ACADEMIC AND RESEARCH PEER-REVIEWED MEDICAL JOURNALISSN 1727-2378 (Print)         ISSN 2713-2994 (Online)
Ru
En

The Epidemiology and Etiopathogenesis of Pelvic Floor Dysfunction

DOI:10.31550/1727-2378-2018-154-10-27-31
For citation: Sukhanov A.A., Dikke G.B., Kukarskaya I.I. The Epidemiology and Etiopathogenesis of Pelvic Floor Dysfunction. Doctor.Ru. 2018; 10(154): 27–31. DOI: 10.31550/1727-2378-2018-154-10-27-31
16 November 09:52

Objective of the Review: To evaluate the epidemiology and the main causes of pelvic floor dysfunction (PFD).

Key Points: Analysis was performed on data from 50 foreign and Russian publications in international and Russian open-access databases. The prevalence of pelvic organ prolapse in the female population is 32-64%, and that of urinary and fecal incontinence is 48-72% and 0.5-28%, respectively. At weeks 36-38 of pregnancy, PFD is present in 36% of women and at week 6 after delivery it is seen in 32% of women who had vaginal delivery and 35% of those who had cesarean section. At 12 months after delivery, the prevalence of PFD in the general population increases, and is 60-77% at 10 years and later. The main causes of PFD are pregnancy and labor, during which the musculus levator ani and fascia pubocervicalis may be damaged. Other contributing factors are mechanical stretching, ischemia, denervation of the muscular and fascial structures, and incomplete repair of the elastic fibers in the vaginal and pelvic floor tissues.

Conclusion: These epidemiological data on PFD suggest a high prevalence of this condition among young women. Early detection and conservative treatment of PFD help prevent disease progression and maintain women’s quality of life at a good level for many years.


A.A. Sukhanov — Perinatal Center, Tyumen. Tyumen State Medical University, Russian Ministry of Health. E-mail: such-anton@yandex.ru

G.B. Dikke — Peoples’ Friendship University of Russia, Moscow. E-mail: galadikke@yandex.ru

I.I. Kukarskaya — Perinatal Center, Tyumen. Tyumen State Medical University, Russian Ministry of Health. E-mail: galadikke@yandex.ru


Доктор.ру
16 November 09:52
LITERATURE
  1. Аполихина И.А., Дикке Г.Б., Кочев Д.М. Современная лечебно-профилактическая тактика при опущении и выпадении половых органов у женщин. Знания и практические навыки врачей. Акушерство и гинекология. 2014; 10: 4–5. [Apolikhina I.A., Dikke G.B., Kochev D.M. Sovremennaya lechebno-profilakticheskaya taktika pri opushchenii i vypadenii polovykh organov u zhenshchin. Znaniya i prakticheskiye navyki vrachey. Akusherstvo i ginekologiya. 2014; 10: 4–5. (in Russian)]
  2. Hallock J.L., Handa V.L. The epidemiology of pelvic floor disorders and childbirth: an update. Obstet Gynecol Clin North Am. 2016; 43(1): 1–13. DOI: 10.1016/j.ogc.2015.10.008
  3. Буянова С.Н., Щукина Н.А., Рижинашвили И.Д. Пролапс гениталий. Рос. вестн. акушера-гинеколога. 2017; 17(1): 37–45. [Buyanova S.N., Shchukina N.A., Rizhinashvili I.D. Prolaps genitaliy. Ros. vestn. akushera-ginekologa. 2017; 17(1): 37–45. (in Russian)]
  4. Солуянов М.Ю., Любарский М.С., Королева Е.Г., Ракитин Ф.А. Ошибки и осложнения хирургического лечения пролапса тазовых органов с использованием синтетических материа­лов. Успехи современного естествознания. 2012; 10: 48–52. [Soluyanov M.Yu., Lyubarskiy M.S., Koroleva E.G., Rakitin F.A. Oshibki i oslozhneniya khirurgicheskogo lecheniya prolapsa tazovykh organov s ispol'zovaniyem sinteticheskikh materialov. Uspekhi sovremennogo yestestvoznaniya. 2012; 10: 48–52. (in Russian)]
  5. Gyhagen M., Bullarbo M., Nielsen T.F., Milsom I. Prevalence and risk factors for pelvic organ prolapse 20 years after childbirth: a national cohort study in singleton primiparae after vaginal or caesarean delivery. BJOG. 2013; 120(2): 152–60. DOI: 10.1111/1471-0528.12020
  6. Гаспаров А.С., Бабичева И.А., Дубинская Е.Д., Лаптева Н.В., Дорфман М.Ф. Хирургическое лечение пролапса тазовых органов. Казанский мед. журн. 2014; 95(3): 341–7. [Gasparov A.S., Babicheva I.A., Dubinskaya Ye.D., Lapteva N.V., Dorfman M.F. Khirurgicheskoye lecheniye prolapsa tazovykh organov. Kazanskiy med. zhurn. 2014; 95(3): 341–7. (in Russian)]
  7. Oversand S.H., Staff A.C., Spydslaug A.E., Svenningsen R., Borstad E. Long-term follow-up after native tissue repair for pelvic organ prolapse. Int. Urogynecol. J. 2014; 25(1): 81–9. DOI: 10.1007/s00192-013-2166-z
  8. Кочев Д.М., Дикке Г.Б. Дисфункция тазового дна до и после родов и превентивные стратегии в акушерской практике. Акушерство и гинекология. 2017; 5: 9–15. [Kochev D.M., Dikke G.B. Disfunktsiya tazovogo dna do i posle rodov i preventivnyye strategii v akusherskoy praktike. Akusherstvo i ginekologiya. 2017; 5: 9–15. (in Russian)]
  9. Nevler A. Epidemiology of anal incontinence and evaluation of the severity of symptoms. Gastroenterology Report. 2014; 2(2): 79–84. DOI: 10.1093/gastro/gou005
  10. De Vita D., Giordano S. Two successful natural pregnancies in a patient with severe uterine prolapse: a case report. J. Med. Case Reports. 2011; 5: 459. DOI: 10.1186/1752-1947-5-459
  11. Ammari A., Tsikouras P., Dimitraki M., Liberis A., Kontomanolis E., Galazios G. et al. Uterine prolapse complicating pregnancy: a case report. HJOG. 2014; 13(2): 74–7
  12. 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. DOI: 10.1111/1471-0528.12369
  13. Memon H.U., Handa V.L. Vaginal childbirth and pelvic floor disorders. Womens Health. 2013; 9(3): 265–77. DOI: 10.2217/whe.13.17
  14. Wai C.Y., McIntire D.D., Atnip S.D., Schaffer J.I., Bloom S.L., Leveno K.J. Urodynamic indices and pelvic organ prolapse quantification 3 months after vaginal delivery in primiparous women. Int. Urogynecol. J. 2011; 22(10): 1293–8. DOI: 10.1007/s00192-011-1438-8
  15. Sze E.H., Hobbs G. Relation between vaginal birth and pelvic organ prolapse. Acta Obstet. Gynecol. Scand. 2009; 88(2): 200–3. DOI: 10.1080/00016340802596033
  16. Sangsawang B., Sangsawang N. Stress urinary incontinence in pregnant women: a review of prevalence, pathophysiology, and treatment. Int. Urogynecol. J. 2013; 24(6): 901–12. DOI: 10.1007/s00192-013-2061-7
  17. Дикке Г.Б., Аполихина И.А., Кочев Д.М., Щербатых Е.Ю. Распространенность дисфункции тазового дна среди акушеров-гинекологов и факторы, влияющие на выбор терапевтических подходов. Акушерство и гинекология. 2017; 10: 111–19. [Dikke G.B., Apolikhina I.A., Kochev D.M., Shcherbatykh Ye.Yu. Rasprostranennost' disfunktsii tazovogo dna sredi akusherov-ginekologov i faktory, vliyayushchiye na vybor terapevticheskikh podkhodov. Akusherstvo i ginekologiya. 2017; 10: 111–19. (in Russian)]
  18. Камоева С.В., Абаева Х.А., Иванова А.В. Экстраперитонеальная кольпопексия с использованием систем «Элевейт» в реконст­руктивной хирургии постгистерэктомического пролапса тазовых органов. Рус. мед. журн. 2014; 1: 14–16. [Kamoyeva S.V., Abayeva Kh.A., Ivanova A.V. Ekstraperitoneal'naya kol'popeksiya s ispol'zovaniyem sistem “Eleveyt” v rekonstruktivnoy khirurgii postgisterektomicheskogo prolapsa tazovykh organov. Rus. med. zhurn. 2014; 1: 14–16. (in Russian)]
  19. Naboka Y.L., Rymashevskiy A.N., Kogan M.I., Boravleva O.A., Nikitina E.S. Bacterial colonization of the reproductive tract of women with genital prolapse. Medical Advice. 2014; 19: 53–5
  20. Maher C.M. Anterior vaginal compartment surgery. Int. Urogynecol. J. 2013; 24(11): 1791–802. DOI: 10.1007/s00192-013-2170-3
  21. Arnouk A., De E., Rehfuss A., Cappadocia C., Dickson S., Lian F. Physical, complementary, and alternative medicine in the treatment of pelvic floor disorders. Curr. Urol. Rep. 2017; 18(6): 47. DOI: 10.1007/s11934-017-0694-7
  22. Brown S., Gartland D., Perlen S., McDonald E., MacArthur C. Consultation about urinary and faecal incontinence in the year after childbirth: a cohort study. BJOG. 2015; 122(7): 954–62. DOI: 10.1111/1471-0528.12963
  23. 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. DOI: 10.1097/DCR.0000000000000471
  24. Mørkved S., Bø K. Effect of pelvic floor muscle training during pregnancy and after childbirth on prevention and treatment of urinary incontinence: a systematic review. Br. J. Sports Med. 2014; 48(4): 299–310. DOI: 10.1136/bjsports-2012-091758
  25. Eason E., Labrecque M., Marcoux S., Mondor M. Anal incontinence after childbirth. CMAJ. 2002; 166(3): 326–30
  26. 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. DOI: 10.1111/1471-0528.12039
  27. Odar E., Wandabwa J., Kiondo P. Sexual practices of women within six months of childbirth in Mulago hospital, Uganda. Afr. Health Sci. 2003; 3(3): 117–23
  28. Dabiri F., Yabandeh A.P., Shahi A., Kamjoo A., Teshnizi S.H. The Effect of mode of delivery on postpartum sexual functioning in primiparous women. Oman Med. J. 2014; 29(4): 276–9. DOI: 10.5001/omj.2014.72
  29. Andreucci C.B., Bussadori J.C., Pacagnella R.C., Chou D., Filippi V., Say L. et al. Sexual life and dysfunction after maternal morbidity: a systematic review. BMC Pregnancy Childbirth. 2015; 11: 307. DOI: 10.1186/s12884-015-0742-6
  30. Yeniel A.O., Petri E. Pregnancy, childbirth, and sexual function: perceptions and facts. Int. Urogynecol. J. 2014; 25(1): 5–14. DOI: 10.1007/s00192-013-2118-7
  31. Thomas J., Paranjothy S. The National Sentinel Caesarean Section audit report. Royal College of Obstetricians and Gynaecolo­gists’ clinical effectiveness support unit. London: RCOG Press; 2000. 120 р.
  32. Sayasneh A., Pandeva I. Postpartum sexual dysfunction: a literature review of risk factors and role of mode of delivery. BJMP. 2010; 3(2): 316
  33. Дубинская Е.Д., Бабичева И.А., Колесникова С.Н., Дорфман М.Ф. Клинические особенности и сексуальная функция у пациенток с ранними формами пролапса тазовых органов. Вопр. гинекологии, акушерства и перинатологии. 2015; 14(6): 5–11. [Dubinskaya Ye.D., Babicheva I.A., Kolesnikova S.N., Dorfman M.F. Klinicheskiye osobennosti i seksual'naya funktsiya u patsiyentok s rannimi formami prolapsa tazovykh organov. Vopr. ginekologii, akusherstva i perinatologii. 2015; 14(6): 5–11. (in Russian)]
  34. Токтар Л.В. Женская пролаптология: от патогенеза к эффективности профилактики и лечения. Акушерство и гинекология. Новости, мнения, обучение. 2017; 3(17): 98–107. [Toktar L.V. Zhenskaya prolaptologiya: ot patogeneza k effektivnos­ti profilaktiki i lecheniya. Akusherstvo i ginekologiya. 2017; 3(17): 98–107. (in Russian)]
  35. Wu J.M., Matthews C.A., Conover M.M., Pate V., Jonsson Funk M. Lifetime risk of stress urinary incontinence or pelvic organ prolapse surgery. Obstet. Gynecol. 2014; 123(6): 1201–6. DOI: 10.1097/AOG.0000000000000286
  36. Тигиева А.В. Несостоятельность тазового дна у женщин репродуктивного возраста: Автореф. дис. … канд. мед. наук. М.; 2014. 20 с. [Tigiyeva A.V. Nekompetentnost' tazovogo dna u zhenshchin reproduktivnogo vozrasta: Avtoref. ... kand. med. nauk. M.; 2014. 20 s. (in Russian)]
  37. Русина Е.И. Смешанное и сочетанное с пролапсом тазовых органов недержание мочи у женщин: патогенез, диагностика, лечение: Автореф. дис. ... докт. мед. наук. СПб.; 2015. 40 c. [Rusina Ye.I. Smeshannoye i sochetannoye s prolapsom tazovykh organov nederzhaniye mochi u zhenshchin: patogenez, diagnostika, lecheniye: Avtoref. dis. ... dokt. med. nauk. SPb.; 2015. 40 s. (in Russian)]
  38. Dietz H.P., Moegni F., Shek K.L. Diagnosis of levator avulsion injury: a comparison of three methods. Ultrasound Obstet. Gynecol. 2012; 40(6): 693–8. DOI: 10.1002/uog.11190
  39. Alperin M., Debes K., Hoyte L., Damaser M., eds. Biomechanics of the female pelvic floor. Academic press; 2016. 437 р.
  40. Connell K.A. Elastogenesis in the vaginal wall and pelvic-organ prolapse. N. Engl. J. Med. 2011; 364(24): 2356–8. doi: 10.1056/NEJMcibr1104976
  41. Акуленко Л.В., Касян Г.Р., Козлова Ю.О., Тупикина Н.В., Вишневский Д.А., Пушкарь Д.Ю. Дисфункция тазового дна у женщин в аспекте генетических исследований. Урология. 2017; 1: 76–81. [Akulenko L.V., Kasyan G.R., Kozlova Yu.O., Tupikina N.V., Vishnevskiy D.A., Pushkar' D.Yu. Disfunktsiya tazovogo dna u zhenshchin v aspekte geneticheskikh issledovaniy. Urologiya. 2017; 1: 76–81. (in Russian)]
  42. Зиганшин А.М., Кулавский В.А. Метод прогнозирования факторов риска развития пролапса тазовых органов. Таврический мед.-биол. вестн. 2016; 19(2): 65–8. [Ziganshin A.M., Kulavskiy V.A. Metod prognozirovaniya faktorov riska razvitiya prolapsa tazovykh organov. Tavricheskiy med.-biol. vestn. 2016; 19(2): 65–8. (in Russian)]
  43. Awwad J., Sayegh R., Yeretzian J., Deeb M. Prevalence, risk factors, and predictors of pelvic organ prolapse: a community-based study. Menopause. 2012; 19(11): 1235–41. DOI: 10.1097/gme.0b013e31826d2d94
  44. Куликов А.А., Персада О.А., Соловей С.В., Котов Г.С. Возможности консервативного лечения пролапса тазовых органов у женщин. Охрана материнства и детства. 2016; 2(28): 58–63. [Kulikov A.A., Persada O.A., Solovey S.V., Kotov G.S. Vozmozhnosti konservativnogo lecheniya prolapsa tazovykh organov u zhenshchin. Okhrana materinstva i detstva. 2016; 2(28): 58–63. (in Russian)]
  45. Смольнова Т.Ю. Пролапс гениталий и дисплазия соединительной ткани. Клин. и эксперим. хирургия. Журн. им. акад. Б.В. Пет­ровского. 2015; 2: 53–64. [Smol'nova T.Yu. Prolaps genitaliy i displaziya soyedinitel'noy tkani. Klin. i eksperim. khirurgiya. Zhurn. im. akad. B.V. Petrovskogo. 2015; 2: 53–64. (in Russian)]
  46. Lince S.L., van Kempen L.C., Vierhout M.E., Kluivers K.B. A systematic review of clinical studies on hereditary factors in pelvic organ prolapse. Int. Urogynecol. J. 2012; 23(10): 1327–36. DOI: 10.1007/s00192-012-1704-4
  47. Harvey M.A., Johnston S.L., Davies G.A. Mid-trimester serum relaxin concentrations and post-partum pelvic floor dysfunction. Acta Obstet. Gynecol. Scand. 2013; 87(12): 1315–21. DOI: 10.1080/00016340802460321
  48. Макаров О.В., Камоева С.В., Хаджиева М.Б., Иванова А.В., Чумаченко А.Г., Абилев С.К. и др. Связь полиморфизма гена fbln5 с риском развития пролапса тазовых органов у женщин с травмами мягких родовых путей. Акушерство и гинекология. 2015; 1: 42–50. [Makarova O.V., Kamoyeva S.V., Khadzhiyeva M.B., Ivanova A.V., Chumachenko A.G., Abilev S.K. i dr. Svyaz' polimorfizma gena fbln5 s riskom razvitiya prolapsa tazovykh organov u zhenshchin s travmami myagkikh rodovykh putey. Akusherstvo i ginekologiya. 2015; 1: 42–50. (in Russian)]

News

30 June 00:00
A New Issue of Doctor.Ru Neurology Psychiatry, Vol. 20, No. 5 (2021), Published

Find original articles and reviews covering various aspects of neurology, psychiatry and the interview with Professor Marina Arkadievna Kinkulkina

28 June 00:00
A New Issue of Doctor.Ru Internal Medicine, Vol. 20, No. 4 (2021), Published

Find original articles and reviews covering various aspects of cardiology, gastroenterology, internal medicine and the interview with Professor Elena Zelikovna Golukhova

 

3 May 17:06
A New Issue of Doctor.Ru Pediatrics, Vol. 20, No. 3 (2021), Published

Find original articles and reviews covering various aspects of pediatrics and the interview with Professor Evgeny Grigorievich Furman

3 May 17:06
A New Issue of Doctor.Ru Endocrinology, Vol. 20, No. 2 (2021), Published

Find original articles and reviews covering various aspects of endocrinology and the interview with Professor Valentin Viktorovich Fadeev

16 April 11:57
Igor Evgenievich Khatkov joined the American Surgical Association

Igor Evgenievich Khatkov, Head of A. S. Loginov Moscow Clinical Scientific and Practical Centre, Chief Oncologist in and for Moscow is now an honoured member of the American Surgical Association.

All news