Survey Shows 37% Prevalence of Pelvic Floor Disorders

By Charles Bankhead
SAN DIEGO, March 3 -- More than a third of community-dwelling women have a pelvic floor disorder, and most have more than one disorder, according to a survey here. Overall 37% of women reported one or more pelvic floor disorders, Emily S. Lukacz, M.D., of the University of California San Diego, and colleagues, reported in the March issue of Obstetrics & Gynecology. Anal incontinence, defined as involuntary discharge of gas or fecal matter, led the way with a 25% prevalence, followed by stress urinary incontinence, overactive bladder, and pelvic organ prolapse. To the investigators' surprise, age did not predict an increased risk of the disorders in an adjusted analysis.
As many as 80% of women with one disorder had one or more coexisting pelvic floor disorders.
"The high co-occurrence of pelvic floor disorders suggests that physicians seeing women seeking care for one condition should inquire about symptoms of other disorders," the authors concluded. Recent studies have shown that pelvic floor disorders remain underreported and undertreated, complicating efforts to determine the prevalence of the conditions, the authors noted. Prevalence estimates have ranged from 10% to 58% for urinary incontinence and less than 1% to 39% for anal incontinence.
Moreover, they continued, despite nearly non-existent prevalence data, organ prolapse remains one of the most common indications for hysterectomy.
So with the approval and cooperation of Kaiser Permanente Southern California, the investigators randomly selected 3,050 female members of the health plan from each of four age groups: 25 to 39, 40 to 54, 55 to 69, and 70 to 84.
A validated survey of pelvic floor disorders was mailed to each of the 12,200 women originally selected for the study. Participants returned 4,458 surveys, and after exclusions for insufficient data, the investigators had 4,103 complete surveys for analysis.
The study population was 764 women ages 25 to 39, 981 ages 40 to 54, 1,187 ages 55 to 69, and 1,171 ages 70 to 84. About two thirds of respondents were married or living with a partner; fewer than 30% had no vaginal deliveries with birth weights of more than 2,000g; three-fourths had some college education, one-fourth were obese, and two-thirds were postmenopausal.
The survey showed that 15% of respondents had stress urinary incontinence, 13% had overactive bladder, and 6% had pelvic organ prolapse. Co-occurrence of two or more pelvic floor disorders was reported by:
About 80% of women with stress urinary incontinence or overactive bladder.
About 70% of women with pelvic organ prolapse.
Almost 50% of women with anal incontinence.
Although age did not increase the likelihood of a pelvic floor disorder, menopause had a positive correlation with all of the disorders except pelvic organ prolapse. The covariates most consistently associated with pelvic floor disorders were obesity, increasing vaginal parity, hormone use, and hysterectomy.
A limitation of the study noted by the authors was that the response rate, particularly among younger health plan members, was lower than anticipated. Younger members were hardest to reach; the likelihood of having the survey returned as undeliverable by the post office decreased with increasing age, from 11% of 25- to 39-year-olds to 3% of 70- to 84-year-olds.
The study was supported by the National Institutes of Health and Kaiser Permanente.

Primary source: Obstetrics & GynecologySource reference:Lawrence JM, et al. "Prevalence and co-occurrence of pelvic floor disorders in community-dwelling women" Obstetr Gynecol 2008; 111: DOI: 10.1097/AOG.Ob013e3181660c1b.