Pelvic floor dysfunction in pregnant women in the third trimester
Objective. To estimate the frequency and severity of pelvic floor dysfunction (PFD) symptoms in pregnant women in the third trimester.Sukhanov A.A., Dikke G.B., Kukarskaya I.I.
Material and methods. The study enrolled 395 pregnant women at 28-38 weeks’ gestation, who filled out a Pelvic Floor Distress Inventory (PFDI-20).
Results. 280 (61.7%) of the 395 pregnant women specified 2 or more symptoms characteristic of prolapse; colorectal and urinary symptoms were reported by 304 (77%) and 292 (73.9%) of the 395 respondents, respectively. Although prolapse symptoms were statistically less frequently reported than were colorectal and urinary ones, but the degree of their severity was higher. One-quarter of the women experienced moderate or severe prolapse symptoms and the same number of women pointed that they should reduce evagination to empty the bowel and bladder, suggesting that they might have more than grade 1 prolapse. Every four women among those who had colorectal symptoms noted that the latter were moderate or severe. Every six women of those who indicated the presence of urinary symptoms also pointed to their severity with frequent and very frequent urine leakage associated with coughing, sneezing or laughing; every three of them said that this symptom was of the greatest significance.
Conclusion. The high frequency of PFD symptoms in pregnant women suggests that these risk groups need to be actively identified through screening and to be provided with timely medical care.
Keywords
pelvic floor dysfunction
urinary incontinence
pelvic organ prolapse
fecal incontinence
pregnancy
third trimester
Supplementary Materials
References
1. Memon H.U., Handa V.L. Vaginal childbirth and pelvic floor disorders. Womens Health. 2013; 9(3): 265-77.
2. Sangsawang B., Sangsawang N. Stress urinary incontinence in pregnant women: a review of prevalence, pathophysiology, and treatment. Int. Urogynecol. J. Pelvic Floor Dysfunct. 2013; 24(6): 901-12. Available at: https://www.ncbi.nlm.nih.gov/
3. Mørkved S., Bø K. Prevalence of urinary incontinence during pregnancy and postpartum. Int. Urogynecol. J. Pelvic Floor Dysfunct. 1999; 10(6): 394-8.
4. Lewicky-Gaupp C., Cao D.C., Culbertson S. Urinary and anal incontinence in African American teenaged gravidas during pregnancy and the puerperium. J. Pediatr. Adolesc. Gynecol. 2008; 21(1): 21-6.
5. Altman D., Ekström A., Gustafsson C., López A., Falconer C., Zetterström J. Risk of urinary incontinence after childbirth: a 10-year prospective cohort study. Obstet. Gynecol. 2006; 108(4): 873-8.
6. Dolan L.M., Hilton P. Obstetric risk factors and pelvic floor dysfunction 20 years after first delivery. Int. Urogynecol. J. 2010; 21(5): 535-44.
7. Xu X.Y., Wang H.Y., Su L. et al. Women’s sexual health after delivery and its related influential factors. J. Clin. Rehab. Tissue Engineer. Res. 2007; 11:1673-8225.
8. Dixon M., Booth N., Powell R. Sex and relationships following childbirth: a first report from general practice of 131 couples. Br. J. Gen. Pract. 2000; 50(452): 223-4.
9. Kline C.R., Martin D.P., Deyo R.A. Health consequences of pregnancy and childbirth as perceived by women and clinicians. Obstet. Gynecol. 1998; 92(5): 842-8.
10. Chiarelli P., Murphy B., Cockburn J. Fecal incontinence after high-risk delivery. Obstet. Gynecol. 2003; 102(6): 1299-305.
11. Brown S.J., Gartland D., Donath S., MacArthur C. Fecal incontinence during the first 12 months postpartum: complex causal pathways and implications for clinical practice. Obstet. Gynecol. 2012; 119(2, Pt 1): 240-9.
12. Eason E., Labrecque M., Marcoux S., Mondor M. Anal incontinence after childbirth. CMAJ. 2002; 166(3): 326-30.
13. Macarthur C., Wilson D., Herbison P., Lancashire R.J., Hagen S., Toozs-Hobson P. et al. Faecal incontinence persisting after childbirth: a 12 year longitudinal study. BJOG. 2013; 120(2): 169-78.
14. Chen Y., Li F.Y., Lin X., Chen J., Chen C., Guess M.K. The recovery of pelvic organ support during the first year postpartum. BJOG. 2013; 120(11): 1430-7.
15. Liang C.C., Chang S.D., Lin S.J., Lin Y.J. Lower urinary tract symptoms in primiparous women before and during pregnancy. Arch. Gynecol. Obstet. 2012; 285(5): 1205-10.
16. Ammari A., Tsikouras P., Dimitraki M., Liberis A., Kontomanolis E., Galazios G., Liberis V. Uterine prolapse complicating pregnancy: A case report. HJOG. 2014; 13(2): 74-7.
17. Parés D., Martinez-Franco E., Lorente N., Viguer J., Lopez-Negre J.L., Mendez Z.R. Prevalence of fecal incontinence in women during pregnancy: a large cross-sectional study. Dis. Colon Rectum. 2015; 58(11): 1098-103.
18. Pearl G., Herbert J.H. Assessing pelvic floor during childbearing year. Nurs. Times. 2008; 104(18): 40-4.
19. Khajehei M. Sexuality after childbirth: Gaps and needs. World J. Obstet. Gynecol. 2012; 1(2): 14-6.
Received 15.09.2017
Accepted 22.09.2017
About the Authors
Anton А. Sukhanov, head of the office of family planning and reproduction Tyumen Perinatal Centre, postgraduate student of the Department of obstetrics, gynecology and reanimatology with the course of clinical laboratory diagnostics, Tyumen State Medical University, Ministry of Health of Russia.625002, Russia, Tyumen, Daudelnaya str. 1. Tel.: +73452508277. E-mail: such-anton@yandex.ru
Galina B. Dikke, Honored Scientist and Education Worker, MD, Professor of the Department of Obstetrics, Gynecology and Reproductive Medicine, Faculty of Advanced Training of Medical Workers, Peoples’ Friendship University of Russia. 117198, Russia, Moscow, Miklukho-Maklaya str. 6. Tel.: +74954345300. E-mail: galadikke@yandex.ru
Irina I. Kukarskаya, MD, chief specialist on obstetrics and gynecology of the Department of Health of the Tyumen region, Professor, Department of obstetrics, gynecology and reanimatology with the course of clinical laboratory diagnostics, Tyumen State Medical University, Ministry of Health of Russia; chief physician of Tyumen Perinatal centre. 625002, Russia, Tyumen, Daudelnaya str. 1. Tel.: +73452508277. E-mail: kukarskay@mail.ru
For citations: Sukhanov A.A., Dikke G.B., Kukarskaya I.I. Pelvic floor dysfunction in pregnant women in the third trimester. Akusherstvo i Ginekologiya/Obstetrics and Gynecology. 2017; (11): 123-8. (in Russian)
https://dx.doi.org/10.18565/aig.2017.11.123-128
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