Lectures

Prolapse

  • Vaginal prolapse is common, affecting up to half of adult women [1]
  • Lifetime risk of undergoing 1st time POP surgery 11-12%, up to 19% in an Australian study [2,3]
  • The presence of prolapse doesn't necessarily mean it needs treatment - it depends on how much it is affecting the woman's quality of life.
  • In severe cases of prolapse, obstruction of the ureters (the tubes which connect the kidneys to the baldder) and kidney function impairment can offer. In these cases, treatment is required [4]
  • Vaginal prolapse is divided into 3 compartments: anterior (bladder), posterior (rectum), and apical (uterine or vault).

Urinary Incontinence

  • It is estimated that nearly 50% of adult women experience urinary incontinence, and only 20-61% of symptomatic community-dwelling women seek care. [5-7]
  • Stress urinary incontinence and urge incontinence are the 2 most common types of incontinence that women present with.
  • Stress urinary incontinence is urine leakage with any activities that increase intra-abdominal pressure e.g. coughing, laughing, sneezing - this is most common in younger women especially 45-49 years old [5,8-9]
  • Urge incontinence is urine leakage preceded by a sudden and strong need to urinate.
  • "Overactive bladder" is a term that describes a syndrome of urinary urgency with or without incontinence, which is often accompanies by nocturia and urinary frequency.
  • Overall prevalence of urinary incontinence in non-pregnant women >20 years = 10-17% [10-11]
  • Compared with no treatment, women treated with pelvic muscle exercises were more likely to report improvement or cure of any urinary incontinence (67% vs 29%; RR 2.39) [13]. Outcomes are better with regular exercise that has been supervised.
  • Urinary incontinence only needs treatment if it is significantly affecting the woman's quality of life.

References:

  1. Hendrix SL, et al. Pelvic organ prolapse in the Women's Health Initiative: gravity and gravidity. Am J Obstet Gynecol. 2002;186(6):1160.
  2. Olsen AL, et al. Epidemiology of surgically managed pelvic organ prolapse and urinary incontinence. Obstet Gynecol. 1997;89(4):501.
  3. Smith FJ, Holman CDJ, Moorin RE, Tsokos N, Obstet Gynecol 2010; 116,5:1096-1100
  4. Australian Commission on Safety and Quality in Healthcare. Treatment Options for pelvic organ prolapse. Accessed 26 Aug 2019 at: https://www.safetyandquality.gov.au/sites/default/files/migrated/Treatment-Options-POP-Consumer-Info.pdf
  5. Hannestad YS, Rortveit G, Hunskaar S. Help-seeking and associated factors in female urinary incontinence. The Norwegian EPINCONT Study. Epidemiology of Incontinence in the County of Nord-Tr√łndelag. Scand J Prim Health Care. 2002 Jun;20(2):102-7.
  6. Minassian VA, et al. The iceberg of health care utilization in women with urinary incontinence. Int Urogynecol J. 2012;23(8):1087. Epub 2012 Apr 12
  7. Morrill M, et al. Seeking healthcare for pelvic floor disorders: a population-based study. Am J Obstet Gynecol. 2007 Jul;197(1):86.e1-6.
  8. Wood LN, Anger JT. Urinary incontinence in women. BMJ. 2014;349:g4531. Epub 2014 Sep 15.
  9. Minassian VA, et al. Clinical epidemiological insights into urinary incontinence. Int Urogynecol J. 2017;28(5):687. Epub 2017 Mar 20.
  10. O'Halloran T, et al. Urinary incontinence in young nulligravid women: a cross-sectional analysis. Ann Intern Med. 2012;157(2):87.
  11. Wu JM, et al. Prevalence and trends of symptomatic pelvic floor disorders in U.S. women. Obstet Gynecol. 2014 Jan;123(1):141-8.
  12. Urinary Incontinence: An inevitable part of aging? National Poll on Health Aging. University of Michigan. November 2018 www.healthyagingpoll.org/sites/default/files/2018-11/NPHA_Incontinence-Report_FINAL-110118.pdf (Accessed on November 02, 2018).
  13. Dumoulin C, et al. Cochrane Database Syst Rev. 2018;10:CD005654. Epub 2018 Oct 4