Achille Lucio Gaspari and Pierpaolo Sileri (eds.)Updates in SurgeryPelvic Floor Disorders: Surgical Approach10.1007/978-88-470-5441-7_2
© Springer-Verlag Italia 2014
2. Epidemiology and Prevalence of Pelvic Floor Disorders
(1)
Department of Experimental Medicine and Surgery, Tor Vergata University, Rome, Italy
Abstract
Pelvic floor disorders (PFDs) manifest with a variable spectrum of symptoms and can involve anterior, middle and posterior compartments. PFDs represent an important aspect of global healthcare, with about 28 million women affected by these diseases worldwide. This number is expected to reach 44 million in the next 40 years. In the literature, the incidence and prevalence of PFDs are often reported inconsistently, depending on the definitions used, the measures considered to assess the stages, the gender and age of the patient, and the severity of the pathology. The etiology of these disorders is multifactorial and it is important to identify the risk factors, because avoiding them or reducing exposure to them can change the natural history of PFDs, allowing physicians to make an earlier diagnosis and use more effective therapy.
2.1 Introduction
Pelvic floor disorders (PFDs) manifest with a variable spectrum of symptoms and can involve anterior, middle and posterior compartments. PFDs represent an important aspect of global healthcare, with about 28 million women affected by these diseases worldwide. This number is expected to reach 44 million in the next 40 years. In the literature, the incidence and prevalence of PFDs are often reported inconsistently, depending on the definitions used, the measures considered to assess the stages, the gender and age of the patient, and the severity of the pathology. The etiology of these disorders is multifactorial and it is important to identify the risk factors, because avoiding them or reducing exposure to them can change the natural history of PFDs, allowing physicians to make an earlier diagnosis and use more effective therapy.
2.2 Definitions, Costs, and Prevalence of Pelvic Floor Disorders
Pelvic floor disorders (PFDs) manifest with a variable spectrum of symptoms and can involve the anterior, middle, and posterior compartments of the pelvic floor. PFDs can manifest as:
Urinary incontinence and sensory abnormalities of lower urinary tract
Pelvic organ prolapse
Anal incontinence
Obstructed defecation
Chronic pain syndromes related to the pelvic organs
PFDs represent an important aspect of global healthcare, with an incidence of about 4 million visits per year to physicians in the USA (1% of total ambulatory visits). In 1997, costs of pelvic organ prolapsed (POP) surgery in the USA were US$1,012 million, including US$494 million for vaginal hysterectomy, US$279 million dollars for cystocele and rectocele repair, and US$135 million for abdominal hysterectomy. Moreover, costs for physician services and hospitalization increase the total expense. An indirect expense is represented by days absent from work due to illness [1].
The incidence of PFDs is increasing: 48,000 surgical procedures for urinary incontinence (UI) were performed in 1979, and over 100,000 were performed in 2004 [2]. For a woman aged 80 years, the lifetime risk of undergoing surgery for PFD is 11% [3]. Annually, in the USA, 80,000 surgical procedures are performed for UI, 220,000 for POP, and 3,500 for fecal incontinence. The following rates have been reported for age distribution of surgical treatment: 7, 24, 31, and 17 per 10,000 in reproductive, perimenopausal, postmenopausal, and elderly women, respectively [4].
It is thought that these numbers will increase, as the number of women expected to develop PFD increases in future decades. At present, the number of women affected by PFDs is about 28 million, and this number is expected to reach 44 million in the next 40 years. Moreover, the prevalence of PFD increases as the average age of the women increases; the percentage of PFD recurrence (currently 30%) also increases with age [5].
In the scientific literature, reports of the incidence and prevalence of PFD can be inconsistent, depending on the definitions used, the measures considered to assess the stages of PFD, the gender and age of the patient, and the severity of the pathology. Globally, we can assume that the prevalence of PFD may vary from 37% to 68% [6]. The National Health and Nutrition Examination Survey (NHANES) estimated that 24% of adult women experienced PFD symptoms. This prevalence increased with age: about 38% of women aged 60–79 years, and about 50% of women aged 80 years, were affected by PFD. In 2010, about 28 million people had a PFD in the USA.
2.3 Pelvic Floor Disorders
In order to increase our knowledge of the pathology of PFDs and their real impact on the global population, it is important to analyze the prevalence and incidence of each of the various manifestations of PFD.
2.3.1 Urinary Incontinence
The International Continence Society defined UI as “the complaint of any involuntary leakage of urine”. A review of 21 studies revealed a prevalence of 34% for any incontinence. Younger women are more affected by stress incontinence, while older women are affected by mixed and urge incontinence. Some studies have not found any relationship between ethnic origin and incidence of UI [7], while other studies on the USA population have found that 36% of Hispanic, 30% of white, 35% of black, and 19% of Asian American women experienced UI [8].
2.3.2 Pelvic Organ Prolapse
POP is defined as the complex of rectocele, cistocele and uterine prolapse. Based on a study conducted by Women’s Health Initiative [9], the general prevalence of POP is thought to be 41%. Further distinguishing between the different clinical manifestations of POP, the prevalence of cystocele varies from 25% to 34%, that of rectocele from 13% to 19%, and that of uterine prolapse from 4% to 14%, considering any grade of prolapse.
2.3.3 Anal Incontinence
Anal incontinence (AI) is defined as involuntary passage of gas, mucus, or liquid or solid feces. In the literature, the reported prevalence of AI varies from 2% to 24%, depending on the different definitions used for AI in scientific papers. Age is a risk factor for AI and an increase in adds ratio of 1.20 has been demonstrated for an increase of 10 years in age. According to scientific data, ethnicity does not appear to be a relevant factor in AI [2].
2.3.4 Obstructed Defecation
Obstructed defecation (OD) is defined as a persistent, difficult, infrequent, and incomplete evacuation. The prevalence of OD is 2–30% in the general population. OD can be caused either by slow intestinal transit and functional abnormalities, such as dyssynergic contraction of the pelvic floor muscles, which are more frequent in younger women, or by structural abnormalities of the pelvic floor, such as rectal prolapse and rectocele, which are more frequent in older women. It is important to distinguish between various causes of OD, as they can be treated differently [10].
Related posts:
Stay updated, free articles. Join our Telegram channel
Full access? Get Clinical Tree
