Pelvic floor dysfunction and quality of life in women

Abstract

This thesis started with testing the psychometric qualities of the Dutch version of the Urogenital Distress Inventory (UDI) and the Incontinence Impact Questionnaire (IIQ). Our analysis of the UDI showed that it consists of five domains that are clinically sound and reliable. Factor analysis of the IIQ showed that, in addition to the original four domains, a fifth factor with four items about embarrassment was extracted. Since women with urinary incontinence often report that they are embarrassed by their incontinence, the inclusion of such a domain in a disease-specific Quality of Life (QoL) questionnaire on urogenital symptoms is essential. With the UDI we found that one out of four women reported symptoms of overactive bladder and that these symptoms had the same negative consequences on QoL as urge incontinence. The prevalence of stress incontinence was as high as 40% but this symptom did not seem to bother women. Besides urinary symptoms we studied the prevalence of flatus and faecal incontinence in a community-based cross-sectional cohort study. We aimed at identifying whether childbirth is a risk factor for flatus and faecal incontinence as is commonly stated in literature. Our results, the first in its kind, show that there is no evidence for a general causal relationship between childbirth and faecal incontinence. Another common life event in women is a hysterectomy. We studied the consequences of hysterectomy on urinary continence. We compared the prevalence and severity of stress- and urge urinary incontinence in women scheduled for hysterectomy with women from a random community sample who were not scheduled for hysterectomy . We did not demonstrate a difference in prevalence between these two groups. However, if urinary incontinence is present, women scheduled for hysterectomy are significantly more bothered by it as compared to women from the community sample. We also studied the long-term consequences of hysterectomy on urge and stress urinary incontinence and found that hysterectomy increases the risk for urge incontinence but not for stress incontinence. Especially since urge incontinence negatively affects QoL, we recommend that women should be informed about this long-term consequence of hysterectomy. Finally we studied the effect of different coping strategies on QoL in women with symptoms of pelvic floor dysfunction. We showed that, at the same level of symptom severity, women who more frequently used emotion-oriented and passive coping strategies reported a significantly worse QoL as compared to women who applied more problemoriented, active coping strategies. These coping strategies were also of importance in relation to help-seeking behaviour in women with symptoms of pelvic floor dysfunction. First, we analysed differences between clinical cases and community cases with mild symptoms of pelvic floor dysfunction and found that clinical cases expressed more passive coping strategies as compared to community cases. Secondly, we analysed differences between clinical cases and community cases with severe symptoms of pelvic floor dysfunction and found that clinical cases expressed more problem-oriented, active coping strategies as compared to community cases. In addition, we found that lower educated women significantly more often presented themselves with mild symptoms at our clinic as compared to higher educated women. This implicates that these women have an increased risk of undergoing diagnostic and therapeutic procedures at low symptom severity levels.