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Kumar S, Chaudhary RK, Shah SS, Kumar D, Nepal P, Ojili V. Current update on the role of endoanal ultrasound: a primer for radiologists. Abdom Radiol (NY) 2024; 49:2873-2890. [PMID: 38580791 DOI: 10.1007/s00261-024-04300-0] [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: 01/07/2024] [Revised: 03/16/2024] [Accepted: 03/20/2024] [Indexed: 04/07/2024]
Abstract
Endoanal ultrasound (EAUS) is a valuable imaging modality for the evaluation of anal and perianal pathologies. It provides detailed information about the anatomy and physiology of the anorectal region and has been used in pre-and post-operative settings of anorectal pathologies. EAUS is not only useful in the evaluation of benign pathologies but also in loco-regional staging of anal and rectal tumors. EAUS has several advantages over MRI, including reduced cost, better patient tolerance, and improved scope of application in patients with contraindications to MRI. Despite its benefits, EAUS is not widely performed in many centers across the globe. This article aims to educate radiologists, trainees, and surgeons about the indications, contraindications, patient preparation, imaging technique, and findings of EAUS. We will also highlight the technical difficulties, diagnostic challenges, and procedural complications encountered during EAUS, along with a comparative analysis of EAUS with other imaging approaches.
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Affiliation(s)
- Shruti Kumar
- Department of Radiology, University of Arkansas for Medical Sciences, 4301 W Markham St, Slot 556, Little Rock, AR, 72205, USA.
| | - Ranjit K Chaudhary
- Department of Radiology, St. Vincent's Medical Center, Bridgeport, CT, USA
| | - Samir S Shah
- Department of Radiology, Canpic Medical and Education Foundation, Pune, India
| | - Devendra Kumar
- Department of Clinical Imaging, Hamad Medical Corporation, Doha, Qatar
| | - Pankaj Nepal
- Department of Radiology, Inova Fairfax Hospital, Fairfax, VA, USA
| | - Vijayanadh Ojili
- Department of Radiology, University of Texas Health, San Antonio, TX, USA
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André K, Stuart A, Källén K. Maternal origin matters: Country of birth as a risk factor for obstetric anal sphincter injuries. Int J Gynaecol Obstet 2024; 166:426-434. [PMID: 38358267 DOI: 10.1002/ijgo.15427] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Accepted: 01/30/2024] [Indexed: 02/16/2024]
Abstract
OBJECTIVE Obstetric anal sphincter injuries (OASIS) are severe complications to vaginal births with potential long-term consequences. Maternal origin has been proposed to affect the overall risk, but the association and underlying explanation are uncertain. The objective was to assess the association between maternal country of birth and OASIS. METHODS A Swedish nationwide cohort study including singleton term vaginal births during 2005-2016. Data were extracted from the Swedish Medical Birth Registry and Statistics Sweden. Modified Poisson regression analyses were performed to obtain crude and adjusted risk ratios (RRs). Adjustments were made in four cumulative steps. Sub-analyses were performed to investigate the risk of OASIS associated with female genital circumcision (FGC). RESULTS In all, 988 804 births were included. The rate of OASIS in Swedish-born women was 3.5%. Women from East/Southeast Asia had an increased risk of OASIS (adjusted RR [aRR] 1.71, 95% confidence interval [CI] 1.60-1.83), as did women born in Sub-Saharan Africa (aRR 1.60, 95% CI 1.49-1.72). The risk remained significantly increased also after adjustment for maternal height. By contrast, women from South/Central America had a decreased risk of OASIS (aRR 0.65, 95% CI 0.56-0.76). FGC was associated with an increased risk of OASIS (aRR 3.05, 95% CI 2.60-3.58). Episiotomy appeared to have an overall protective effect (aRR 0.95, 95% CI 0.92-0.98), but not significantly more protective among women with female genital mutilation. CONCLUSIONS Country of birth plays an important role in the risk of OASIS. Women from East/Southeast Asia and Sub-Saharan Africa are at significantly increased risk as compared with Swedish-born women, whereas women from South/Central America are at lower risk. FGC is also a significant risk factor for OASIS.
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Affiliation(s)
- Kristin André
- Institution of Clinical Sciences, Lund University, Lund, Sweden
- Department of Obstetrics and Gynecology, Helsingborg Central Hospital, Helsingborg, Sweden
| | - Andrea Stuart
- Institution of Clinical Sciences, Lund University, Lund, Sweden
- Department of Obstetrics and Gynecology, Helsingborg Central Hospital, Helsingborg, Sweden
| | - Karin Källén
- Institution of Clinical Sciences, Lund University, Lund, Sweden
- Centre for Reproductive Epidemiology, Tornblad Institute, Lund University, Lund, Sweden
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Perelmuter S, Burns R, Shearer K, Grant R, Soogoor A, Jun S, Meurer JA, Krapf J, Rubin R. Genitourinary syndrome of lactation: a new perspective on postpartum and lactation-related genitourinary symptoms. Sex Med Rev 2024; 12:279-287. [PMID: 38757214 DOI: 10.1093/sxmrev/qeae034] [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: 03/11/2024] [Revised: 04/16/2024] [Accepted: 04/25/2024] [Indexed: 05/18/2024]
Abstract
BACKGROUND The genitourinary syndrome of menopause (GSM) is a well-documented condition characterized by a range of genitourinary symptoms in peri- and postmenopausal women. As with GSM, postpartum lactating women experience reduced estrogen and androgen levels. However, there is limited research on the impact of symptoms during the postpartum breastfeeding period. OBJECTIVES The aim was to review the literature for genitourinary health in the postpartum breastfeeding population and summarize key findings and potential treatments. METHODS We performed a comprehensive literature review in PubMed, Google Scholar, and Scopus from inception of database to November 2023 using the following keywords individually and in combination: "physiology of postpartum" or "physiology of lactogenesis" or "vulvovaginal health" or "vaginal atrophy" or "vaginal dryness" or "dyspareunia" or "urinary incontinence" or "lactation" or "breastfeeding" or "vaginal estrogen." All identified articles published in English were considered. Relevant studies were extracted, evaluated, and analyzed. The work presented in this article represents a summative review of the identified literature. RESULTS During lactation, high levels of prolactin inhibit estrogen and androgen secretion via negative feedback, which leads to an increased prevalence of vulvovaginal atrophy, vaginal dryness, dyspareunia, and urinary incontinence in lactating postpartum women. Despite these highly prevalent and potentially devastating symptoms, there is a lack of consistent screening at postpartum visits and no treatment guidelines available to health care providers. CONCLUSION Postpartum breastfeeding women experience similar physiology and symptoms to the postmenopausal phase, as seen in GSM. We propose the introduction of a novel term to describe the genitourinary changes seen in postpartum breastfeeding individuals: genitourinary syndrome of lactation. The diagnostic use of genitourinary syndrome of lactation will equip health care providers with an all-encompassing term to bring awareness to the symptoms experienced by postpartum breastfeeding individuals and lead to improved screening and treatment for the high numbers of individuals experiencing these genitourinary changes.
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Affiliation(s)
- Sara Perelmuter
- Weill Cornell Medical College, New York, NY 10021, United States
| | - Ramzy Burns
- Department of Urology, Indiana University, Indianapolis, IN 47405, United States
| | - Katie Shearer
- University of Tennessee Health Science Center, Memphis, TN 38163, United States
| | - Raeven Grant
- David Geffen School of Medicine, University of California, Los Angeles, CA 90095, United States
| | - Anantha Soogoor
- College of Osteopathic Medicine, William Carey University, Hattiesburg, MS 39401, United States
| | - Soyoun Jun
- Texas College of Osteopathic Medicine, University of North Texas Health Science Center, Fort Worth, TX 76107, United States
| | - Janine Alexis Meurer
- Jacobs School of Medicine and Biomedical Sciences, University at Buffalo School of Medicine and Biomedical Sciences, Buffalo, NY 14203, United States
| | - Jill Krapf
- Obstetrics and Gynecology, Center for Vulvovaginal Disorders, Washington, DC 20037, United States
| | - Rachel Rubin
- Department of Urology, Georgetown University, Washington, DC 20007, United States
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Yu Z, Guo M, Bai X, Ruan G, Sun Y, Han W, Yang H. Exploring the association between cardiovascular health and bowel health. Sci Rep 2024; 14:11819. [PMID: 38783080 PMCID: PMC11116406 DOI: 10.1038/s41598-024-62715-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2023] [Accepted: 05/21/2024] [Indexed: 05/25/2024] Open
Abstract
Chronic constipation, diarrhea, and fecal incontinence have high incidence, potential disability, and socioeconomic impact, imposing a heavy burden on the quality of life. We aim to explore the association between cardiovascular health (CVH) and bowel health from National Health and Nutrition Survey 2005-2010. CVH is assessed using Life's Essential 8 (LE8). Chronic constipation, chronic diarrhea, and fecal incontinence are assessed based on Bristol Stool Form Scale classification, bowel movements, and bowel leakage. Better health behaviors (odds ratio [OR]: 0.71, 95% confidence interval [CI] 0.53-0.94, p = 0.02) and worse health factors (OR: 1.45, CI 1.03-2.04, p = 0.04) were associated with less chronic constipation. Less chronic diarrhea is correlated with better CVH (OR: 0.53, 95% CI 0.35-0.79, p = 0.003) and health factors (OR: 0.61, CI 0.46-0.81, p = 0.001). Meanwhile, the proportion of chronic diarrhea significantly decreases when the health behaviors score exceeds 59.42. Lower fecal incontinence was associated with better health behaviors (OR: 0.63, CI 0.44-0.90, p = 0.01) CVH. Better CVH and health behaviors are both linked to lower all-cause mortality in participants with chronic constipation and chronic diarrhea. A higher health behaviors score is also associated with less all-cause mortality in patients with fecal incontinence. Maintaining CVH at the population level contributes to intestinal health, achieving the dual management of both while saving on healthcare costs. However, further prospective research is needed to confirm these associations.
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Affiliation(s)
- Ziqing Yu
- Department of Gastroenterology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, 100730, China
| | - Mingyue Guo
- Department of Gastroenterology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, 100730, China
| | - Xiaoyin Bai
- Department of Gastroenterology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, 100730, China
| | - Gechong Ruan
- Department of Gastroenterology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, 100730, China
| | - Yinghao Sun
- Department of Gastroenterology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, 100730, China
| | - Wei Han
- Department of Epidemiology and Biostatistics, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, 100730, China
| | - Hong Yang
- Department of Gastroenterology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, 100730, China.
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Bhandari Randhawa S, Rizkallah A, Nelson DB, Duryea EL, Spong CY, Pruszynski JE, Rahn DD. Factors Associated With Persistent Bothersome Urinary Symptoms and Leakage After Pregnancy. UROGYNECOLOGY (PHILADELPHIA, PA.) 2024:02273501-990000000-00219. [PMID: 38710008 DOI: 10.1097/spv.0000000000001528] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/08/2024]
Abstract
IMPORTANCE Urinary incontinence is a common postpartum morbidity that negatively affects quality of life. OBJECTIVE This study aimed to identify factors associated with persistent (ie, 12 months postpartum) bothersome urinary symptoms, including stress urinary incontinence (SUI) and urgency urinary incontinence (UUI), and explore their association with mental health in medically underserved communities. STUDY DESIGN This was a cross-sectional analysis of a prospective study of individuals enrolled into "extending Maternal Care After Pregnancy," a program providing 12 months of postpartum care to individuals with health disparities. Patients were screened at 12 months for urinary dysfunction, anxiety, and depression using the Urinary Distress Index-6, Generalized Anxiety Disorder-7, and Edinburgh Postnatal Depression Scale, respectively. Bivariate and multivariable logistic regression analyses were performed for at-least-somewhat-bothersome SUI versus no-SUI, UUI versus no-UUI, and for bothersome versus asymptomatic urinary symptoms, using demographic and peripartum and postpartum variables as associated factors. RESULTS Four hundred nineteen patients provided data at median 12 months postpartum. Patients were 77% Hispanic White and 22% non-Hispanic Black. After multivariable analysis, SUI (n = 136, 32.5%) was significantly associated with increasing body mass index at the time of delivery and greater depression screening scores. Fetal birthweight, mode of delivery, degree of laceration, and breastfeeding status were not associated. Urgency urinary incontinence (n = 69, 16.5%) was significantly associated with increasing parity and higher anxiety screening scores. Similarly, participants with urinary symptom bother had significantly greater parity and higher anxiety screening scores. CONCLUSIONS At 12 months postpartum, bothersome urinary symptoms and incontinence were quite common. Since these are treatable, postpartum screening for urinary complaints-and associated anxiety and depression-is essential, as is assisting patients in achieving a healthy weight.
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Affiliation(s)
- Sonia Bhandari Randhawa
- From the Department of Obstetrics and Gynecology, University of Texas Southwestern Medical Center, Dallas, TX
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Meyling MMG, Frieling ME, Vervoort JPM, Feijen-de Jong EI, Jansen DEMC. Health problems experienced by women during the first year postpartum: A systematic review. Eur J Midwifery 2023; 7:42. [PMID: 38111746 PMCID: PMC10726257 DOI: 10.18332/ejm/173417] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Revised: 10/05/2023] [Accepted: 11/15/2023] [Indexed: 12/20/2023] Open
Abstract
INTRODUCTION During pregnancy and childbirth, health issues can arise that can negatively influence women's postpartum health. Although it is imperative to identify these health problems in order to tailor care to women's needs, they often remain unrecognized. A comprehensive overview of postpartum health problems does not exist in the current literature. This systematic review aimed to explore the health problems experienced by women residing in high-income countries during the first year postpartum. METHODS Scientific databases were searched for articles on health problems experienced by women during the first year postpartum, published between January 2000 and 2 July 2021. Studies investigating the experiences of healthy women from the age of 18 years, residing in high-income countries, who gave birth to a healthy neonate, were included. Identified health issues were divided into five categories and presented in an overview. RESULTS A total of 25 articles were eligible for inclusion. In all, 83 health problems were identified and divided into five different categories (physical health problems, mental health problems, social health problems, problems related to feeding the infant, and other challenges). Common health issues postpartum were exhaustion, urinary incontinence, painful breasts, depressive symptoms, problems related to sexuality and sleep, lack of social support, and problems with breastfeeding. CONCLUSIONS This systematic review contributes to a wider understanding of postpartum health problems and can be used to adapt healthcare to women's needs. It distinguishes itself from previous studies by the wide variety of identified health problems and its specific focus on women's experiences in the postpartum period.
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Affiliation(s)
| | | | - Johanna P. M. Vervoort
- Department of Health Sciences, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Esther I. Feijen-de Jong
- Department of Primary and Long-term Care, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
- Department of Midwifery Science, Amsterdam University Medical Centers, Vrije Universiteit Amsterdam, Amsterdam Public Health Research Institute, Amsterdam, Amsterdam, the Netherlands
- Midwifery Academy Amsterdam Groningen, Inholland, Groningen, the Netherlands
| | - Danielle E. M. C. Jansen
- Department of Primary and Long-term Care, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
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Wang Y, Li N, Zhou Q, Wang P. Fecal incontinence was associated with depression of any severity: insights from a large cross-sectional study. Int J Colorectal Dis 2023; 38:271. [PMID: 37991579 DOI: 10.1007/s00384-023-04563-x] [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] [Accepted: 11/08/2023] [Indexed: 11/23/2023]
Abstract
OBJECTIVE Current studies on the association between fecal incontinence (FI) and depression are very limited, and most of them are restricted to women or elderly patients. This study aims to evaluate in detail the association between FI and depression among US adults. METHODS 13,480 adults aged 20 years and older were selected from the National Health and Nutrition Examination Survey 2005-2010. Monthly loss of solid, liquid, or mucous stool was defined as FI. Clinical depression and depression severity were assessed by the validated Patient Health Questionnaide-9 (PHQ-9). Models of multivariate logistic regression were used to calculate adjusted odds ratios (ORs). A subgroup analysis was carried out to ensure that the results were stable. RESULTS After adjusting for covariates such as demographics, risk behaviors and associated comorbidities, the PHQ-9 score and clinical depression were both significantly associated with FI, with ORs and 95%CIs of 1.11 (1.10-1.13) and 3.01 (2.53-3.57). Depression of all severities was also significantly associated with FI. The ORs and 95%CIs of FI with mild depression, moderate depression, and moderately severe to severe depression were 2.29 (1.96-2.68), 3.44 (2.77-4.27) and 4.65 (3.61-6.00), respectively. Subgroup analyses showed no statistically significant interactions (P > 0.05). CONCLUSIONS In conclusion, FI significantly associated with depression of any severity. Like the elderly or female patients with FI, young and middle-aged or men with FI are also at high risk of depression and should also be the focus of depression screening and early intervention.
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Affiliation(s)
- Yan Wang
- Department of Oncology, China Academy of Chinese Medical Sciences Guang' anmen Hospital, 100053, Beijing, China
| | - Na Li
- Department of Anesthesiology, Hekou District People's Hospital, 257200, Dongying City, Shandong Province, China
| | - Qiang Zhou
- Department of Orthopedic Surgery, Hekou District People's Hospital, 257200, Dongying City, Shandong Province, China
| | - Pengfei Wang
- Department of Anorectal surgery, China Academy of Chinese Medical Sciences Xiyuan Hospital, 100091, Beijing, China.
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Simmelink R, Moll E, Verhoeven C. The influence of the attending midwife on the occurrence of episiotomy: A retrospective cohort study. Midwifery 2023; 125:103773. [PMID: 37453396 DOI: 10.1016/j.midw.2023.103773] [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: 08/01/2022] [Revised: 05/23/2023] [Accepted: 07/07/2023] [Indexed: 07/18/2023]
Abstract
BACKGROUND Episiotomy at the time of vaginal birth can result in short- and long-term complications for women. Therefore, it is important to study factors that influence the occurrence of episiotomy. AIM To examine to what extent the individual factors of clinical midwives in the same working conditions contribute to variations in episiotomy. METHODS A retrospective cohort study was performed at a secondary care hospital in Amsterdam, the Netherlands, using data from women who were assisted by a clinical midwife during birth in 2016. The clinical midwives filled out a questionnaire to determine individual factors. The predictive value of the individual factors of the clinical midwives was examined in a multiple logistic regression model on episiotomy. RESULTS A total of 1302 births attended by 27 midwives were included. The mean episiotomy rate was 12.7%, with a range from 3.2% to 30.8% among midwives (p = 0.001). When stratified for parity, within the primipara group there was a significant variation in episiotomy among midwives with a range from 7.9% to 47.8% (p = 0.006). No significant variation was found in the occurrence of third/fourth degree tears or intact perineum. There was a significant difference in episiotomy for maternal indication among midwives (p = 0.041). Predictors for an episiotomy were number of years since graduation and place of bachelor education of the clinical midwife. CONCLUSION This study shows that individual factors of clinical midwives influence the rate of episiotomy. Predictors for an episiotomy were the number of years since graduation and place of bachelor education. This shows that continuous training of clinical midwives could contribute to reducing the number of unnecessary episiotomies. Since suspected fetal distress is the only evidence based indication to perform an episiotomy, there is room for improvement given the variation in the number of episiotomies performed for maternal indication.
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Affiliation(s)
- Renate Simmelink
- Amsterdam UMC location Vrije Universiteit Amsterdam, Midwifery Science, De Boelelaan 1117, Amsterdam, the Netherlands; Department of Obstetrics and Gynaecology, OLVG-West Hospital, Jan Tooropstraat 164, Amsterdam, the Netherlands.
| | - Etelka Moll
- Department of Obstetrics and Gynaecology, OLVG-West Hospital, Jan Tooropstraat 164, Amsterdam, the Netherlands
| | - Corine Verhoeven
- Amsterdam UMC location Vrije Universiteit Amsterdam, Midwifery Science, De Boelelaan 1117, Amsterdam, the Netherlands; Division of Midwifery, School of Health Sciences, University of Nottingham, Nottingham NG7 2RD, United Kingdom; Department of Obstetrics and Gynaecology, Maxima Medical Centre, De Run 4600, Veldhoven, the Netherlands
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Okeahialam NA, Taithongchai A, Thakar R, Sultan AH. The incidence of anal incontinence following obstetric anal sphincter injury graded using the Sultan classification: a network meta-analysis. Am J Obstet Gynecol 2023; 228:675-688.e13. [PMID: 36379266 DOI: 10.1016/j.ajog.2022.11.1279] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Revised: 11/06/2022] [Accepted: 11/08/2022] [Indexed: 11/15/2022]
Abstract
OBJECTIVE This study aimed to systematically determine and compare the incidence of anal incontinence between those with different grades of obstetric anal sphincter injury. DATA SOURCES Ovid MEDLINE, Embase, and the Cochrane Library were searched from January 2000 to April 2021. STUDY ELIGIBILITY CRITERIA Observational studies investigating the incidence of anal incontinence following an obstetric anal sphincter injury that was graded using the Sultan classification were eligible for inclusion. To allow comparison between individual tear grades (3a, 3b, 3c, fourth), a network meta-analysis was performed using Stata (version 15.1). METHODS For binary outcomes, odds ratios with corresponding 95% confidence intervals were reported. Obstetric anal sphincter injury grades were ranked from the best clinical outcome to the worst clinical outcome. The percentage chance of each grade taking each rank with regards to outcome was calculated. Study quality and risk of bias was assessed using the relevant tool from the Joanna Briggs Institute. RESULTS Of the 696 studies identified, 10 were eligible for inclusion and were included in the network meta-analysis (n=2467 women). The mean incidence of anal incontinence among those with 3a tears was 22.4% (range, 6.1%-51.2%), 24.9% (range, 6.9%-46.7%) among those with 3b tears, 26.8% (range, 0%-55.6%) among those with 3c tears, and 28.6% (0%-71.4%) among those with fourth-degree tears. Anal incontinence incidence was found to be significantly higher among those with 3c (odds ratio, 1.79; 95% confidence interval, 1.09-2.94) and fourth-degree tears (odds ratio, 2.37; 95% confidence interval, 1.40-4.02) than among those with 3a tears. In addition, anal incontinence incidence was significantly higher among those with fourth-degree tears (odds ratio, 1.89; 95% confidence interval, 1.10-3.22) than among those with 3b tears. Those with 3a tears had the highest probability of having the best clinical outcome; those with 3b; second-, 3c; third- and fourth-degree tears had the highest probability of having the worst clinical outcome. Overall, all studies had a high or unclear risk of bias across 1 or more assessed element. CONCLUSION This was a network meta-analysis comparing the incidence of anal incontinence among those with different grades of obstetric anal sphincter injury. Increasing tear-grade severity is associated with worse clinical outcomes. This study provides useful, clinically applicable information that can assist clinicians in the counseling of women following an obstetric anal sphincter injury. In addition, it highlights the importance of accurately diagnosing the obstetric anal sphincter injury grade and subsequently performing the appropriate repair.
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Affiliation(s)
| | | | - Ranee Thakar
- Croydon University Hospital, Thornton Heath, London, United Kingdom
| | - Abdul H Sultan
- Croydon University Hospital, Thornton Heath, London, United Kingdom; St George's University of London, London, United Kingdom.
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Wang P, Wang Y, Jia X. Association between fecal incontinence and suicidal ideation in adult Americans: Evidence from NHANES 2005-2010. J Psychosom Res 2023; 170:111377. [PMID: 37229822 DOI: 10.1016/j.jpsychores.2023.111377] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2023] [Revised: 05/11/2023] [Accepted: 05/14/2023] [Indexed: 05/27/2023]
Abstract
OBJECTIVES Currently, research on the relationship between fecal incontinence (FI) and suicidal ideation is very limited. This study aims to evaluate whether FI is associated with suicidal ideation among US adults. METHODS In this cross-sectional study, 13,480 adults aged 20 years and older were selected from the National Health and Nutrition Examination Survey 2005-2010. Monthly loss of solid, liquid, or mucous stool was defined as FI. As part of the Patient Health Questionnaire-9, item 9 assessed suicidal ideation. Models of multivariate logistic regression were used to calculate adjusted odds ratios. A subgroup analysis was carried out to ensure that the results were stable. RESULTS It was found that FI was associated with an increased risk of suicidal ideation after controlling for baseline characteristics, risk behaviors, and comorbid conditions such as depression (OR: 1.60, 95%CI: 1.24-2.08, P < 0.001). In subgroup analyses, FI remained significantly associated with suicidal ideation among participants aged 45 years and older, with odds ratios and 95% confidence intervals of 1.62 (1.11-2.38) and 2.49 (1.51-4.13), respectively. For age category <45 years, the association between FI and suicidal ideation weakened (OR: 1.02, 95%CI: 0.60-1.75, P = 0.932). CONCLUSIONS In conclusion, this study showed that FI was significantly associated with suicidal ideation. Patients aged middle-aged and older are at high risk and should be the focus of screening and timely intervention for suicidal ideation.
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Affiliation(s)
- Pengfei Wang
- Department of Anorectal surgery, Xiyuan Hospital, China Academy of Chinese Medical Sciences, 1 Xiyuan Playground, Haidian District, Beijing, China
| | - Yan Wang
- Department of Oncology, Guang' anmen Hospital, China Academy of Chinese Medical Sciences, 5 Beixiange, Xicheng District, Beijing, China
| | - Xiaoqiang Jia
- Department of Anorectal surgery, Xiyuan Hospital, China Academy of Chinese Medical Sciences, 1 Xiyuan Playground, Haidian District, Beijing, China.
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Mou T, Nelson L, Lewicky-Gaupp C, Brown O. Opportunities to Advance Postpartum Pelvic Floor Care With a Health Equity-based Conceptual Framework. Clin Obstet Gynecol 2023; 66:86-94. [PMID: 36657047 DOI: 10.1097/grf.0000000000000757] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
An essential part of postpartum care includes the evaluation and treatment of pelvic floor disorders (PFDs). Postpartum PFDs are common and occur in over 40% of postpartum women. Despite significant advancements in urogynecology to understand postpartum PFDs and their treatments, there has been a lack of attention to addressing equity in postpartum pelvic floor care. In this article, we address the current scientific understanding of postpartum PFDs while adapting a health equity-based conceptual framework to highlight areas of opportunity in optimizing postpartum pelvic floor care.
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Affiliation(s)
- Tsung Mou
- Division of Urogynecology and Pelvic Reconstructive Surgery, Tufts Medical Center, Boston, Massachusetts
| | | | - Christina Lewicky-Gaupp
- Division of Female Pelvic Medicine and Reconstructive Surgery, Northwestern University, Chicago, Illinois
| | - Oluwateniola Brown
- Division of Female Pelvic Medicine and Reconstructive Surgery, Northwestern University, Chicago, Illinois
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Moossdorff-Steinhauser HFA, Berghmans BCM, Spaanderman MEA, Bols EMJ. Prevalence, incidence and bothersomeness of urinary incontinence between 6 weeks and 1 year post-partum: a systematic review and meta-analysis. Int Urogynecol J 2021; 32:1675-1693. [PMID: 34142179 PMCID: PMC8295150 DOI: 10.1007/s00192-021-04877-w] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Accepted: 05/20/2021] [Indexed: 11/30/2022]
Abstract
Introduction and hypothesis Urinary incontinence (UI) is a common complaint for post-partum women. Reported prevalence and incidence figures show a large range due to varying study methodology. The crude prevalence of post-partum UI may differ when accounting for bother. Precise prevalence and incidence figures on (bothersome) UI are of relevance for health care providers, research planning, and policy makers. Therefore, we conducted a systematic review and meta-analysis to investigate the prevalence and incidence of UI in post-partum women in the Western world for relevant subgroups and assessed experienced bother in relation to UI. Methods Observational studies, published between January 1998 and March 2020 and reporting on prevalence and incidence between 6 weeks and 1 year post-partum, were included, regardless of type of UI or setting. We used a random effects model with subgroup analyses for post-partum period, parity and subtype of UI. Results The mean (weighted) prevalence based on 24 included studies, containing a total of 35.064 women, was 31.0%. After an initial drop in prevalence at 3 months post-partum, prevalence rises up to nearly the same level as in the third trimester of pregnancy at 1 year post-partum (32%). Stress UI (54%) is the most prevalent type. UI prevalence is equal among primi- and multiparous women. Experienced bother of UI is heterogeneously assessed and reported to be mild to moderate. Conclusions Post-partum UI is highly prevalent in women in the Western world. After an initial drop it rises again at 1 year post-partum. Experienced bother is mild to moderate. Supplementary Information The online version contains supplementary material available at 10.1007/s00192-021-04877-w.
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Affiliation(s)
- Heidi F A Moossdorff-Steinhauser
- Faculty of Health, Medicine and Life Sciences, Department of Epidemiology, Care and Public Health Research Institute (CAPHRI), Maastricht University, P.O. Box 616, 6200, MD, Maastricht, The Netherlands.
| | - Bary C M Berghmans
- Pelvic care Center Maastricht, CAPHRI, Maastricht University Medical Centre (MUMC+), Maastricht, The Netherlands
| | | | - Esther M J Bols
- Faculty of Health, Medicine and Life Sciences, Department of Epidemiology, Care and Public Health Research Institute (CAPHRI), Maastricht University, P.O. Box 616, 6200, MD, Maastricht, The Netherlands
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Sultan P, Sharawi N, Blake L, Ando K, Sultan E, Aghaeepour N, Carvalho B, Sadana N. Use of Patient-Reported Outcome Measures to Assess Outpatient Postpartum Recovery: A Systematic Review. JAMA Netw Open 2021; 4:e2111600. [PMID: 34042993 PMCID: PMC8160591 DOI: 10.1001/jamanetworkopen.2021.11600] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
IMPORTANCE Outpatient postpartum recovery is an underexplored area of obstetrics. There is currently no consensus regarding which patient-reported outcome measure (PROM) clinicians and researchers should use to evaluate postpartum recovery. OBJECTIVE To evaluate PROMs of outpatient postpartum recovery using Consensus-Based Standards for the Selection of Health Measurement Instruments (COSMIN) guidelines. EVIDENCE REVIEW An initial literature search performed in July 2019 identified postpartum recovery PROMs and validation studies. A secondary search in July 2020 identified additional validation studies. Both searches were performed using 4 databases (Web of Science, Embase, PubMed, and CINAHL), with no date limiters. Studies with PROMs evaluating more than 3 proposed outpatient postpartum recovery domains were considered. Studies were included if they assessed any psychometric measurement property of the included PROMs in the outpatient postpartum setting. The PROMs were assessed for the following 8 psychometric measurement properties, as defined by COSMIN: content validity, structural validity, internal consistency, cross-cultural validity and measurement invariance, reliability, measurement error, hypothesis testing, and responsiveness. Psychometric measurement properties were evaluated in each included study using the COSMIN criteria by assessing (1) the quality of the methods (very good, adequate, doubtful, inadequate, or not assessed); (2) overall rating of results (sufficient, insufficient, inconsistent, or indeterminate); (3) level of evidence assessed using the Grading of Recommendations, Assessment, Development and Evaluations assessment tool; and (4) level of recommendation, which included class A (recommended for use; showed adequate content validity with at least low-quality evidence for sufficient internal consistency), class B (not class A or class C), or class C (not recommended). FINDINGS In total, 15 PROMs (7 obstetric specific and 8 non-obstetric specific) were identified, evaluating outpatient postpartum recovery in 46 studies involving 19 165 women. The majority of psychometric measurement properties of the included PROMs were graded as having very-low-level or low-level evidence. The best-performing PROMs that received class A recommendations were the Maternal Concerns Questionnaire, the Postpartum Quality of Life tool, and the World Health Organization Quality of Life-BREF. The remainder of the evaluated PROMs had insufficient evidence to make recommendations regarding their use (and received class B recommendations). CONCLUSIONS AND RELEVANCE This review found that the best-performing PROMs currently available to evaluate outpatient postpartum recovery were the Maternal Concerns Questionnaire, the Postpartum Quality of Life tool, and the World Health Organization Quality of Life-BREF; however, these tools all had significant limitations. This study highlights the need to focus future efforts on robustly developing and validating a new PROM that may comprehensively evaluate outpatient postpartum recovery.
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Affiliation(s)
- Pervez Sultan
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, California
| | - Nadir Sharawi
- Department of Anesthesiology, University of Arkansas for Medical Sciences, Little Rock
| | - Lindsay Blake
- Clinical Services,University of Arkansas for Medical Sciences, Little Rock
| | - Kazuo Ando
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, California
| | - Ellile Sultan
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, California
| | - Nima Aghaeepour
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, California
| | - Brendan Carvalho
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, California
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Hwang UJ, Lee MS, Jung SH, Ahn SH, Kwon OY. Relationship Between Sexual Function and Pelvic Floor and Hip Muscle Strength in Women With Stress Urinary Incontinence. Sex Med 2021; 9:100325. [PMID: 33662705 PMCID: PMC8072144 DOI: 10.1016/j.esxm.2021.100325] [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: 11/09/2020] [Revised: 01/06/2021] [Accepted: 01/12/2021] [Indexed: 10/26/2022] Open
Abstract
INTRODUCTION The pelvic floor muscle (PFM) could affect female sexual functions. The hip muscles are morphologically and functionally linked to PFM and are important elements of female sexual attraction. AIM To determine the relationship between female sexual function and hip muscle strength and PFM functions in women with stress urinary incontinence (SUI). METHODS A total of 42 women with SUI were recruited in this study. Female sexual function was measured using the pelvic organ prolapse urinary incontinence sexual function questionnaire (PISQ). PFM functions were measured using a perineometer. Hip muscle strength was measured using a Smart KEMA tension sensor. The relationship between female sexual function and PFM function and hip muscle strength was assessed using Pearson correlation coefficients and multiple regression analyses with forward selection. MAIN OUTCOME MEASURES PISQ score, PFM functions (strength and endurance), and strength of hip extensor, abductor, and adductor were the main outcome measures. RESULTS For the behavioral/emotive domain in the PISQ, hip extensor strength (r = 0.452), PFM strength (r = 0.441), PFM endurance (r = 0.362), and hip adductor strength (r = 0.324) were significantly correlated and hip extensor strength emerged in multiple regression. For the physical domain in the PISQ, hip abductor strength (r = 0.417), PFM endurance (r = 0.356), hip adductor strength (r = 0.332), and PFM strength (r = 0.322) were significantly correlated and hip abductor strength entered in multiple regression. For partner-related domain in the PISQ, hip adductor (r = 0.386) and abductor strength (r = 0.314) were significantly correlated and hip adductor strength appeared in multiple regression. For the PISQ total score, hip extensor strength (r = 0.484), PFM endurance (r = 0.470), hip adductor strength (r = 0.424), hip abductor strength (r = 0.393), and PFM strength (r = 0.387) were significantly correlated and hip extensor strength and PFM endurance emerged in multiple regression. CONCLUSION The female sexual function could be related to not only PFM functions but also hip muscle strength in women with SUI. Hwang UJ, Lee MS, Jung SH, Ahn SH, Kwon OY. Relationship Between Sexual Function and Pelvic Floor and Hip Muscle Strength in Women With Stress Urinary Incontinence. Sex Med 2021;9:100325.
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Affiliation(s)
- U J Hwang
- Department of Physical Therapy, Graduate School, Yonsei University, Wonju, South Korea
| | - M S Lee
- Sophie-Marceau Women's Clinic, Daegu, South Korea
| | - S H Jung
- Department of Physical Therapy, Graduate School, Yonsei University, Wonju, South Korea
| | - S H Ahn
- Department of Physical Therapy, Graduate School, Yonsei University, Wonju, South Korea
| | - O Y Kwon
- Department of Physical Therapy, College of Health Science, Laboratory of Kinetic Ergocise Based on Movement Analysis, Yonsei University, Wonju, South Korea.
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Graf J, Abele H, Kagan KO, Jakubowski P. Vaginale Geburt und Inkontinenz – ist eine Aufklärung über dieses Risiko vor Geburt zielführend? Geburtshilfe Frauenheilkd 2021. [DOI: 10.1055/a-1109-2237] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
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Tejedor P, Bodega-Quiroga I, Plaza J, Ortega López M, Gutierrez C, García Olmo D, Pastor C. Quality of life and 3D-EUS assessment for anal incontinence after childbirth. REVISTA ESPANOLA DE ENFERMEDADES DIGESTIVAS 2020; 111:453-459. [PMID: 31021166 DOI: 10.17235/reed.2019.6040/2018] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
BACKGROUND the incidence of obstetric sphincter tears has risen to 15-30% and the prevalence of anal incontinence (AI) symptoms after childbirth may be as high as 40%. The present study evaluates the correlation between obstetric injuries detected by endoanal ultrasound (3D-EUS) and AI symptoms, as well as their impact on the quality of life (QOL) of women after childbirth. METHODS a prospective observational study was performed of pregnant women evaluated before (baseline) and three months after childbirth to ensure the integrity of the anal sphincters and to evaluate possible injuries. The Fecal Incontinence Quality of Life (FIQL) questionnaire and the Cleveland Clinic Score of Incontinence (Wexner) were completed before and after childbirth. The questionnaire results were correlated with an assessment of sphincter defects performed by 3D-EUS. RESULTS a total of 56 females were included in the study. Overall, 48% developed symptoms of AI after childbirth, with a significant decrease in their FIQL compared to the initial evaluation, 3.9 (0.05) vs 3.4 (0.8), respectively (p = 0.000). In addition, 42% of the cohort presented with some kind of obstetric sphincter defect on the 3D-EUS. Instrumental assisted delivery and the sphincter defects were the only two significant factors identified via multivariate analysis that were associated with a decrease in QOL (0.4, 95% CI, 0.07-0.8). CONCLUSIONS AI after childbirth was associated with a huge impact on QOL, especially in patients with sphincter injuries. A complete clinical evaluation, including 3D-EUS, is recommended to prevent, manage or treat AI in primiparous females.
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Affiliation(s)
- Patricia Tejedor
- Department of Colorectal Surgery, Hospital Universitario Fundación Jiménez Díaz, Spain
| | | | - Javier Plaza
- Department of Gynaecology and Obstetrics, Hospital Universitario Fundación Jiménez Díaz, Spain
| | - Mario Ortega López
- Colorectal Surgery, Hospital Universitario Fundación Jiménez Díaz, Spain
| | | | - Damian García Olmo
- Cirugía General y Digestivo, Hospital Universitario Fundación Jiménez Díaz, Spain
| | - Carlos Pastor
- Colorectal Surgery, Hospital Universitario Fundación Jiménez Díaz, Spain
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Okeahialam NA, Thakar R, Naidu M, Sultan AH. Outcome of anal symptoms and anorectal function following two obstetric anal sphincter injuries (OASIS)-a nested case-controlled study. Int Urogynecol J 2020; 31:2405-2410. [PMID: 32556846 PMCID: PMC7561534 DOI: 10.1007/s00192-020-04377-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2020] [Accepted: 05/28/2020] [Indexed: 11/24/2022]
Abstract
Introduction and hypothesis Obstetric anal sphincter injury (OASI) is a significant risk factor for developing anal incontinence. It can therefore be hypothesised that recurrent OASI in a subsequent delivery may predispose women to further anal sphincter dysfunction. Methods A nested case-controlled study based on data collected prospectively between 2006 and 2019. Women matched for age and ethnicity, with a history of one OASI and no sphincter damage in a subsequent delivery (control) were compared to women sustaining a second OASI. Assessment was carried out using the St Mark’s score (SMIS), anorectal manometry and endoanal ultrasound scan (findings quantified using the modified Starck score). Results Eighty-four women were included and equally distributed between the two groups, who were followed up 12 weeks postnatally. No difference in SMIS scores was found. Maximum resting pressure (MRP, mmHg) and maximum squeeze pressure (MSP, mmHg) were significantly reduced in the study group. Median (IQR) MRP in the study group was 40.0 (31.3–54.0) versus 46.0 (39.3–61.5) in the control group (p = 0.030). Median (IQR) MSP was 73.0 (58.3–93.5) in the study group versus 92.5 (70.5–110.8) (p = 0.006) in the control group. A significant difference (p = 0.002) was found in the modified Starck score between the study group (median 0.0 [IQR 0.0–6.0]) and control group (median 0.0 [IQR 0.0–0.0]). Conclusions We have demonstrated that women with recurrent OASI do not have significant anorectal symptoms compared to those with one OASI 12 weeks after delivery, but worse anal sphincter function and integrity. Therefore, on long-term follow-up, symptoms may possibly develop. This information will be useful when counselling women in a subsequent pregnancy.
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Affiliation(s)
| | - Ranee Thakar
- Croydon University Hospital, 530 London Rd, Thornton Heath, CR7 7YE, UK
| | | | - Abdul H Sultan
- Croydon University Hospital, 530 London Rd, Thornton Heath, CR7 7YE, UK. .,Honorary Reader at St George's University of London, London, UK.
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Effects of surface electrical stimulation during sitting on pelvic floor muscle function and sexual function in women with stress urinary incontinence. Obstet Gynecol Sci 2020; 63:370-378. [PMID: 32489983 PMCID: PMC7231947 DOI: 10.5468/ogs.2020.63.3.370] [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: 08/21/2019] [Revised: 10/21/2019] [Accepted: 11/06/2019] [Indexed: 11/08/2022] Open
Abstract
Objective Dysfunction of the pelvic floor muscles (PFM) is associated with sexual dysfunction in women with stress urinary incontinence (SUI). The EasyK7 device was developed to stimulate the PFM by surface electrical stimulation during sitting (SESdS). We investigated the effects of SESdS on PFM function and sexual function in women with SUI. Methods Women with SUI were randomized into the SESdS and control groups. PFM function and sexual function were assessed using a perineometer and the pelvic organ prolapse–urinary incontinence sexual function questionnaire (PISQ), respectively. After 8 weeks, the groups were compared using either analysis of covariance with the baseline values as covariates or the paired Student's t-test. Results The final analysis included 16 subjects from each group. There were significant differences between the SESdS and control groups after the intervention, as well as within the SESdS group between the pre- and post-intervention measurements. The P-values for the differences in PFM measurements between the groups, and between the pre- and post- intervention measurements within the SESdS group, were 0.001 and 0.004 for power, 0.015 and 0.011 for strength, and 0.012 and 0.034 for endurance, respectively. In addition, in the PISQ, there were significant differences between the groups and between the pre- and post-intervention measurements within the SESdS group in the partner-related domain (between groups: P=0.003; within SESdS group: P=0.024) and total score (between groups: P<0.001; within SESdS group: P=0.001). Conclusion SESdS can improve PFM function and sexual function in women with SUI. Trial Registration Clinical Research Information Service Identifier: KCT0003357
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Woodley SJ, Lawrenson P, Boyle R, Cody JD, Mørkved S, Kernohan A, Hay-Smith EJC. Pelvic floor muscle training for preventing and treating urinary and faecal incontinence in antenatal and postnatal women. Cochrane Database Syst Rev 2020; 5:CD007471. [PMID: 32378735 PMCID: PMC7203602 DOI: 10.1002/14651858.cd007471.pub4] [Citation(s) in RCA: 93] [Impact Index Per Article: 23.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
BACKGROUND About one-third of women have urinary incontinence (UI) and up to one-tenth have faecal incontinence (FI) after childbirth. Pelvic floor muscle training (PFMT) is commonly recommended during pregnancy and after birth for both preventing and treating incontinence. This is an update of a Cochrane Review previously published in 2017. OBJECTIVES To assess the effects of PFMT for preventing or treating urinary and faecal incontinence in pregnant or postnatal women, and summarise the principal findings of relevant economic evaluations. SEARCH METHODS We searched the Cochrane Incontinence Specialised Register, which contains trials identified from the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, MEDLINE In-Process, MEDLINE Epub Ahead of Print, CINAHL, ClinicalTrials.gov, WHO ICTRP, and handsearched journals and conference proceedings (searched 7 August 2019), and the reference lists of retrieved studies. SELECTION CRITERIA We included randomised or quasi-randomised trials in which one arm included PFMT. Another arm was no PFMT, usual antenatal or postnatal care, another control condition, or an alternative PFMT intervention. Populations included women who, at randomisation, were continent (PFMT for prevention) or incontinent (PFMT for treatment), and a mixed population of women who were one or the other (PFMT for prevention or treatment). DATA COLLECTION AND ANALYSIS We independently assessed trials for inclusion and risk of bias. We extracted data and assessed the quality of evidence using GRADE. MAIN RESULTS We included 46 trials involving 10,832 women from 21 countries. Overall, trials were small to moderately-sized. The PFMT programmes and control conditions varied considerably and were often poorly described. Many trials were at moderate to high risk of bias. Two participants in a study of 43 pregnant women performing PFMT for prevention of incontinence withdrew due to pelvic floor pain. No other trials reported any adverse effects of PFMT. Prevention of UI: compared with usual care, continent pregnant women performing antenatal PFMT probably have a lower risk of reporting UI in late pregnancy (62% less; risk ratio (RR) 0.38, 95% confidence interval (CI) 0.20 to 0.72; 6 trials, 624 women; moderate-quality evidence). Antenatal PFMT slightly decreased the risk of UI in the mid-postnatal period (more than three to six months' postpartum) (29% less; RR 0.71, 95% CI 0.54 to 0.95; 5 trials, 673 women; high-quality evidence). There was insufficient information available for the late postnatal period (more than six to 12 months) to determine effects at this time point (RR 1.20, 95% CI 0.65 to 2.21; 1 trial, 44 women; low-quality evidence). Treatment of UI: compared with usual care, there is no evidence that antenatal PFMT in incontinent women decreases incontinence in late pregnancy (very low-quality evidence), or in the mid-(RR 0.94, 95% CI 0.70 to 1.24; 1 trial, 187 women; low-quality evidence), or late postnatal periods (very low-quality evidence). Similarly, in postnatal women with persistent UI, there is no evidence that PFMT results in a difference in UI at more than six to 12 months postpartum (RR 0.55, 95% CI 0.29 to 1.07; 3 trials; 696 women; low-quality evidence). Mixed prevention and treatment approach to UI: antenatal PFMT in women with or without UI probably decreases UI risk in late pregnancy (22% less; RR 0.78, 95% CI 0.64 to 0.94; 11 trials, 3307 women; moderate-quality evidence), and may reduce the risk slightly in the mid-postnatal period (RR 0.73, 95% CI 0.55 to 0.97; 5 trials, 1921 women; low-quality evidence). There was no evidence that antenatal PFMT reduces the risk of UI at late postpartum (RR 0.85, 95% CI 0.63 to 1.14; 2 trials, 244 women; moderate-quality evidence). For PFMT started after delivery, there was uncertainty about the effect on UI risk in the late postnatal period (RR 0.88, 95% CI 0.71 to 1.09; 3 trials, 826 women; moderate-quality evidence). Faecal incontinence: eight trials reported FI outcomes. In postnatal women with persistent FI, it was uncertain whether PFMT reduced incontinence in the late postnatal period compared to usual care (very low-quality evidence). In women with or without FI, there was no evidence that antenatal PFMT led to a difference in the prevalence of FI in late pregnancy (RR 0.64, 95% CI 0.36 to 1.14; 3 trials, 910 women; moderate-quality evidence). Similarly, for postnatal PFMT in a mixed population, there was no evidence that PFMT reduces the risk of FI in the late postnatal period (RR 0.73, 95% CI 0.13 to 4.21; 1 trial, 107 women, low-quality evidence). There was little evidence about effects on UI or FI beyond 12 months' postpartum. There were few incontinence-specific quality of life data and little consensus on how to measure it. AUTHORS' CONCLUSIONS This review provides evidence that early, structured PFMT in early pregnancy for continent women may prevent the onset of UI in late pregnancy and postpartum. Population approaches (recruiting antenatal women regardless of continence status) may have a smaller effect on UI, although the reasons for this are unclear. A population-based approach for delivering postnatal PFMT is not likely to reduce UI. Uncertainty surrounds the effects of PFMT as a treatment for UI in antenatal and postnatal women, which contrasts with the more established effectiveness in mid-life women. It is possible that the effects of PFMT might be greater with targeted rather than mixed prevention and treatment approaches, and in certain groups of women. Hypothetically, for instance, women with a high body mass index (BMI) are at risk of UI. Such uncertainties require further testing and data on duration of effect are also needed. The physiological and behavioural aspects of exercise programmes must be described for both PFMT and control groups, and how much PFMT women in both groups do, to increase understanding of what works and for whom. Few data exist on FI and it is important that this is included in any future trials. It is essential that future trials use valid measures of incontinence-specific quality of life for both urinary and faecal incontinence. In addition to further clinical studies, economic evaluations assessing the cost-effectiveness of different management strategies for FI and UI are needed.
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Affiliation(s)
| | - Peter Lawrenson
- Department of Anatomy, University of Otago, Dunedin, New Zealand
| | - Rhianon Boyle
- Academic Urology Unit, University of Aberdeen, Aberdeen, UK
| | - June D Cody
- c/o Cochrane Incontinence, Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Siv Mørkved
- Clinical Service, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
| | - Ashleigh Kernohan
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - E Jean C Hay-Smith
- Rehabilitation Teaching and Research Unit, Department of Medicine, University of Otago, Wellington, New Zealand
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Hwang UJ, Lee MS, Jung SH, Ahn SH, Kwon OY. Pelvic Floor Muscle Parameters Affect Sexual Function After 8 Weeks of Transcutaneous Electrical Stimulation in Women with Stress Urinary Incontinence. Sex Med 2019; 7:505-513. [PMID: 31563553 PMCID: PMC6963109 DOI: 10.1016/j.esxm.2019.08.011] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2019] [Revised: 08/08/2019] [Accepted: 08/27/2019] [Indexed: 10/25/2022] Open
Abstract
INTRODUCTION Stress urinary incontinence (SUI) is often associated with female sexual dysfunction. We investigated which pelvic floor muscle (PFM) parameters (strength, power, and endurance) are associated with improvement of sexual function after 8 weeks of transcutaneous electrical stimulation (TES) training. AIM This study was performed to determine the effects of TES in the seated position on PFM parameters and female sexual function and to identify correlation between improved PFM parameters and sexual function after 8 weeks of TES training in women with SUI. METHODS The present study was performed between August 2018 and November 2018 in women with SUI who were randomized into a TES group (n = 17) or a control group (n = 17). One subject in each of the TES and control groups ultimately withdrew during the intervention due to a lack of time. Both groups were measured at baseline and after 8 weeks of intervention. MAIN OUTCOME MEASURE As outcome measures, PFM parameters (strength, power, and endurance) and female sexual function were assessed using a perineometer and the Female Sexual Function Index (FSFI), respectively. RESULTS The final study population consisted of 32 women with SUI. There were significant differences in PFM strength, power, and endurance and FSFI domain scores (desire, arousal, orgasm, satisfaction, and total score) in both between-group analyses (TES vs control group) and within-group analyses (pre-TES vs post-TSE). Change in PFM endurance had the highest association with change in total FSFI total score (r = 0.437; P = .006), and change in PFM power had the highest association with change in FSFI satisfaction (r = 0.420; P = .008). CONCLUSION TES in a seated position showed a beneficial effect on sexual function in females with SUI. Consideration of PFM parameters associated with FSFI domain scores may be important when developing intervention guidelines to improve female sexual function. Hwang UJ, Lee MS, Jung SH, et al. Pelvic Floor Muscle Parameters Affect Sexual Function After 8 Weeks of Transcutaneous Electrical Stimulation in Women with Stress Urinary Incontinence. Sex Med 2019;7:505-513.
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Affiliation(s)
- Ui-Jae Hwang
- Laboratory of Kinetic Ergocise Based on Movement Analysis, Department of Physical Therapy, College of Health Science, Yonsei University, Heungeop-myun, Wonju, South Korea
| | - Min-Seok Lee
- Sophie-Marceau Women's Clinic, Daegu, South Korea
| | - Sung-Hoon Jung
- Laboratory of Kinetic Ergocise Based on Movement Analysis, Department of Physical Therapy, College of Health Science, Yonsei University, Heungeop-myun, Wonju, South Korea
| | - Sun-Hee Ahn
- Laboratory of Kinetic Ergocise Based on Movement Analysis, Department of Physical Therapy, College of Health Science, Yonsei University, Heungeop-myun, Wonju, South Korea
| | - Oh-Yun Kwon
- Laboratory of Kinetic Ergocise Based on Movement Analysis, Department of Physical Therapy, College of Health Science, Yonsei University, Heungeop-myun, Wonju, South Korea.
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Moossdorff-Steinhauser HFA, Bols EMJ, Spaanderman MEA, Dirksen CD, Weemhoff M, Nieman FHM, Berghmans B. Long-term effects of motherfit group therapy in pre-(MOTHERFIT1) and post-partum women (MOTHERFIT2) with stress urinary incontinence compared to care-as-usual: study protocol of two multi-centred, randomised controlled trials. Trials 2019; 20:237. [PMID: 31023381 PMCID: PMC6485130 DOI: 10.1186/s13063-019-3331-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2018] [Accepted: 03/25/2019] [Indexed: 11/13/2022] Open
Abstract
Background Stress urinary incontinence (SUI) is highly prevalent during pregnancy and after delivery. It is often associated with a failing pelvic floor, sphincteric and/or supportive system. Pelvic-floor-muscle training (PFMT) peri-partum has been proven effective for up to 1 year post-partum; however, its long-term effects are unknown. Group PFMT, given by a physiotherapist, has been proven to be as equally effective as individual therapy. Motherfit is a group-PFMT therapy with an emphasis on pelvic floor exercises, adherence and general fitness. Care-as-usual (CAU), if guideline driven, should, as first treatment option, consist of PFMT. Cost-effective strategies are of relevance, given the rise of health care costs. Motherfit group therapy has the potential to be cost-effective in women with urinary incontinence. Therefore, the objectives of the two current studies are: (1) to investigate whether intensive, supervised, pre-partum (MOTHERFIT1) or post-partum (MOTHERFIT2) pelvic-floor-muscle group therapy reduces 18-month post-partum severity of SUI compared to CAU and (2) whether MOTHERFIT1 OR MOTHERFIT 2 is more (cost-)effective compared to CAU. Methods Two multi-centred, randomised controlled trials (MOTHERFIT1, n = 150, MOTHERFIT2, n = 90) will be performed. Participants will be recruited by their midwife or gynaecologist during their routine check. Participants with SUI will receive either motherfit group therapy or CAU. Motherfit group therapy consists of eight group sessions of 60 min each, instructed and supervised by a registered pelvic physiotherapist. Motherfit group therapy includes instructions on pelvic floor anatomy and how to contract, relax and train the pelvic-floor muscles correctly and is combined with general physical exercises. Adherence during and after motherfit will be stimulated by reinforcement techniques and a mobile app. The primary outcome measure is the absence of self-reported SUI based on the severity sum score of the International Consultation on Incontinence Questionnaire Short Form (ICIQ-UI-SF) at 18 months post-partum. Secondary outcomes evaluate quality of life, subjective improvement and health care costs. Discussion The motherfit studies are, to our knowledge, the first studies that evaluate both long-term results and health care costs compared to CAU in pregnant and post-partum women with SUI. If motherfit is shown to be (cost-)effective, implementation in peri-partum care should be considered. Trial registration Netherlands Trial Register, ID: NL5816. Registered on 18 July 2016. Electronic supplementary material The online version of this article (10.1186/s13063-019-3331-6) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Heidi F A Moossdorff-Steinhauser
- Faculty of Health, Medicine and Life Sciences, Department Epidemiology, CAPHRI Care and Public Health Research Institute, Maastricht University, P.O. Box 616, 6200, MD, Maastricht, The Netherlands.
| | - Esther M J Bols
- Faculty of Health, Medicine and Life Sciences, Department Epidemiology, CAPHRI Care and Public Health Research Institute, Maastricht University, P.O. Box 616, 6200, MD, Maastricht, The Netherlands
| | - Marc E A Spaanderman
- Maastricht University Medical Centre, P.O. Box 5800, 6202, AZ, Maastricht, The Netherlands.,Department of Obstetrics and Gynecology, Maastricht, The Netherlands
| | - Carmen D Dirksen
- Maastricht University Medical Centre, P.O. Box 5800, 6202, AZ, Maastricht, The Netherlands.,Department of Clinical Epidemiology and Medical Technology Assessment, Maastricht, The Netherlands
| | - Mirjam Weemhoff
- Department of Obstetrics and Gynecology, Zuyderland Medisch Centrum, P.O. Box 5500, 6130, MB, Sittard-Geleen, The Netherlands
| | - Fred H M Nieman
- Maastricht University Medical Centre, P.O. Box 5800, 6202, AZ, Maastricht, The Netherlands
| | - Bary Berghmans
- Maastricht University Medical Centre, P.O. Box 5800, 6202, AZ, Maastricht, The Netherlands.,Pelvic Care Center Maastricht, Maastricht, The Netherlands
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Cauley CE, Savitt LR, Weinstein M, Wakamatsu MM, Kunitake H, Ricciardi R, Staller K, Bordeianou L. A Quality-of-Life Comparison of Two Fecal Incontinence Phenotypes: Isolated Fecal Incontinence Versus Concurrent Fecal Incontinence With Constipation. Dis Colon Rectum 2019; 62:63-70. [PMID: 30451749 DOI: 10.1097/dcr.0000000000001242] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
BACKGROUND Many patients with fecal incontinence report coexisting constipation. This subset of patients has not been well characterized or understood. OBJECTIVE The purpose of this study was to report the frequency of fecal incontinence with concurrent constipation and to compare quality-of-life outcomes of patients with fecal incontinence with and without constipation. DESIGN This was a prospective cohort study. Survey data, including Fecal Incontinence Severity Index, Constipation Severity Instrument, Fecal Incontinence Quality of Life survey (categorized as lifestyle, coping, depression, and embarrassment), Pelvic Organ Prolapse Inventory and Urinary Distress Inventory surveys, and anorectal physiology testing were obtained. SETTINGS The study was conducted as a single-institution study from January 2007 to January 2017. PATIENTS Study patients had fecal incontinence presented to a tertiary pelvic floor center. MAIN OUTCOME MEASURES Quality-of-life survey findings were measured. RESULTS A total of 946 patients with fecal incontinence were identified, and 656 (69.3%) had coexisting constipation. Patients with fecal incontinence with constipation were less likely to report a history of pregnancy (89.2% vs 91.4%; p = 0.001) or complicated delivery, such as requiring instrumentation (9.1% vs 18.1%; p = 0.005), when compared with patients with isolated fecal incontinence. Patients with fecal incontinence with constipation had higher rates of coexisting pelvic organ prolapse (Pelvic Organ Prolapse Inventory: 18.4 vs 8.2; p < 0.01), higher rates of urinary incontinence (Urinary Distress Inventory: 30.2 vs 23.4; p = 0.01), and higher pressure findings on manometry; intussusception on defecography was common. Patients with fecal incontinence with concurrent constipation had less severe incontinence scores at presentation (21.0 vs 23.8; p < 0.001) and yet lower overall health satisfaction (28.9% vs 42.5%; p < 0.001). Quality-of-life scores declined as constipation severity increased for lifestyle, coping, depression, and embarrassment. LIMITATIONS This was a single-institution study, and surgeon preference could bias population and anorectal physiology testing. CONCLUSIONS Patients with fecal incontinence with concurrent constipation represent a different disease phenotype and have different clinical and anorectal physiology test findings and worse overall quality of life. Treatment of these patients requires careful consideration of prolapse pathology with coordinated treatment of coexisting disorders. See Video Abstract at http://links.lww.com/DCR/A783.
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Affiliation(s)
- Christy E Cauley
- Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts
| | - Lieba R Savitt
- Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts
| | - Milena Weinstein
- Department of Gynecology, Massachusetts General Hospital, Boston, Massachusetts
| | - May M Wakamatsu
- Department of Gynecology, Massachusetts General Hospital, Boston, Massachusetts
| | - Hiroko Kunitake
- Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts
| | - Rocco Ricciardi
- Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts
| | - Kyle Staller
- Department of Gastroenterology, Massachusetts General Hospital, Boston, Massachusetts
| | - Liliana Bordeianou
- Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts
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Nijagal MA, Wissig S, Stowell C, Olson E, Amer-Wahlin I, Bonsel G, Brooks A, Coleman M, Devi Karalasingam S, Duffy JMN, Flanagan T, Gebhardt S, Greene ME, Groenendaal F, R Jeganathan JR, Kowaliw T, Lamain-de-Ruiter M, Main E, Owens M, Petersen R, Reiss I, Sakala C, Speciale AM, Thompson R, Okunade O, Franx A. Standardized outcome measures for pregnancy and childbirth, an ICHOM proposal. BMC Health Serv Res 2018; 18:953. [PMID: 30537958 PMCID: PMC6290550 DOI: 10.1186/s12913-018-3732-3] [Citation(s) in RCA: 84] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2018] [Accepted: 11/19/2018] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND Value-based health care aims to optimize the balance of patient outcomes and health care costs. To improve value in perinatal care using this strategy, standard outcomes must first be defined. The objective of this work was to define a minimum, internationally appropriate set of outcome measures for evaluating and improving perinatal care with a focus on outcomes that matter to women and their families. METHODS An interdisciplinary and international Working Group was assembled. Existing literature and current measurement initiatives were reviewed. Serial guided discussions and validation surveys provided consumer input. A series of nine teleconferences, incorporating a modified Delphi process, were held to reach consensus on the proposed Standard Set. RESULTS The Working Group selected 24 outcome measures to evaluate care during pregnancy and up to 6 months postpartum. These include clinical outcomes such as maternal and neonatal mortality and morbidity, stillbirth, preterm birth, birth injury and patient-reported outcome measures (PROMs) that assess health-related quality of life (HRQoL), mental health, mother-infant bonding, confidence and success with breastfeeding, incontinence, and satisfaction with care and birth experience. To support analysis of these outcome measures, pertinent baseline characteristics and risk factor metrics were also defined. CONCLUSIONS We propose a set of outcome measures for evaluating the care that women and infants receive during pregnancy and the postpartum period. While validation and refinement via pilot implementation projects are needed, we view this as an important initial step towards value-based improvements in care.
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Affiliation(s)
- Malini Anand Nijagal
- University of California, Zuckerberg San Francisco General Hospital, San Francisco, CA USA
| | - Stephanie Wissig
- International Consortium for Health Outcomes Measurement, Cambridge, MA USA
| | - Caleb Stowell
- International Consortium for Health Outcomes Measurement, Cambridge, MA USA
| | - Elizabeth Olson
- International Consortium for Health Outcomes Measurement, Cambridge, MA USA
- University of Maryland School of Medicine, Baltimore, MD 21201 USA
| | | | | | - Allyson Brooks
- Hoag Memorial Hospital Presbyterian, Newport Beach, CA USA
| | | | | | - James M N Duffy
- Balliol College, University of Oxford, Oxford, UK
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | | | - Stefan Gebhardt
- Stellenbosch University and Tygerberg Hospital, Cape Town, South Africa
| | | | | | | | - Tessa Kowaliw
- South Australian Maternity Reform Association (SAMRA) Inc, Adelaide, Australia
| | | | - Elliott Main
- California Maternal Quality Care Collaborative, Stanford, CA USA
| | - Michelle Owens
- University of Mississippi Medical Center, Jackson, MS USA
| | - Rod Petersen
- Women and Children’s Health Network, North Adelaide, South Australia
| | - Irwin Reiss
- University Hospital Southampton, Hampshire, UK
| | - Carol Sakala
- National Partnership for Women & Families, Washington, D.C., USA
| | | | - Rachel Thompson
- The Dartmouth Institute for Health Policy and Clinical Practice, Lebanon, NH USA
| | - Oluwakemi Okunade
- International Consortium for Health Outcomes Measurement, Cambridge, MA USA
| | - Arie Franx
- International Consortium for Health Outcomes Measurement, Cambridge, MA USA
- Wilhelmina Children’s Hospital, University Medical Center Utrecht, Utrecht, 3508 AB The Netherlands
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24
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Validation of the Polish version of the Pelvic Floor Distress Inventory. Int Urogynecol J 2018; 30:101-105. [PMID: 30003284 DOI: 10.1007/s00192-018-3715-2] [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: 01/23/2018] [Accepted: 06/26/2018] [Indexed: 10/28/2022]
Abstract
INTRODUCTION AND HYPOTHESIS The aim of this study was to develop a Polish language version of the short form of the Pelvic Floor Distress Inventory (PFDI-20) and to validate it in a sample of Polish-speaking women with pelvic floor disorders (PFDs). METHODS The PFDI-20 was initially translated in a stepwise fashion as guided by the International Urogynecological Association (IUGA) Translation Protocol. After initial forward translation from English to Polish, a community review process consisting of cognitive interviews and confirmation via back translation was performed. The final Polish version of the PFDI-20 was administered to Polish-speaking patients presenting with PFDs at university-based urogynecology clinics in Poland and the United States, along with a Polish version of the King's Health Questionnaire (KHQ). Internal consistency and criterion validity were assessed. Test-retest reliability was assessed in 100 patients after 2 weeks. RESULTS A total of 254 women with PFDs enrolled in this multicenter study. Complete data from 44 Polish-speaking women in the United States and 200 women in Poland were analyzed. Participants had a mean age of 60.3 ± 11.2 years and mean body mass index (BMI) 27.6 ± 4.7. Internal consistency as measured by Cronbach's alpha was good (0.89). Criterion validity was adequate between responses on the KHQ and PFDI-20 with Pearson correlations in particular domains (0.27-0.50, P < 0.05). Excellent test-retest reliability was demonstrated by intraclass correlation using a two-way mixed-effects model with absolute agreement (0.87). CONCLUSIONS The Polish version of the PFDI is a reliable tool for evaluating pelvic floor symptoms in Polish-speaking women with PFDs.
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Persistent stress urinary incontinence during pregnancy and one year after delivery; its prevalence, risk factors and impact on quality of life in Taiwanese women: An observational cohort study. Taiwan J Obstet Gynecol 2018; 57:340-345. [DOI: 10.1016/j.tjog.2018.04.003] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/12/2018] [Indexed: 11/15/2022] Open
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27
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Development and Validation of a Quantitative Measure of Adaptive Behaviors in Women With Pelvic Floor Disorders. Female Pelvic Med Reconstr Surg 2018. [PMID: 28650896 DOI: 10.1097/spv.0000000000000431] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
PURPOSE To establish validity for the Pelvic Floor Disorders Network (PFDN) self-administered Adaptive Behavior Index (ABI) and to assess whether ABI assesses known discordance between severity of pelvic floor symptoms and self-reported bother. METHODS In addition to the ABI questionnaire, participants in 1 of 6 Pelvic Floor Disorders Network trials completed condition-specific measures of pretreatment symptom severity (including Pelvic Floor Distress Inventory; PFDI) and health-related quality of life (Pelvic Floor Impact Questionnaire; PFIQ). The final survey was developed from an iterative process using subject and expert endorsement, factor analyses, and response distributions. Domains were created using a development cohort (n = 304 women), reliability and validity were established using a validation cohort (n = 596 women), and test-retest reliability was assessed (n = 111 women). RESULTS Factor analyses supported an 11-item avoidance domain and a 6-item hygiene domain. Cronbach' alphas were 0.88 and 0.68, respectively. Test-retest reliability was 0.84 for both domains. Construct validity was demonstrated in correlations between the ABI domains and baseline PFDI and PFIQ (r values, 0.43-0.79 with all P values <0.0001). Moreover, the ABI accounted for 8% to 26% of unexplained variance between the symptoms severity measure and the impact on health related quality of life. After treatment, avoidance domain scores improved for urinary and fecal incontinence groups and hygiene scores improved for the fecal incontinence group. CONCLUSIONS The ABI is a reliable and valid measure in women with pelvic floor disorders. Adaptive behaviors account in part for discordance between pelvic floor symptom severity and bother.
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Woodley SJ, Boyle R, Cody JD, Mørkved S, Hay‐Smith EJC. Pelvic floor muscle training for prevention and treatment of urinary and faecal incontinence in antenatal and postnatal women. Cochrane Database Syst Rev 2017; 12:CD007471. [PMID: 29271473 PMCID: PMC6486304 DOI: 10.1002/14651858.cd007471.pub3] [Citation(s) in RCA: 68] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
BACKGROUND About one-third of women have urinary incontinence and up to one-tenth have faecal incontinence after childbirth. Pelvic floor muscle training (PFMT) is commonly recommended during pregnancy and after birth for both prevention and treatment of incontinence.This is an update of a review previously published in 2012. OBJECTIVES To determine the effectiveness of pelvic floor muscle training (PFMT) in the prevention or treatment of urinary and faecal incontinence in pregnant or postnatal women. SEARCH METHODS We searched the Cochrane Incontinence Specialised Register (16 February 2017) and reference lists of retrieved studies. SELECTION CRITERIA Randomised or quasi-randomised trials in pregnant or postnatal women. One arm of the trial included PFMT. Another arm was no PFMT, usual antenatal or postnatal care, another control condition, or an alternative PFMT intervention. DATA COLLECTION AND ANALYSIS Review authors independently assessed trials for inclusion and risk of bias. We extracted data and checked them for accuracy. Populations included: women who were continent (PFMT for prevention), women who were incontinent (PFMT for treatment) at randomisation and a mixed population of women who were one or the other (PFMT for prevention or treatment). We assessed quality of evidence using the GRADE approach. MAIN RESULTS The review included 38 trials (17 of which were new for this update) involving 9892 women from 20 countries. Overall, trials were small to moderate sized, and the PFMT programmes and control conditions varied considerably and were often poorly described. Many trials were at moderate to high risk of bias. Other than two reports of pelvic floor pain, trials reported no harmful effects of PFMT.Prevention of urinary incontinence: compared with usual care, continent pregnant women performing antenatal PFMT may have had a lower risk of reporting urinary incontinence in late pregnancy (62% less; risk ratio (RR) for incontinence 0.38, 95% confidence interval (CI) 0.20 to 0.72; 6 trials, 624 women; low-quality evidence). Similarly, antenatal PFMT decreased the risk of urinary incontinence in the mid-postnatal period (more than three to six months' postpartum) (29% less; RR 0.71, 95% CI 0.54 to 0.95; 5 trials, 673 women; moderate-quality evidence). There was insufficient information available for the late (more than six to 12 months') postnatal period to determine effects at this time point.Treatment of urinary incontinence: it is uncertain whether antenatal PFMT in incontinent women decreases incontinence in late pregnancy compared to usual care (RR 0.70, 95% CI 0.44 to 1.13; 3 trials, 345 women; very low-quality evidence). This uncertainty extends into the mid- (RR 0.94, 95% CI 0.70 to 1.24; 1 trial, 187 women; very low-quality evidence) and late (RR 0.50, 95% CI 0.13 to 1.93; 2 trials, 869 women; very low-quality evidence) postnatal periods. In postnatal women with persistent urinary incontinence, it was unclear whether PFMT reduced urinary incontinence at more than six to 12 months' postpartum (RR 0.55, 95% CI 0.29 to 1.07; 3 trials; 696 women; very low-quality evidence).Mixed prevention and treatment approach to urinary incontinence: antenatal PFMT in women with or without urinary incontinence (mixed population) may decrease urinary incontinence risk in late pregnancy (26% less; RR 0.74, 95% CI 0.61 to 0.90; 9 trials, 3164 women; low-quality evidence) and the mid-postnatal period (RR 0.73, 95% CI 0.55 to 0.97; 5 trials, 1921 women; very low-quality evidence). It is uncertain if antenatal PFMT reduces urinary incontinence risk late postpartum (RR 0.85, 95% CI 0.63 to 1.14; 2 trials, 244 women; low-quality evidence). For PFMT begun after delivery, there was considerable uncertainty about the effect on urinary incontinence risk in the late postnatal period (RR 0.88, 95% CI 0.71 to 1.09; 3 trials, 826 women; very low-quality evidence).Faecal incontinence: six trials reported faecal incontinence outcomes. In postnatal women with persistent faecal incontinence, it was uncertain whether PFMT reduced incontinence in the late postnatal period compared to usual care (RR 0.68, 95% CI 0.24 to 1.94; 2 trials; 620 women; very low-quality evidence). In women with or without faecal incontinence (mixed population), antenatal PFMT led to little or no difference in the prevalence of faecal incontinence in late pregnancy (RR 0.61, 95% CI 0.30 to 1.25; 2 trials, 867 women; moderate-quality evidence). For postnatal PFMT in a mixed population, there was considerable uncertainty about the effect on faecal incontinence in the late postnatal period (RR 0.73, 95% CI 0.13 to 4.21; 1 trial, 107 women, very low-quality evidence).There was little evidence about effects on urinary or faecal incontinence beyond 12 months' postpartum. There were few incontinence-specific quality of life data and little consensus on how to measure it. We found no data on health economics outcomes. AUTHORS' CONCLUSIONS Targeting continent antenatal women early in pregnancy and offering a structured PFMT programme may prevent the onset of urinary incontinence in late pregnancy and postpartum. However, the cost-effectiveness of this is unknown. Population approaches (recruiting antenatal women regardless of continence status) may have a smaller effect on urinary incontinence, although the reasons for this are unclear. It is uncertain whether a population-based approach for delivering postnatal PFMT is effective in reducing urinary incontinence. Uncertainty surrounds the effects of PFMT as a treatment for urinary incontinence in antenatal and postnatal women, which contrasts with the more established effectiveness in mid-life women.It is possible that the effects of PFMT might be greater with targeted rather than mixed prevention and treatment approaches and in certain groups of women. Hypothetically, for instance, women with a high body mass index are at risk factor for urinary incontinence. Such uncertainties require further testing and data on duration of effect are also needed. The physiological and behavioural aspects of exercise programmes must be described for both PFMT and control groups and how much PFMT women in both groups do, to increase understanding of what works and for whom.Few data exist on faecal incontinence or costs and it is important that both are included in any future trials. It is essential that future trials use valid measures of incontinence-specific quality of life for both urinary and faecal incontinence.
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Affiliation(s)
- Stephanie J Woodley
- University of OtagoDepartment of AnatomyLindo Ferguson Building270 Great King StreetDunedinNew Zealand9054
| | - Rhianon Boyle
- University of AberdeenAcademic Urology Unit2nd Floor, Health Sciences BuildingForesterhillAberdeenUKAB25 2ZD
| | - June D Cody
- Newcastle Universityc/o Cochrane Incontinence GroupInstitute of Health & SocietyBaddiley‐Clark Building, Richardson RoadNewcastle upon TyneUKNE2 4AX
| | - Siv Mørkved
- St. Olavs Hospital, Trondheim University HospitalClinical ServiceOlav Kyrresgt.TrondheimNorway7006
| | - E Jean C Hay‐Smith
- University of OtagoRehabilitation Teaching and Research Unit, Department of MedicineWellingtonNew Zealand
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Reddy P, Frantz JM. The quality of life of HIV-infected and non-infected women post-caesarean section delivery. Health SA 2017. [DOI: 10.1016/j.hsag.2016.09.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
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Cahill AG. Identifying the Best Way to Manage Labor. MISSOURI MEDICINE 2017; 114:160-162. [PMID: 30228572 PMCID: PMC6140234] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
The second stage of labor, defined as the interval from complete cervical dilation through delivery of the fetus, is the most physiologically demanding period of labor for both the mother and the fetus. Additionally, prolongation of this stage can lead to operative deliveries, which are associated with increased risks of adverse neonatal and maternal outcomes. However, the optimal technique for managing maternal pushing during this stage, immediate or delayed pushing, is unknown. Washington University School of Medicine is addressing this question by conducting a large, multi-site, randomized controlled trial that will assess both maternal and neonatal outcomes. Completion is expected by 2018.
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Affiliation(s)
- Alison G Cahill
- Alison G. Cahill, MD, MSCI, MSMA member since 2016, is Director, Division of Maternal Fetal Medicine, Associate Professor, Department of Obstetrics and Gynecology, Washington University School of Medicine
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Triviño-Juárez JM, Romero-Ayuso D, Nieto-Pereda B, Forjaz MJ, Criado-Álvarez JJ, Arruti-Sevilla B, Avilés-Gamez B, Oliver-Barrecheguren C, Mellizo-Díaz S, Soto-Lucía C, Plá-Mestre R. Health related quality of life of women at the sixth week and sixth month postpartum by mode of birth. Women Birth 2017; 30:29-39. [DOI: 10.1016/j.wombi.2016.06.005] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2016] [Revised: 06/07/2016] [Accepted: 06/10/2016] [Indexed: 01/20/2023]
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TAKAOKA S, KONDO Y, KOBAYASHI Y, TANIGUCHI T. Evaluation of the relationship between postpartum lower urinary tract symptoms and QOL: Examination using the comprehensive questionnaire, SF-12ver.2. ACTA ACUST UNITED AC 2017. [DOI: 10.3418/jjam.31.78] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Affiliation(s)
- Satoko TAKAOKA
- University of Yamanashi, Department of Education Interdisciplinary Graduate School of Medicine and Engineering
| | - Yoshie KONDO
- Keio University, Faculty of Nursing and Medical Care
| | - Yasue KOBAYASHI
- University of Yamanashi, Graduate Faculty of Interdisciplinary Research
| | - Tamami TANIGUCHI
- University of Yamanashi, Graduate Faculty of Interdisciplinary Research
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Relationship between delivery history and health-related quality of life in menopausal South Korean women: The Korea National Health and Nutrition Examination Surveys. Maturitas 2016; 92:24-29. [DOI: 10.1016/j.maturitas.2016.07.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2016] [Revised: 06/21/2016] [Accepted: 07/01/2016] [Indexed: 11/18/2022]
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Anal incontinence and fecal urgency following vaginal delivery with episiotomy among primiparous patients. Int J Gynaecol Obstet 2016; 135:290-294. [DOI: 10.1016/j.ijgo.2016.06.025] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2016] [Revised: 06/18/2016] [Accepted: 08/22/2016] [Indexed: 12/12/2022]
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Linneberg S, Leenskjold S, Glavind K. A five year follow-up of women with obstetric anal sphincter rupture at their first delivery. Eur J Obstet Gynecol Reprod Biol 2016; 203:315-9. [DOI: 10.1016/j.ejogrb.2016.06.018] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2016] [Revised: 05/05/2016] [Accepted: 06/20/2016] [Indexed: 01/07/2023]
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Ménard S, Poupon C, Bourguignon J, Théau A, Goffinet F, Le Ray C. [Predictive factors of 2-month postpartum anal incontinence among patients with an obstetrical anal sphincter injury]. ACTA ACUST UNITED AC 2016; 45:900-907. [PMID: 26780843 DOI: 10.1016/j.jgyn.2015.12.008] [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: 10/05/2015] [Revised: 12/10/2015] [Accepted: 12/21/2015] [Indexed: 10/22/2022]
Abstract
OBJECTIVES To determine prevalence of short-term postpartum anal incontinence after obstetrical anal sphincter injury and prognostic factors. MATERIALS AND METHODS Retrospective study including every patient with an obstetrical anal sphincter injury between January 2006 and December 2012 in one tertiary maternity unit. Patients were interviewed and examined at 2-month postpartum. Anal incontinence was defined by the presence of at least one of the following symptoms: flatus incontinence, faecal incontinence and faecal urgency. RESULTS Among 17,110 patients who delivered vaginally during period study, 134 (0.8%) presented an anal sphincter injury. Postpartum obstetrical data were available for 110 of them. Among those patients, 50 women (45.5%) had at least one symptom of anal incontinence at 2-month postpartum and 8 (7.3%) had faecal incontinence. Only maternal age and second stage duration were significantly associated with anal incontinence after obstetrical anal sphincter injury. The degree of sphincter damage at delivery (IIIa, b, c, IV) was not associated with the risk of anal incontinence at 2-month postpartum. CONCLUSION Maternal age and second stage duration were the only risk factor for anal incontinence after obstetrical anal sphincter injury in this study. High prevalence of anal incontinence at 2-month postpartum of obstetrical anal sphincter injury is observed no matter what is the degree of anal sphincter damage. Our results highlight the importance to diagnose all obstetrical anal sphincter injuries whatever the degree of damage.
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Affiliation(s)
- S Ménard
- Maternité Port-Royal, groupe hospitalier Cochin-Broca-Hôtel-Dieu, Assistance publique-Hôpitaux de Paris, DHU risques et grossesse, 53, avenue de l'Observatoire, 75014 Paris, France
| | - C Poupon
- Maternité Port-Royal, groupe hospitalier Cochin-Broca-Hôtel-Dieu, Assistance publique-Hôpitaux de Paris, DHU risques et grossesse, 53, avenue de l'Observatoire, 75014 Paris, France
| | - J Bourguignon
- Maternité Port-Royal, groupe hospitalier Cochin-Broca-Hôtel-Dieu, Assistance publique-Hôpitaux de Paris, DHU risques et grossesse, 53, avenue de l'Observatoire, 75014 Paris, France
| | - A Théau
- Maternité Port-Royal, groupe hospitalier Cochin-Broca-Hôtel-Dieu, Assistance publique-Hôpitaux de Paris, DHU risques et grossesse, 53, avenue de l'Observatoire, 75014 Paris, France
| | - F Goffinet
- Maternité Port-Royal, groupe hospitalier Cochin-Broca-Hôtel-Dieu, Assistance publique-Hôpitaux de Paris, DHU risques et grossesse, 53, avenue de l'Observatoire, 75014 Paris, France
| | - C Le Ray
- Maternité Port-Royal, groupe hospitalier Cochin-Broca-Hôtel-Dieu, Assistance publique-Hôpitaux de Paris, DHU risques et grossesse, 53, avenue de l'Observatoire, 75014 Paris, France.
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Meyer I, Richter HE. Impact of fecal incontinence and its treatment on quality of life in women. ACTA ACUST UNITED AC 2015; 11:225-38. [PMID: 25776296 DOI: 10.2217/whe.14.66] [Citation(s) in RCA: 68] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Fecal incontinence (FI) is a physically and psychosocially debilitating disorder which negatively impacts quality of life (QOL). It bears a significant burden not only on patients but also on their families, caretakers as well as society as a whole. Even though it is considered a somewhat common condition, especially as women age, the prevalence is often underestimated due to patients' reluctance to report symptoms or seek care. The evaluation and treatment of FI can be also hindered by lack of understanding of the current management options among healthcare providers and how they impact on QOL. This article provides a comprehensive review on the impact of FI and its treatment on QOL in women.
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Affiliation(s)
- Isuzu Meyer
- Division of Urogynecology & Pelvic Reconstructive Surgery, Department of Obstetrics & Gynecology, University of Alabama at Birmingham, 1700 6th Avenue South, Suite 10382, Birmingham, AL 35233, USA
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Elvander C, Ahlberg M, Thies-Lagergren L, Cnattingius S, Stephansson O. Birth position and obstetric anal sphincter injury: a population-based study of 113 000 spontaneous births. BMC Pregnancy Childbirth 2015; 15:252. [PMID: 26453177 PMCID: PMC4600206 DOI: 10.1186/s12884-015-0689-7] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2015] [Accepted: 10/05/2015] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND The association between birth position and obstetric anal sphincter injury (OASIS) in spontaneous vaginal deliveries is unclear. METHODS The study was based on the Stockholm-Gotland Obstetric Database (Sweden) from Jan 1(st) 2008 to Oct 22(nd) 2014 and included 113 279 singleton spontaneous vaginal births with no episiotomy. We studied risk of OASIS with respect to the following birth positions: a) sitting, b) lithotomy, c) lateral, d) standing on knees, e) birth seat, f) supine, g) squatting, h) standing and i) all fours. All analyses were stratified for parity. General linear models were used to calculate risk ratios (RR) adjusted for maternal, pregnancy and fetal characteristics. RESULTS The rates of OASIS among nulliparous women, parous women and women undergoing vaginal birth after a caesarean (VBAC) were 5.7%, 1.3% and 10.6%, respectively. The rates varied by birth position: from 3.7 to 7.1% in nulliparous women, 0.6% to 2.6% in parous women and 5.6% to 18.2% in women undergoing VBAC. Regardless of parity, the lowest rates were found among women giving birth in standing position and the highest rates among women birthing in the lithotomy position. Compared with sitting position, the lithotomy position involved an increased risk of OASIS among nulliparous (adjusted RR 1.17, 95% CI 1.06-1.29) and parous women (adjusted RR 1.66, 95% CI 1.35-2.05). Birth seat and squatting position involved an increased risk of OASIS among parous women (adjusted RR [95% CI] 1.36 [1.03-1.80] and 2.16 [1.15-4.07], respectively). Independent risk factors for OASIS were maternal age, head circumference ≥35 cm, birth weight ≥4000 g, length of gestation ≥ 40 weeks, prolonged second stage of labour, non-occiput anterior presentation and oxytocin augmentation. CONCLUSIONS Compared with sitting position, lateral position has a slightly protective effect in nulliparous women whilst an increased risk is noted among women in the lithotomy position, irrespective of parity. Squatting and birth seat position involve an increase in risk among parous women.
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Affiliation(s)
- Charlotte Elvander
- Department of Medicine, Division of Clinical Epidemiology, T2, Karolinska University Hospital, 171 76, Stockholm, Sweden.
| | - Mia Ahlberg
- Department of Medicine, Division of Clinical Epidemiology, T2, Karolinska University Hospital, 171 76, Stockholm, Sweden.
| | - Li Thies-Lagergren
- The Department of Health Sciences, Faculty of Medicine, Lund University, Box 117, 221 00, Lund, Sweden.
| | - Sven Cnattingius
- Department of Medicine, Division of Clinical Epidemiology, T2, Karolinska University Hospital, 171 76, Stockholm, Sweden.
| | - Olof Stephansson
- Department of Medicine, Division of Clinical Epidemiology, T2, Karolinska University Hospital, 171 76, Stockholm, Sweden.
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MacArthur C, Wilson D, Herbison P, Lancashire RJ, Hagen S, Toozs-Hobson P, Dean N, Glazener C. Urinary incontinence persisting after childbirth: extent, delivery history, and effects in a 12-year longitudinal cohort study. BJOG 2015; 123:1022-9. [PMID: 25846816 DOI: 10.1111/1471-0528.13395] [Citation(s) in RCA: 64] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/03/2015] [Indexed: 12/01/2022]
Abstract
OBJECTIVE To investigate the extent of persistent urinary incontinence (UI) 12 years after birth, and association with delivery-mode history and other factors. DESIGN Twelve-year longitudinal cohort study. SETTING Maternity units in Aberdeen, Birmingham, and Dunedin. POPULATION Women who returned questionnaires 3 months and 12 years after index birth. METHODS Data on all births over a period of 12 months were obtained from the units and then women were contacted by post. MAIN OUTCOME MEASURE Persistent UI reported at 12 years, with one or more previous contact. RESULTS Of 7879 women recruited at 3 months, 3763 (48%) responded at 12 years, with 2944 also having responded at 6 years; non-responders had similar obstetric characteristics. The prevalence of persistent UI was 37.9% (1429/3763). Among those who had reported UI at 3 months, 76.4% reported it at 12 years. Women with persistent UI had lower SF12 quality of life scores. Compared with having only spontaneous vaginal deliveries (SVDs), women who delivered exclusively by caesarean section were less likely to have persistent UI (odds ratio, OR 0.42, 95% CI 0.33-0.54). This was not the case in women who had a combination of caesarean section and SVD births (OR 1.01, 95% CI 0.78-1.30). Older age at first birth, greater parity, and overweight/obesity were associated with persistent UI. Of 54 index primiparae with UI before pregnancy, 46 (85.2%) had persistent UI. CONCLUSIONS This study, demonstrating that UI persists to 12 years in about three-quarters of women, and that risk was only reduced with caesarean section if women had no other delivery mode, has practice implications. TWEETABLE ABSTRACT A longitudinal study of 3763 women showed a prevalence of persistent UI 12 years after birth of 37.9%.
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Affiliation(s)
- C MacArthur
- Public Health, Epidemiology and Biostatistics, School of Health and Population Sciences, University of Birmingham, Birmingham, UK
| | - D Wilson
- Department of Women's and Children's Health, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand
| | - P Herbison
- Department of Preventive and Social Medicine, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand
| | - R J Lancashire
- Public Health, Epidemiology and Biostatistics, School of Health and Population Sciences, University of Birmingham, Birmingham, UK
| | - S Hagen
- NMAHP Research Unit, Glasgow Caledonian University, Glasgow, UK
| | - P Toozs-Hobson
- Birmingham Women's Hospital, Birmingham Women's NHS Foundation Trust, Edgbaston, Birmingham, UK
| | - N Dean
- Department of Obstetrics and Gynaecology, York Hospital, York, UK
| | - C Glazener
- Health Services Research Unit, University of Aberdeen, Aberdeen, UK
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Determinants of health-related quality of life in the postpartum period after obstetric complications. Eur J Obstet Gynecol Reprod Biol 2015; 185:88-95. [DOI: 10.1016/j.ejogrb.2014.11.038] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2014] [Accepted: 11/27/2014] [Indexed: 11/23/2022]
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41
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MacArthur C, Wilson D, Herbison P, Lancashire RJ, Hagen S, Toozs-Hobson P, Dean N, Glazener C. Faecal incontinence persisting after childbirth: a 12 year longitudinal study. BJOG 2012. [DOI: 10.1111/1471-0528.12039] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- C MacArthur
- Public Health, Epidemiology and Biostatistics; School of Health and Population Sciences; University of Birmingham; Birmingham UK
| | - D Wilson
- Department of Women's and Children's Health; Dunedin School of Medicine; University of Otago; Dunedin New Zealand
| | - P Herbison
- Department of Preventive and Social Medicine; Dunedin School of Medicine; University of Otago; Dunedin New Zealand
| | - RJ Lancashire
- Public Health, Epidemiology and Biostatistics; School of Health and Population Sciences; University of Birmingham; Birmingham UK
| | - S Hagen
- NMAHP Research Unit; Glasgow Caledonian University; Glasgow UK
| | - P Toozs-Hobson
- Birmingham Women's Hospital; Birmingham Women's NHS Foundation Trust; Birmingham UK
| | - N Dean
- Department of Obstetrics and Gynaecology; York Hospital; York UK
| | - C Glazener
- Health Services Research Unit; University of Aberdeen; Aberdeen UK
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42
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Measurement invariance of the SF-12 across European-American, Latina, and African-American postpartum women. Qual Life Res 2012; 22:1135-44. [DOI: 10.1007/s11136-012-0232-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/09/2012] [Indexed: 11/28/2022]
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43
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Gartland D, Donath S, MacArthur C, Brown SJ. The onset, recurrence and associated obstetric risk factors for urinary incontinence in the first 18 months after a first birth: an Australian nulliparous cohort study. BJOG 2012; 119:1361-9. [PMID: 22827735 DOI: 10.1111/j.1471-0528.2012.03437.x] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To investigate the contribution of obstetric risk factors to persistent urinary incontinence (UI) between 4 and 18 months postpartum. DESIGN Prospective pregnancy cohort. SETTING Six metropolitan public hospitals in Victoria, Australia. SAMPLE A total of 1507 nulliparous women recruited to the Maternal Health Study in early pregnancy (≤24 weeks of gestation). METHODS Data from hospital records and self-administered questionnaires/telephone interviews at ≤24 and 30-32 weeks of gestation and at 3, 6, 9, 12 and 18 months postpartum analysed using logistic regression. MAIN OUTCOME MEASURES Persistent UI 4-18 months postpartum in women continent before pregnancy. RESULTS Of the women who were continent before pregnancy, 44% reported UI 4-18 months postpartum, and 25% reported persistent UI (symptoms at multiple follow ups). Compared with spontaneous vaginal birth, women who had a caesarean before labour (adjusted odds ratio [aOR] 0.4, 95% confidence interval [95% CI] 0.2-0.9), in first-stage labour (aOR 0.4, 95% CI 0.2-0.6) or in second-stage labour (aOR 0.4, 95% CI 0.2-1.0) were less likely to report persistent UI 4-18 months postpartum. Prolonged second-stage labour in women who had an operative vaginal birth was associated with increased likelihood of UI (aOR 2.5, 95% CI 1.3-4.6). Compared with women who were continent in pregnancy, women reporting UI in pregnancy had a seven-fold increase in odds of persistent UI (aOR 7.4, 95% CI 5.1-10.7). CONCLUSIONS Persistent UI is common after childbirth and is more likely following prolonged labour in combination with operative vaginal birth. The majority of women reporting persistent UI at 4-18 months postpartum also experienced symptoms in pregnancy.
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Affiliation(s)
- D Gartland
- Healthy Mothers Healthy Families Research Group, Murdoch Children's Research Institute, Melbourne, Australia
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Leroy LDS, Lopes MHBDM. Urinary incontinence in the puerperium and its impact on the health-related quality of life. Rev Lat Am Enfermagem 2012; 20:346-53. [DOI: 10.1590/s0104-11692012000200018] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2011] [Accepted: 02/29/2012] [Indexed: 11/22/2022] Open
Abstract
This case-control study evaluated whether UI in the puerperium compromises the health-related quality of life (HRQoL) and if so, in which aspects. The study included 344 women (77 case group and 267 control group) up to 90 days postpartum, who were attended the Obstetrics Outpatient Clinic of a public teaching hospital, for the postpartum follow up consultation. A socio-demographic and clinical data questionnaire formulated and validated for the study, the International Consultation on Incontinence Questionnaire - Short-Form (ICIQ-SF), the King's Health Questionnaire (KHQ) and the Medical Outcomes Study 36 - Item Short Form Health Survey (SF-36), were applied. The mean score of the ICIQ-SF was 13.9 (SD: 3.7). The case group presented high mean scores in the domains Impact of the Incontinence, Emotions, Daily Activity Limitations and Physical Limitations, of the KHQ. The groups differed significantly in the domains Physical Aspects, Pain, General Health Status, Vitality, Social Aspects and Mental Health of the SF-36. It is concluded that UI significantly affects the physical and mental health of puerperae.
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45
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Parker-Autry CY, Burgio KL, Richter HE. Vitamin D status: a review with implications for the pelvic floor. Int Urogynecol J 2012; 23:1517-26. [PMID: 22415704 DOI: 10.1007/s00192-012-1710-6] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2011] [Accepted: 02/09/2012] [Indexed: 12/31/2022]
Abstract
Vitamin D is a micronutrient vital in calcium homeostasis and musculoskeletal function. Vitamin D insufficiency is a common variant of vitamin D deficiency that shows clinical signs of rickets and osteomalacia. The clinical significance of vitamin D insufficiency is being explored in several medical conditions. However, the most robust work suggests a role in musculoskeletal disease. The pelvic floor is a unique part of the body and the function of which is dependent on interrelationships between muscle, nerve, connective tissue, and bone. Pelvic floor disorders result when these relationships are disrupted. This paper reviews current knowledge regarding vitamin D nutritional status, the importance of vitamin D in muscle function, and how insufficient or deficient vitamin D levels may play a role in the function of the female pelvic floor.
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Affiliation(s)
- Candace Y Parker-Autry
- Division of Urogynecology and Pelvic Reconstructive Surgery, Department of Obstetrics and Gynecology, University of Alabama at Birmingham, 619 19th Street South, 176F, Suite 10382, Birmingham, AL 35249, USA.
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46
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Torrisi G, Minini G, Bernasconi F, Perrone A, Trezza G, Guardabasso V, Ettore G. A prospective study of pelvic floor dysfunctions related to delivery. Eur J Obstet Gynecol Reprod Biol 2012; 160:110-5. [DOI: 10.1016/j.ejogrb.2011.10.010] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2011] [Revised: 08/03/2011] [Accepted: 10/18/2011] [Indexed: 10/15/2022]
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Salcedo L, Sopko N, Jiang HH, Damaser M, Penn M, Zutshi M. Chemokine upregulation in response to anal sphincter and pudendal nerve injury: potential signals for stem cell homing. Int J Colorectal Dis 2011; 26:1577-81. [PMID: 21706136 DOI: 10.1007/s00384-011-1269-6] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/10/2011] [Indexed: 02/04/2023]
Abstract
PURPOSE Stromal derived factor-1 (SDF-1) and monocyte chemotactic protein-3 (MCP-3) are signals forcing the migration of bone marrow-derived stem cells to ischemic tissue. This study investigates SDF-1 and MCP-3 expression following direct injury to the anal sphincter and pudendal nerve and to determine if these same mechanisms have any role. METHODS Chemokine expression was studied after anal sphincter injury in female rats after either a sphincterotomy (n = 15), pudendal nerve crush (PNC; n = 15), sham pudendal nerve crush (n = 15), or acted as unmanipulated controls (n = 5). Analysis was done at 1 h and 10 and 21 days after injury. RESULTS After injury, SDF-1 expression increased 40.2 ± 6.42 (P = 0.01) at 1 h and 28.2 ± 2.37 (P = 0.01) at 10 days, respectively, compared to controls. Likewise, MCP-3 expression increased 40.8 ± 8.17 (P = 0.02) at the same intervals compared to controls. After PNC, SDF-1 expression increased 46.4 ± 6.01 (P = 0.02) and 50.6 ± 10.11 (P = 0.01), and MCP-3 expression increased 46.3 ± 7.76 (P = 0.03) and 190.8 ± 22.15 (P = 0.01), respectively, at the same time intervals compared to controls. However, when PNC was compared to sham injured, a significant increase was seen in SDF-1 and MCP-3 at 10 days. At 21 days, PNC compared to sham injured was significantly low in expression for both SDF-1 and MCP-3 (P < 0.05). CONCLUSIONS Direct anal sphincter injury results in higher levels of SDF-1 and MCP-3 expression soon after injury, whereas denervation via pudendal nerve crush results in greater SDF-1 and MCP-3 expression 10 days after injury. Chemokine overexpression suggests the potential for cell-based therapeutic strategies.
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Affiliation(s)
- Levilester Salcedo
- Department of Colorectal Surgery, Cleveland Clinic Foundation, Cleveland, OH 44195, USA
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Pelvic Organ Prolapse Repair with and without Concomitant Burch Colposuspension in Incontinent Women: A Randomised Controlled Trial with at Least 5-Year Followup. Obstet Gynecol Int 2011; 2012:967923. [PMID: 22028719 PMCID: PMC3199042 DOI: 10.1155/2012/967923] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2011] [Revised: 08/15/2011] [Accepted: 08/17/2011] [Indexed: 11/17/2022] Open
Abstract
The aim of this study was to reevaluate and update the followup of a previously published randomized controlled trial (RCT) on the impact of Burch Colposuspension (BC), as an anti-incontinence procedure, in patients with UI and POP, who underwent POP repair. Forty-seven women were randomly assigned to abdominal POP repair and concomitant BC (24 patients; group A) or POP repair alone without any anti-incontinence procedure (23 patients; group B). Median followup was 82 months (range 60-107); from over 47 patients, 30 reached 6-year followup. Two patients were lost at followup. In group A, 2 patients showed a stage I rectocele. In group B, 2 patients had a stage I rectocele and 1 a stage II rectocele. In group A, 13/23 (56.5%) were still incontinent after surgery compared with 9/22 patients (40.9%) in group B (P = 0.298). No significant changes were observed between the first and the current followup. The update of long-term followup confirmed that BC did not improve outcome significantly in incontinent women when they undergo POP repair.
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Weinstein MM, Pretorius DH, Jung SA, Wan JJ, Nager CW, Mittal RK. Anal sphincter complex muscles defects and dysfunction in asymptomatic parous women. Int Urogynecol J 2011; 22:1143-50. [PMID: 21604060 DOI: 10.1007/s00192-011-1446-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2011] [Accepted: 04/26/2011] [Indexed: 12/26/2022]
Abstract
INTRODUCTION AND HYPOTHESIS We aimed to determine anatomy and function of anal sphincter complex using three-dimensional ultrasound (3D-US) and manometry in asymptomatic parous women. METHODS 3D-US of puborectalis muscle (PRM), external (EAS), and internal anal sphincters (IAS) anatomy was performed in 45 women without pelvic floor dysfunction. To assess function, rest and squeeze vaginal and anal pressures were measured. Based on 3D-US, subjects were divided into injured and uninjured groups. RESULTS Forty-four of 45 subjects had adequate PRM images. The injured PRM (N = 14) group had significantly lower vaginal pressures as compared with uninjured PRM group (N = 30; p = 0.001). Four of 45 subjects with IAS and EAS defects had lower resting and squeeze anal canal pressure. Muscle injury to IAS, EAS and PRM in the same individual was uncommon. CONCLUSIONS In asymptomatic parous women, PRM defects were more common than the EAS/IAS defects but defects in more than one muscle were infrequent. Subjects with injured PRM had low vaginal pressure than the ones without.
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Affiliation(s)
- Milena M Weinstein
- The Pelvic Floor Function and Disorder Group, University of California, San Diego, CA, USA
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50
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Laine K, Skjeldestad FE, Sanda B, Horne H, Spydslaug A, Staff AC. Prevalence and risk factors for anal incontinence after obstetric anal sphincter rupture. Acta Obstet Gynecol Scand 2011; 90:319-24. [PMID: 21306321 DOI: 10.1111/j.1600-0412.2010.01057.x] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVE To study prevalence and risk factors for anal incontinence (AI) after obstetric anal sphincter rupture. MATERIAL AND METHODS This was a retrospective clinical observational study. Among 14 959 vaginal deliveries, 591 women were diagnosed with obstetric anal sphincter ruptures (3.9%) at one Norwegian University Hospital in 2003-2005. Patients were examined and interviewed approximately 10 months after delivery. Anal continence was classified with St. Mark's incontinence score (0, complete anal continence; ≥3, anal incontinence), and defects in anal sphincter muscles were diagnosed by endoanal ultrasound. Prevalence of anal incontinence was assessed in relation to obstetrical and maternal characteristics as well as the correlation between anal incontinence and ultrasound-detectable defects of sphincter muscle. RESULTS Anal incontinence with a St. Mark's score of ≥3 was reported by 21% of women with obstetric anal sphincter rupture, with inability to control gas as the most prevalent symptom. Women with AI were more likely to report urinary incontinence compared with women having no AI. In a multiple regression analysis of maternal and obstetrical risk factors, fourth degree sphincter tear was the only significant risk factor for AI. Anal incontinence was more frequent in patients diagnosed with than without ultrasound-identified anal sphincter muscle defects at 10 months postpartum follow-up. CONCLUSION Anal as well as urinary incontinence after delivery with obstetric anal sphincter rupture is common, and prenatal obstetric and maternal variables could not predict anal incontinence. Fourth degree perineal tear and a persistent ultrasound-detected defect in the anal sphincter muscles are associated with AI.
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Affiliation(s)
- Katariina Laine
- Department of Obstetrics and Department of Gynecology, Faculty of Medicine, Oslo University Hospital Ullevål, University of Oslo, Oslo, Norway.
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