423-y. [DOI: 10.1007/s00192-022-05423-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2022] [Accepted: 11/08/2022] [Indexed: 12/24/2022]
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22
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Stress-Induced Changes in Trophic Factor Expression in the Rodent Urinary Bladder: Possible Links With Angiogenesis. Int Neurourol J 2022; 26:299-307. [PMID: 36599338 PMCID: PMC9816446 DOI: 10.5213/inj.2244118.059] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Accepted: 12/12/2022] [Indexed: 12/30/2022] Open
Abstract
PURPOSE Substantive evidence supports a role of chronic stress in the development, maintenance, and even enhancement of functional bladder disorders such as interstitial cystitis/bladder pain syndrome (IC/BPS). Increased urinary frequency and bladder hyperalgesia have been reported in rodents exposed to a chronic stress paradigm. Here, we utilized a water avoidance stress (WAS) model in rodents to investigate the effect of chronic stress on vascular perfusion and angiogenesis. METHODS Female Wistar-Kyoto rats were exposed to WAS for 10 consecutive days. Bladder neck tissues were analyzed by western immunoblot for vascular endothelial growth factor (VEGF) and nerve growth factor precursor (proNGF). Vascular perfusion was assessed by fluorescent microangiography followed by Hypoxyprobe testing to identify regions of tissue hypoxia. RESULTS The expression of VEGF and proNGF in the bladder neck mucosa was significantly higher in the WAS rats than in the controls. There was a trend toward increased vascular perfusion, but without a statistically significant difference from the control group. The WAS rats displayed a 1.6-fold increase in perfusion. Additionally, a greater abundance of vessels was observed in the WAS rats, most notably in the microvasculature. CONCLUSION These findings show that chronic psychological stress induces factors that can lead to increased microvasculature formation, especially around the bladder neck, the region that contains most nociceptive bladder afferents. These findings may indicate a link between angiogenesis and other inflammatory factors that contribute to structural changes and pain in IC/BPS.
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Tatschl JM, Schwerdtfeger AR. Squeeze the beat: Enhancing cardiac vagal activity during resonance breathing via coherent pelvic floor recruitment. Psychophysiology 2022; 59:e14129. [PMID: 35722933 PMCID: PMC9786605 DOI: 10.1111/psyp.14129] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2022] [Revised: 05/18/2022] [Accepted: 05/31/2022] [Indexed: 12/30/2022]
Abstract
Resonance breathing (RB) has been shown to benefit health and performance within clinical and non-clinical populations. This is attributed to its baroreflex stimulating effect and the concomitant increase in cardiac vagal activity (CVA). Hence, developing methods that strengthen the CVA boosting effect of RB could improve its clinical effectiveness. Therefore, we assessed whether supplementing RB with coherent pelvic floor activation (PRB), which has been shown to entrain the baroreflex, yields stronger CVA than standard RB. N = 32 participants performed 5-min of RB and PRB, which requires to recruit the pelvic floor during the complete inspiratory phase and release it at the initiation of the expiration. CVA was indexed via heart rate variability using RMSSD and LF-HRV. PRB induced significantly larger RMSSD (d = 1.04) and LF-HRV (d = 0.75, ps < .001) as compared to RB. Results indicate that PRB induced an additional boost in CVA relative to RB in healthy individuals. However, subsequent studies are warranted to evaluate whether these first findings can be replicated in individuals with compromised health, including a more comprehensive psychophysiological assessment to potentially elucidate the origin of the observed effects. Importantly, longitudinal studies need to address whether PRB translates to better treatment outcomes.
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Barasinski C, Debost‐Legrand A, Savary D, Bouchet P, Curinier S, Vendittelli F. Does the type of pushing at delivery influence pelvic floor function at 2 months postpartum? A pragmatic randomized trial-The EOLE study. Acta Obstet Gynecol Scand 2022; 102:67-75. [PMID: 36352788 PMCID: PMC9780713 DOI: 10.1111/aogs.14461] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Revised: 09/02/2022] [Accepted: 09/09/2022] [Indexed: 11/12/2022]
Abstract
INTRODUCTION Maternal pushing techniques during the second stage of labor may affect women's pelvic floor function. Our main objective was to assess the impact of the type of pushing used at delivery on the mother's medium-term pelvic floor function. MATERIAL AND METHODS This is a secondary analysis of a randomized clinical trial (clinicaltrials.gov: NCT02474745) that took place in four French hospitals from 2015 through 2017 (n = 250). Women in labor with a singleton fetus in cephalic presentation at term who had undergone standardized training in both of these types of pushing were randomized after cervical dilation ≥7 cm. The exclusion criteria were a previous cesarean, a cesarean delivery in this pregnancy or a fetal heart rate anomaly. In the intervention group, open-glottis (OG) pushing was defined as a prolonged exhalation contracting the abdominal muscles to help move the fetus down the birth canal. Closed-glottis (CG) pushing was defined as Valsalva pushing. The principal outcome was the stage of pelvic organ prolapse (POP) assessed by the Pelvic Organ Prolapse-Quantification 2 months after delivery. A secondary outcome was incidence of urinary incontinence (UI). The results of our multivariable, modified intention-to-treat analysis are reported as crude relative risks (RRs) with their 95% confidence intervals. RESULTS Our analysis included 207 women. Mode of birth was similar in both groups. The two groups did not differ for stage II POP: 10 of 104 (9.4%) in the OG group compared with 7 of 98 (7.1%) in the CG group, for a RR 1.32, 95% confidence interval [CI] 0.52-3.33, and an adjusted RR of 1.22, 95% CI 0.42-3.6. Similarly, the incidence of UI did not differ: 26.7% in the OG group and 28.6% in the CG group (aRR 0.81, 95% CI 0.42-1.53). Subgroup analysis suggests that for secundiparous and multiparous women, OG pushing could have a protective effect on the occurrence of UI (RR 0.33, 95% CI 0.13-0.80). CONCLUSIONS The type of directed pushing used at delivery did not impact the occurrence of pelvic organ prolapse 2 months after delivery. OG pushing may have a protective effect against UI among secundiparous and multiparous women.
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Affiliation(s)
- Chloé Barasinski
- Centre National de la Recherche Scientifique, Institut PascalUniversité Clermont Auvergne, University Hospital Center Clermont‐FerrandClermont‐FerrandFrance
| | - Anne Debost‐Legrand
- Centre National de la Recherche Scientifique, Institut PascalUniversité Clermont Auvergne, University Hospital Center Clermont‐FerrandClermont‐FerrandFrance,Auvergne Perinatal Health NetworkClermont‐FerrandFrance
| | | | - Pamela Bouchet
- University Hospital Center Clermont‐FerrandClermont‐FerrandFrance
| | - Sandra Curinier
- University Hospital Center Clermont‐FerrandClermont‐FerrandFrance
| | - Françoise Vendittelli
- Centre National de la Recherche Scientifique, Institut PascalUniversité Clermont Auvergne, University Hospital Center Clermont‐FerrandClermont‐FerrandFrance,Auvergne Perinatal Health NetworkClermont‐FerrandFrance,AUDIPOG (Association of Users of Computerized Records in Pediatrics, Obstetrics and Gynecology)RTH Laennec Medical UniversityLyonFrance
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Reed P, Osborne LA, Whittall CM, Emery S, Truzoli R. Patient and economic benefits of psychological support for noncompliant patients. Front Psychol 2022; 13:829880. [PMID: 36186372 PMCID: PMC9521354 DOI: 10.3389/fpsyg.2022.829880] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Accepted: 07/25/2022] [Indexed: 12/03/2022] Open
Abstract
The current paper provides an overview of treatment noncompliance at various points in the treatment pathway, especially with respect to treatment for Pelvic-floor Dysfunction (PFD). The effects of noncompliance on healthcare are considered, and examples of supporting patients psychologically to increase compliance are discussed. An outline of a method to identify costs of non-compliance, and where such costs most intensely impact the healthcare system, is provided. It is suggested that psychological support is effective in terms of increased compliance and improved healthcare economics. The model is presented for PFD, but the principles developed can be generalised to many aspects of healthcare.
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Affiliation(s)
- Phil Reed
- Department of Psychology, Swansea University, Swansea, United Kingdom
| | - Lisa A. Osborne
- School of Psychology and Counselling, The Open University, Milton Keynes, United Kingdom
- Swansea Bay University Health Board, Swansea, United Kingdom
| | | | - Simon Emery
- Swansea Bay University Health Board, Swansea, United Kingdom
| | - Roberto Truzoli
- Department of Biomedical and Clinical Sciences, University of Milan, Milan, Italy
- *Correspondence: Roberto Truzoli,
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Brand AM, Rosas S, Waterink W, Stoyanov S, van Lankveld JJDM. Conceptualization and Inventory of the Sexual and Psychological Burden of Women With Pelvic Floor Complaints; A Mixed-Method Study. Sex Med 2022; 10:100504. [PMID: 35339057 PMCID: PMC9177886 DOI: 10.1016/j.esxm.2022.100504] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2021] [Revised: 02/07/2022] [Accepted: 02/07/2022] [Indexed: 12/02/2022] Open
Abstract
Introduction Despite the fact that the literature reports various restrictions and types of distress in women with pelvic floor complaints, a comprehensive overview of women's sexual and psychological burden emerging from these complaints is lacking, which compromises our ability to assess and grasp the impact to women. Aim This study was performed to conceptualize women's sexual and psychological burden and create a more comprehensive overview on this topic from both women's and health care providers’ perspectives. Furthermore, this research intended to identify items to populate a to-be-developed instrument to assess sexual and psychological burden. Methods In Group Concept Mapping, 125 statements were used about restrictions and distress that women with pelvic floor complaints experienced. Women with, and health care providers with and without pelvic floor complaints (13 women and 3 men) sorted the statements into comprehensive self-labeled clusters and rated their nature and severity. Multidimensional scaling and hierarchical cluster analyses were performed to identify a conceptual model of coherent clusters of statements. Item-total correlations of severity scores were calculated to identify statements that can be used in future research to represent women's sexual and psychological burden. Main Outcome Measure A conceptual model emerged, and outcomes of item-total correlations were then examined again using the conceptual model. Results Seven distress clusters were identified, namely, loss of control, sexual distress, feeling insecure, feeling wronged, feeling helpless, feeling angry, and feeling disappointed. Feeling insecure appeared more pervasive than other distresses. Furthermore, 33 statements were identified that can be used in future research to develop an instrument to assess sexual and psychological burden representing both women's and health care providers’ perspectives. Conclusion The conceptual model and list of statements may concisely represent the sexual and psychological burden of women with pelvic floor complaints from both women's and health care providers’ perspectives on this topic. Brand AM, Rosas S, Waterink W, et al. Conceptualization and Inventory of the Sexual and Psychological Burden of Women With Pelvic Floor Complaints; A Mixed-Method Study. Sex Med 2022;10:100504.
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Affiliation(s)
- Alma M Brand
- Faculty of Psychology, Open University of The Netherlands, Heerlen, The Netherlands.
| | | | - Wim Waterink
- Faculty of Psychology, Open University of The Netherlands, Heerlen, The Netherlands
| | - Slavi Stoyanov
- Faculty of Educational Sciences, Open University of The Netherlands, Heerlen, The Netherlands
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Quinton S, Doerfler B. Psychological and Nutritional Factors in Pelvic Floor Disorders. Gastroenterol Clin North Am 2022; 51:145-156. [PMID: 35135659 DOI: 10.1016/j.gtc.2021.10.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/21/2023]
Abstract
This article discusses the role of psychological and nutritional factors in gastrointestinal pelvic floor disorders such as dyssynergic defection and explores the use of multidisciplinary strategies to enhance treatment.
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Affiliation(s)
| | - Bethany Doerfler
- Division of Gastroenterology and Hepatology, Northwestern University Feinberg School of Medicine, 676 N. Saint Clair Street, Suite 1400, Chicago, IL 60611, USA.
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Quaghebeur J, Petros P, Wyndaele JJ, De Wachter S. The innervation of the bladder, the pelvic floor, and emotion: A review. Auton Neurosci 2021; 235:102868. [PMID: 34391125 DOI: 10.1016/j.autneu.2021.102868] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2021] [Revised: 06/26/2021] [Accepted: 08/05/2021] [Indexed: 12/30/2022]
Abstract
The innervation of the pelvic region is complex and includes extensive neurologic pathways. The higher centres' organisation determining the pelvic floor and organs' function remains a challenge understanding the physiological and pain mechanisms. Psychological and emotional factors have a profound influence on the pelvic floor and organ dysfunction such as LUTS. LUTS are associated with stress, depression, and anxiety. Neuroception is a subconscious neuronal system for detecting threats and safety and might explain the permanent disturbance of higher brain centres maintaining functional urological and gastrointestinal disorders and sphincter dysfunction.
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Affiliation(s)
- Jörgen Quaghebeur
- Department of Urology, University of Antwerp, Edegem, Belgium; Faculty of Medicine and Health Sciences, University of Antwerp, Edegem, Belgium.
| | - Peter Petros
- Faculty of Medicine, University of New South Wales, Kensington, Sydney, Australia
| | | | - Stefan De Wachter
- Department of Urology, University of Antwerp, Edegem, Belgium; Faculty of Medicine and Health Sciences, University of Antwerp, Edegem, Belgium
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29
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Eustice S, James A, Endacott R, Kent B. Identifying the health care-initiated and self-initiated interventions used by women for the management of rectal emptying difficulty secondary to obstructive defecation: a scoping review protocol. JBI Evid Synth 2021; 19:491-498. [PMID: 33027103 DOI: 10.11124/jbies-20-00026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
OBJECTIVE This scoping review aims to identify interventions used by women for the management of rectal emptying difficulty secondary to obstructive defecation. INTRODUCTION Rectal emptying difficulty is typically a symptom of obstructive defecation syndrome. Even though a range of interventions are already available for this condition, this review is necessary to increase understanding of what interventions women find useful and are acceptable for them. This depth of understanding will facilitate the development of a specific care pathway to support women living with rectal emptying difficulty secondary to obstructive defecation syndrome. INCLUSION CRITERIA This review will consider studies that include adult women (over 18 years of age) living in the community who have experienced difficulty with rectal emptying secondary to obstructive defecation and who have not had surgical intervention. Exclusion criteria include prolapse surgery and surgical techniques, oral laxatives, vaginal pessaries, cognitive impairment, pregnancy, and those residing in care homes. METHODS The databases to be searched include MEDLINE, Embase, CINAHL, PsycINFO, Emcare, AMED, Web of Science, Scopus, PROSPERO, Open Grey, ClinicalTrials.gov, International Clinical Trials Registry Platform Search Portal, UK Clinical Trials Gateway, International Standard Randomised Controlled Trial Number Registry, JBI Evidence Synthesis, Epistemonikos, Cochrane Library, and gray literature. Studies conducted in English from any time period will be considered for inclusion. The titles and abstracts will then be screened by two independent reviewers for assessment against the inclusion criteria for the review.
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Affiliation(s)
- Sharon Eustice
- Bladder and Bowel Specialist Service, Cornwall Foundation NHS Trust, St Austell, UK
| | - Alison James
- School of Nursing and Midwifery, Faculty of Health: Medicine, Dentistry and Human Sciences, University of Plymouth, Plymouth, UK
| | - Ruth Endacott
- School of Nursing and Midwifery, Faculty of Health: Medicine, Dentistry and Human Sciences, University of Plymouth, Plymouth, UK.,The University of Plymouth Centre for Innovations in Health and Social Care: A JBI Centre of Excellence, Plymouth, UK
| | - Bridie Kent
- School of Nursing and Midwifery, Faculty of Health: Medicine, Dentistry and Human Sciences, University of Plymouth, Plymouth, UK.,The University of Plymouth Centre for Innovations in Health and Social Care: A JBI Centre of Excellence, Plymouth, UK
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Cross-sectional study of early postpartum pelvic floor dysfunction and related bother in primiparous women 6-10 weeks postpartum. Int Urogynecol J 2021; 32:1847-1855. [PMID: 33938963 DOI: 10.1007/s00192-021-04813-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2020] [Accepted: 04/18/2021] [Indexed: 10/21/2022]
Abstract
INTRODUCTION AND HYPOTHESIS To study the prevalence of pelvic floor dysfunction and related bother in primiparous women 6-10 weeks postpartum, comparing vaginal and cesarean delivery. METHODS Cross-sectional study of 721 mothers with singleton births in Reykjavik, Iceland, 2015 to 2017, using an electronic questionnaire. Information on urinary and anal incontinence, pelvic organ prolapse and sexual dysfunction with related bother (trouble, nuisance, worry, annoyance) was collected. Main outcome measures were prevalence of pelvic floor dysfunction and related bother. RESULTS The overall prevalence of urinary and anal incontinence was 48% and 60%, respectively. Bother regarding urinary symptoms was experienced by 27% and for anal symptoms by 56%. Pelvic organ prolapse was noted by 29%, with less than half finding this bothersome. Fifty-five percent were sexually active, of whom 66% reported coital pain. Of all the women, 48% considered sexual issues bothersome. Urinary incontinence and pelvic organ prolapse were more prevalent in women who delivered vaginally compared to cesarean section, but no differences were observed for anal incontinence and coital pain. Compared to women with BMI < 25, obesity was a predictor for urinary incontinence after vaginal delivery (OR 1.94; 95% CI 1.20-3.14). Birthweight > 50th percentile was predictive for urgency incontinence after vaginal delivery (OR 1.53; 95% CI 1.05-2.21). Episiotomy predicted more anal incontinence (OR 2.19; 95% CI 1.30-3.67). No associations between maternal and delivery characteristics were found for pelvic floor dysfunction after cesarean section. CONCLUSIONS Bothersome pelvic floor dysfunction symptoms are prevalent among first-time mothers in the immediate postpartum period.
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Personality of patients with fecal incontinence. Int J Colorectal Dis 2021; 36:331-337. [PMID: 33000298 DOI: 10.1007/s00384-020-03758-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/17/2020] [Indexed: 02/04/2023]
Abstract
BACKGROUND/AIMS Although idiopathic fecal incontinence (FI) patients have some psychological characteristics, the personality of FI patients was not described. The present study aims to describe the clinical and personality characteristics of FI patients. PATIENTS AND METHODS This retrospective observational study included 996 outpatients, 72 with fecal incontinence. They filled out the Rome III diagnostic questionnaire, the personality inventory MMPI-2, the questionnaires for urological and sexual disorders, and Likert scales for bowel disorders perceived symptom severity. The main outcome measures were the presence in FI patients of functional gastrointestinal disorders, the self-reported symptom severity, and the personality profile. RESULTS Patients were mainly females (72%). FI patients were characterized by higher age (P = 0.015), and by a higher prevalence of functional diarrhea (P = 0.001), urological (P = 0.001), and sexual disorders (P = 0.005). These patients also report higher diarrhea severity (P < 0.001) and lower abdominal pain severity (P = 0.009). The personality of FI patients is distinguished by a higher score for psychopathic deviate (P = 0.006), social responsibility (P = 0.003), Mac Andrew revised scale (P = 0.005), and antisocial practice (P = 0.007), and a lower score for type A behavior (P = 0.005). CONCLUSION FI patients are characterized not only by older age, and a high prevalence of diarrhea but also by a specific personality profile characterized by an unfavorable comparison with others.
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Vencill JA, Kacel EL, Avulova S, Ehlers SL. Barriers to sexual recovery in women with urologic cancers. Urol Oncol 2020; 40:372-378. [PMID: 33248897 DOI: 10.1016/j.urolonc.2020.11.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2020] [Revised: 09/27/2020] [Accepted: 11/04/2020] [Indexed: 01/23/2023]
Abstract
Sexual health concerns are prevalent and distressing in oncology patients and survivors. While urologic cancers are more prevalent in men, women often have more advanced disease at initial diagnosis, require more advanced surgical resection, and experience higher postoperative complication rates, as well as morbidity and mortality. Women with urologic cancers undergo treatment that is highly likely to impact their sexual function and well-being, however, attention to sexual recovery in this patient population has been limited. Barriers to sexual recovery in women with urologic cancers are biopsychosocial in nature and include complications related to treatment procedures, cancer-related distress, sexual anxiety and avoidance, partner and relational dynamics, and sexual communication skills. Healthcare providers do not adequately address sexual difficulties for these patients and their partners. Sexual minority women and transgender patients with urologic cancer have unique psychosocial and sexual health needs though, due to a lack of research, these remain poorly understood. More research is needed to pinpoint the sexual health needs of this specific oncology population and to explore how various treatment options, such as pelvic organ-sparing cystectomy, can impact sexual health outcomes. Evidence-based and multidisciplinary oncologic and survivorship care, which includes licensed mental health providers, certified sex therapists, and other sexual health experts, is essential for assisting women in their sexual recovery following urologic cancer.
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Affiliation(s)
- Jennifer A Vencill
- Division of General Internal Medicine, Mayo Clinic, Rochester, MN; Department of Psychiatry & Psychology, Mayo Clinic, Rochester, MN.
| | | | | | - Shawna L Ehlers
- Department of Psychiatry & Psychology, Mayo Clinic, Rochester, MN
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Tarcan T, Selai C, Herve F, Vrijens D, Smith PP, Apostolidis A, Panicker JN, Kirschner-Hermanns R, Arlandis S, Mosiello G, Dmochowski R, Cardozo L, von Gontard A. Should we routinely assess psychological morbidities in idiopathic lower urinary tract dysfunction: ICI-RS 2019? Neurourol Urodyn 2020; 39 Suppl 3:S70-S79. [PMID: 32662559 DOI: 10.1002/nau.24361] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2019] [Accepted: 04/02/2020] [Indexed: 12/20/2022]
Abstract
AIMS Psychological morbidities play a major role in idiopathic lower urinary tract dysfunction (iLUTD). The aim of the Think Tank (TT) was to discuss the relevance of psychological morbidities in idiopathic LUTD over the life span, including overactive bladder (OAB) or dysfunctional voiding (DV) and methods of assessment. METHODS The paper is based on a selective review of the literature and in-depth discussions, leading to research recommendations regarding the assessment of psychological morbidities in iLUTD on children and adults held during the TT of the International Consultation on Incontinence Research Society in 2019. RESULTS Psychological comorbidities affect the health behaviors and treatment outcomes in patients with iLUTD. Both clinically relevant comorbid mental disorders, as well as subclinical psychological symptoms have a major impact and negatively influence incontinence treatment. Research is needed to elucidate mechanisms underlying iLUTD and psychological comorbidities. Clinical studies are needed to determine how perception generation and cognition impacts on the relationship of urinary perceptions, symptoms, and objective urodynamic function. Due to high psychological comorbidity rates, screening with validated, generic questionnaires for emotional and behavioral disorders in children with nocturnal enuresis, daytime urinary incontinence, and fecal incontinence is recommended. Brief screening is recommended for all adults with iLUTD, especially with OAB and DV, who are refractory to treatment. CONCLUSIONS Due to the high rate and relevance in clinical practice, screening for psychological comorbidities is recommended for all age groups. The research recommendations of this TT may be followed to improve the assessment of psychological morbidities in iLUTD.
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Affiliation(s)
- Tufan Tarcan
- Department of Urology, Marmara University School of Medicine, Istanbul, Turkey.,Department of Urology, Koç University School of Medicine, Istanbul, Turkey
| | - Caroline Selai
- Department of Clinical and Movement Neurosciences, UCL Queen Square Institute of Neurology, London, UK
| | - François Herve
- Department of Urology, Cliniques Universitaires Saint Luc, Brussels, Belgium
| | - Desiree Vrijens
- Department of Urology, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Phillip P Smith
- Department of Surgery, University of Connecticut School of Medicine, Farmington, Connecticut
| | - Apostolos Apostolidis
- 2nd Department of Urology, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Jalesh N Panicker
- Department of Uro-Neurology, The National Hospital for Neurology and Neurosurgery and UCL Institute of Neurology, London, UK
| | - Ruth Kirschner-Hermanns
- Department of Urology, Pediatric Urology, and Neurourology, University Hospital of Bonn, Bonn, Germany
| | - Salvador Arlandis
- Department of Urology, La Fe University and Polytechnic Hospital, Valencia University, Spain
| | - Giovanni Mosiello
- Department of Surgery, Neuro-Urology Unit, Bambino Gesu Pediatric Hospital, Rome, Italy
| | - Roger Dmochowski
- Department of Urologic Surgery, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Linda Cardozo
- Department of Urogynaecology, King's College Hospital, London, UK
| | - Alexander von Gontard
- Department of Child and Adolescent Psychiatry, Saarland University Hospital, Homburg, Germany
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Risk Factors Associated with Prolonged Hospital Stay and Readmission in Patients After Primary Bariatric Surgery. Obes Surg 2020; 30:2395-2402. [DOI: 10.1007/s11695-020-04507-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
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Pham TT, Chen YB, Adams W, Wolff B, Shannon M, Mueller ER. Characterizing anxiety at the first encounter in women presenting to the clinic: the CAFÉ study. Am J Obstet Gynecol 2019; 221:509.e1-509.e7. [PMID: 31201810 DOI: 10.1016/j.ajog.2019.06.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2018] [Revised: 05/16/2019] [Accepted: 06/06/2019] [Indexed: 10/26/2022]
Abstract
BACKGROUND Clinically based anxiety questionnaires measure 2 forms of anxiety that are known as state anxiety and trait anxiety. State anxiety is temporary and is sensitive to change; trait anxiety is a generalized propensity to be anxious. OBJECTIVE Our study aims to characterize the reasons for anxiety among women about the initial consultation for their pelvic floor disorders to measure change in participant state anxiety after the visit and to correlate improvement in anxiety with visit satisfaction. STUDY DESIGN All new patients at our tertiary urogynecology clinic were invited to participate. After giving consent, participants completed pre- and postvisit questionnaires. Providers were blinded to pre- and postvisit questionnaire responses. The previsit questionnaires included the Pelvic Floor Distress Inventory, the Generalized Anxiety Disorder-7, and the 6-item short form of the Spielberg State Trait Anxiety Inventory. Participants were also asked to list their previsit anxieties. The postvisit questionnaires comprised of the Spielberg State Trait Anxiety Inventory, patient global impression of improvement of participant anxiety, patient satisfaction, and the participant's perception of whether her anxiety was addressed during the visit. The anxieties listed by participants were then reviewed independently and categorized by 2 of the authors. A separate panel arbitrated when there were disagreements among anxiety categories. RESULTS Fifty primarily white (66%) women with a median age of 53 years (interquartile range, 41-66) completed the study. The visit diagnoses included stress urinary incontinence (54%), urge urinary incontinence (46%), myofascial pain (28%), pelvic organ prolapse (20%), and recurrent urinary tract infection (12%). Less than one-quarter of participants (22%) had a history of anxiety diagnosis. The average previsit Spielberg State Trait Anxiety Inventory score was 42.9 (standard deviation, 11.98) which decreased by an average of 12.60 points in the postvisit (95% confidence interval, -16.56 to -8.64; P<.001). Postvisit decreased anxiety was associated with improvements in the patient global impression of improvement anxiety (P<.001) and participants' perception that their anxiety symptoms had been addressed completely (P=.045). The most reported causes for consultation related anxiety were lack of knowledge of diagnosis and ramifications, personal or social issues, and fear of the physical examination. Participants reported that improvements in anxiety were related to patient education and reassurance, medical staff appreciation, and acceptable treatment plan. Participants who reported complete satisfaction demonstrated a greater decrease in the postvisit Spielberg State Trait Anxiety Inventory scores compared with the participants who did not report complete satisfaction (P=.045). Changes in the Spielberg State Trait Anxiety Inventory score were not associated with the Pelvic Floor Distress Inventory (P=.35) or Generalized Anxiety Disorder-7 scores (P=.78). CONCLUSION Women with the highest satisfaction after their initial urogynecology visit also demonstrated the largest decreases in anxiety after the visit. Changes in anxiety scores were not correlated with the Pelvic Floor Distress Inventory or with measures of generalized anxiety (Generalized Anxiety Disorder-7). Recognizing and addressing patient anxiety may help physicians better treat their patients and improve overall patient satisfaction.
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Siddiqui NY, Wiseman JB, Cella D, Bradley CS, Lai HH, Helmuth ME, Smith AR, Griffith JW, Amundsen CL, Kenton KS, Clemens JQ, Kreder KJ, Merion RM, Kirkali Z, Kusek JW, Cameron AP. Mental Health, Sleep and Physical Function in Treatment Seeking Women with Urinary Incontinence. J Urol 2018; 200:848-855. [PMID: 29730202 PMCID: PMC6146022 DOI: 10.1016/j.juro.2018.04.076] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/27/2018] [Indexed: 11/21/2022]
Abstract
PURPOSE We examined how mental health measures, sleep and physical function are associated with the presence and type of urinary incontinence and severity in women seeking treatment for lower urinary tract symptoms. MATERIALS AND METHODS This baseline cross-sectional analysis was performed in treatment seeking women with lower urinary tract symptoms. All participants completed the LUTS (Lower Urinary Tract Symptoms) Tool (Pfizer, New York, New York), which was used to classify women based on urinary incontinence symptoms and measure severity. The PROMIS (Patient-Reported Outcomes Measurement Information System) questionnaire for depression, anxiety, sleep disturbance and physical function, the PSS (Perceived Stress Scale) and the IPAQ-SF (International Physical Activity Questionnaire Short Form) were administered. Multivariable regression modeling was done to assess associations with urinary symptom presence, type and severity. RESULTS We studied 510 women with a mean ± SD age of 56 ± 14 years. Of the women 82% were Caucasian, 47% were obese and 14% reported diabetes. Urinary incontinence was reported by 420 women (82.4%), including stress urinary incontinence in 70, urgency urinary incontinence in 85, mixed urinary incontinence in 240 and other urinary incontinence in 25. On adjusted analyses there was no difference in any mental health, sleep or physical function measure based on the presence vs the absence of urinary incontinence. Among women with urinary incontinence PROMIS anxiety and sleep disturbance scores were higher in those with mixed urinary incontinence than stress urinary incontinence. Increasing urinary incontinence severity was associated with higher PROMIS depression and anxiety scores, and higher PSS scores. However, higher urinary incontinence severity was not associated with a difference in sleep or physical function. CONCLUSIONS Among treatment seeking women with lower urinary tract symptoms, increasing urinary incontinence severity rather than the presence or type of urinary incontinence was associated with increased depression, anxiety and stress.
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Affiliation(s)
- Nazema Y Siddiqui
- Division of Urogynecology and Reconstructive Surgery, Department of Obstetrics and Gynecology, Duke University, Durham, North Carolina.
| | | | - David Cella
- Department of Medical Social Sciences, Northwestern University, Chicago, Illinois
| | - Catherine S Bradley
- Departments of Obstetrics and Gynecology and Urology, University of Iowa Carver College of Medicine, Iowa City, Iowa
| | - H Henry Lai
- Departments of Surgery and Anesthesiology, Washington University School of Medicine, St. Louis, Missouri
| | | | - Abigail R Smith
- Arbor Research Collaborative for Health, Ann Arbor, Michigan
| | - James W Griffith
- Department of Medical Social Sciences, Northwestern University, Chicago, Illinois
| | - Cindy L Amundsen
- Division of Urogynecology and Reconstructive Surgery, Department of Obstetrics and Gynecology, Duke University, Durham, North Carolina
| | - Kimberly S Kenton
- Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | | | - Karl J Kreder
- Departments of Obstetrics and Gynecology and Urology, University of Iowa Carver College of Medicine, Iowa City, Iowa
| | - Robert M Merion
- Arbor Research Collaborative for Health, Ann Arbor, Michigan
| | - Ziya Kirkali
- National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, Maryland
| | - John W Kusek
- National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, Maryland
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Pan H, Bao Y, Cao H, Jin R, Wang P, Zhang J. The effectiveness of magnetic stimulation for patients with pelvic floor dysfunction: A systematic review and meta-analysis. Neurourol Urodyn 2018; 37:2368-2381. [PMID: 30221818 DOI: 10.1002/nau.23797] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2018] [Accepted: 07/11/2018] [Indexed: 12/26/2022]
Abstract
AIMS To evaluate the value of magnetic stimulation (MS) in patients with pelvic floor dysfunction (PFD). METHODS The Preferred Reporting Items for Systematic Review and Meta-analysis (PRISMA) statement was followed. We searched five databases for articles published until November 2017. Included studies investigated the effects of MS on PFD. Meta-analysis of RCTs was performed using a random effects model, and narrative analysis was undertaken where meta-analysis was not possible. RESULTS A total of 20 studies including 1019 patients were eligible for inclusion whose level of evidence for the included studies was low. Meta-analysis of four trials comparing MS with sham intervention showed that MS was not associated with significant improvement in ICIQ-SF score (-0.52, 95%CI -1.05, 0.01; P = 0.06, I2 = 16%), QOL score (-0.27, 95%CI -0.57, 0.04; P = 0.09, I2 = 0%), number of leakages (-0.16, 95%CI -0.62, 0.29; P = 0.48, I2 = 52%), and pad test (-1.36, 95%CI -2.64, -0.08; P = 0.04, I2 = 94%). Narrative review showed that there were no convincing evidences that MS was effective for chronic pelvic floor pain, detrusor overactivity, overactive bladder, and the included RCTs had controversial results. MS may have some benefits for nocturnal enuresis and erectile dysfunction according to the trials. CONCLUSIONS There is no convinced evidence to support the benefits of using MS in the management of PFD. The applicability of MS in the treatment of PFD remains uncertain, so larger, well-designed trials with longer follow-up periods adopted relevant and comparable outcomes are needed to be further explored to provide a definitive conclusion.
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Affiliation(s)
- Hong Pan
- College of Preventive Health and Rehabilitation, Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, China
| | - Yong Bao
- Ruijin Rehabilitation Hospital of Shanghai Jiao Tong University, Shanghai, China
| | - Honghao Cao
- Department of Urology, Affiliated Hospital and Clinical Medical College of Chengdu University, Chengdu, Sichuan, China
| | - Rongjiang Jin
- College of Preventive Health and Rehabilitation, Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, China
| | - Pu Wang
- Department of Rehabilitation Medicine, Rui Jin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Junmei Zhang
- Department of Physical Education, Wuhan University of Technology, Wuhan, China
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Collins AF, Doyle PJ, Duecy EE, Lipetskaia LV, Lee TG, Buchsbaum GM. Do anxiety traits predict subjective short-term outcomes following prolapse repair surgery? Int Urogynecol J 2018; 30:417-421. [PMID: 30116845 DOI: 10.1007/s00192-018-3734-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2018] [Accepted: 07/23/2018] [Indexed: 10/28/2022]
Abstract
BACKGROUND Studies conducted in orthopedic surgery have suggested that patients with anxiety have less symptomatic improvement following surgery than those without. We hypothesized for this study that patients with anxiety traits experience less symptomatic improvement following pelvic organ prolapse surgery than patients without. METHODS All patients presenting for prolapse repair surgery were offered enrollment in this prospective cohort study. Prior to surgery, subjects were asked to complete the Spielberger State-Trait Anxiety Inventory and the Pelvic Floor Distress Inventory 20. Subjects were also asked to list up to five goals related to the outcome of surgery for goal-attainment scaling. At the 6-8-week postoperative visit, subjects were asked to repeat the STAI and PFDI questionnaires and respond to the single question tool assessing Patient Global Impression of Improvement. Subjects were also asked to rate on a Visual Assessment Scale how well preoperative goals were met. All three questionnaires were repeated at >12 weeks following surgery. RESULTS A total of 32 patients with anxiety trait and 58 without were recruited. Preoperatively, the mean STAI-T was 45.0 (± 7.2.) and 27.7 (± 4.9) for subjects with and without anxiety; PFDI 20 scores were 96.1 (± 48.8) and 94.7 (± 57.5), respectively. At 12+ weeks postoperatively, the mean PFDI-20 for subjects with anxiety was 31.3 (± 20.9) and 30.3 (± 27.9) (p = 0.22) for those without. CONCLUSIONS We did not find the anxiety trait to be a predictor of subjective outcomes following pelvic organ prolapse surgery.
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Affiliation(s)
- Amy F Collins
- Department of Obstetrics and Gynecology, University of Rochester Medical Center, 601 Elmwood Avenue, Box 668, Rochester, NY, 14642, USA.
| | - Paula J Doyle
- Department of Obstetrics and Gynecology, University of Rochester Medical Center, 601 Elmwood Avenue, Box 668, Rochester, NY, 14642, USA
| | - Erin E Duecy
- Department of Obstetrics and Gynecology, University of Rochester Medical Center, 601 Elmwood Avenue, Box 668, Rochester, NY, 14642, USA
| | - Lioudmila V Lipetskaia
- Department of Obstetrics and Gynecology, University of Rochester Medical Center, 601 Elmwood Avenue, Box 668, Rochester, NY, 14642, USA
| | - Toy Gee Lee
- Department of Obstetrics and Gynecology, University of Rochester Medical Center, 601 Elmwood Avenue, Box 668, Rochester, NY, 14642, USA
| | - Gunhilde M Buchsbaum
- Department of Obstetrics and Gynecology, University of Rochester Medical Center, 601 Elmwood Avenue, Box 668, Rochester, NY, 14642, USA
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Eustice S, Endacott R, Morris J, Shankar R, Kent B. Women's experiences of managing digitation: do we ask enough in primary care? JRSM Open 2018; 9:2054270418783616. [PMID: 30094048 PMCID: PMC6080083 DOI: 10.1177/2054270418783616] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
The aim of this paper was to consider the available evidence for the current
management of pelvic organ prolapse, which is a common presentation in primary
care. However, not all women will present, only presenting when symptoms become
bothersome. Particular attention was paid to understanding the problem of
rectocele and its influence on obstructive defaecation symptoms. The burden of
rectocele and its consequences are not truly known. Furthermore, healthcare
professionals may not always enquire about bowel symptoms and patients may not
disclose them. Complex emotions around coping and managing stress add to the
challenges with seeking healthcare. Therefore, the impact on the lived
experience of women who have difficulty with rectal emptying can be significant.
The review identified a dearth of knowledge about women living with the problem
of obstructive defaecation resulting in the use of digitation. Improving the
management of digitation, an under-reported problem, is necessary to improve the
quality of life for women. Primary care needs to increase access to conservative
measures for women struggling with bothersome symptoms, such as constipation,
the need to digitate or anxiety.
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Affiliation(s)
- Sharon Eustice
- Bladder and Bowel Specialist Service, Cornwall Foundation Trust, Cornwall PL31 1FB, UK
| | - Ruth Endacott
- School of Nursing and Midwifery, Plymouth University/Royal Devon and Exeter Clinical School, Devon, UK
| | - Jenny Morris
- Faculty of Health and Human Sciences, Plymouth University, Truro, UK
| | - Rohit Shankar
- Adult Developmental Neuropsychiatry, Cornwall Foundation Trust, Cornwall, UK
| | - Bridie Kent
- School of Nursing and Midwifery, Faculty of Health and Human Sciences, Plymouth University, Devon, UK
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Carrillo-Izquierdo MD, Slim M, Hidalgo-Tallon J, Calandre EP. Pelvic floor dysfunction in women with fibromyalgia and control subjects: Prevalence and impact on overall symptomatology and psychosocial function. Neurourol Urodyn 2018; 37:2702-2709. [PMID: 29974511 DOI: 10.1002/nau.23723] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2018] [Accepted: 05/11/2018] [Indexed: 12/28/2022]
Abstract
AIMS To evaluate the prevalence, distress, and impact of pelvic floor dysfunction (PFD) symptomatology in women with fibromyalgia and control women. We also aimed to evaluate the impact of PFD symptomatology on several psychosocial measures such as mood, sleep, pain, and quality of life. METHODS We conducted a cross-sectional study in women with fibromyalgia and control women from the general population. Using a structured survey, we collected sociodemographic and clinical data, assessed the prevalence of PFD and evaluated the distress (PFDI-20) and the impact (PFIQ-7) caused by its symptomatology. Using Spanish-validated questionnaires, we also evaluated mood and sleep disturbances, bodily pain, and quality of life in subjects with and without PFD. In participants with fibromyalgia, we assessed the severity and impact of the disease using the Fibromyalgia Impact Questionnaire (FIQR). RESULTS Two hundred and twenty-six patients with fibromyalgia and 222 control women completed the surveys. Two hundred and twenty patients (93%) and 140 controls (63%) reported PFD-related symptoms. Both the scores of distress (143.1 ± 5.7 vs 96.1 ± 4.8, P < 0.0001) and impact (122.4 ± 5.6 vs 100.6 ± 6.4, P < 0.0001) caused by PFD symptoms were significantly higher in women with fibromyalgia than in controls. There was a significant positive relationship between fibromyalgia severity and both PFDI-20 (r2 = 0.32, P < 0.0001) and PFIQ-7 scores (r2 = 0.375, P < 0.0001). Depression severity, sleep disturbances, bodily pain, and low quality of life were highest in women with fibromyalgia and PFD and lowest in control women without PFD. CONCLUSIONS PFD-related symptoms were significantly more frequent in women with fibromyalgia than in controls. PFD symptomatology, when present, negatively influenced mood, sleep quality, and quality of life of both patients with fibromyalgia and controls.
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Affiliation(s)
| | - Mahmoud Slim
- Division of Neurology, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Javier Hidalgo-Tallon
- Cátedra de Ozonoterapia y Dolor, Universidad Católica "San Antonio" de Murcia, Murcia, Andalucía, Spain
| | - Elena P Calandre
- Instituto de Neurociencias, Universidad de Granada, Armilla, Granada, Spain
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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. Am J Obstet Gynecol 2018; 218:335.e1-335.e6. [PMID: 29229409 DOI: 10.1016/j.ajog.2017.11.604] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2017] [Revised: 10/26/2017] [Accepted: 11/30/2017] [Indexed: 01/30/2023]
Abstract
BACKGROUND Postpartum depression and pelvic floor disorders are both common conditions that affect women; however, the association between the 2 has yet to be determined. OBJECTIVE The aims of our study are to: (1) determine the prevalence of a positive postpartum depression screen in a specialty postpartum perineal clinic, and (2) identify risk factors for postpartum depression in this population. STUDY DESIGN A retrospective chart review was performed of 294 women referred to a specialty postpartum perineal clinic at the University of Michigan from March 30, 2012, through May 3, 2016. Women who completed a new patient intake form, including the Edinburgh Postnatal Depression Scale, were included. The prevalence of a positive Edinburgh Postnatal Depression Scale screen (≥10) was determined. Bivariate analyses were used to compare demographics, delivery characteristics, referral indications, and postpartum pelvic floor symptoms between women with and without a positive Edinburgh Postnatal Depression Scale screen. Significant variables identified in the analyses were then used to perform logistic regression to identify factors independently associated with a positive Edinburgh Postnatal Depression Scale screen. RESULTS In all, 15.6% (46/294) of women had a positive postpartum depression screen. Average age was 30.6 ± 4.8 years, average body mass index was 28.9 ± 5.06 kg/m2, 68.0% (200/294) were Caucasian, 79.6% (234/294) were primiparous, and 86.0% (245/285) were breast-feeding. Using multivariable logistic regression, women with a positive postpartum depression screen had higher odds of being non-Caucasian (adjusted odds ratio, 2.72; 95% confidence interval, 1.27-5.832; P = .01), having a history of depression and/or anxiety (adjusted odds ratio, 2.77; 95% confidence interval, 1.23-6.24; P = .01), having been referred for pain (adjusted odds ratio, 2.61; 95% confidence interval, 1.24-5.49; P = .01), and reporting urinary incontinence during and after pregnancy (adjusted odds ratio, 3.81; 95% confidence interval, 1.57-9.25; P = .003). CONCLUSION Urinary incontinence during and after pregnancy and referral for pain were pelvic floor symptoms independently associated with a positive postpartum depression screen in women referred to a specialty perineal clinic. Therefore, consideration should be given to depression screening in women presenting with perinatal urinary incontinence and persistent postpartum pain, as these women may be at increased risk of developing postpartum depression.
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Ai FF, Mao M, Zhang Y, Kang J, Zhu L. Effect of generalized anxiety disorders on the success of pessary treatment for pelvic organ prolapse. Int Urogynecol J 2018; 29:1147-1153. [PMID: 29478112 DOI: 10.1007/s00192-018-3562-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2017] [Accepted: 01/10/2018] [Indexed: 12/01/2022]
Abstract
INTRODUCTION AND HYPOTHESIS Our aim was to evaluate the impact of generalized anxiety disorders (GAD) on the effectiveness of pessary treatment for pelvic organ prolapse (POP) in postmenopausal women. METHODS One-hundred and ten women with symptomatic POP who underwent pessary treatment were enrolled in this prospective study. Subjective evaluations of pelvic floor symptoms were assessed using the Pelvic Floor Distress Inventory (PFDI-20) and the Pelvic Floor Impact Questionnaire-7 (PFIQ-7), both at baseline and at the 3-month follow-up visit after pessary use. GAD was measured by the Generalized Anxiety Disorder-7 (GAD-7). Independent samples t tests, Mann-Whitney U test, chi-square test, Fisher's exact test, and Wilcoxon signed rank test were used to analyze data. RESULTS Twenty-one patients (20.6%) had GAD at baseline. After 3 months of pessary use, PFIQ-7, PFDI-20, and GAD scores were significantly improved in all participants (P < 0.001). In the GAD-negative group, total PFIQ-7 and PFDI-20 scores, including all subscales scores, were significantly decreased from baseline to posttreatment (P < 0.05). However, in the GAD-positive group, both PFIQ-7 and PFDI-20 scores, including subscales, were also significantly decreased from baseline to posttreatment (P < 0.05), except for subscale Colorectal-Anal Impact Questionnaire (CRAIQ-7) of PFIQ-7 (P = 0.225), which represented the impact on quality of life (QoL) from bowel dysfunction. CONCLUSIONS Both groups of women with or without GAD showed significant improvement in QoL scores after 3 months of pessary treatment. GAD had no influence on the success of pessary treatment for POP.
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Affiliation(s)
- Fang-Fang Ai
- Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, People's Republic of China
| | - Meng Mao
- Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, People's Republic of China
| | - Ye Zhang
- Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, People's Republic of China
| | - Jia Kang
- Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, People's Republic of China
| | - Lan Zhu
- Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, People's Republic of China. .,Department of Gynecology and Obstetrics, Peking Union Medical College Hospital, No. 1 Shuaifu Road, Dongcheng District, Beijing, 100730, China.
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Ai F, Deng M, Mao M, Xu T, Zhu L. Screening for general anxiety disorders in postmenopausal women with symptomatic pelvic organ prolapse. Climacteric 2017; 21:35-39. [PMID: 29095064 DOI: 10.1080/13697137.2017.1392502] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
OBJECTIVE This study aimed to investigate the prevalence of general anxiety disorder (GAD) among postmenopausal women with symptomatic pelvic organ prolapse (POP) and to identify its associated factors. METHODS A cross-sectional study was conducted among postmenopausal women with symptomatic POP. Sociodemographic data and medical histories were obtained. Participants completed the POP Quantification (POP-Q), the Pelvic Floor Impact Questionnaire-7 (PFIQ-7), and the Pelvic Floor Distress Inventory (PFDI-20) measures. Measures of GAD were obtained using the Generalized Anxiety Disorder-7 (GAD-7). The data were analyzed using independent sample t-tests, the Mann-Whitney U-test, χ2 tests, Fisher's exact tests and logistic regression. RESULTS Of the 177 participants interviewed, 19.2% had symptoms of GAD. There were no statistically significant differences in the sociodemographic characteristics or the POP-Q stage between women with and without GAD (p > 0.05). GAD was significantly associated with higher PFDI-20 and PFIQ-7 subscale scores (p < 0.05). After multiple logistic regression analyses, only the PFIQ-7 subscale UIQ-7 (odds ratio = 1.025, 95% confidence interval 1.007-1.043, p = 0.005) and the PFDI-20 subscale CRADI-8 (odds ratio = 1.025, 95% confidence interval 1.004-1.047, p = 0.021), which represented the impact on quality of life from lower urinary tract symptoms and the distress caused by bowel dysfunction, were risk factors that were independently associated with GAD. CONCLUSIONS GAD is prevalent in almost one-fifth of postmenopausal women with symptomatic POP. GAD is not associated with the severity of the POP-Q stage but is associated with higher scores for lower urinary tract and bowel dysfunction caused by POP.
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Affiliation(s)
- F Ai
- a Department of Obstetrics and Gynecology , Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College , Beijing , PR China
| | - M Deng
- a Department of Obstetrics and Gynecology , Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College , Beijing , PR China
| | - M Mao
- a Department of Obstetrics and Gynecology , Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College , Beijing , PR China
| | - T Xu
- b Department of Epidemiology and Statistics , Institute of Basic Medical Sciences, Chinese Academy of Medical Sciences and School of Basic Medicine, Peking Union Medical College , Beijing , PR China
| | - L Zhu
- a Department of Obstetrics and Gynecology , Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College , Beijing , PR China
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