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)
PREVALENCE
EPIDEMIOLOGY
in WOMEN
of
UI
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
45
40
Percentage
35
30
25
20
15
10
5
0
90
9
-8
4
-8
9
-7
4
-7
9
-6
4
-6
9
-5
4
-5
9
-4
4
-4
9
-3
4
-3
9
-2
4
-2
l
ta
+
85
80
75
70
65
60
55
50
45
40
35
30
25
20
To
URINARY INCONTINENCE
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
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 within each age
group (%)
Data from the EPINCONT study
70
60
50
Stress
Urge
Mixed
Other
40
30
20
10
0
90
9
-8
9
-7
9
-6
9
-5
9
-4
9
-3
9
-2
+
80
70
60
50
40
30
20
Age (years)
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
Distribution of severity within
each type (%)
Data from the EPINCONT study
60
50
40
Slight
Moderate
Severe
30
20
10
0
Stress
Urge
Type of UI
Mixed
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)
Degree
0
%
6,4
1
43,3
2
47,7
3
2,6
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