Walton LM1,2, Ali Pour N1, Younes Khattab S1, Neyyer Z1, Aldosarey N1, Almuzaini N1
1University of Sharjah, Physiotherapy, Sharjah, United Arab Emirates, 2University of St. Augustine for Health Sciences, Physical Therapy DPT Program, San Marcos, United States
Background: Research reports indicate 50% of pregnant women suffer from Pelvic Girdle Pain (PGP) and nearly 8% report associated disability. C-section (CS) birth delivery in UAE (42-50%) are substantially higher than World Health Organization recommended safe rates (5-10%).
Purpose: To determine prevalence and impact of pelvic floor dysfunction, low back & pelvic pain on HRQOL, maternal health outcomes and differences by birth mode for women in the chronic postpartum period living in in the UAE.
Methods: This study was a prospective, cross-sectional, correlation design with purposive sampling of 150 Arabic and English Speaking postpartum females, age 18-50. IRB approval was obtained from University of Sharjah REC in February 2018. Subjects who volunteered to participate in the study signed a written consent prior to data collection. Each subject completed the Health Questionnaire, Short-Form 12-Item Health Survey, Pelvic Floor Distress Inventory (PFDI) and Quebec Back Pain Disability Scale (QBPDS). Data was analyzed utilizing SPSS, 24.0 using frequency distributions for prevalence and Kruskal Wallis for between group comparisons.
Results: Seventy-nine percent (n=112/141) of the overall sample reported some form of pelvic and low back pain; 13.3% (18/137) reported abdominal pain, with AVD (87%), CS (77.4%) and MBM (77.8%) reporting significantly more pain than those with NVD (68%). Significant differences were found between groups in PFDI scores, by birth mode, parity and age. Total PFDI scores reported highest for the age group (25-34), those with AVD (95.41 +/- 58.6), MBD (85.65 +/- 50.9) and CS (78.2 +/- 49.2) reporting significantly higher than NVD (60.9 +/- 49.2). Total PFDI scores showed significantly higher scores with greater parity (3 or >) and for those in the 25-34 age group for Section 3(Urinary Incontinence) (p=.0002) and Section 2 (Colorectal-Anal impact) (p=0.005). Significant differences were also
reported by birth mode with AVD, MBD, and CS groups reporting higher scores compared to the NVD group in Section 1 scores (p=0.034).
Conclusion(s): Conclusion Overall, significant differences were found in scores of PFDI by age , parity and birth mode, with those in the 25-34 year age group, those with parity of 3 or more and those in the AVD, CS, and MBM groups reporting the greatest amount of pelvic floor dysfunction and pelvic and low back pain, overall. Birth mode appears to be an important factor in postpartum pelvic floor distress and pain, with AVD, CS and MBM carrying the highest prevalence of pelvic organ prolapse, color-rectal-anal dysfunction and urinary incontinence compared to NVD. Furthermore our sample reported significantly lower scores on SF-12 HRQOL compared to the norm standard values for SF-12 in emotional, physical and vitality domains during pregnancy.
Implications: This research informs physiotherapy practice in obstetrics and women´s health with respect to birth mode and early intervention pelvic rehabilitation programs for prevention of pelvic organ prolapse, colo-rectal-anal dysfunction and urinary incontinence.
Keywords: pelvic floor dysfunction, colo-rectal-anal dysfunction, urinary incontinence
Funding acknowledgements: International Academy on Gender Equity and Women´s Health, NY, NY.
Purpose: To determine prevalence and impact of pelvic floor dysfunction, low back & pelvic pain on HRQOL, maternal health outcomes and differences by birth mode for women in the chronic postpartum period living in in the UAE.
Methods: This study was a prospective, cross-sectional, correlation design with purposive sampling of 150 Arabic and English Speaking postpartum females, age 18-50. IRB approval was obtained from University of Sharjah REC in February 2018. Subjects who volunteered to participate in the study signed a written consent prior to data collection. Each subject completed the Health Questionnaire, Short-Form 12-Item Health Survey, Pelvic Floor Distress Inventory (PFDI) and Quebec Back Pain Disability Scale (QBPDS). Data was analyzed utilizing SPSS, 24.0 using frequency distributions for prevalence and Kruskal Wallis for between group comparisons.
Results: Seventy-nine percent (n=112/141) of the overall sample reported some form of pelvic and low back pain; 13.3% (18/137) reported abdominal pain, with AVD (87%), CS (77.4%) and MBM (77.8%) reporting significantly more pain than those with NVD (68%). Significant differences were found between groups in PFDI scores, by birth mode, parity and age. Total PFDI scores reported highest for the age group (25-34), those with AVD (95.41 +/- 58.6), MBD (85.65 +/- 50.9) and CS (78.2 +/- 49.2) reporting significantly higher than NVD (60.9 +/- 49.2). Total PFDI scores showed significantly higher scores with greater parity (3 or >) and for those in the 25-34 age group for Section 3(Urinary Incontinence) (p=.0002) and Section 2 (Colorectal-Anal impact) (p=0.005). Significant differences were also
reported by birth mode with AVD, MBD, and CS groups reporting higher scores compared to the NVD group in Section 1 scores (p=0.034).
Conclusion(s): Conclusion Overall, significant differences were found in scores of PFDI by age , parity and birth mode, with those in the 25-34 year age group, those with parity of 3 or more and those in the AVD, CS, and MBM groups reporting the greatest amount of pelvic floor dysfunction and pelvic and low back pain, overall. Birth mode appears to be an important factor in postpartum pelvic floor distress and pain, with AVD, CS and MBM carrying the highest prevalence of pelvic organ prolapse, color-rectal-anal dysfunction and urinary incontinence compared to NVD. Furthermore our sample reported significantly lower scores on SF-12 HRQOL compared to the norm standard values for SF-12 in emotional, physical and vitality domains during pregnancy.
Implications: This research informs physiotherapy practice in obstetrics and women´s health with respect to birth mode and early intervention pelvic rehabilitation programs for prevention of pelvic organ prolapse, colo-rectal-anal dysfunction and urinary incontinence.
Keywords: pelvic floor dysfunction, colo-rectal-anal dysfunction, urinary incontinence
Funding acknowledgements: International Academy on Gender Equity and Women´s Health, NY, NY.
Topic: Women's & men's pelvic health; Musculoskeletal
Ethics approval required: Yes
Institution: University of Sharjah
Ethics committee: University of Sharjah REC College of Health Sciences
Ethics number: REC-18-02-12-03-S
All authors, affiliations and abstracts have been published as submitted.
