UK Lifetime Risk of Female Pelvic Floor Surgery

Researchers in the UK recently asked this question: For women in the UK who have given birth, what is the risk for pelvic floor surgery and for repeat surgery? Surgery for pelvic organ prolapse (POP), urinary incontinence (UI), and rectal prolapse or fecal incontinence (RP-FI) were included in the study. The research also addressed re-operation rates and the length of time between repeat surgery for prolapse and incontinence.

From the national registry in Scotland, 34,630 health records of women were accessed. The lifetime risk for women (up to age 80) having pelvic floor surgery was just over 12%. Re-operation rate was 19%; women who had a mid-urethral sling (MUR) versus a retropubic operation had reduced rates of re-operation.The average time between repeat surgeries for prolapse or incontinence was 2.8-3 years. A woman who gave birth to a first child when she was less than 20 years old, or women who had all births via c-section had reduced lifetime rates of surgery. Conversely, increased body mass index (BMI), having one perineal laceration, or having 1 birth that involved forceps for delivery increased rate of surgery. (Sustaining a third degree perineal tear was a risk factor for rectal prolapse-fecal incontinence.)

The bottom line: in the UK, more than 1 in 10 parous women will undergo pelvic floor surgery. This is a general population study, therefore the authors express confidence that these rates should hold true for the general UK or for the European communities. The authors also compare their findings to several other epidemiological studies completed in the US, Australia, and France, and it is interesting to read the discussion related to comparison of populations in these studies. As in all the studies addressing pelvic floor surgery rates, the numbers are sufficiently high to warrant increased national attention towards prevention, including pelvic rehabilitation. The average time interval between surgeries struck me as being relatively short, and it would be valuable to have more research that compares repeat surgeries in those patients who have had pelvic rehabilitation versus those who have not been educated about pelvic floor functional use and/or strengthening. If you are interested in reading the full, free-access article, please click here.