Читать книгу Ambulatory Urology and Urogynaecology - Группа авторов - Страница 42

 Genetic predisposition: Women with prolapse were more likely to have positive family history and an increased prevalence of congenital weakness of connective tissue. A systematic review of genetic studies found that collagen type 3 alpha 1 was associated with POP (OR 4.79).

 Age: According to The National Institute of Health study, the prevalence of PFD varies from 10% at ages 20–39 years, 27% at 40–59 years, 37% at 60–79 years to nearly 50% affected at 80 years of age and older. The US National Health and Nutrition Examination Survey 2005–2010 stated that the prevalence of faecal incontinence increased from 2.91% among the 20–29 years old to 16.16% among participants 70 years and older.

 Race: Although the evidence is scarce, Latin and Caucasian women were found to have a higher risk of symptomatic POP as compared to African American women. Similarly, the age‐adjusted prevalence of weekly UI varied based on ethnicity. Hispanic women had the highest rates, followed by white, black, and Asian American women (36, 30, 25, and 19% respectively, p > 0.001). It may be important to note the bias due to the impact of culture‐based differences in perception of symptoms.

 Obesity: Increased body mass index (BMI) is an independent risk factor for pelvic floor disorders and progression of POP. Weight loss has not been associated with prolapse resolution, but studies have shown that weight loss through lifestyle changes and/or bariatric surgery in overweight or obese women improves both urinary and faecal incontinence.

 Parity: Though vaginal birth has been considered the most important inciting factor for pelvic floor disorders, pregnancy itself has been shown to be a risk factor. Studies have shown a direct correlation between the incidence of pelvic floor disorders and parity: 12.8, 18.4, 24.6, and 32.4 for 0, 1, 2, and 3 or more deliveries, respectively (P < 0.001). Operative vaginal deliveries and perineal lacerations increase the risk further. Spontaneous vaginal birth as compared to caesarean birth without labour has been associated with higher rates of prolapse or stress incontinence.

 Smoking: The Pelvic Organ Support Study (POSST) 2005, revealed that smoking was an independent risk factor for pelvic disorders including POP and UI. The prevalence of prolapse increased significantly amongst nulliparous smokers as compared to nulliparous non‐smokers (28vs 12%, adjusted OR 1.95).

 Medical disorders: Studies have shown an association between pelvic floor disorders and various medical conditions including diabetes mellitus, connective tissue disorders, chronic obstructive pulmonary disease (COPD), and certain neurological diseases.

 Coexisting pelvic floor disorders: Pelvic floor disorders often coexist. Patients with POP often complain of SUI due to obvious reasons. It is often difficult to find patients with any one form of incontinence as most patients have concurrent stress and urge incontinence. Therefore, it is important to analyse these patients thoroughly before formulating a treatment plan.

 Others: Traumatic injury to the pelvic region including injuries due to pelvic surgery or pelvic irradiation and heavy lifting are associated with PFD.