What to do about female pelvic floor dysfunctional disorders

  Female pelvic floor dysfunctional diseases are common in middle-aged and elderly women, with a prevalence of about 40%, mainly including pelvic organ prolapse (POP) and stress urinary incontinence (SUI). Currently, a new discipline of gynecologic urology and female pelvic floor reconstructive surgery has been formed for the study of these diseases. There are more studies on POP and SUI in foreign countries, and new theories, new concepts and new procedures are constantly proposed. Domestic research on PFD has just started, but it is developing rapidly. 2005, the Chinese Medical Association Obstetrics and Gynecology Branch established the National Female Pelvic Floor Group, which holds regular academic exchange meetings to promote new theories and concepts and implement new diagnostic and therapeutic methods, which has become a hot issue in the obstetrics and gynecology field and has received widespread attention. Since 1852, when Professor Marion established the relationship between gynecology and urology, gynecologic urology, i.e., the study of pelvic floor dysfunctional diseases, has a history of more than 100 years, and it has been found that pelvic floor diseases are common in women and directly endanger women’s quality of life and physical and mental health. Clinicians’ understanding of the dangers of the disease comes from epidemiological studies. The prevalence of female incontinence in the United States is 2 to 46 percent, and the cost of incontinence in the United States in 2002 was $16.3 billion, much higher than the cost of hemodialysis plus coronary artery bypass grafting. In addition to treatment, the cost of absorbent items (pads) is also large, and about 1/3 of patients are not seen. Nearly 200,000 patients with pelvic organ prolapse are treated surgically throughout the United States. The prevalence of female urinary incontinence in Beijing and Guangzhou, China, is reported to be 18.1% to 57.5%, and up to 50% in postmenopausal women. The actual prevalence of urinary incontinence among women in general may be higher than the clinical statistics due to the influence of the survey area, survey methods and other factors. Survey data in economically developed countries show that urinary incontinence is more common than hypertension, depression and diabetes, and the cost of medical care has been much higher than coronary heart disease, osteoporosis and breast cancer, becoming one of the five most common chronic diseases that threaten women’s health.  However, at present, the majority of female incontinence patients in China, less than 1/3 of the awareness of medical treatment, due to the lack of knowledge, low social concern, incontinence patients have a very low rate of consultation. Patients have poor knowledge of the disease, or they think it is an inevitable manifestation of old age, or they do not take the initiative to consult a doctor due to shyness and other reasons. According to some data, the knowledge of gynecologists and nurses in four tertiary hospitals in Beijing is lacking, with 6.6% of doctors and 7.4% of nurses believing that the prevalence of adult female incontinence in Beijing is currently above 30%; when women with pelvic organ prolapse were asked about their common combined diseases, only 45.9% of doctors and 27.8% of nurses wrote that they might be accompanied by stress incontinence; 50.8% of physicians believed that the majority of clinical gynecologists currently do not pay enough attention to urinary incontinence. Therefore, physicians’ awareness of this disease should be improved in order to further educate patients and increase their awareness of this disease. It is recommended that gynecologists should take the initiative to screen patients for urinary incontinence, especially when pelvic organ prolapse is detected, and routinely ask about urinary incontinence and its impact on quality of life.