Primary Prevention in Female with Pelvic Floor Disorders

¹Spinal Unit, ICS Maugeri SPA SB, Institute of Pavia, IRCCS, Pavia, Italy

²Neurologic Rehabilitation Unit, ICS Maugeri SPA SB, Institute of Pavia, IRCCS, Pavia, Italy

Received Date: 25 May 2023; Accepted Date: 10 June 2023; Published Date: 28 June 2023

*Correspondence Address: Gabriella Fizzotti, Spinal Unit, ICS Maugeri SPA SB, Institute of Pavia, IRCCS, Pavia, Italy.

Copyright©2023 by Fizzotti G, et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Introduction: Problems that affect the pelvic floor including: incontinence, leaking, and pelvic organ prolapse. Although it is commonly believed that pelvic floor disorders (PFDs) affect a large segment of the adult female population, reliable estimates of the prevalence of these disorders have been difficult to establish [1]. Historically, researchers have depended on non-validated or incompletely validated screening tools which have generated widely different estimates of prevalence of PFDs. Primary prevention aims to prevent a disease from arising (or to reduce its incidence), for example by increasing the body’s defenses, eliminating the causal factors of the disease, selecting and treating the risk conditions. The aim of this study was to verify whether the candidates for pelvic floor rehabilitation were aware of the factors predisposing to the dysfunctional pathologies of the pelvic floor and the behavioral rules for correct prevention.

Material and Methods: 50 females, aged between 30 and 80 with diagnosis of PFDs were considered to individual rehabilitation project, in the period between January 2019 and December 2019. The anamnestic questionnaire proposed to the patients for access to conservative treatment included the personal data, family and personal history and questions aimed at identifying the factors that usually contribute to the development of this pathology: childbirth, if natural, obesity, constipation, age, gynecological surgery such as hysterectomy, work activity, all situations that can lead to a chronic increase in intra-abdominal pressure.

Results: The evaluation of the responses showed that 49 of considered females did not know the predisposing factors and behavioral strategies aimed at a correct primary prevention of dysfunctional pathologies of the pelvic floor.

Discussion: The results highlighted the lack of knowledge by women of the conditions that favor a pathology that directly affects them. Primary prevention represents the first step in reducing the probability that a pathology will occur. The specific skills should already be present before a person identifies a conservative rehabilitation path.

Conclusions: Scheduling activities that are not necessarily medical, such as health education in schools or through the media, is a form of prevention, since young women, by learning daily behavioral strategies, will have a lower risk of developing pathologies at the perineal level. Prevention should involve various figures and professions in the health field but not only: doctor, nurse, physiotherapist, teacher, psychologist, psychotherapist, parents.

Keywords: Primary prevention, Pelvic floor dysfunction, Conservative treatment.

Introduction

Female pelvic floor disorders (PFD)s is a term applied to a wide variety of clinical conditions, including urinary incontinence, anal incontinence, pelvic organ prolapse, sensory and emptying abnormalities of the lower urinary tract, defecatory dysfunction, sexual dysfunction, and several chronic pain syndromes [2].

The scope of prevention has changed over time. A 1967 textbook stated: “Prevention, in a narrow sense, means averting the development of a pathological state. In a broader sense, it includes all measures-definitive therapy among them-that limit the progression of disease at any stage of its course” [3]. By 1978, the distinctions between types of prevention had expanded to include primary prevention to promote health prior to the development of disease or injuries; secondary prevention to detect disease in early (asymptomatic) stages; and tertiary prevention to reverse, arrest or delay progression of disease [4]. In 1998 the World Health Organization, in addressing “disease” prevention, stated that it “covers measures not only to prevent the occurrence of disease, such as risk factor reduction, but also to arrest its progress and reduce its consequences once established. Identification of “risk factors” as part of prevention has been designated a new era in public health and clinical medicine” and as a new professional activity of epidemiologists [5,6]. Despite the clinical and economic importance of

female incontinence and prolapse, data informing best practices for prevention and treatment of these conditions are limited. The aetiology of

PFDs is known to be multifactorial, prevention of PFDs, when possible, should be a primary goal.

The aim of this study is twofold, to evaluate the knowledge of primary prevention of PFDs of female with PFDs, focusing on the associations among functional status and awareness of health dimension.

Material and methods

 In this prospective study, from January 2019 and December 2019, 50 females were enrolled with a mean age of 60.32. The clinical conditions of PFDs were different including: 3 urinary incontinence, 14 fecal incontinence, 33 defecatory dysfunction. A standardized questionnaire was administrated, immediately before to start conservative treatment, it allowed to determine the knowledge of primary prevention of PFDs.

The questionnaire comprised 40 items: 16 questions were related to general aspects of medical history including drug intake and the particular gynecological history, and 24 questions referred to predisposing factors to development of urinary incontinence, anal incontinence or pelvic organ prolapse. Following risk factors were mentioned: childbirth, if natural, obesity, constipation, age, gynecological surgery such as hysterectomy, work activity, all situations that can lead to a chronic increase in intra-abdominal pressure.

The questionnaire included closed-ended type of question. Patients can answer a question with only a “yes” or “no” response. All observational analyses considered patients before conservative

rehabilitation path. The sample size was estimated from the clinical practice. A consecutive case series that met the inclusion criteria was analyzed and underwent treatment according to the conservative treatment.

Results

 The evaluation of the questionnaire responses showed that 49 of the women considered unaware

of the predisposing factors and behavioral strategies aimed at a correct primary prevention of dysfunctional pathologies of the pelvic floor. (Table 1).

In considered sample, 34 were in menopause, 6 were affected by respiratory chronic obstructive pulmonary disease, 11(22%) presented obesity or overweight (measured by the body mass index) and 61 childbirths (Figure 1).