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

Abstract

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, puerperium

Keywords

• Pelvic Floor Dysfunction. Women’s Health. Adolescent. Puerperium.