The prevalence, natural history and risk factors for female pelvic floor disorders (PFD) are poorly understood. These disorders, which include urinary incontinence, anal incontinence and pelvic organ prolapse, have a profound effect upon women's lives and impact a large percentage of the adult female population in the United States. Despite years of research, the fundamental question of the effects of pregnancy versus parity versus aging alone on the development of these disorders remains unanswered. The primary aims of this study are to (1) to determine whether the effects of pregnancy, vaginal delivery or aging act as independent risk factors for the development of PFD, (2) to establish the prevalence of individual PFDs across a full age spectrum of a multi-ethnic population, and, (3) to validate and implement a multifaceted questionnaire for large population screening that includes information related to urinary incontinence (stress and urge), anal incontinence, and prolapse symptomatology. In order to control for potential confounders, race/ethnicity, socioeconomic status, physical activities, smoking, menopause, hormone use, and co-morbid medical conditions will be measured and their relative contributions to PFD will be evaluated. The association between prolapse symptoms and incontinence symptoms will also be examined. Validation of a questionnaire to evaluate PFD will be done with female patients recruited from the Gynecology and Female Pelvic Medicine clinics in Kaiser Permanente's San Diego Service Area. The subjects for the population-based study will be drawn from approximately one million female members of Kaiser Foundation Health Plan that reside in the Southern California region who are between the ages of 25 and 84 years. For the population-based study, women will be invited to complete a self-administered, mailed questionnaire after receiving an introductory letter in the mail explaining the study. Responses from the questionnaire will be analyzed to ascertain the impact of age, pregnancy, and vaginal birth on PFD. It remains unknown whether vaginal delivery increases the risk of PFD independent of other risk factors, specifically pregnancy and aging. To answer these questions, large population based studies on the prevalence of these disorders among women of all ages and various reproductive histories, specifically nulliparas, those delivered by elective cesarean section alone and those with a history of vaginal delivery, are needed. The answer to these questions will direct future research in both treatment and prevention of PFDs, and enable physicians to counsel their patients on the risk of vaginal delivery as it relates to PFD particularly for women with a history of cesarean section delivery.
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