EPIDEMIOLOGIA delle DISFUNZIONI

PERINEALI

P. Di BenedettoDipartimento di Medicina RiabilitativaIstituto di Medicina Fisica e Riabilitazione, UDINE

Pelvic Floor Dysfunction

• Urinary incontinence (urge, stress,

mixed )• Genital Prolapse

• Chronic Pelvic Pain (CPP)

EPIDEMIOLOGY of UI in WOMEN

PREVALENCE

Examples of prevalence of any UI in studies of women living in the

community

URINARY INCONTINENCE

Several European and Americans epidemiologic studies a range of prevalence between 10 and 40%

Among older women a range of prevalence between 10 and 50% or even wider remains a reasonable estimate

Examples of prevalence of any UI in studies of older women living in the

community

URINARY INCONTINENCE

Higher prevalence estimates in older ages.

Some studies noted an early prevalence peak in midlife and then a steady increase among the aged (from EPINCONT study gradual increase of prevalences across adulthood until age 50 when prevalence reaches 30%, a stabilization or even slight decline until age 70 when prevalence start rising again).

Prevalence of UI (any leakage) in women of 20 years+

Data from the EPINCONT study

0

5

10

15

20

25

30

35

40

45

Total

20-24

25-29

30-34

35-39

40-44

45-49

50-54

55-59

60-64

65-69

70-74

75-79

80-84

85-89

90+

Per

cen

tag

e

URINARY INCONTINENCE

Prevalence has always been higher in institutions because residents in nursing homes or in residential care facilities tend to be older and more impaired than community residing women.

A prevalence range from 6 to 72%.

Several recent studies suggest prevalences of 50% or higher.

Relative proportion of different types of UI among women living in the

community

URINARY INCONTINENCE

Approximately half of all incontinent women are classified as stress incontinent, the highest proportion among urge, stress, and mixed types of incontinence

A smaller proportion is classified as mixed incontinent, the smallest one as urge incontinent.Several recent studies suggest prevalences of 50% or higher.

URINARY INCONTINENCE

Prevalence has always been higher in institutions because residents in nursing homes or in residential care facilities tend to be older and more impaired than community residing women.

A prevalence range from 6 to 72%.

Several recent studies suggest prevalences of 50% or higher.

Distribution of different type of UI in age groups.

Data from the EPINCONT study

0

10

20

30

40

50

60

70

20-29

30-39

40-49

50-59

60-69

70-79

80-89

90+

Age (years)

Dis

trib

uti

on

wit

hin

eac

h a

ge

gro

up

(%

) Stress

Urge

Mixed

Other

URINARY INCONTINENCE

Proportion of types of UI differ by age.

Mixed UI predominates in older women.

Genuine stress incontinence (GSI) predominates in young and middle-aged group.

In regard to this a recent study (Hannestd et al, 2000), demonstrated a fairly regular increase in prevalence of mixed incontinence across the age range, and a regular decrease in prevalence GSI.

The prevalence of “any” and “severe” UI among older women living in the

community

Prevalence of UI by age group and severity

Data from the EPINCONT study

Prevalence of UI by age group and impact

Data from the EPINCONT study

Severity of the different types of UIData from the EPINCONT study

0

10

20

30

40

50

60

Stress Urge Mixed

Type of UI

Dis

trib

uti

on

of

seve

rity

wit

hin

ea

ch t

ype

(%)

Slight

Moderate

Severe

Established and suggested risk factors for UI in women

• Age• Pregnancy• Childbirth• Menopause• Histerectomy• Obesity• LUTS• Functional impairment• Cognitive impairment• Occupational risks• Family history and genetics• Other factors

URINARY INCONTINENCE in athletes women

Nygaard et al (1994) 158 athletes, mean age 19.9 years all nulliparous 28% urinary incontinence during sport

activities (2/3 IU more often that rarely)67% gymnastics66% basketball50% tennis10% swimming 0% golf

URINARY INCONTINENCE in athletes women

Warren and Shantha high impact sports activities may

produce urinary incontinence

Greydanus and Patel adolescent gynecology:

stress urinary incontinence is common in female athetes

URINARY INCONTINENCE in athletes women

Bø and Borgen

high prevalence of stress and urge incontinence in female elite athletes,mainly in eating disordered athletes compared with healthy athletes

URINARY INCONTINENCE in athletes women

Thyssen et al elite women athletes and dancers 291 women, mean age 22.8 years 51,9% urinary loss (43% during

sport/dancing; 42% during daily life)

the activity most likely correlated with urinary incontinence was jumping

Incontinenza urinaria: fattori di rischio

• Età• Gravidanza• Parità• Fattori legati al parto ed al feto• Menopausa e livelli ormonali• Isterectomia• Obesità• Infezioni urinarie ricorrenti• Riduzione delle capacità motorie• Riduzione delle capacità cognitive• Fumo• Storia familiare

Incontinenza urinaria maschile

Nel sesso maschile la prevalenza di incontinenza urinaria è decisamente diversa, variando tra l’11 ed il 34%.

Vi è una predominanza di incontinenza da urgenza (40-80%) seguita da forme miste (10-30%) e da incontinenza da sforzo (<10%).

Incontinenza urinaria maschile

L’aumento della prevalenza di incontinenza urinaria con l’età nel maschio è dovuto principalmente alle forme da urgenza.

Fattori di rischio sono rappresentati, oltre che dall’età, da riduzione delle capacità motorie e/io cognitive, da malattie neurologiche e, soprattutto, dall’intervento di prostatectomia (sia transuretrale che radicale).

La prostatectomia radicale sembra legata ad una prevalenza più elevata di incontinenza urinaria rispetto alla TURP .

Incontinenza fecale

Nell’adulto, la IF sembra avere una prevalenza addirittura tra l’11 ed il 15% adottando un questionario validato ma anonimo.

Si stima che il 30% dei residenti in istituti geriatrici abbia avuto almeno un episodio di IF.

Incontinenza fecale:fattori di rischio

• Sesso• Parto• Residenza in casa di

riposo• Diarrea• Interventi chirurgici

perineali• Malattie neurologiche

EPIDEMIOLOGY EPIDEMIOLOGY of of

GENITAL PROLAPSEGENITAL PROLAPSE

PREVALENCE (18-86 yrs)

2,63

47,72

43,31

6,40

%Degree

Swift SE, 2000

PROLAPSE

• 50% of parous women have some degree of genital prolapse

• 10 to 20% of these are symptomatic• 20% of gynaecological waiting lists• 59% of major gynaecological surgery

in the elderly• More common amongst caucasians• Only 2% amongst nulliparous women

GENITAL PROLAPSEGENITAL PROLAPSE

In women there is 11,1% likelihood of

surgery for genital prolapse

(Olsen, 1997)

CPPEPIDEMIOLOGY

• CPP has a prevalence of about 12% in the USA

• It accounts for 10% of gynaecological consultations, and up to 33% of laparoscopies

• It also accounts for 12-16% of

hysterectomies