Pelvic floor disorders in postpartum adolescents in the Western Amazon: a cross-sectional study

Lea Tami Suzuki Zuchelo,1,2 Edige Felipe de Sousa Santos,1,3 Francisco Winter Dos Santos Figueiredo,1,4 Fernando Adami,4 Italla Maria Pinheiro Bezerra,1,5 Rodrigo Daminello Raimundo,1 Isabel Cristina Esposito Sorpreso,1,6 Luiz Carlos de Abreu1 1Study Design and Scientific Writing Laboratory, ABC Medical School (FMABC), Santo André, SP, Brazil; 2School of Physiotherapy, Universidade Federal de Juiz de Fora (UFJF), Juiz de Fora, MG, Brazil; 3Department of Epidemiology, Universidade de São Paulo (USP), São Paulo, SP, Brazil; 4Epidemiology and Data Analysis Laboratory, ABC Medical School (FMABC), Santo André, SP, Brazil; 5Nursing Department, School of Sciences of Santa Casa de Misericórdia de Vitoria (EMESCAM), Vitória, ES, Brazil; 6Gynecology Discipline, Obstetrics and Gynecology Department, Faculdade de Medicina FMUSP, Universidade de São Paulo, São Paulo, SP, Brazil Purpose: To analyze the postpartum pelvic floor disorders (PFD) and mode of delivery among adolescents, late adolescents, and young women from Western Amazon. Patients and methods: Cross-sectional study was carried out in the urban area of Western Amazon in the city of Rio Branco, Acre, Brazil, from October 2016 to February 2017. This is a convenience sample of women up to 30 years who completed six months postpartum, separated in three groups according to maternal age: adolescents (age ≤19 years), late adolescents (20–24 years), and young women (25–30 years). Participants were home interviewed and answered Pelvic Floor Distress Inventory-20 (PFDI-20). Delivery clinical data were collected from patient’s medical records. Results: In total, 285 participants were interviewed: 41 adolescents, 103 late adolescents, and 141 young women. After controlling for confounding factors, prevalences of PFD were higher in the adolescents’ group compared with the young women’s group (urinary incontinence [UI], prevalence ratio [PR] = 1.75, 95% CI 1.14–2.69; urge urinary incontinence [UUI], PR = 1.88, 95% CI 1.02–3.47; stress urinary incontinence, PR = 2.00, 95% CI 1.11–3.62; fecal incontinence [FI], PR = 4.40, 95% CI 1.36–14.27). PFDI-20 scores also presented higher values in the adolescent group (Pelvic Organ Prolapse Distress Inventory [POPDI], PR = 2.02, 95% CI 1.49–2.75; urinary distress inventory [UDI], PR = 2.09, 95% CI 1.47–2.98; PFDI, PR = 2.12, 95% CI 1.47–2.98). Analyzing the influence of cesarean section, adolescents have higher prevalence of UI (PR = 1.84, 95% CI 1.04–3.26, P=0.037), UUI (PR = 2.36, 95% CI 1.03–5.40, P=0.042), and FI (PR = 4.09, 95% CI 1.21–13.81, P=0.023). In addition, POPDI (PR = 2.15, 95% CI 1.60–2.89, P<0.001), UDI (PR = 2.25, 95% CI 1.61–3.16, P<0.001), and PFDI (PR = 2.27, 95% CI 1.68–3.08, P<0.001) scores are also higher among adolescents where the baby is born by cesarean section. Conclusion: Adolescents present higher prevalence and symptoms of PFD; furthermore, cesarean delivery has a greater negative influence on the pelvic floor of adolescents when compared with young women. This reinforces the importance of PFD investigation among the adolescent population, mainly in developing countries which have high rates of adolescent pregnancy and cesarean section. Keywords: pelvic floor dysfunction, women’s health, adolescent, puerperiu

Questionnaires to evaluate pelvic floor dysfunction in the postpartum period: a systematic review

Lea Tami Suzuki Zuchelo,1,2 Italla Maria Pinheiro Bezerra,1,3 Adna Thaysa Marcial Da Silva,1,4 Jéssica Menezes Gomes,1,4 José Maria Soares Júnior,4 Edmund Chada Baracat,4 Luiz Carlos de Abreu,1,3 Isabel Cristina Esposito Sorpreso1,4 1Study Design and Scientific Writing Laboratory at ABC Medical School, Santo André, Brazil; 2Research Laboratory of Uninorte (Barão do Rio Branco Faculty), Rio Branco, Brazil; 3School of Sciences of Santa Casa de Misericórdia de Vitoria, Vitória, Brazil; 4Faculty of Medicine, University of São Paulo, São Paulo, Brazil Background: Pelvic floor dysfunctions (PFDs) affect the female population, and the postpartum period can be related to the onset or aggravation of the disease. Early identification of the symptoms and the impact on quality of life can be achieved through assessment instruments. Objective: The purpose of this systematic review is to evaluate questionnaires used to assess PFD in the postpartum period. Methods: A systematic review study was conducted, following Preferred Reporting Items for the Systematic Reviews and Meta-Analyses (PRISMA) criteria, using the databases: PubMed, Biblioteca Virtual de Saúde (BVS), Web of Science, and Scopus, and the keywords PFD or pelvic floor disorders, postpartum or puerperium, and questionnaire. Articles published up till May 2018 were included, searching for articles using validated questionnaires for the evaluation of PFDs in postpartum women. The articles included were evaluated according to a checklist, and the validation studies and translated versions of the questionnaires were identified. Results: The search of the databases resulted in 359 papers, and 33 were selected to compose this systematic review, using nine validated questionnaires to assess PFDs in the postpartum period: International Consultation on Incontinence Questionnaire – Vaginal Symptoms (ICIQ-VS), Pelvic Floor Distress Inventory 20 (PFDI-20), Pelvic Floor Impact Questionnaire (PFIQ-7), PFDI-46, Pelvic Floor Impact Questionnaire (PFIQ-31), Pelvic Floor Bother Questionnaire (PFBQ), Female Pelvic Floor Questionnaire, electronic Personal Assessment Questionnaire – Pelvic Floor, and PFD questionnaire specific for pregnancy and postpartum. The most frequently reported questionnaires included PFDI-20, PFIQ-7, and ICIQ-VS and are recommended by ICI. In addition, the review identified a specific questionnaire, recently developed, to access PFD during pregnancy and postpartum. Conclusion: The questionnaires used to evaluate PFD during postpartum period are developed for general population or urology/gynecology patients with incontinence and reinforce the paucity of highly recommended questionnaires designed for postpartum, in order to improve early and specific approach for this period of life. Keywords: pelvic floor disorders, puerperium, women’s health, primary health care, surveys and questionnaires, patient reported outcome measur