liu.seSearch for publications in DiVA
Change search
CiteExportLink to record
Permanent link

Direct link
Cite
Citation style
  • apa
  • harvard1
  • ieee
  • modern-language-association-8th-edition
  • vancouver
  • oxford
  • Other style
More styles
Language
  • de-DE
  • en-GB
  • en-US
  • fi-FI
  • nn-NO
  • nn-NB
  • sv-SE
  • Other locale
More languages
Output format
  • html
  • text
  • asciidoc
  • rtf
Pelvic floor dysfunction: a clinical and epidemiological study
Linköping University, Department of Molecular and Clinical Medicine, Obstetrics and gynecology. Linköping University, Faculty of Health Sciences.
2003 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

In a prospective study established in 1990, anal sphincter rupture at delivery was found in 2.4% of women and 47% of these women had problems with fecal incontinence. Although less severe, fecal incontinence was also found among 45% in a comparison group without anal sphincter rupture. In a follow-up study after ten years, no improvement was noted in either group. Women with anal sphincter rupture were more subjectively incontinent and had lower anal pressures than the comparison group. Women with subsequent vaginal deliveries had lower anal pressures and more incontinence than those delivered by caesarean section or no subsequent delivery.

In an epidemiological study of 1368 women, urinary incontinence was found in 9% of 40-year-olds and 19% of 60-year-olds. Flatus incontinence was found in 9% and 19%, incontinence for liquid stool in 5% and 8% and for solid stool 0.3% and 1. 7% in 40-year-olds and 60-year-olds, respectively. Genital prolapse symptoms were found in 4% (genital bulge), 15% (pelvic heaviness) and use of finger in vagina or perineum by defecation (12%) in all women.

Factors associated with urinary and fecal incontinence were anal sphincter rupture, chronic bronchitis, overweight, multiparity, age, hiatus and groin hernias and hysterectomy. Prolapse symptoms were associated with vaginal delivery and large tears at delivery but not with overweight. All types of incontinence and genital prolapse were strongly associated with each other.

For epidemiological studies, the definition of urinary incontinence as leakage weekly or more often is suggested. The concept of flatus incontinence needs careful operationalization to be of value in differentiating symptoms of anal sphincter dysfunction from disorders of bowel motility and normal passing of wind. A model for operationalization is proposed. Possible measures for the prevention of PFD could be prevention of chronic bronchitis, overweight and large injuries at delivery, especially after large tears and anal sphincter rupture.

Place, publisher, year, edition, pages
Linköping: Linköpings universitet , 2003. , 78 p.
Series
Linköping University Medical Dissertations, ISSN 0345-0082 ; 822
National Category
Medical and Health Sciences
Identifiers
URN: urn:nbn:se:liu:diva-26675Local ID: 11242ISBN: 91-7373-511-6 (print)OAI: oai:DiVA.org:liu-26675DiVA: diva2:247224
Public defence
2003-11-14, Victoriasalen, Universitetssjukhuset, Linköping, 09:00 (Swedish)
Opponent
Available from: 2009-10-08 Created: 2009-10-08 Last updated: 2012-10-16Bibliographically approved
List of papers
1. Clinical consequences of anal sphincter rupture during vaginal delivery
Open this publication in new window or tab >>Clinical consequences of anal sphincter rupture during vaginal delivery
Show others...
1996 (English)In: Journal of the American College of Surgeons, ISSN 1072-7515, E-ISSN 1879-1190, Vol. 183, no 6, 553-558 p.Article in journal (Refereed) Published
Abstract [en]

BACKGROUND:

Rupture of the anal sphincters at childbirth is considered rare in obstetric literature. Long-term effects are sparingly mentioned. In clinical practice, however, it is not uncommon to meet women with anal incontinence. The aim of our study was to record the incidence and to evaluate the consequences of rupture of the anal sphincter at childbirth.

STUDY DESIGN:

Fifty-one consecutive women with primarily sutured anal sphincter rupture and 31 women without anal sphincter rupture were prospectively studied after vaginal delivery. All were assessed clinically at 3 days, 6 weeks, and 6 months after delivery. After 6 months, all women underwent anorectal manometry and answered a questionnaire about incontinence, social function, and general health.

RESULTS:

The overall incidence of sphincter rupture was 2.4 percent. Significantly lower values were found for maximum anal squeeze pressure and squeeze pressure area 6 months postpartum in the women with sphincter rupture compared with those without rupture. The resting pressures did not differ between groups. Approximately 40 percent of the women in both groups had noted some fecal incontinence by 6 months postpartum. Symptoms were significantly more severe in patients with sphincter rupture.

CONCLUSIONS:

Anal sphincter rupture was 2.4 times as common as reported in Swedish birth statistics. The high incidence of fecal incontinence by 6 months postpartum in all women is surprising and deserves further investigation, specifically regarding occult sphincter rupture.

National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-84646 (URN)8957456 (PubMedID)
Available from: 2012-10-16 Created: 2012-10-16 Last updated: 2017-12-07Bibliographically approved
2. Prevalence of urinary and fecal incontinence and symptoms of genital prolapse in women
Open this publication in new window or tab >>Prevalence of urinary and fecal incontinence and symptoms of genital prolapse in women
2003 (English)In: Acta Obstetricia et Gynecologica Scandinavica, ISSN 0001-6349, E-ISSN 1600-0412, Vol. 82, no 3, 280-286 p.Article in journal (Refereed) Published
Abstract [en]

Background. Urinary incontinence is common in women. How often incontinence occurs has been only briefly investigated. Studies on the prevalence of fecal incontinence are few. The epidemiology of genital prolapse symptoms is unknown. This epidemiological study describes a general population of women aged 40 and 60 years with regard to the prevalence and frequency of urinary and fecal incontinence and the prevalence of genital prolapse symptoms.

Methods. A questionnaire on medical background, urinary and fecal incontinence, and genital prolapse symptoms was sent to 1000 40-year-old and 1000 60-year-old randomly selected women.

Results. Sixty-seven per cent answered: 53% were continent for urine; 9% of the 40-year-olds and 19% of the 60-year-olds had urinary incontinence weekly or more often. Detrusor instability score was significantly higher in the 60-year-olds. Incontinence of flatus, weekly or more often, was reported by 9% and 19%, loose feces by 5% and 8%, and solid feces by 0.3% and 1.7% according to the 40- and 60-year-olds, respectively. Fifty-three per cent reported no flatus incontinence. Of the prolapse symptoms investigated, 15% of the females reported pelvic heaviness, 4% genital bulge, and 12% use of fingers in the vagina or perineum by defecation.

Conclusions. Incontinence of urine is common in this population. Flatus incontinence is as common, but the concept must be operationalized if used as an endpoint in research. The International Continence Society's (ICS) definition of urinary incontinence is unpractical for use in epidemiological research. We suggest leakage weekly or more often as a criterion for significant incontinence in epidemiological research.

National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-26510 (URN)10.1034/j.1600-0412.2003.00103.x (DOI)11067 (Local ID)11067 (Archive number)11067 (OAI)
Available from: 2009-10-08 Created: 2009-10-08 Last updated: 2017-12-13Bibliographically approved
3. Factors associated with pelvic floor dysfunction with emphasis on urinary and fecal incontinence and genital prolapse: an epidemiological study
Open this publication in new window or tab >>Factors associated with pelvic floor dysfunction with emphasis on urinary and fecal incontinence and genital prolapse: an epidemiological study
2004 (English)In: Acta Obstetricia et Gynecologica Scandinavica, ISSN 0001-6349, E-ISSN 1600-0412, Vol. 83, no 4, 383-389 p.Article in journal (Refereed) Published
Abstract [en]

Objective.  To describe a general population of women with regard to factors associated with urinary and fecal incontinence and genital prolapse symptoms.

Methods.  A questionnaire about medical background, urinary and fecal incontinence and genital prolapse symptoms was mailed to 1000 40-year-old and 1000 60-year-old Swedish women. Associations were described by odds ratios (ORs) with 95% confidence intervals (CIs).

Results.  Sixty-seven percent answered the questionnaire. Multivariate analysis showed urinary incontinence to be associated with anal sphincter rupture [OR 4.4 (95%  CI 1.0–18.8)], pelvic heaviness [3.8 (2.1–7.0)], body mass index (BMI) ≥30 kg/m2[3.7 (2.0–6.7)], multiparity [1.8 (1.0–3.4)], varicose veins surgery [1.9 (1.2–3.2)] and age [1.9 (1.2–3.2)]. Univariate analyses revealed statistically significant associations between urinary incontinence and incontinence for flatus [4.8 (3.0–7.8)], for liquid stool [5.0 (2.9–8.6)] and for solid stool [5.9 (2.4–14.2)]. Chronic bronchitis [5.7 (1.7–18.9)] was strongly associated with urinary incontinence but was only reported by the older age group. Prolapse symptoms were strongly associated with both urinary and fecal incontinence. Prolapse symptoms as opposed to urinary and fecal incontinence seemed to be associated more with injuries at delivery than with chronic pelvic floor strain.

Conclusions.  Women with urinary incontinence are also likely to suffer from fecal incontinence and prolapse and vice versa. Other associated factors for pelvic floor dysfunction were overweight, and especially obesity, chronic bronchitis, vaginal delivery and multiparity, age, heredity and diseases suggestive of collagen disorders. A multidisciplinary management of women with pelvic floor symptoms is suggested and possible prevention is discussed.

National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-22262 (URN)10.1111/j.0001-6349.2004.00367.x (DOI)1435 (Local ID)1435 (Archive number)1435 (OAI)
Available from: 2009-10-07 Created: 2009-10-07 Last updated: 2017-12-13Bibliographically approved
4. Obstetric anal sphincter injury ten years after: subjective and objective long term effects
Open this publication in new window or tab >>Obstetric anal sphincter injury ten years after: subjective and objective long term effects
2005 (English)In: British Journal of Obstetrics and Gynecology, ISSN 1470-0328, E-ISSN 1471-0528, Vol. 112, no 3, 312-316 p.Article in journal (Refereed) Published
Abstract [en]

Objective  To establish the long term effects of obstetric anal sphincter rupture.

Design  Prospective observational study.

Setting  University hospital in Sweden.

Population  Eighty-two women from a prospective study from 1990 to compare anorectal function after third degree tear.

Methods  Women completed a structured questionnaire, underwent a clinical examination and anorectal manometry, endoanal ultrasound (EAUSG) with perineal body measurement.

Main outcome measures  Symptoms of anal incontinence, sexual symptoms, anal manometry scores and evidence of sphincter damage on EAUSG.

Results  Five women had undergone secondary repair and three were lost to follow up. Fifty-one women (80%) completed the questionnaire. Twenty-six out of 46 (57%) of the original study group and 6/28 (20%) of the original controls were examined. Incontinence to flatus and liquid stool was more severe in the study group than in controls. Flatus incontinence was significantly more pronounced among women with subsequent vaginal deliveries. Mean maximal anal squeeze pressures were 69 mmHg in the partial rupture group and 42 mmHg in the complete rupture group (P= 0.04). Study group women with signs of internal sphincter injury reported more pronounced faecal incontinence and had lower anal resting pressures (24 mmHg) than those with intact internal sphincters (40 mmHg) (P= 0.01). Perineal body thickness of less than 10 mm was associated with incontinence for flatus and liquid stools, less lubrication during sex and lower anal squeeze pressures (58 mmHg vs 89 mmHg, P= 0.04).

Conclusions  Subjective and objective anal function after anal sphincter injury deteriorates further over time and with subsequent vaginal deliveries. Thin perineal body and internal sphincter injury seem to be important for continence and anal pressure.

National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-24618 (URN)10.1111/j.1471-0528.2004.00400.x (DOI)6797 (Local ID)6797 (Archive number)6797 (OAI)
Available from: 2009-10-07 Created: 2009-10-07 Last updated: 2017-12-13Bibliographically approved

Open Access in DiVA

No full text

Authority records BETA

Uustal Fornell, Eva

Search in DiVA

By author/editor
Uustal Fornell, Eva
By organisation
Obstetrics and gynecologyFaculty of Health Sciences
Medical and Health Sciences

Search outside of DiVA

GoogleGoogle Scholar

isbn
urn-nbn

Altmetric score

isbn
urn-nbn
Total: 250 hits
CiteExportLink to record
Permanent link

Direct link
Cite
Citation style
  • apa
  • harvard1
  • ieee
  • modern-language-association-8th-edition
  • vancouver
  • oxford
  • Other style
More styles
Language
  • de-DE
  • en-GB
  • en-US
  • fi-FI
  • nn-NO
  • nn-NB
  • sv-SE
  • Other locale
More languages
Output format
  • html
  • text
  • asciidoc
  • rtf