Symptomatic pelvic organ prolapse in middle-aged women: a national matched cohort study on the influence of childbirth

Åkervall, Sigvard; Othman, Jwan Al-Mukhtar; Molin, Mattias; Gyhagen, Maria

doi:10.1016/j.ajog.2019.10.007

Cited by 15 publications

(4 citation statements)

References 31 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…POP risk increases with increasing parity and number of vaginal deliveries (2,124,126). Caesarean section has been shown to reduce the risk of POP later in life (7,47,(126)(127)(128).…”

Section: Pelvic Organ Prolapsementioning

confidence: 99%

Fecal incontinence in nonpregnant nulliparous women aged 25 to 64 years-a randomly selected national cohort prevalence study

Othman

Åkervall

Nilsson

et al. 2022

American Journal of Obstetrics and Gynecology

Self Cite

View full text Add to dashboard Cite

Background: Pelvic floor dysfunction (PFD) is a public health problem affecting millions of women worldwide. In addition to personal suffering, it also creates an economic burden for health care systems and society. Parity and mode of delivery are well known risk factors for PFDs. Therefore, examining the prevalence of PFDs in women not exposed to childbirth provides insight into the natural history of the condition without the confounding effect of obstetric injury. Aim: To obtain a detailed description of the age-related prevalence and predictors of PFDs in a large, national, randomly selected cohort of nulliparous women aged 25 to 64 years. This knowledge is necessary for comparisons with parous women to demonstrate the effect of pregnancy and the effect of vaginal delivery on future PFD. Material and methods: This was a national cohort study where the study population was drawn from the Total Population Register by Statistics Sweden. The final study population consisted of 9,197 women registered in Sweden, with no births aged 25 and 64 years. Selfreported information regarding possible PFD was obtained via the web and by mail in 2014 using a 40-item questionnaire. Results:Paper I: Urinary function in nulliparous women deteriorated during the four most active decades of adult life. However, 75% remained continent by age 65. In women with a normal BMI this applied to >80%. Almost all aspects of urinary dysfunction increased with age. The most significant increase was observed for nocturia ≥2, mixed urinary incontinence (MUI), leakage ≥ 1/week, leakage of more than a few drops of urine, and bothersome UI. Paper II: Symptoms indicating pelvic organ prolapse (sPOP) were experienced in all ages but surgical procedures for POP were rare. Bothersome sPOP was more prevalent in older women. The symptom of "bulging" was strongly associated with other irritative conditions from the genital area. These co-occurring symptoms increased with increasing frequency of "bulging". Paper III: In nulliparous women with a history of childhood nocturnal enuresis (CNE), all the studied parameters of lower urinary tract symptoms and PFD were approximately doubled and acted as a strong marker for later PFDs. Paper IV: The predominant component of leakage in nullipara with faecal incontinence (FI) was liquid stool, which occurred in >90%. Solid stool leakage was rare. The pattern of distribution of different types of leakage was similar in all age groups. BMI and age were interacting risk factors for FI. Conclusion: Over a 40-year period from age 25, the prevalence of all UI parameters increased in nulliparous women. Bothersome prolapse symptoms were rare in women who have not undergone childbirth. The strongest risk factor for fecal incontinence was abnormal stool consistency. Age, BMI and CNE were important risk factors for almost all PFDs.

show abstract

“…POP risk increases with increasing parity and number of vaginal deliveries (2,124,126). Caesarean section has been shown to reduce the risk of POP later in life (7,47,(126)(127)(128).…”

Section: Pelvic Organ Prolapsementioning

confidence: 99%

Fecal incontinence in nonpregnant nulliparous women aged 25 to 64 years-a randomly selected national cohort prevalence study

Othman

Åkervall

Nilsson

et al. 2022

American Journal of Obstetrics and Gynecology

Self Cite

View full text Add to dashboard Cite

show abstract

“…In many studies, age, vaginal delivery, and obesity were identified as risk factors for PFD. Additionally, it has been suggested that diabetes mellitus, connective tissue diseases, and neurological disorders may also be risk factors (9)(10)(11)(12). Our study mostly includes premenopausal women and, the BMI of these women is <30 kg /m2.…”

Section: Table 4: Logistic Regression Analysis Of Parity and Delivery...mentioning

confidence: 99%

Doğum şekli ve paritenin pelvik organ prolapsusu ve üriner inkontinans gelişimi üzerine etkisi

Sağniç

Kokanali

Cavkaytar

et al. 2021

Jinekoloji-Obstetrik Ve Neonatoloji Tıp Dergisi

View full text Add to dashboard Cite

Aim: To investigate the effect of delivery mode and parity number on development of pelvic organ prolapse (POP) and urinary incontinence (UI). Materials and methods: 1500 women who had undergone surgery for POP and UI between 2007-2012 were retrospectively evaluated. After exclusion criteria, 875 women were included. 353 women with history of POP surgery were compared with 129 controls who had no POP and 201 patients with history of anti-incontinence surgery were compared with 192 controls who had no such surgery. Multiple effect of possible factors on the development of POP and UI was determined by logistic regression. Results: The characteristics of POP group and the controls, as well as anti incontinence surgery group and controls were similar, except parity number. The risk of having a POP surgery was higher with increasing number of parity. The highest risk was found in women with a history of 5 and more deliveries. For UI, multiparity seemed as a risk factor, however the risk of undergoing incontinence surgery did not increase with increasing number of parity. Delivery mode was not a risk factor for either POP or anti-incontinence group. Conclusion: The risk of POP increases with increasing number of parity, and also multiparity is a risk factor for UI. Women planning more than one delivery should be informed about this concern. Since the impact of delivery mode has not been shown clearly, we believe the incidence of pelvic floor dysfunction can be decreased with proper obstetric

show abstract

“…Furthermore, no difference was found in the risk of POP between operative vaginal delivery (cup and forceps) vs spontaneous vaginal delivery [2]. In addition, Akervall et al concluded that most likely, vaginal delivery is the only clinically dominant predictor of symptomatic POP [3]. Otherwise, in two studies the risk factors for POP were not identi ed in the long-term (6 months) postpartum period [4][5].…”

Section: Introductionmentioning

confidence: 99%

Pelvic floor dysfunction at 3 and 6 months postpartum. A sub-analysis of the Perineal Massage and Warm Compresses technique during second stage of labor randomized controlled trial (PeMWaC)

Rodrigues

Silva²,

Borges³

et al. 2023

Preprint

View full text Add to dashboard Cite

Purpose: The influence of perineal trauma in pelvic floor dysfunction (PFD) has been described. Although the perineal massage and warm compresses techniques during the second stage of labor reduce perineal trauma, but the impact of combined perineal massage and warm compresses technique in PFD has never been investigated. To evaluate the effects of combined perineal massage and warm compresses or hands-on technique on PFD symptoms at 3 and 6 months. Methods: Randomised controlled trial (PeMWaC - Perineal Massage and Warm Compresses) was carried out at Hospital of Braga from March 1st, 2019 to December 31st, 2020. The sample included 496 women (242 perineal massage and warm compresses and 254 hands-on) who had a singleton term spontaneous vaginal delivery. A sub-analysis of primary data was performed to assess postpartum PFD symptoms, Pelvic Floor Distress Inventory-20 (PFDI-20) survey was applied at 3 and 6 months postpartum. Results: Of the 800 women recruited, 496 were included, 48.8% with combined perineal massage and warm compresses and 51.2% with standard-care. Frequency of intact perineum (p<0.001) and vaginal tears (p<0.001) were significantly higher in combined perineal massage and warm compresses. At 3 months postpartum, women undergoing standard care during the second stage of labor had higher Urinary Distress Inventory (UDI) score and global score with no differences at 6 months. After controlling for confounding variables, combined perineal massage and warm compresses technique were associated with lower UDI scores at 3 months postpartum. Conclusion: Combined perineal massage and warm compresses technique, seems to be associated with a lower prevalence of early PFD symptoms, mainly regarding urinary distress.

show abstract

Symptomatic pelvic organ prolapse in middle-aged women: a national matched cohort study on the influence of childbirth

Cited by 15 publications

References 31 publications

Fecal incontinence in nonpregnant nulliparous women aged 25 to 64 years-a randomly selected national cohort prevalence study

Fecal incontinence in nonpregnant nulliparous women aged 25 to 64 years-a randomly selected national cohort prevalence study

Doğum şekli ve paritenin pelvik organ prolapsusu ve üriner inkontinans gelişimi üzerine etkisi

Pelvic floor dysfunction at 3 and 6 months postpartum. A sub-analysis of the Perineal Massage and Warm Compresses technique during second stage of labor randomized controlled trial (PeMWaC)

Contact Info

Product

Resources

About