Davis Kathryn, Kumar Devinder
Department of Surgery and Gastrointestinal Motility Unit, St George's Hospital, London, UK.
J Adv Nurs. 2003 Sep;43(6):555-68. doi: 10.1046/j.1365-2648.2003.02754.x.
Pelvic floor dysfunction is a disorder predominantly affecting females. It is common and undermines the quality of lives of at least one-third of adult women and is a growing component of women's health care needs. Identifying and supporting these needs is a major public health issue with a strong psychosocial and economic basis. The importance of the interdependence of mechanical, neural, endocrine and environmental factors in the development of pelvic floor dysfunction is well recognized. There is a paucity of data investigating the true prevalence, incidence, specific risk factors, poor outcome of treatment and subsequent prevention strategies for women with multiple pelvic floor symptomatology.
The aim of this paper is to present a critical review of the literature on the mechanism, presentation and management of multiple symptomatology in pelvic floor dysfunction and to propose a conceptual framework by which to consider the impact and problems women with pelvic floor dysfunction face.
A comprehensive although not exhaustive literature search was carried out using medical and nursing databases BIOMED (1966-2002) NESLI (1989-2002) and EMBASE (1980-2003) CINAHL (1982-2003) and Cochrane databases using the key words 'pelvic floor dysfunction', 'incontinence (urinary and faecal)', 'genital prolapse', sexual dysfunction, 'aetiology', epidemiology' and 'treatment'. Retrospective and prospective studies and previous clinical reviews were considered for review. The articles retrieved were hand searched for further citations and referrals were made to relevant textbooks. Particular attention was paid to papers that focused on multiple pelvic floor symptoms.
Pelvic floor dysfunction affects women of all ages and is associated with functional problems of the pelvic floor. Pelvic floor dysfunction describes a wide range of clinical problems that rarely occur in isolation. Inaccurate knowledge, myths and misconceptions of the incidence, cause and treatment of pelvic floor dysfunction abound. Given the significance of the aetiological contribution of factors such as pregnancy and obstetric trauma, ageing, hormonal status, hysterectomy and lifestyle in the development of pelvic floor disorders, the assessment, management and prevention of pelvic floor dysfunction remains a neglected part of many health care professionals educational preparation. This not only has major economic but also psychosocial implications for women, the general population and women's health care providers. A conceptual framework is also discussed that considers not only the impact and difficulties women with pelvic floor dysfunction face but also areas in which health care professionals can improve assessment and eventual treatment outcomes.
This paper demonstrates gaps in the current provision of women's health care services. Functional pelvic floor problems are perceived to have low priority compared with other health disorders, and treatment remains sub-optimal. Inherent in achieving and promoting better health care services for women is the need for better collaborative approaches to care. There is a need to identify and develop comprehensive interdisciplinary, multi-professional strategies that improve the assessment and treatment of pelvic floor dysfunction in primary, secondary and tertiary settings. If this area of women's health care is to be improved nurses, whether community- or hospital-based, must play a front-line role in challenging and changing current practices. Education needs to be given greater priority and the development of a specialist pelvic floor nurse role explored. Such strategies could substantially influence a more effective approach to women's health care needs, result in improved treatment outcomes and liberate women from the embarrassment, social and sexual isolation, restriction to employment and leisure opportunities and potential loss of independence that multiple symptomatology can generate.
盆底功能障碍是一种主要影响女性的疾病。它很常见，至少影响三分之一成年女性的生活质量，并且在女性医疗保健需求中所占比重日益增加。识别并满足这些需求是一个具有强大社会心理和经济基础的重大公共卫生问题。机械、神经、内分泌和环境因素在盆底功能障碍发生过程中的相互依存关系已得到充分认识。目前针对具有多种盆底症状的女性的真实患病率、发病率、特定风险因素、治疗效果不佳及后续预防策略的数据较少。
本文旨在对盆底功能障碍中多种症状的机制、表现及管理方面的文献进行批判性综述，并提出一个概念框架，用以考量盆底功能障碍女性所面临的影响和问题。
使用医学和护理数据库BIOMED（1966 - 2002年）、NESLI（1989 - 2002年）、EMBASE（1980 - 2003年）、CINAHL（1982 - 2003年）以及Cochrane数据库，通过关键词“盆底功能障碍”、“失禁（尿失禁和粪失禁）”、“生殖器脱垂”、“性功能障碍”、“病因学”、“流行病学”和“治疗”进行了全面但非详尽无遗的文献检索。纳入回顾的有回顾性和前瞻性研究以及既往的临床综述。对检索到的文章进行手工检索以获取更多引用文献，并参考相关教科书。特别关注聚焦多种盆底症状的论文。
盆底功能障碍影响各年龄段女性，并与盆底的功能问题相关。盆底功能障碍描述了一系列广泛的临床问题，这些问题很少单独出现。关于盆底功能障碍的发病率、病因及治疗，存在不准确的认知、误解和错误观念。鉴于妊娠和产科创伤、衰老、激素状态、子宫切除术及生活方式等因素在盆底疾病发生过程中的病因学作用，盆底功能障碍的评估、管理和预防在许多医疗保健专业人员的教育准备中仍是被忽视的部分。这不仅对女性、普通人群及女性医疗保健提供者具有重大经济影响，还具有社会心理影响。还讨论了一个概念框架，该框架不仅考量盆底功能障碍女性所面临的影响和困难，还涉及医疗保健专业人员可在哪些方面改进评估及最终治疗效果。
本文揭示了当前女性医疗保健服务提供方面的差距。与其他健康问题相比，功能性盆底问题被认为优先级较低，治疗仍未达到最佳效果。要实现并促进为女性提供更好的医疗保健服务，就需要更好的协作式护理方法。有必要识别并制定全面的跨学科、多专业策略，以改善在初级、二级和三级医疗机构中对盆底功能障碍的评估和治疗。如果要改善女性医疗保健的这一领域，无论是社区护士还是医院护士，都必须在挑战和改变当前做法方面发挥一线作用。需要更加重视教育，并探索设立专科盆底护士这一角色。此类策略可能会极大地影响对女性医疗保健需求采取更有效的方法，改善治疗效果，并使女性摆脱多种症状可能导致的尴尬、社交和性孤立、就业及休闲机会受限以及潜在的独立丧失。
