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Gynecologic cancers predict coexisting pelvic floor disorders


 

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ORLANDO – Women diagnosed with a gynecologic malignancy have a strong likelihood of presenting with a coexisting pelvic floor disorder, according to data collected prospectively from a cancer survivorship cohort.

Bladder symptoms on validated questionnaires completed soon after diagnosis and prior to surgical treatment were especially common, with an overall urinary incontinence rate of 46.1% and a stress incontinence (SUI) rate of 59.5%, Dr. C. Emi Bretschneider reported at the annual scientific meeting of the Society of Gynecologic Surgeons.

“We think increased awareness of pelvic health issues will allow for more individualized and comprehensive counseling and care of these women,” said Dr. Bretschneider of the department of obstetrics and gynecology at the University of North Carolina, Chapel Hill.

She identified pelvic floor disorders as a major potential source of diminished quality of life in women with gynecologic malignancies.

Dr. C. Bryce Bowling, a urogynecologist at the University of Tennessee, Knoxville, agreed. Although he observed that the risk of both pelvic floor disorders and gynecologic malignancies increase with age, he said the reported rates at which they coexist is “sobering.”

“These are important data for those who are not already aware of this relationship,” Dr. Bowling, a discussant invited by the Society of Gynecologic Surgeons, said in an interview.

At many institutions, including his own, screening for pelvic floor disorders in women with gynecologic malignancies is already routine.

“Screening for incontinence is a very important consideration even for those with a poor prognosis,” he said. “Control of urinary symptoms over the course of the woman’s survival will have a very positive impact on quality of life.”

The data on pelvic floor disorders was drawn from 154 women with gynecologic cancers who completed baseline evaluations of bowel and bladder symptoms using two validated questionnaires in a recent 10-month period. Most (62%) had endometrial cancer, but other cancers, such as ovarian (17%) and cervical (11%) were represented. There were no significant differences in the rates of pelvic floor disorders among the cancer types.

In addition to the substantial rates of urinary incontinence and SUI, 40.8% of patients reported urinary incontinence with urgency and 21.5% reported nocturia most or every night. The rate of enuresis was 7.2%. In addition, 3.9% reported fecal incontinence.

Complaints of abdominal pain (46.8%), constipation (42.2%), and diarrhea (20.1%) were also common, Dr. Bretschneider reported at the meeting, jointly sponsored by the American College of Surgeons.

When women older than 50 years were compared to younger women, the rates of nearly every indicator of a pelvic floor disorder were higher. Most differences, such as overall urinary incontinence (P = .009), SUI (P = .005), and abdominal pain (P = .002) had a high degree of statistical significance. However, overall urinary incontinence and SUI were not significantly associated with age when modeled as a continuous variable.

Recognizing pelvic floor disorders at the time of the diagnosis of gynecologic malignancy can be relevant to planning cancer treatment, according to Dr. Bretschnieder. The study results highlight the need for a proactive approach that includes screening at the time of diagnosis, she said.

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