EPIDEMIOLOGIA delle DISFUNZIONI PERINEALI P. Di Benedetto Dipartimento di Medicina Riabilitativa Istituto 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

URINARY INCONTINENCE A prevalence range from 6 to 72%. 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 A prevalence range from 6 to 72%. 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 Distribution of different type of UI in age groups. Data from the EPINCONT study

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 UI Data from the EPINCONT study

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% gymnastics 66% basketball 50% tennis 10% 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 of GENITAL PROLAPSE

PREVALENCE (18-86 yrs) 2,6 3 47,7 2 43,3 1 6,4 % 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 PROLAPSE In women there is 11,1% likelihood of surgery for genital prolapse (Olsen, 1997)

CPP EPIDEMIOLOGY 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