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Risk Factors Associated With Pelvic Floor Disorders in Women Undergoing Surgical Repair

From the Section of Urogynecology and Reconstructive Pelvic Surgery, Division of Gynecologic Specialties, Department of Obstetrics, Gynecology, and Research, Magee Womens Hospital, Magee Womens Research Institute, University of Pittsburgh, Pittsburgh, Pennsylvania.

Address reprint requests to: Pamela A. Moalli, MD, PhD, Magee Womens Hospital, Department of Obstetrics, Gynecology, and Research, 300 Halket Street, Pittsburgh, PA 15213; E-mail: rsipam{at}mail.magee.edu.

OBJECTIVE: To identify demographic, obstetric, and gynecologic risk factors associated with the development of pelvic floor disorders in women who undergo surgical correction.

METHODS: We conducted a case–control study, with cases selected from all women who had surgery by our urogynecology service from July 1, 1999 to July 1, 2000 and who had a first obstetric delivery at Magee Womens Hospital (n = 80). Controls were patients seen in the general gynecology office over the same time period who had no complaints associated with pelvic floor disorders in the previous 3 years, less than stage I prolapse on pelvic examination, and first obstetric delivery at Magee Womens Hospital (n = 176). Demographic, obstetric, and gynecologic variables were compared between cases and controls.

RESULTS: There were no significant differences in race, current age, gravidity, or parity. Cases were more likely than controls to have a higher body mass index (BMI) (28.6 ± 6.3 versus 26.4 ± 6.1 kg/m², P = .01), to be younger at first delivery (25.8 ± 5.3 versus 28.4 ± 4.9 years, P < .001), to have undergone a forceps delivery (64% versus 44%, P .001), and to have had previous gynecologic surgery (34% versus 16%, P = .003). Using logistic regression modeling, all of these factors were found to be independently associated with pelvic floor disorders. After menopause, use of hormone replacement therapy 5 or more years was protective (P = .001).

CONCLUSION: In our surgical patients, younger age at first delivery, higher BMI, forceps delivery, and history of gynecologic surgery were significantly associated with subsequent development of pelvic floor disorders.