Zhang Lei, Wang Xiaoxiao, Hou Xinnan, Zhuang Xinrong, Wang Yu, Wang Xiaoqing, Lu Ye
Department of Obstetrics and Gynecology, Peking University First Hospital, Beijing, China.
Department of Obstetrics and Gynecology, The Affiliated Hospital of Chengde Medical University, Chengde, China.
Front Glob Womens Health. 2024 Dec 2;5:1416429. doi: 10.3389/fgwh.2024.1416429. eCollection 2024.
Studies on lower urinary tract symptoms (LUTS) in women, especially in relation to different modes of delivery, are limited. The relationship between the emergence of LUTS and the decline of pelvic muscle function after childbirth remains uncertain.
This observational study was carried out at the Peking University First Hospital over a time span of 2019-2022. A total of 2,462 women were recruited and surveyed 6 weeks after delivery, utilizing questionnaires for data collection. Additionally, gynecological physical examinations and pelvic floor muscle screenings were conducted as part of the study. To assess individual LUTS and the level of discomfort caused by these symptoms, a modified Chinese version of the Bristol Female Lower Urinary Tract Symptoms questionnaire was employed. Data analysis methods such as descriptive statistics, tests, one-way ANOVAs, and multivariate logistic regressions were used to thoroughly examine the collected data.
A high prevalence of LUTS was observed in the study participants, with 70.6% experiencing any symptoms. Storage symptoms were reported by 65.4%, while voiding symptoms were reported by 23.0%. Nocturia was the most commonly reported symptom (35.4%), followed by frequency (25.6%) and urgency (25.3%). Stress urinary incontinence (SUI) was reported by 20.8% of women. Interestingly, nocturia and frequency were generally perceived as less troublesome, with only a minority rating them as problematic. In contrast, urinary incontinence (UI) was frequently reported as highly bothersome, with SUI and urge urinary incontinence (UUI) accounting for significant proportions. Vaginal delivery (VD) and forceps delivery (FD) were identified as significant predictors of LUTS, with statistical significance observed ( < 0.05). Specifically, women who underwent VD, particularly FD, exhibited lower surface electromyography (sEMG) activity compared to those who had cesarean section (CS), both in terms of resting baseline and contraction amplitude ( < 0.001).
Over half of the examined women exhibited LUTS 6 weeks postpartum, with the most common symptoms being nocturia, frequency, urgency, and SUI. Straining and urinary incontinence were commonly reported as significantly uncomfortable, particularly severe in cases of UI. Additionally, vaginal delivery methods, especially those involving the use of forceps (FD), seemed to be more likely to cause pelvic floor muscle or nerve damage, making it the key predictor of storage-related LUTS.
关于女性下尿路症状（LUTS）的研究，尤其是与不同分娩方式相关的研究有限。产后LUTS的出现与盆底肌肉功能下降之间的关系仍不确定。
这项观察性研究于2019年至2022年期间在北京大学第一医院进行。共招募了2462名女性，并在产后6周进行调查，使用问卷收集数据。此外，作为研究的一部分，还进行了妇科体格检查和盆底肌肉筛查。为了评估个体LUTS及其引起的不适程度，采用了改良中文版的布里斯托尔女性下尿路症状问卷。使用描述性统计、检验、单因素方差分析和多因素逻辑回归等数据分析方法对收集到的数据进行全面检查。
研究参与者中LUTS的患病率较高，70.6%的人有任何症状。65.4%的人报告有储尿期症状，23.0%的人报告有排尿期症状。夜尿是最常见的症状（35.4%），其次是尿频（25.6%）和尿急（25.3%）。20.8%的女性报告有压力性尿失禁（SUI）。有趣的是，夜尿和尿频通常被认为困扰较小，只有少数人认为它们有问题。相比之下，尿失禁（UI）经常被报告为非常困扰，其中SUI和急迫性尿失禁（UUI）占很大比例。阴道分娩（VD）和产钳助产（FD）被确定为LUTS的重要预测因素，具有统计学意义（<0.05）。具体而言，与剖宫产（CS）的女性相比，接受VD尤其是FD的女性，无论是静息基线还是收缩幅度，其表面肌电图（sEMG）活动都较低（<0.001）。
超过一半的受检女性在产后6周出现LUTS，最常见的症状是夜尿、尿频、尿急和SUI。用力排尿和尿失禁通常被报告为明显不适，在UI病例中尤为严重。此外，阴道分娩方式，尤其是涉及使用产钳（FD）的方式，似乎更有可能导致盆底肌肉或神经损伤，使其成为与储尿相关LUTS的关键预测因素。
