The 'Descent of Women' a Silent Epidemic
Thursday, 23 November 2000
Sometimes medical research turns folklore on its head.
Pelvic floor disorders can be a serious cause of discomfort and even disease, especially among women. The disorders may prompt incontinence, vaginal or uterine prolapse, and haemorrhoids. Bowel and bladder problems can add to a marked reduction in the quality of life.
These pelvic floor disorders may also be much more common that was supposed. Adelaide University researchers, in the first comprehensive study of its kind in the world, have found a remarkably high prevalence of pelvic floor disorders in the general population.
Pelvic floor problems have traditionally been associated with pregnancy, the bearing of large numbers of children and with having them delivered by instrument. Delivery by caesarean section has been supposed to lessen the chances of resulting pelvic floor disorders, but the researchers discovered that birth by caesarean section reduces those risks only slightly.
Most of these complaints were still common among women who had never had a vaginal birth.
"It seems that caesarean section, contrary to popular belief, cannot avoid permanent connective tissue changes that seem to happen during pregnancy," said Associate Professor Alastair MacLennan of the University's Department of Obstetrics and Gynaecology.
"Pelvic floor exercises and surgery can help," said Professor MacLennan, "but unless mothers avoid giving birth, by means such as surrogacy or adoption, future pelvic floor problems after pregnancy are very likely," he said.
The cross-sectional population survey involved more than 3,000 South Australians.
Urinary incontinence was found in 4% of men, but in 35% of women aged from 15 to 95, increasing to 50% among older women..
More than 14% of women were found to suffer from rectal incontinence of flatus or faeces, while fewer than 10% of men suffered from the same conditions.
Other health factors associated with pelvic floor disorders were found to be weight, coughing, osteoporosis, arthritis, and reduced quality of life.
Symptoms of haemorrhoids also increased with age, appearing in 20% of men and more than 30% of women.
"The survey highlights the high prevalence and major social impact of pelvic floor prolapse and incontinence in our society," said Professor MacLennan. "It is a silent epidemic, as those with the problem are often embarrassed to talk about it," he said.
The results of the study are being published this month in the British Journal of Obstetrics and Gynaecology.
The research will also feature in the December issue of Climacteric, the journal of the International Menopause Society, which will devote its editorial to a discussion of the problem and a plea that it should receive greater medical attention.
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The University of Adelaide
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Mr David Ellis
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