Parameters of quality of life in patients with pelvic floor dysfunction and diastasis recti in the postpartum period

Introduction. Today, the problem of weak core muscles in the postpartum period, primarily pelvic floor descent and diastasis recti in women of reproductive age, is becoming a significant challenge for practical medicine. Aim. A comprehensive assessment of urogenital symptoms and manifestations of sexual dysfunction in the formation of parameters of quality-of-life components in primiparous women after urgent delivery. Materials. The study was conducted in two groups of patients aged 18 to 35 years: 60 patients with signs of pelvic floor dysfunction and diastasis recti (main group) and 60 women who did not have these symptoms (comparison group). Patients were included in the study 6 months after the first full-term spontaneous delivery in cephalic presentation with minimal signs of pelvic floor dysfunction and diastasis recti detected during a routine examination. The following validated questionnaires were used: the International Conference on Incontinence Questionnaire-Short Form (ICIQ-SF), the Female Sexual Function Index (FSFI), the Functional Pelvic Pain Scale (FPPS), and the MOS SF-36 quality-of-life score. The statistical processing of the results was performed in the Windows 7 operating environment using the statistical software ‘Statistica 6.0’. Results. Inheritance of genital prolapse was noted in more than a third of patients in the main group (38.3%), signs of undifferentiated connective tissue dysplasia (UCTD) were found in almost half of the observations (43.3%), the most significant were complications in childbirth, birth trauma (61.7%) and shoulder dystocia (13.3%). The main complaints were pain in the lower back and pelvis (56.7%), perineal pain (31.7%), increased transient urinary incontinence (26.7%), increased secretory function (36.7%), recurrent vaginal dysbiosis (48.3%), dyspareunia (31.7 %), lack of sexual desire and reduced sexual activity (38.3 %). Most patients noted a prolonged recovery time for sexual activity after childbirth (more than 10 weeks) and the presence of a cosmetic defect of the perineum and anterior abdominal wall. Vaginal relaxation syndrome (loss of vaginal wall tone and elasticity, increased vaginal volume), as well as urinary incontinence, was quite common in almost every fifth patient (26.7% of observations). It should be noted that the proportion of psycho-emotional manifestations such as postpartum depression, anxiety, tokophobia has increased in almost every fourth patient. The dysfunction of the muscles of the anterior abdominal wall and pelvic floor has negative influence on psychological health of women, as demonstrated by differences in the average indicators of vital activity (66.7±3.2 points) social functioning (71.6±2.4 points), role functioning due to emotional state (62.8±1.5 points) and mental health (61.6±2.4 points) compared to the comparison group (82.6±1.4 points) (p<0.01). In 19 (31.7 %) patients of the main group, the lowest mental health score (less than 60 points) was noted, which is associated with an increase in anxiety, depressive disorders and a decrease in the proportion of positive emotions. Conclusions. This study established a correlation between pregnancy and childbirth in primiparous women and the prevalence of disorders such as low back pain, pelvic and perineal pain, urinary incontinence, fecal incontinence, and sexual dysfunction. These symptoms in young primiparous women are often asymptomatic and remain undiagnosed; however, in the late postpartum period, they lead to the development of psycho-emotional disorders in one out of four patients and negatively affect the psychological component of quality of life.