The Role of Urogynecology In Women’s Pelvic Floor Disorders

摘要

Pelvic floor disorders (PFD) include urinary incontinence (UI), fecal/ anal in- continence (AI), and pelvic organ pro- lapse (POP). An estimated one third of women will experience at least one of these disorders in her lifetime. A prevalence rate of all PFD combined is not available, but estimates of each of these dysfunctions have been reported in epidemiologic stud- ies. UI is the 8 th most prevalent chronic medical condition. It affects approximately 13 million Americans: 50% of nursing home residents, and 15-30% of the com- munity elderly. POP is a common condi- tion amongst women. The exact preva- lence rate of the condition is not known, but a study by Henrdrix et al of 16,616 women with a uterus found the rate of uterine prolapse to be 14.2%; the rate of cystocele 34.3%, and the rate of rectocele 18.6%. In the same study 10,727 women who had undergone hysterectomy had similar rates of prolapse, the prevalence of cystocele was 32.9% and of rectocele was 18.3%. 1 Olsen et al found that American women have an 11% lifetime risk of un- dergoing surgery before the age of 80 for either urinary incontinence or prolapse with 30% of women undergoing repeat surgery. 2 AI may have the most devastat- ing effects on quality of life, self-image, and social functioning of all pelvic floor disor- ders. It is defined by the International Consultation on Incontinence as the in- voluntary loss of gas, liquid, or solid stool that causes a social or hygienic problem. Women are twice as likely to report AI as men. Symptoms are highly associated with anal sphincter injury following vaginal delivery. A recent multi-center survey study by Boreham, et al found that up to 28% of women presenting for routine gynecologic care reported AI in the pre- ceding year.