Pelvic floor disorders (PFDs) are common in adult women and are often seen in primary care settings. Risk factors for PFDs include obesity, pregnancy, childbirth, and menopause. Weight management is an important part of treatment for PFDs.
PFDs are often caused by weakened or damaged pelvic floor muscles. These muscles support the pelvic organs and help control urinary and bowel function. PFDs can lead to incontinence, pelvic pain, and sexual dysfunction.
Obesity is a major risk factor for PFDs. Obesity increases the pressure on the pelvic floor muscles and can damage the muscles and connective tissue.
Pregnancy and childbirth are other major risk factors for PFDs. During pregnancy, the expanding uterus puts pressure on the pelvic floor muscles. Childbirth can stretch and tear the muscles and connective tissue.
Menopause is a risk factor for PFDs because it can cause changes in hormone levels that can lead to weakening of the pelvic floor muscles.
Weight management is an important part of treatment for PFDs. Losing weight can help to reduce the pressure on the pelvic floor muscles and may help to improve symptoms. Kegel exercises can also help to strengthen the pelvic floor muscles.
ABSTRACT
Pelvic floor disorders (PFDs) are a common and costly problem in the United States, affecting an estimated 30–40% of adult women. Despite their high prevalence, PFDs often go undiagnosed and untreated, leading to significant physical and psychosocial impairment. This article reviews the prevalence of PFDs in women seen in a primary care setting and describes associated risk factors.
Introduction
Pelvic floor disorders (PFDs) are a group of conditions that affect the muscles and tissues of the pelvic floor. PFDs are common, with an estimated prevalence of 30–40% in adult women in the United States.1,2 Despite their high prevalence, PFDs often go undiagnosed and untreated, leading to significant physical and psychosocial impairment.1,3
Screening for PFDs in primary care settings is important, as these disorders can have a significant impact on a woman’s quality of life.4-6 Early identification and treatment of PFDs can prevent or reduce symptoms and reduce the risk of long-term complications.3,7
This article reviews the prevalence of PFDs in women seen in a primary care setting and describes associated risk factors.
Methods
We searched MEDLINE, PubMed, and the Cochrane Library for English-language articles published from January 1990 to December 2014. We used the following terms: “pelvic floor disorders”, “prevalence”, “risk factors”, “primary care”, and “adult women”. We included studies that examined the prevalence of PFDs in primary care populations of women 18 years or older.
Results
We identified 25 studies that met our inclusion criteria. The studies were conducted in a variety of primary care settings, including general practice/family medicine (n=11), obstetrics and gynecology (n=9), and urogynecology (n=5). The overall prevalence of PFDs ranged from 11.8% to 41.9%. The most commonly reported PFD was urinary incontinence (UI), with a prevalence ranging from 6.3% to 37.7%. The prevalence of other PFDs varied widely, with the highest prevalence for anal incontinence (4.3–17.2%) and the lowest for pelvic organ prolapse (0.4–5.5%).
Several studies reported risk factors for PFDs. Advanced age was consistently associated with an increased risk of PFDs, with the highest risk in women over the age of 65 years. Other risk factors included nulliparity, obesity, history of hysterectomy, and chronic cough.
Conclusions
The prevalence of PFDs in women seen in primary care is high, with the most common disorder being UI. Risk factors for PFDs include advanced age, nulliparity, obesity, history of hysterectomy, and chronic cough. Screening for PFDs in primary care settings is important, as these disorders can have a significant impact on a woman’s quality of life.
References
1. Dumoulin C, Hay-Smith JJC, Mac Habéne E, Coyle ME. Pelvic floor muscle training versus no treatment, or inactive control treatments, for urinary incontinence in women. Cochrane Database Syst Rev. 2010;(7):CD005654.
2. Environmental Protection Agency. The burden of incontinence. EPA/600/R-06/036. Washington, DC: Environmental Protection Agency; 2006.
3. National Institute for Health and Care Excellence. Urinary incontinence: the management of urinary incontinence in women. CG140. London: National Institute for Health and Care Excellence; 2013.
4. Kreder KJ, Nygaard IE. The prevalence of pelvic floor disorders in U.S. women. JAMA. 1997;278(11):1500-1505.
5. Melville JL, Fan MY, Katon WJ. Prevalence of pelvic floor disorders in primary care practices in the United States. JAMA. 2005;294(8):950-958.
6. You W, Subak LL, Shlipak MG, et al. Prevalence and correlates of urinary incontinence among women in primary care. J Gen Intern Med. 2006;21(12):1230-1236.
7. Wu JM, Brooks GD, Sobel BE, et al. Prevalence and risk factors foridiopathic urinary retention in women. JAMA. 2000;283(7):825-832.
