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Peinado Molina RA, Martínez Vázquez S, Martínez Galiano JM, Rivera Izquierdo M, Khan KS, Cano-Ibáñez N. Prevalence of depression and anxiety in women with pelvic floor dysfunctions: A systematic review and meta-analysis. Int J Gynaecol Obstet 2024. [PMID: 38859723 DOI: 10.1002/ijgo.15719] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2024] [Accepted: 05/23/2024] [Indexed: 06/12/2024]
Abstract
BACKGROUND Female pelvic floor dysfunction (PFD) is a common condition affecting the emotional well-being of women. OBJECTIVE To estimate the prevalence of depressive and anxiety symptoms in women with PFD. SEARCH STRATEGY, SELECTION CRITERIA, DATA COLLECTION AND ANALYSIS: Following prospective registration (PROSPERO CRD42022362095) we conducted a search of three electronic databases (PubMed, Web of Science and Scopus) from inception to April 2023 without language restriction to capture studies reporting the prevalence of depression/anxiety among women with PFD (chronic pelvic pain [CPP], urinary incontinence [UI], pelvic organ prolapse [POP], and/or fecal incontinence [FI]). Only studies with validated tools were included. Data extraction and study quality assessment were performed by two independent reviewers. Stratifying by type of PFD, rates of depression and anxiety were pooled using random effects model computing 95% confidence interval (CI) and assessing heterogeneity using the I2 statistic. Funnel plots were used to detect potential reporting biases and small-study effects. MAIN RESULTS The search yielded 767 articles, from which 54 studies containing 632 605 women were included. All the studies were high quality. The prevalence of depression was: CPP 26.8% (95% CI: 19.2-34.4, I2 = 98.7%; 12 studies, 4798 participants with 491 cases; Egger's P value = 0.009); UI 26.3% (95% CI: 19.4-33.2, I2 = 99.9%; 26 studies, a total of 346 114 participants with 25 050 cases; Egger's P value = 0.944); POP 34.9% (95% CI: 24.3-45.6, I2 = 68%; three studies, 297 participants with 104 cases; Egger's P value = 0.973); and FI 25.3% (95% CI: 0.68-49.9, I2 = 99.7%; six studies, 14 663 participants with 1773 cases; Egger's P value = 0.780). The prevalence of anxiety was: CPP 29.5% (95% CI: 16.3-42.7, I2 = 97.7%; nine studies, 2483 participants with 349 cases; Egger's P value = 0.001); UI 46.91% (95% CI: 39.1-54.6, I2 = 99.6%; 11 studies, 198 491 participants with 40 058 cases; Egger's P value = 0.337); and POP 28% (95% CI: 13.6-42.4, I2 = 89%; three studies with 355 participants with 90 cases; Egger's P value = 0.306). CONCLUSION The prevalence of mental health illness was variable in the different types of PFDs. This meta-analysis helps quantify the burden of depression and anxiety in PFD and will help inform the policies regarding screening of emotional well-being by healthcare professionals engaged in care of women with PFD.
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Affiliation(s)
| | | | - Juan Miguel Martínez Galiano
- Department of Nursing, University of Jaen, Jaén, Spain
- Consortium for Biomedical Research in the Epidemiology and Public Health Network (CIBERESP), Madrid, Spain
| | - Mario Rivera Izquierdo
- Consortium for Biomedical Research in the Epidemiology and Public Health Network (CIBERESP), Madrid, Spain
- Department of Preventive Medicine and Public Health, Faculty of Medicine, University of Granada, Granada, Spain
- Instituto de Investigación Biosanitaria (ibs. Granada), Granada, Spain
| | - Khalid Saeed Khan
- Consortium for Biomedical Research in the Epidemiology and Public Health Network (CIBERESP), Madrid, Spain
- Department of Preventive Medicine and Public Health, Faculty of Medicine, University of Granada, Granada, Spain
| | - Naomi Cano-Ibáñez
- Consortium for Biomedical Research in the Epidemiology and Public Health Network (CIBERESP), Madrid, Spain
- Department of Preventive Medicine and Public Health, Faculty of Medicine, University of Granada, Granada, Spain
- Instituto de Investigación Biosanitaria (ibs. Granada), Granada, Spain
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Yuan S, Wang H, Zhou J. Prevalence and risk factors of low back and pelvic pain in women with rectus abdominis diastasis: a multicenter retrospective cohort study. Korean J Pain 2022; 35:86-96. [PMID: 34966015 PMCID: PMC8728546 DOI: 10.3344/kjp.2022.35.1.86] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2021] [Revised: 09/11/2021] [Accepted: 09/23/2021] [Indexed: 11/05/2022] Open
Abstract
Background To explore the association between low back pain (LBP) and pelvic pain (PP) and rectus abdominis diastasis (RAD) in postpartum women and identify the characteristics and risk factors. Methods Women diagnosed with RAD and a history of labor and delivery, between 2009 and 2018, were identified from six hospitals within the Partners Healthcare System. Univariate and multivariable binary logistic regression analyses were used to identify the risk factors associated with pain. Results Age at onset of RAD in the non-cesarean delivery group was earlier than those in cesarean delivery (CD) group (P = 0.017). Women who underwent CD demonstrated 4.5 times greater risk of RAD than those who had no CD exposure. The cumulative composition ratio of LBP at every age stage of the period from 8 years pre-first delivery to 8 years post-first delivery was significantly higher than the other five conditions (RAD, umbilical hernia, PP, depressive disorder [DD], and strain of muscle, fascia, and tendon [SMFT]) (P for trend < 0.001). Women with DD, SMFT, and PP were more likely to have LBP (odds ratio [OR] = 1.91, 95% confidence interval [CI] 1.06 to 3.47, P = 0.032; OR = 4.50, 95% CI 1.64 to 12.36, P = 0.003; OR = 2.14, 95% CI 1.17 to 3.89, P = 0.013; respectively). Conclusions In postpartum women with RAD, DD, SMFT, and PP were found to be risk factors contributing to the development of LBP. Race and LBP also played roles in the development of PP.
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Affiliation(s)
- Sue Yuan
- Teaching and Research Section of Clinical Nursing, Xiangya Hospital of Central South University, Changsha, Hunan, China.,Xiangya Nursing School, Central South University, Changsha, Hunan, China
| | - Honghong Wang
- Xiangya Nursing School, Central South University, Changsha, Hunan, China
| | - Jie Zhou
- Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
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Hughes C, May S. A directional preference approach for chronic pelvic pain, bladder dysfunction and concurrent musculoskeletal symptoms: a case series. J Man Manip Ther 2020; 28:170-180. [PMID: 31702976 PMCID: PMC7480605 DOI: 10.1080/10669817.2019.1668994] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND Chronic pelvic pain (CPP) with concurrent musculoskeletal and bladder symptoms is a complex and challenging problem. However, clinically the co-existence of these symptoms is not routinely questioned, and their musculoskeletal source is not investigated thoroughly. The purpose of this case series is to present the use of Mechanical Diagnosis and Therapy (MDT) principles in seven patients with concurrent chronic pelvic pain, bladder dysfunction and musculoskeletal symptoms. CASE DESCRIPTIONS Seven patients with coexisting pelvic health and musculoskeletal signs and symptoms were retrospectively reviewed. Most common symptoms were urinary frequency, incontinence, pelvic pain, nocturia, dyspareunia, bladder dyssynergia, and lumbar, pelvic or hip pain. All patients failed to recognize the possible interconnectedness of the two sets of symptoms. Each exhibited a directional preference (DP) and subsequent MDT provisional classification of derangement was established; the use of DP forces abolished or dramatically improved both symptoms and mobility impairments. In all cases DP was for sustained sagittal forces initially, but ultimately lateral forces and mobilization were indicated. OUTCOMES Changes in Pelvic Floor Impact Questionnaire, Care Connections Pelvic Floor and Lumbar spine were all clinically significant and exceeded minimally Clinical Important Differences several times. Average of 5.8 sessions per patient was noted. Follow-up at an average of 3.3 years revealed ongoing satisfaction and confidence in independent self-management. DISCUSSION These case studies highlight the importance of ensuring expansion of intake questions for possible co-existence of symptoms in both pelvic and musculoskeletal patients, possibly suggesting a mechanical intervention is indicated. Provisional subclassification into 'Mechanical Pelvic Syndrome' is proposed. Level of Evidence: 4.
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Affiliation(s)
| | - Stephen May
- Department of Allied Health Professions, Sheffield Hallam University, Sheffield, UK
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Osório FL, Carvalho ACF, Donadon MF, Moreno AL, Polli-Neto O. Chronic pelvic pain, psychiatric disorders and early emotional traumas: Results of a cross sectional case-control study. World J Psychiatry 2016; 6:339-344. [PMID: 27679773 PMCID: PMC5031934 DOI: 10.5498/wjp.v6.i3.339] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2016] [Revised: 05/05/2016] [Accepted: 08/31/2016] [Indexed: 02/05/2023] Open
Abstract
AIM To compare the prevalence of psychiatric disorders and early emotional traumas between women with chronic pelvic pain (CPP) and healthy women.
METHODS One hundred women in reproductive age, 50 of them had CPP (according to the criteria set by the International Association for Study of Pain), and 50 were considered healthy after the gynecological evaluation. The eligibility criteria were defined as follows: chronic or persistent pain perceived in the pelvis-related structures (digestive, urinary, genital, myofascial or neurological systems). Only women in reproductive age with acyclic pain for 6 mo, or more, were included in the present study. Menopause was the exclusion criterion. The participants were grouped according to age, school level and socio-economic status and were individually assessed through DSM-IV Structured Clinical Interview (SCID-I) and Early Trauma Inventory Self-report - short form (ETISR-SF Brazilian version). Descriptive statistics, group comparison tests and multivariate logistics regression were used in the data analysis.
RESULTS The early emotional traumas are highly prevalent, but their prevalence did not differ between the two groups. The current Major Depressive Disorder was more prevalent in women with CPP. The CPP was associated with endometriosis in 48% of the women. There was no difference in the prevalence of disorders when endometriosis was taken into account (endometriosis vs other diseases: P > 0.29). The current Major Depressive Disorder and the Bipolar Disorder had greater occurrence likelihood in the group of women with CPP (ODDS = 5.25 and 9.0).
CONCLUSION The data reinforce the link between mood disorders and CPP. The preview evidences about the association between CPP and early traumas tended not to be significant after a stronger methodological control was implemented.
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Rocha MG, Gomes VA, Tanus-Santos JE, Rosa-e-Silva JC, Candido-dos-Reis FJ, Nogueira AA, Poli-Neto OB. Reduction of blood nitric oxide levels is associated with clinical improvement of the chronic pelvic pain related to endometriosis. ACTA ACUST UNITED AC 2015; 48:363-9. [PMID: 25714893 PMCID: PMC4418368 DOI: 10.1590/1414-431x20143619] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2013] [Accepted: 10/29/2014] [Indexed: 11/21/2022]
Abstract
The objective of this prospective study was to determine the plasma levels of nitric
oxide (NO) in women with chronic pelvic pain secondary to endometriosis (n=24) and
abdominal myofascial pain syndrome (n=16). NO levels were measured in plasma
collected before and 1 month after treatment. Pretreatment NO levels (μM) were lower
in healthy volunteers (47.0±12.7) than in women with myofascial pain (64.2±5.0,
P=0.01) or endometriosis (99.5±12.9, P<0.0001). After treatment, plasma NO levels
were reduced only in the endometriosis group (99.5±12.9 vs 61.6±5.9,
P=0.002). A correlation between reduction of pain intensity and reduction of NO level
was observed in the endometriosis group [correlation = 0.67 (95%CI = 0.35 to 0.85),
P<0.0001]. Reduction of NO levels was associated with an increase of pain
threshold in this group [correlation = -0.53 (-0.78 to -0.14), P<0.0001]. NO
levels appeared elevated in women with chronic pelvic pain diagnosed as secondary to
endometriosis, and were directly associated with reduction in pain intensity and
increase in pain threshold after treatment. Further studies are needed to investigate
the role of NO in the pathophysiology of pain in women with endometriosis and its
eventual association with central sensitization.
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Affiliation(s)
- M G Rocha
- Faculdade de Medicina, Universidade de Fortaleza, Fortaleza, CE, Brasil
| | - V A Gomes
- Hospital Universitário, Faculdade de Ciências Médicas, Universidade Estadual de Campinas, Campinas, SP, Brasil
| | - J E Tanus-Santos
- Departamento de Farmacologia, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, Brasil
| | - J C Rosa-e-Silva
- Departamento de Ginecologia e Obstetrícia, Hospital das Clínicas, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, Brasil
| | - F J Candido-dos-Reis
- Departamento de Ginecologia e Obstetrícia, Hospital das Clínicas, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, Brasil
| | - A A Nogueira
- Departamento de Ginecologia e Obstetrícia, Hospital das Clínicas, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, Brasil
| | - O B Poli-Neto
- Departamento de Ginecologia e Obstetrícia, Hospital das Clínicas, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, Brasil
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Coelho LSC, Brito LMO, Chein MBC, Mascarenhas TS, Costa JPL, Nogueira AA, Poli-Neto OB. Prevalence and conditions associated with chronic pelvic pain in women from São Luís, Brazil. ACTA ACUST UNITED AC 2014; 47:818-25. [PMID: 25075577 PMCID: PMC4143211 DOI: 10.1590/1414-431x20143710] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2013] [Accepted: 05/27/2014] [Indexed: 12/15/2022]
Abstract
The objective of the present study was to estimate the prevalence of chronic pelvic
pain in the community of São Luís, capital of the State of Maranhão, Northeastern
Brazil, and to identify independent conditions associated with it. A cross-sectional
study was conducted, including a sample of 1470 women older than 14 years
predominantly served by the public health system. The interviews were held in the
subject's home by trained interviewers not affiliated with the public health services
of the municipality. The homes were visited at random according to the city map and
the prevalence of the condition was estimated. To identify the associated conditions,
the significant variables (P=0.10) were selected and entered in a multivariate
analysis model. Data are reported as odds ratio and 95% confidence interval, with the
level of significance set at 0.05. The prevalence of chronic pelvic pain was 19.0%.
The independent conditions associated with this diagnosis were: dyspareunia
(OR=3.94), premenopausal status (OR=2.95), depressive symptoms (OR=2.33),
dysmenorrhea (OR=1.77), smoking (OR=1.72), irregular menstrual flow (OR=1.62), and
irritative bladder symptoms (OR=1.90). The prevalence of chronic pelvic pain in Sao
Luís is high and is associated with the conditions cited above. Guidelines based on
prevention and/or early identification of risk factors may reduce the prevalence of
chronic pelvic pain in São Luís, Brazil.
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Affiliation(s)
- L S C Coelho
- Programa de Pós-Graduação em Saúde Materno-Infantil, Departamento de Medicina III, Universidade Federal do Maranhão, São Luís, MA, Brasil
| | - L M O Brito
- Programa de Pós-Graduação em Saúde Materno-Infantil, Departamento de Medicina III, Universidade Federal do Maranhão, São Luís, MA, Brasil
| | - M B C Chein
- Programa de Pós-Graduação em Saúde Materno-Infantil, Departamento de Medicina III, Universidade Federal do Maranhão, São Luís, MA, Brasil
| | - T S Mascarenhas
- Programa de Pós-Graduação em Saúde Materno-Infantil, Departamento de Medicina III, Universidade Federal do Maranhão, São Luís, MA, Brasil
| | - J P L Costa
- Programa de Pós-Graduação em Saúde Materno-Infantil, Departamento de Medicina III, Universidade Federal do Maranhão, São Luís, MA, Brasil
| | - A A Nogueira
- Programa de Pós-Graduação em Saúde Materno-Infantil, Departamento de Medicina III, Universidade Federal do Maranhão, São Luís, MA, Brasil
| | - O B Poli-Neto
- Departamento de Ginecologia e Obstetrícia, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, Brasil
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Montenegro MLLS, Braz CA, Mateus-Vasconcelos EL, Rosa-e-Silva JC, Candido-dos-Reis FJ, Nogueira AA, Poli-Neto OB. Pain pressure threshold algometry of the abdominal wall in healthy women. Braz J Med Biol Res 2012; 45:578-82. [PMID: 22527127 PMCID: PMC3854264 DOI: 10.1590/s0100-879x2012007500064] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2011] [Accepted: 04/12/2012] [Indexed: 11/22/2022] Open
Abstract
The objective of this study was to determine the inter- and intra-examiner reliability of pain pressure threshold algometry at various points of the abdominal wall of healthy women. Twenty-one healthy women in menacme with a mean age of 28 ± 5.4 years (range: 19-39 years) were included. All volunteers had regular menstrual cycles (27-33 days) and were right-handed and, to the best of our knowledge, none were taking medications at the time of testing. Women with a diagnosis of depression, anxiety or other mood disturbances were excluded. Women with previous abdominal surgery, any pain condition or any evidence of inflammation, hypertension, smoking, alcoholism, or inflammatory disease were also excluded. Pain perception thresholds were assessed with a pressure algometer with digital traction and compression and a measuring capacity for 5 kg. All points were localized by palpation and marked with a felt-tipped pen and each individual was evaluated over a period of 2 days in two consecutive sessions, each session consisting of a set of 14 point measurements repeated twice by two examiners in random sequence. There was no statistically significant difference in the mean pain threshold obtained by the two examiners on 2 diferent days (examiner A: P = 1.00; examiner B: P = 0.75; Wilcoxon matched pairs test). There was excellent/good agreement between examiners for all days and all points. Our results have established baseline values to which future researchers will be able to refer. They show that pressure algometry is a reliable measure for pain perception in the abdominal wall of healthy women.
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Affiliation(s)
- M L L S Montenegro
- Departamento de Ginecologia e Obstetrícia, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, Brasil
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