By Chiara Ghetti, MD

Associate Professor, Obstetrics and Gynecology, Division of Female Pelvic Medicine and Reconstructive Surgery, Washington University School of Medicine, St. Louis

Dr. Ghetti reports no financial relationships relevant to this field of study.

SYNOPSIS: Pelvic floor disorders are common in women before surgery for suspected gynecological malignancy.

SOURCE: Bretschneider CE, Doll KM, Bensen JT, et al. Prevalence of pelvic floor disorders in women with suspected gynecological malignancy: A survey-based study. Int Urogynecol J 2016;27:1409-1414. doi: 10.1007/s00192-016-2962-3. Epub 2016 Feb 12.

The main objective of this cross-sectional study was to describe the prevalence of pelvic floor disorders in women with suspected gynecological malignancy before cancer treatment. This was an analysis of the University of North Carolina at Chapel Hill Health Registry/Cancer Survivorship Cohort, a large hospital database. Subjects were identified and recruited for the cohort at the time of a new patient visit at the outpatient oncology clinics. Subjects for this study presented for treatment of gynecological malignancies and were recruited over an 11-month period. The main outcome measures were validated self-report pelvic floor symptoms questionnaires: the Rotterdam Symptom Checklist (RSC) and the International Consultation on Incontinence Questionnaire-Female Lower Urinary Tract Symptoms (ICIQ-FLUTS).

The authors enrolled 152 women who completed baseline assessments before surgery. The majority of subjects were Caucasian, parous, postmenopausal, and had private insurance. The most common gynecological malignancy types were uterine, ovarian, cervical, vulvar/vaginal, and other, in order of prevalence. Responses to the RSC and ICIQ-FLUTS revealed a high prevalence of urinary symptoms. Sixty percent of women reported symptoms of stress incontinence and 34% reported urge urinary incontinence. Nearly half the cohort reported any symptom of abdominal pain or constipation (46% and 43%, respectively).

COMMENTARY

Pelvic floor disorders are common in the general population. There are limited data suggesting a high prevalence of pelvic floor disorders in women following treatment for gynecologic cancers. The estimated rates of urinary incontinence following radiation therapy for cervical and uterine cancer range from 48% to 84%, respectively.1,2 However, the baseline prevalence of concomitant pelvic floor disorders in women with suspected or diagnosed gynecologic malignancy is unknown.

This study of subjects undergoing new patient visits for gynecologic malignancy suggests that urinary incontinence and bowel dysfunction is very prevalent in this population. These findings were similar to a 2013 cross-sectional study by Thomas et al that found more than half of 357 patients with gynecologic cancer reported baseline urinary incontinence and 11% reported feeling a bulge from their vagina.3

Although both studies used validated questionnaires, the current study did not use the Pelvic Floor Disorders Inventory (a validated and commonly used questionnaire in the urogynecology literature), outcomes measures did not include questions regarding pelvic organ prolapse symptoms, and study measures relied solely on patient report without clinical examination.

Despite several limitations, this study further adds to the small body of literature emphasizing the high prevalence of pelvic floor symptoms in women with gynecologic malignancy. This study highlights the importance of screening women presenting with gynecologic malignancy for pelvic floor disorders and including pelvic floor symptoms in perioperative planning and counselling.

REFERENCES

  1. Kadar N, Saliba N, Nelson JH. The frequency, causes and prevention of severe urinary dysfunction after radical hysterectomy. Br J Obstet Gynecol 1983;90:858-863.
  2. Erekson EA, Sung VW, DiSilvestro PA, Myers DL. Urinary symptoms and impact on quality of life in women after treatment for endometrial cancer. Int Urogynecol J Pelvic Floor Dysfunct 2009;20:159-163.
  3. Thomas SG, Sato HR, Glantz JC, et al. Prevalence of symptomatic pelvic floor disorders among gynecologic oncology patients. Obstet Gynecol 2013;122:976-980. doi: 10.1097/AOG.0b013e3182a7ef3.