Advertisement

International Urogynecology Journal

, Volume 30, Issue 12, pp 2001–2011 | Cite as

Prevalence of symptomatic pelvic floor disorders in community-dwelling women in low and middle-income countries: a systematic review and meta-analysis

  • Rakibul M. IslamEmail author
  • John Oldroyd
  • Juwel Rana
  • Lorena Romero
  • Md Nazmul Karim
Review Article
First Online:

Abstract

Introduction and hypothesis

Pelvic floor disorders (PFDs), including urinary incontinence (UI), faecal incontinence (FI) and pelvic organ prolapse (POP), are common debilitating conditions globally, with considerable variation of prevalence reported in low and middle-income countries (LMICs). It was hypothesised that the variation could be due to both random and non-random errors. The aim was to determine the pooled prevalence estimates of PFDs among community-dwelling women in LMICs and to examine possible reasons for the variations of prevalence reported.

Methods

A systematic search of MEDLINE, EMBASE, PsycINFO, CINAHL and Maternity & Infant Care was conducted to retrieve eligible studies. A meta-analysis with a random effects model and a meta-regression were performed. The manuscript was structured using the PRISMA checklist .

Results

A total of 49 studies were included. The overall pooled prevalence of PFDs in LMICs was 25% (95% CI 22–29%). The pooled prevalence of UI, FI and POP was 30% (95% CI 25–35%), 8% (95% CI 4–11%) and 15% (95% CI 10–20%), respectively. A significant difference in the prevalence of UI was found between studies conducted in low and lower middle-income and upper middle-income countries and for FI between studies that used validated and non-validated questionnaires. Other methodological features did not show any effect on the variation of prevalence estimates of UI, FI and POP.

Conclusions

PFDs affect a substantial proportion of women in LMICs. Since methodological heterogeneity was unexplained, this review suggests the need for large nationally representative population-based surveys to provide reliable estimates of the prevalence of PFDs in LMICs.

Keywords

Faecal incontinence Low and middle-income countries Pelvic floor disorders Pelvic organ prolapse Urinary incontinence 
This is a preview of subscription content, log in to check access.

Notes

Compliance with ethical standards

Ethics approval

This review is entirely based on published data. Thus, ethics committee approval or written informed consent is not required.

Conflicts of interest

None.

Supplementary material

192_2019_3992_MOESM1_ESM.docx (241 kb)
ESM 1 (DOCX 240 kb)

References

  1. 1.
    Swift S, Woodman P, O'boyle A, Kahn M, Valley M, Bland D, et al. Pelvic Organ Support Study (POSST): the distribution, clinical definition, and epidemiologic condition of pelvic organ support defects. Am J Obstet Gynecol. 2005;192(3):795–806.PubMedGoogle Scholar
  2. 2.
    Walker GJ, Gunasekera P. Pelvic organ prolapse and incontinence in developing countries: review of prevalence and risk factors. Int Urogynecol J. 2011;22(2):127–35.PubMedGoogle Scholar
  3. 3.
    Weber A, Abrams P, Brubaker L, Cundiff G, Davis G, Dmochowski R, et al. The standardization of terminology for researchers in female pelvic floor disorders. Int Urogynecol J. 2001;12(3):178–86.Google Scholar
  4. 4.
    Nygaard I, Barber MD, Burgio KL, Kenton K, Meikle S, Schaffer J, et al. Prevalence of symptomatic pelvic floor disorders in US women. JAMA. 2008;300(11):1311–6.PubMedPubMedCentralGoogle Scholar
  5. 5.
    Wu JM, Vaughan CP, Goode PS, Redden DT, Burgio KL, Richter HE, et al. Prevalence and trends of symptomatic pelvic floor disorders in US women. Obstet Gynecol. 2014;123(1):141.PubMedPubMedCentralGoogle Scholar
  6. 6.
    Abrams P, Cardozo L, Wagg A, Wein A, editors. Incontinence 6th Edition ICI-ICS. International Continence Society, Bristol UK; 2017.Google Scholar
  7. 7.
    Gunasekera P, Sazaki J, Walker G. Pelvic organ prolapse: don't forget developing countries. Lancet. 2007;369(9575):1789–90.PubMedGoogle Scholar
  8. 8.
    Popkin BM. New dynamics in global obesity facing low- and middle-income countries. Obes Rev. 2013;14(02):11–20.PubMedPubMedCentralGoogle Scholar
  9. 9.
    Shrestha LB. Population aging in developing countries. Health Aff (Millwood). 2000;19(3):204–12.Google Scholar
  10. 10.
    Akter F, Gartoulla P, Oldroyd J, Islam RM. Prevalence of, and risk factors for, symptomatic pelvic organ prolapse in rural Bangladesh: a cross-sectional survey study. Int Urogynecol J. 2016;27(11):1753-1759.PubMedGoogle Scholar
  11. 11.
    Bodner-Adler B, Shrivastava C, Bodner K. Risk factors for uterine prolapse in Nepal. Int Urogynecol J. 2007;18(11):1343–6.Google Scholar
  12. 12.
    Lien Y-S, Chen G-D, Ng S-C. Prevalence of and risk factors for pelvic organ prolapse and lower urinary tract symptoms among women in rural Nepal. Int J Gynecol Obstet. 2012;119(2):185–8.Google Scholar
  13. 13.
    Moher D, Liberati A, Tetzlaff J, Altman DG. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. Ann Intern Med. 2009;151(4):264–9.PubMedPubMedCentralGoogle Scholar
  14. 14.
    World Bank, World Bank Country Classification. (2015) http://data.worldbank.org/about/country-and-lending-groups. Retrieved on 29 June 2015.
  15. 15.
    Islam RM, Oldroyd J, Karim MN, Hossain SM, Hoque DME, Romero L, et al. Systematic review and meta-analysis of prevalence of, and risk factors for, pelvic floor disorders in community-dwelling women in low and middle-income countries: a protocol study. BMJ Open. 2017;7(6):e015626.PubMedPubMedCentralGoogle Scholar
  16. 16.
    Ullmann SH, Goldman N, Massey DS. Healthier before they migrate, less healthy when they return? The health of returned migrants in Mexico. Soc Sci Med. 2011;73(3):421–8.PubMedPubMedCentralGoogle Scholar
  17. 17.
    Yagmur Y, Ulukoca N. Urinary incontinence in hospital-based nurses working in Turkey. Int J Gynecol Obstet. 2010;108(3):224–7.Google Scholar
  18. 18.
    Higgins JP, Green S. Cochrane handbook for systematic reviews of interventions. Hoboken: John Wiley & Sons; 2011.Google Scholar
  19. 19.
    Hoy D, Brooks P, Woolf A, Blyth F, March L, Bain C, et al. Assessing risk of bias in prevalence studies: modification of an existing tool and evidence of interrater agreement. J Clin Epidemiol. 2012;65(9):934–9.PubMedGoogle Scholar
  20. 20.
    Higgins JP, Thompson SG. Quantifying heterogeneity in a meta-analysis. Stat Med. 2002;21(11):1539–58.PubMedGoogle Scholar
  21. 21.
    Naing L, Than W, Rusli B. Practical issues in calculating the sample size for prevalence studies. Arch Orofac Sci. 2006;1:9–14.Google Scholar
  22. 22.
    Aguilar-Navarro S, Navarrete-Reyes AP, Grados-Chavarria BH, Garcia-Lara JM, Amieva H, Avila-Funes JA. The severity of urinary incontinence decreases health-related quality of life among community-dwelling elderly. J Gerontol A Biol Sci Med Sci. 2012;67(11):1266–71.PubMedGoogle Scholar
  23. 23.
    Ahmadi B, Alimohammadian M, Golestan B, Mahjubi B, Janani L, Mirzaei R. The hidden epidemic of urinary incontinence in women: a population-based study with emphasis on preventive strategies. Int Urogynecol J Pelvic Floor Dysfunct. 2010;21(4):453–9.Google Scholar
  24. 24.
    Alimohammadian M, Ahmadi B, Janani L, Mahjubi B. Suffering in silence: a community-based study of fecal incontinence in women. Int J Color Dis. 2014;29(3):401–6.Google Scholar
  25. 25.
    de Araujo MP, Takano CC, Girao MJ, Sartori MG. Pelvic floor disorders among indigenous women living in Xingu Indian Park, Brazil. Int Urogynecol J. 2009;20(9):1079–84.Google Scholar
  26. 26.
    Aslan E, Beji NK, Erkan HA, Yalcin O, Gungor F. Urinary incontinence (UI) and quality of life (QoL) of the elderly residing in residential homes in Turkey. Arch Gerontol Geriatr. 2009;49(2):304–10.PubMedGoogle Scholar
  27. 27.
    Badejoko OO, Bola-Oyebamiji S, Awowole IO, Salako AA, Ogunniyi SO. Urinary incontinence: prevalence, pattern, and opportunistic screening in Ile-Ife, Nigeria. Int Urogynecol J. 2016;27(2):269–73.PubMedGoogle Scholar
  28. 28.
    Bodhare T, Valsangkar S, Bele S. An epidemiological study of urinary incontinence and its impact on quality of life among women aged 35 years and above in a rural area. Indian J Urol. 2010;26(3):353–8.PubMedPubMedCentralGoogle Scholar
  29. 29.
    Burti JS, Santos AMB, Pereira RMR, Zambon JP, Marques AP. Prevalence and clinical characteristics of urinary incontinence in elderly individuals of a low income. Arch Gerontol Geriatr. 2012;54(2):e42–6.PubMedGoogle Scholar
  30. 30.
    Demir O, Sen V, Irer B, Bozkurt O, Esen A. Prevalence and possible risk factors for urinary incontinence: a cohort study in the city of Izmir. Urol Int. 2017;99(1):84–90.PubMedGoogle Scholar
  31. 31.
    Santos VL, Domansky Rde C, Hanate C, Matos DS, Benvenuto CV, Jorge JM. Self-reported fecal incontinence in a community-dwelling, urban population in southern Brazil. J Wound Ostomy Continence Nurs. 2014;41(1):77–83.PubMedGoogle Scholar
  32. 32.
    de Souza Santos CR, Santos VL. Prevalence of urinary incontinence in a random sample of the urban population of Pouso Alegre, Minas Gerais, Brazil. Rev Lat Am Enfermagem. 2010;18(5):903–10.PubMedGoogle Scholar
  33. 33.
    Dogan Z, Yalcin A, Atmis V, Cengiz OK, Aras S, Varli M, et al. The prevalence of urinary incontinence and factors associated with urinary incontinence in community dwelling older Turkish people. Eur Geriatr Med. 2015;6(5):417–21.Google Scholar
  34. 34.
    El-Azab AS, Mohamed EM, Sabra HI. The prevalence and risk factors of urinary incontinence and its influence on the quality of life among Egyptian women. Turk J Med Sci. 2007;26(6):783–8.Google Scholar
  35. 35.
    Song YF, Zhang WJ, Song J, Xu B. Prevalence and risk factors of urinary incontinence in Fuzhou Chinese women. Chin Med J. 2005;118(11):887–92.PubMedGoogle Scholar
  36. 36.
    Garcia-Perez H, Harlow SD, Sampselle CM, Denman C. Measuring urinary incontinence in a population of women in northern Mexico: Prevalence and severity. Int Urogynecol J Pelvic Floor Dysfunct. 2013;24(5):847–54.Google Scholar
  37. 37.
    Ge J, Yang P, Zhang Y, Li X, Wang Q, Lu Y. Prevalence and risk factors of urinary incontinence in Chinese women: a population-based study. Asia Pac J Public Health. 2015;27(2):NP1118–31.PubMedGoogle Scholar
  38. 38.
    Gozukara F, Koruk I, Kara B. Urinary incontinence among women registered with a family health center in the southeastern Anatolia region and the factors affecting its prevalence. Turk J Med Sci. 2015;45(4):931–9.PubMedGoogle Scholar
  39. 39.
    Islam R, Bell R, Billah B, Hossain M, Davis S. The prevalence of symptomatic pelvic floor disorders in women in Bangladesh. Climacteric. 2016;19(6):558–64.PubMedGoogle Scholar
  40. 40.
    Jokhio AH, Rizvi RM, Rizvi J, MacArthur C. Urinary incontinence in women in rural Pakistan: Prevalence, severity, associated factors and impact on life. BJOG. 2013;120(2):180–6.PubMedGoogle Scholar
  41. 41.
    Juliato CR, Baccaro LF, Pedro AO, Gabiatti JR, Lui-Filho JF, Costa-Paiva L. Factors associated with urinary incontinence in middle-aged women: a population-based household survey. Int Urogynecol J. 2017;28(3):423–9.PubMedGoogle Scholar
  42. 42.
    Kasikci M, Kilic D, Avsar G, Sirin M. Prevalence of urinary incontinence in older Turkish women, risk factors, and effect on activities of daily living. Arch Gerontol Geriatr. 2015;61(2):217–23.PubMedGoogle Scholar
  43. 43.
    Kocak I, Okyay P, Dundar M, Erol H, Beser E. Female urinary incontinence in the west of Turkey: Prevalence, risk factors and impact on quality of life. Eur Urol. 2005;48(4):634–41.PubMedGoogle Scholar
  44. 44.
    Komeilifar R, Javadifar N, Afshari P, Haghighizade MH, Honarmandpour A. The prevalence, subtypes and obstetric risk factors of urinary incontinence in reproductive age women referred to community health care centers of Dezful, Iran-2015. Int J Community Based Nurs Midwifery. 2017;5(3):275–83.Google Scholar
  45. 45.
    Kumari S, Walia I, Singh A. Self-reported uterine prolapse in a resettlement colony of north India. J Midwifery Women's Health. 2000;45(4):343–50.Google Scholar
  46. 46.
    Liu B, Wang L, Huang SS, Wu Q, Wu DL. Prevalence and risk factors of urinary incontinence among Chinese women in Shanghai. Int J Clin Exp Med. 2014;7(3):686.PubMedPubMedCentralGoogle Scholar
  47. 47.
    Lu S, Zhang H, Zhang YJ, Shao QC. Prevalence and risk factors of urinary incontinence among perimenopausal women in Wuhan. J Huazhong Univ Sci Technolog Med Sci. 2016;36(5):723–6.PubMedGoogle Scholar
  48. 48.
    Manonai J, Poowapirom A, Kittipiboon S, Patrachai S, Udomsubpayakul U, Chittacharoen A. Female urinary incontinence: A cross-sectional study from a Thai rural area. Int Urogynecol J Pelvic Floor Dysfunct. 2006;17(4):321–5.PubMedGoogle Scholar
  49. 49.
    Marques LP, Schneider IJC, Giehl MWC, Antes DL, d'Orsi E. Demographic, health conditions, and lifestyle factors associated with urinary incontinence in elderly from Florianópolis, Santa Catarina, Brazil. Rev Bras Epidemiol. 2015;18:595–606.PubMedGoogle Scholar
  50. 50.
    Megabiaw B, Adefris M, Rortveit G, Degu G, Muleta M, Blystad A, et al. Pelvic floor disorders among women in Dabat district, northwest Ethiopia: a pilot study. Int Urogynecol J Pelvic Floor Dysfunct. 2013;24(7):1135–43.Google Scholar
  51. 51.
    Ojengbede OA, Morhason-Bello IO, Adedokun BO, Okonkwo NS, Kolade CO. Prevalence and the associated trigger factors of urinary incontinence among 5000 black women in sub-Saharan Africa: findings from a community survey. BJU Int. 2011;107(11):1793–800.PubMedGoogle Scholar
  52. 52.
    Onur R, Deveci SE, Rahman S, Sevindik F, Acik Y. Prevalence and risk factors of female urinary incontinence in eastern Turkey. Int J Urol. 2009;16(6):566–9.PubMedGoogle Scholar
  53. 53.
    Ozdemir K, Sahin S, Ozerdogan N, Unsal A. Evaluation of urinary incontinence and quality of life in married women aged between 20 and 49 years (Sakarya, Turkey). Turk J Med Sci. 2018;48(1):100–9.PubMedGoogle Scholar
  54. 54.
    Ozerdogan N, Beji NK, Yalcin O. Urinary incontinence: Its prevalence, risk factors and effects on the quality of life of women living in a region of Turkey. Gynecol Obstet Investig. 2004;58(3):145–50.Google Scholar
  55. 55.
    Pathiraja R, Prathapan S, Goonawardena S. Urinary incontinence of women in a nationwide study in Sri Lanka: prevalence and risk factors. Urol J. 2017;14(3):3075–80.PubMedGoogle Scholar
  56. 56.
    Prasad Paneru D. A study of prevalence and associated factors of uterus prolapse in Doti district of Nepal. Indian J Public Health Res Dev. 2013;4(3):53–7.Google Scholar
  57. 57.
    Prabhu SA, Shanbhag SS. Prevalence and risk factors of urinary incontinence in women residing in a tribal area in Maharashtra, India. J Res Health Sci. 2013;13(2):125–30.PubMedGoogle Scholar
  58. 58.
    Reigota RB, Pedro AO, Souza Santos D, Machado V, Costa-Paiva L, Pinto-Neto AM. Prevalence of urinary incontinence and its association with multimorbidity in women aged 50 years or older: a population-based study. Neurourol Urodyn. 2016;35(1):62–8.PubMedGoogle Scholar
  59. 59.
    Sampaio AS, Fraga LGA, Salomao BA, Oliveira JB, Seixas CL, Veiga ML, et al. Are lower urinary tract symptoms in children associated with urinary symptoms in their mothers? J Pediatr Urol. 2017;13(3):269.e1-269.e6.PubMedGoogle Scholar
  60. 60.
    Seshan, V, Muliira, JK. Self-reported urinary incontinence and factors associated with symptom severity in community dwelling adult women: implications for women's health promotion. BMC Womens Health. 2013;13:16  https://doi.org/10.1186/1472-6874-13-16.
  61. 61.
    Wardani RS, Judistiani RTD, Siddiq A. Prevalence of urinary incontinence in women aged 20–59 years in community dwellings. Althea Med J. 2017;4(2):178–83.Google Scholar
  62. 62.
    Sidik SM. The prevalence of urinary incontinence among the elderly in a rural community in Selangor. Malays J Med Sci. 2010;17(2):18–23.Google Scholar
  63. 63.
    Sumardi R, Mochtar CA, Junizaf, Santoso BI, Setiati S, Nuhonni SA, et al. Prevalence of urinary incontinence, risk factors and its impact: multivariate analysis from Indonesian nationwide survey. Acta Med Indones. 2014;46(3):175–82.PubMedGoogle Scholar
  64. 64.
    Suyasa IG, Xiao LD, Lynn PA, Skuza PP, Paterson J. Prevalence of faecal incontinence in community-dwelling older people in Bali, Indonesia. Australas J Ageing. 2015;34(2):127–33.PubMedGoogle Scholar
  65. 65.
    Townsend MK, Lajous M, Medina-Campos RH, Catzin-Kuhlmann A, Lopez-Ridaura R, Rice MS. Risk factors for urinary incontinence among postmenopausal Mexican women. Int Urogynecol J. 2017;28(5):769–76.PubMedGoogle Scholar
  66. 66.
    Wusu-Ansah OK, Opare-Addo HS. Pelvic organ prolapse in rural Ghana. Int J Gynecol Obstet. 2008;103(2):121–4.Google Scholar
  67. 67.
    Zhu L, Lang J, Wang H, Han S, Huang J. The prevalence of and potential risk factors for female urinary incontinence in Beijing, China. Menopause. 2008;15(3):566–9.PubMedGoogle Scholar
  68. 68.
    Zhu L, Lang J, Liu C, Han S, Huang J, Li X. The epidemiological study of women with urinary incontinence and risk factors for stress urinary incontinence in China. Menopause. 2009;16(4):831–6.PubMedGoogle Scholar
  69. 69.
    Barber MD, Walters MD, Bump RC. Short forms of two condition-specific quality-of-life questionnaires for women with pelvic floor disorders (PFDI-20 and PFIQ-7). Am J Obstet Gynecol. 2005;193(1):103–13.PubMedPubMedCentralGoogle Scholar
  70. 70.
    Bartlett LM, Nowak MJ, Ho Y. Faecal incontinence in rural and regional northern Queensland community-dwelling adults. Rural Remote Health. 2013;13(4):2563.PubMedGoogle Scholar
  71. 71.
    Bharucha AE, Dunivan G, Goode PS, Lukacz ES, Markland AD, Matthews CA, et al. Epidemiology, pathophysiology, and classification of fecal incontinence: state of the science summary for the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) workshop. Am J Gastroenterol. 2015;110(1):127–36.PubMedGoogle Scholar

Copyright information

© The International Urogynecological Association 2019

Authors and Affiliations

  1. 1.Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive MedicineMonash UniversityMelbourneAustralia
  2. 2.Women’s Health Research Program, School of Public Health and Preventive MedicineMonash UniversityMelbourneAustralia
  3. 3.Environmental and Occupational Health SciencesEHESP French School of Public HealthParisFrance
  4. 4.The Ian Potter LibraryThe Alfred HospitalMelbourneAustralia

Personalised recommendations

Cite article

Buy options