The prevalence of pelvic floor disorders and their relationship to gender,age, parity and mode of delivery

Objective To define the prevalence of pelvic floor disorders in a non-insti tutionalised community and to determine the relationship to gender, age, pa rity and mode of delivery. Design A representative population survey using the 1998 South Australian H ealth Omnibus Survey. Sample Random selection of 4400 households; 3010 interviews were conducted in the respondents' homes by trained female interviewers. This cross sectio nal survey included men and women aged 15-97 years. Results The prevalence of all types of self-reported urinary incontinence i n men was 4.4% and in women was 35.3% (P < 0.001). Urinary incontinence was more commonly reported in nulliparous women than men and increased after p regnancy according to parity and age. The highest prevalence (51.9%) was re ported in women aged 70-74 years. The prevalence of flatus and faecal incon tinence was 6.8% and 2.3% in men and 10.9% and 3.5% in women, respectively. Pregnancy (> 20 weeks), regardless of the mode of delivery, greatly increa sed the prevalence of major pelvic floor dysfunction, defined as any type o f incontinence, symptoms of prolapse or previous pelvic floor surgery. Mult ivariate logistic regression showed that, compared with nulliparity, pelvic floor dysfunction was significantly associated with caesarean section (OR 2.5, 95% CI 1.5-4.3), spontaneous vaginal delivery (OR 3.4, 95% CI 2.4-4.9) and at least one instrumental delivery (OR 4.3, 95% CI 2.8-6.6). The diffe rence between caesarean and instrumental delivery was significant (P < 0.03 ) but was not for caesarean and spontaneous delivery. Other associations wi th pelvic floor morbidity were age, body mass index, coughing, osteoporosis , arthritis and reduced quality of life scores. Symptoms of haemorrhoids al so increased with age and parity and were reported in 19.9% of men and 30.2 % of women. Conclusion Pelvic floor disorders are very common and are strongly associat ed with female gender, ageing, pregnancy, parity and instrumental delivery. Caesarean delivery is not associated with a significant reduction in long term pelvic floor morbidity compared with spontaneous vaginal delivery.