Al-Mukhtar Othman Jwan, Åkervall Sigvard, Milsom Ian, Gyhagen Maria
Department of Obstetrics and Gynecology, Sahlgrenska Academy at Gothenburg University, Gothenburg, Sweden.
Department of Surgery, Södra Älvsborgs Hospital, Borås, Sweden.
Am J Obstet Gynecol. 2017 Feb;216(2):149.e1-149.e11. doi: 10.1016/j.ajog.2016.09.104. Epub 2016 Oct 6.
A systematic survey of pelvic floor disorders in nulliparous women has not been presented previously.
The purpose of this study was to determine the prevalence of urinary incontinence parameters in a large cohort of nonpregnant, nulliparous women, and thereby construct a reference group for comparisons with parous women.
This postal and World Wide Web-based questionnaire survey was conducted in 2014. The study population was identified from the Total Population Register in Sweden and comprised women who had not given birth and were aged 25-64 years. Four independent age-stratified, random samples comprising 20,000 women were obtained from the total number of eligible nullipara (n = 625,810). A 40-item questionnaire about pelvic floor symptoms, its severity, and its consequences were used. Age-dependent differences for various aspects of urinary incontinence were analyzed with the youngest group (25-34 years) serving as reference. Crude and body mass index-adjusted prevalence and its 95% confidence limits were calculated for each 10-year category.
The response rate was 52% and the number of study participants was 9197. Urinary incontinence increased >5-fold from 9.7% in the youngest women with a body mass index <25 kg/m to 48.4% among the oldest women with a body mass index ≥35 kg/m. The prevalence of bothersome urinary incontinence almost tripled from 2.8-7.9% among all nulliparas. The proportion with bothersome urinary incontinence among incontinent women increased from 24.4% in the youngest age group to 32.3% in the age group 55-64 years. Nocturia ≥2/night increased 4-fold to 17.0% and leakage ≥1/wk increased 3-fold to 12.8% among the oldest women. Mixed urinary incontinence increased from 22.9-40.9% among the oldest 0-para with incontinence, whereas stress urinary incontinence decreased inversely from 43.6-33.0%. In the total cohort surgical treatment for urinary incontinence occurred in 3 per thousand.
Almost every aspect of urinary incontinence was present in nulliparous women of all ages and prevalence increased with advancing age between 25-64 years. This must be taken into account when using nullipara as a control group in comparisons with parous women to estimate the effect of pregnancy and childbirth.
此前尚未对未生育女性的盆底功能障碍进行系统调查。
本研究旨在确定一大群未怀孕的未生育女性中尿失禁参数的患病率，从而构建一个参考组，以便与经产妇进行比较。
这项基于邮寄问卷和万维网的调查于2014年进行。研究人群从瑞典总人口登记册中确定，包括未生育且年龄在25 - 64岁的女性。从符合条件的未生育女性总数（n = 625,810）中获得了四个独立的按年龄分层的随机样本，每个样本包含20,000名女性。使用了一份关于盆底症状、其严重程度及其后果的40项问卷。以最年轻组（25 - 34岁）为参照，分析了尿失禁各方面的年龄依赖性差异。计算了每10年年龄组的粗患病率和体重指数调整后的患病率及其95%置信区间。
回复率为52%，研究参与者人数为9197人。尿失禁患病率从体重指数<25 kg/m的最年轻女性中的9.7%增加了5倍多，到体重指数≥35 kg/m的最年长女性中的48.4%。所有未生育女性中，困扰性尿失禁的患病率从2.8%增至7.9%，几乎增加了两倍。尿失禁女性中困扰性尿失禁的比例从最年轻年龄组的24.4%增至55 - 64岁年龄组的32.3%。最年长女性中夜尿≥2次/晚的情况增加了4倍，达到17.0%，漏尿≥1次/周的情况增加了3倍，达到12.8%。混合性尿失禁在最年长的未生育尿失禁女性中从22.9%增至40.9%，而压力性尿失禁则从43.6%降至33.0%，呈相反趋势。在整个队列中，每千名中有3人接受了尿失禁手术治疗。
所有年龄段的未生育女性几乎都存在尿失禁的各个方面，且患病率在25 - 64岁之间随年龄增长而增加。在与经产妇进行比较以评估妊娠和分娩的影响时，将未生育女性作为对照组时必须考虑到这一点。
