Influencing Factors Of Urinary Incontinence And Life Quality Evaluation In Women With Pelvic Organ Prolapse In Qinghai Province

Objectives:1.To understand influencing factors of urinary incontinence(UI)in women with Pelvic organ prolapse(POP)in Qinghai province,and provide theoretical basis for preventing UI in POP women.2.To analyze the relationships and influencing factors among pelvic floor function,daily life quality and sexual life quality of POP women,and put forward preventive measures to improve POP women’s life quality.3.To evaluate the effect of low frequency electrical stimulation-biofeedback-pelvic floor muscle training combined with magnetic stimulation for POP women,and provide theoretical basis for improving the quality of life of POP women clinically.Methods:1.This study adopts the method of cross-sectional study.According to the population proportion of each city or state in Qinghai province and the pelvic floor rehabilitation of maternal and child health care institutions,cluster sampling was conducted on January-December 2021,with four maternal and child health care institutions in three cities or states(Xining City,Haixi state and Haibei state)in Qinghai province as the questionnaire survey points.According to the strict inclusion and exclusion criteria and pelvic organ prolapse quantitation(POP-Q),the women diagnosed with POP are investigated for the analysis of POP’s influencing factors and quality of life,and those who have met and completed pelvic floor rehabilitation therapy are evaluated after pelvic floor rehabilitation therapy for POP women.2.The face-to-face or self-filling questionnaire survey methods were adopted.The scores of pelvic floor distress inventory-short form 20(PFDI-20),pelvic floor impact questionnaire‐short form 7(PFIQ-7)and pelvic organ prolapse‐urinary incontinence sexual questionnaire 12(PISQ-12)were used as evaluation tools for pelvic floor function,daily life quality and sexual life quality,and pelvic floor muscle strength was measured for the respondents.For POP women undergoing pelvic floor rehabilitation treatment,pelvic floor electromyography was evaluated before treatment,and POP-Q stage,pelvic floor electromyography evaluation and muscle strength measurement were performed again after treatment,and PFDI-20,PFIQ-7 and PISQ-12 scales were filled in.3.Epidata3.1 software was used to input the questionnaire and related inspection data,and SPSS 20.0 was used to sort out and analyze the data:(1)Univariate analysis(χ~2 test and rank sum test)and multivariate analysis(binary Logistic regression analysis)of UI in women with POP.(2)Correlation analysis of pelvic floor function,daily life quality and sexual life quality of POP women(Spearman correlation),and univariate analysis(χ~2 test,Fisher test and rank sum test)and multivariate analysis(binary Logistic regression and unordered multi-category Logistic regression analysis)of pelvic floor function,daily life quality and sexual life quality.(3)In addition,on the basis of low-frequency electrical stimulation-biofeedback-pelvic floor muscle training combined with magnetic stimulation,the POP-Q stage,pelvic floor electromyography value and muscle strength,pelvic floor function,daily life and sexual life quality before and after treatment were compared(pairedχ~2 test and paired rank sum test).Results:1.A total of 763 POP subjects were included in the study,including 115 cases who met and voluntarily completed pelvic floor rehabilitation.Among 763 women with POP,the POP-Q stage was all within Grade II,and 322 cases(42.20%)had urinary incontinence,with PFDI-20 score of 25.00(8.33,54.17),PFIQ-7 score of0.00(0.00,14.29)and PISQ-12 score of 32.00(28.00,35.00).The pelvic floor function was good in 567(74.30%)cases,moderate in 117(15.30%)cases and poor in 79(10.40%)cases.The quality of daily life was good in 432(56.60%)cases,moderate in257(37.70%)cases and poor in 74(9.70%)cases.There were 366(48.00%)cases with normal sexual function and 397(52.00%)cases with sexual dysfunction.2.Influencing factors of UI in POP women.Binary Logistic regression analysis showed that BMI≥28 kg/m~2(OR=4.75,95%CI=1.69～13.33),1～10 years after delivery(OR=2.48,95%CI=1.61～3.82),11～20 years after delivery(OR=4.67,95%CI=2.92～7.46),21～30 years after delivery(OR=4.76,95%CI=2.87～7.89),≥31 years after delivery(OR=3.66,95%CI=1.98～6.76),vaginal delivery(OR=1.82,95%CI=1.20～2.77),laceration of perineum(OR=1.47,95%CI=1.08～2.10)and the value of Ba point(OR=1.88,95%CI=1.33～2.65)in the stage indicator of POP-Q are risk factors for UI in women with POP,P<0.05.3.Analysis of pelvic floor function,daily life quality and sexual life quality of POP women.Spearman correlation found that there was a correlation among pelvic floor function,daily life quality and sexual life quality of POP women(PFDI-20,PFIQ-7 and PISQ-12 scores,P<0.01).Multivariate logistic regression analysis showed that compared with the group with better pelvic floor function,weight gain during pregnancy(OR=1.06,95%CI=1.02～1.10),pre-pregnancy BMI,laceration of perineum(OR=2.31,95%CI=1.32～4.03)were influencing factors of poor pelvic floor function(P<0.01).Compared with the group with better quality of daily life,weight gain during pregnancy(OR=1.08,95%CI=1.04～1.12),education level,pre-pregnancy BMI,laceration of perineum(OR=2.77,95%CI=1.56～4.92)were influencing factors of poor quality of daily life.(P<0.01).The age was 35～44 years old(OR=0.66,95%CI=0.46～0.95),the education level was junior high school(OR=0.39,95%CI=0.19～0.76),the education level was senior high school or technical secondary school(OR=0.32,95%CI=0.16～0.64),the education level of university or junior college or above(OR=0.22,95%CI=0.12～0.41)is the protective factor for female sexual dysfunction in POP(P<0.01).The values of Ap(OR=1.39,95%CI=1.07～1.80)and D value(OR=1.72,95%CI=1.01～1.36)in the index points of POP-Q staging are risk factors of sexual dysfunction in women with POP(P<0.05).4.The improvement of pelvic floor rehabilitation on POP women.Pairedχ~2 test or paired rank sum test showed that after pelvic floor rehabilitation treatment,the prolapse of POP women was improved(the values of Aa,Ba,and Bp of POP-Q,P<0.01);The pelvic floor muscle strength was improved(Class I muscle strength,Class II muscle strength and electromyography value,P<0.01),and Class II muscle fatigue and vaginal maximum pressure were also improved,P<0.05.Pelvic floor function,quality of daily life and sexual life have been improved(PFDI-20,PFIQ-7 and PISQ-12 scores,P<0.01).Conclusions:1.Urinary incontinence exists in women with POP women in Qinghai province,and the risk factors are BMI,postpartum time,vaginal delivery,laceration of perineum,etc.2.There is a certain correlation among pelvic floor function,daily life quality and sexual life quality of POP women.After POP occurs in female pelvic floor,the pelvic floor function is weakened,which mainly affects the pelvic floor’s function of controlling urine,defecation and sexual life,resulting in the decline of daily life quality,UI,uncomfortable defecation and unsatisfactory sexual life,affecting family and life work.Female pelvic floor function of POP also affects the quality of sexual life to some extent.The income affects the visits of women with POP,resulting in gradual decline of pelvic floor function and excessive weight gain during pregnancy,high BMI before pregnancy and avulsion of perineum cause the decline of pelvic floor function,which also leads to the decline of daily life quality.In addition,POP women with low education level have low quality of life and sex life.Vaginal posterior wall bulge,vaginal top prolapse or uterine prolapse have a direct impact on patients’sexual life quality.3.Low-frequency electrical stimulation-biofeedback-pelvic floor muscle training combined with magnetic stimulation is effective in improving female pelvic floor muscle strength and POP-Q staging,especially in improving pelvic floor function of POP women.After standard treatment,patients’daily life quality and sexual life quality were improved.Low-frequency electrical stimulation-biofeedback-pelvic floor muscle training combined with magnetic stimulation therapy is an effective means for pelvic floor health care to improve the quality of life of POP women.