Abstract
Introduction and hypothesis
The prevalence of pelvic floor disorders (PFD) and their impact on quality of life of women vary among different populations. The purpose of this study was to assess the prevalence of symptoms of PFD, and their degree of bother in a convenience sample of Lebanese women, and to evaluate health-care seeking (HCS) behavior related to PFD.
Methods
Women visiting clinics in a University Medical Center in Beirut, Lebanon, completed the self-filled validated Arabic version of the Global Pelvic Floor Bother Questionnaire (PFBQ). Data covering demographics, comorbidities, and HCS behavior related to PFD were collected. Total individual PFBQ scores, individual PFD symptom scores and HCS behavior were correlated to demographic data and comorbidities.
Results
The study participants included 900 women. PFBQ scores were significantly higher in women of older age, women with a lower level of education, women with higher vaginal parity, and women who engaged in heavy lifting/physical activity. BMI >25 kg/m2 was the strongest independent risk factor for the presence of PFD symptoms. The overall prevalence of urinary incontinence was 42 %. Anal incontinence was the most bothersome PFD. Almost two thirds of the women reported HCS due to any aspect of PFD. Among symptomatic women who believed that their PFD warranted HCS, financial concern was the most common obstacle irrespective of age and educational level.
Conclusions
In this convenience sample of Lebanese women, PFD symptoms were common and were significantly correlated with demographic characteristics and self-reported comorbidities. The key reason for not seeking health care related to PFD was financial concern.
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Abbreviations
- AI:
-
Anal incontinence
- BMI:
-
Body mass index
- CD:
-
Cesarean delivery
- HCS:
-
Health-care seeking
- MUI:
-
Mixed urinary incontinence
- OAB:
-
Overactive bladder
- PFBQ:
-
Pelvic Floor Bother Questionnaire
- PFD:
-
Pelvic floor disorder
- POP:
-
Pelvic organ prolapse
- QoL:
-
Quality of life
- SUI:
-
Stress urinary incontinence
- UI:
-
Urinary incontinence
- UUI:
-
Urgency urinary incontinence
- VD:
-
Vaginal delivery
References
Dieter AA, Wilkins MF, Wu JM. Epidemiological trends and future care needs for pelvic floor disorders. Curr Opin Obstet Gynecol. 2015;275:380–4.
McKinlay JB, Link CL. Measuring the urologic iceberg: design and implementation of the Boston Area Community Health (BACH) Survey. Eur Urol. 2007;52:389–96.
Irwin DE, Milsom I, Hunskaar S, Reilly K, Kopp Z, Herschorn S, et al. Population-based survey of urinary incontinence, overactive bladder, and other lower urinary tract symptoms in five countries: results of the EPIC study. Eur Urol. 2006;50:1306–14.
Cooper J, Annappa M, Dracocardos D, et al. Prevalence of genital prolapse symptoms in primary care: a cross-sectional survey. Int Urogynecol J. 2014;26:505–10.
Walker GJA, Gunasekera P. Pelvic organ prolapse and incontinence in developing countries: review of prevalence and risk factors. Int Urogynecol J. 2010;22:127–35.
Wu JM, Vaughan CP, Goode PS, Redden DT, Burgio KL, Richter HE, et al. Prevalence and trends of symptomatic pelvic floor disorders in U.S. women. Obstet Gynecol. 2014;123:141–8.
Bazi T, Takahashi S, Ismail S, Bø K, Ruiz-Zapata AM, Duckett J, et al. Prevention of pelvic floor disorders: International Urogynecological Association Research and Development Committee opinion. Int Urogynecol J. 2016. doi:10.1007/s00192-016-2993-9.
Barber MD. Questionnaires for women with pelvic floor disorders. Int Urogynecol J Pelvic Floor Dysfunct. 2007;18:461–5.
Peterson TV, Karp DR, Aguilar VC, Davila GW. Validation of a global pelvic floor symptom bother questionnaire. Int Urogynecol J. 2010;21:1129–35.
World Health Organization. Countries: Lebanon. Beirut: World Health Organization; 2016. http://www.who.int/countries/lbn/en/. Accessed 25 June 2016.
Bazi T, Kabakian-Khasholian T, Ezzeddine D, Ayoub H. Validation of an Arabic version of the global Pelvic Floor Bother Questionnaire. Int J Gynecol Obstet. 2013;121:166–9.
Dooley Y, Kenton K, Cao G, et al. Urinary incontinence prevalence: results from the National Health and Nutrition Examination Survey. J Urol. 2008;179:656–61.
Onur R, Deveci SE, Rahman S, et al. Prevalence and risk factors of female urinary incontinence in eastern Turkey. Int J Urol. 2009;16:566–9.
Al-Badr A, Brasha H, Al-Raddadi R, Noorwali F, Ross S. Prevalence of urinary incontinence among Saudi women. Int J Gynaecol Obstet. 2012;117:160–3.
Altaweel W, Alharbi M. Urinary incontinence: prevalence, risk factors, and impact on health related quality of life in Saudi Women. Neurourol Urodyn. 2012;31:642–5.
Haylen BT, Ridder DD, Freeman RM, et al. An International Urogynecological Association (IUGA)/International Continence Society (ICS) joint report on the terminology for female pelvic floor dysfunction. Int Urogynecol J. 2009;21:5–26.
Coyne KS, Sexton CC, Thompson CL, Milsom I, Irwin D, Kopp ZS, et al. The prevalence of lower urinary tract symptoms (LUTS) in the USA, the UK and Sweden: results from the Epidemiology of LUTS (EpiLUTS) study. BJU Int. 2009;104:352–60.
Awwad J, Sayegh R, Yeretzian J, Deeb ME. Prevalence, risk factors, and predictors of pelvic organ prolapse. Menopause. 2012;19:1235–41.
Dunivan GC, Cichowski SB, Komesu YM, et al. Ethnicity and variations of pelvic organ prolapse bother. Int Urogynecol J. 2013;25:53–9.
Townsend MK, Matthews CA, Whitehead WE, Grodstein F. Risk factors for fecal incontinence in older women. Am J Gastroenterol. 2012;108:113–9.
Kinchen KS, Burgio K, Diokno AC, et al. Factors associated with women’s decisions to seek treatment for urinary incontinence. J Womens Health (Larchmt). 2003;12:687–98.
Minassian VA, Yan X, Lichtenfeld MJ, et al. The iceberg of health care utilization in women with urinary incontinence. Int Urogynecol J. 2012;23:1087–93.
El-Azab AS, Shaaban OM. Measuring the barriers against seeking consultation for urinary incontinence among Middle Eastern Women. BMC Womens Health. 2010;10:3.
Apostolidis A, Nunzio CD, Tubaro A. What determines whether a patient with LUTS seeks treatment?: ICI-RS 2011. Neurourol Urodyn. 2012;31:365–9.
O’Donnell M, Lose G, Sykes D, et al. Help-seeking behaviour and associated factors among women with urinary incontinence in France, Germany, Spain and the United Kingdom. Eur Urol. 2005;47:385–92.
Sfeir R. Strategy for national health care reform in Lebanon. 2007. http://www.fgm.usj.edu.lb/pdf/a62007.pdf. Accessed 25 June 2016.
Byblos Bank. Lebanon this week. http://www.byblosbank.com/library/files/lebanon/publications/economic%20Research/Lebanon%20This%20week/Lebanon%20This%20Week/_339.pdf. Accessed 25 Apr 2016.
Heit M, Blackwell L, Kelly S. Measuring barriers to incontinence care seeking. Neurourol Urodyn. 2008;27:174–8.
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Appendices
Appendix 1. PFBQ
Appendix 2. Additional questions
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Ghandour, L., Minassian, V., Al-Badr, A. et al. Prevalence and degree of bother of pelvic floor disorder symptoms among women from primary care and specialty clinics in Lebanon: an exploratory study. Int Urogynecol J 28, 105–118 (2017). https://doi.org/10.1007/s00192-016-3080-y
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DOI: https://doi.org/10.1007/s00192-016-3080-y