Pelvic Floor Disorders and Quality of Life in Women with Self-reported Irritable Bowel Syndrome

J. Wang; M. G. Varma; J. M. Creasman; L. L. Subak; J. S. Brown; D. H. Thom; S. K. van den Eeden


Aliment Pharmacol Ther. 2010;31(3):424-431. 

In This Article

Abstract and Introduction


Background Quality of life among women with irritable bowel syndrome may be affected by pelvic floor disorders.
Aim To assess the association of self-reported irritable bowel syndrome with urinary incontinence, pelvic organ prolapse, sexual function and quality of life.
Methods We analysed data from the Reproductive Risks for Incontinence Study at Kaiser Permanente, a random population-based study of 2109 racially diverse women (mean age = 56). Multivariate analyses assessed the association of irritable bowel syndrome with pelvic floor disorders and quality of life.
Results The prevalence of irritable bowel syndrome was 9.7% (n = 204). Women with irritable bowel had higher adjusted odds of reporting symptomatic pelvic organ prolapse (OR 2.4; 95% CI, 1.4–4.1) and urinary urgency (OR 1.4; 95% CI, 1.0–1.9); greater bother from pelvic organ prolapse (OR 4.3; 95% CI, 1.5–11.9) and faecal incontinence (OR 2.0; 95% CI, 1.3–3.2); greater lifestyle impact from urinary incontinence (OR 2.2; 95% CI, 1.3–3.8); and worse quality of life (P < 0.01). Women with irritable bowel reported more inability to relax and enjoy sexual activity (OR 1.8; 95% CI, 1.3–2.6) and lower ratings for sexual satisfaction (OR 1.8; 95% CI, 1.3–2.5), but no difference in sexual frequency, interest or ability to have an orgasm.
Conclusions Women with irritable bowel are more likely to report symptomatic pelvic organ prolapse and sexual dysfunction, and report lower quality of life.


Irritable bowel syndrome (IBS) is defined by abdominal pain and altered bowel habits. It occurs commonly in the general population and the prevalence is known to be higher in women than in men.[1] A detailed study done to estimate the prevalence of IBS among women in the US found that 5.4% of women had IBS by Rome II criteria, 8.3% of women had IBS by a more liberal variant of the Rome criteria (allowing for pain over 3 months ever in the past), and in a separate sample of households, the prevalence of physician-diagnosed IBS was 8.1%.[2] The authors made a point that the more temporally restrictive criteria of the Rome II may miss some people affected by IBS. The use of 'IBS' in the literature can be difficult because some physicians may label a patient with abdominal symptoms as having 'IBS' even though they do not fit the diagnostic criteria. Thus, a study of self-reported IBS will probably include a broad spectrum of people, some who meet diagnostic criteria and were appropriately diagnosed by a physician with IBS, and those who were labelled as having IBS by a physician or themselves without necessarily meeting diagnostic criteria.

Many people are cognizant of the bowel-related symptoms of IBS, and visits with health care practitioners may focus on these issues. There may be associated conditions that are less frequently addressed. In addition, it is well described that people with IBS report worse quality of life compared with the general public and with those with chronic disease conditions, such as lung disease, heart failure and diabetes.[3,4] While altered bowel habits and pain may be the major factors that affect daily functioning, lifestyle, and hence quality of life, other factors associated with IBS may also affect quality of life, especially in women. Pelvic floor disorders, such as pelvic organ prolapse,[5] urinary urgency and incontinence,[5,6] and sexual dysfunction[7,8] have been associated with IBS in women and can all influence overall quality of life. Several studies have described that women with IBS have a higher likelihood of a co-diagnosis of other somatic conditions. For example, one study found that women with interstitial cystitis or painful bladder syndrome had a greater likelihood of an antecedent diagnosis of fibromyalgia, chronic fatigue syndrome and IBS.[9] A systematic review of the comorbidities associated with IBS described a high prevalence of somatic syndromes such as fibromyalgia (33% incidence), chronic pelvic pain (50% incidence), dysuria (50% incidence) and interstitial cystitis (30%). It is not clear whether these other diagnoses were initially misdiagnoses or whether these conditions coexist, but it is suggested that there is a subgroup of IBS patients who have these other coexisting somatic disorders and often have higher levels of anxiety or depression. Whether these disorders are related because of underlying psychological factors or a common pathophysiological mechanism remains unknown.[10,11]

Our objective was to examine the association of pelvic floor disorders with IBS and the effects of such symptoms on quality of life, using a population-based cohort of middle-aged women. The pelvic floor disorders examined include self-reported symptoms of pelvic organ prolapse, urinary symptoms and sexual dysfunction.


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