عوامل مرتبط با اختلالات کف لگن در زنان ایرانی: یک مرور نظام‌مند

نوع مقاله : Review Article

نویسندگان

1 گروه سلامت باروری و مامایی، دانشکده‌ی علوم پزشکی، دانشگاه تربیت مدرس، تهران، ایران.

2 گروه مامایی، دانشکده‌ی پزشکی، دانشگاه علوم پزشکی ایرانشهر، ایرانشهر، ایران.

3 بیمارستان ایران، دانشگاه علوم پزشکی ایرانشهر، ایرانشهر، ایران

4 گروه مامایی، دانشگاه آزاد اسلامی واحد اردبیل، اردبیل، ایران

5 مرکز تحقیقات مراقبت‌های پرستاری و مامایی، پژوهشکده‌ی مدیریت سلامت، دانشگاه علوم پزشکی ایران، تهران، ایران

6 مرکز پژوهش‌های علمی و فناوری دانشجویان، دانشگاه علوم پزشکی تهران، تهران، ایران

10.48305/jims.v43.i833.1247

چکیده

مقاله مروری




مقدمه: اختلالات کف لگن (Pelvic floor disorders) PFD، از مشکلات شایع بهداشتی در زنان هستند که می‌توانند کیفیت زندگی را تحت تأثیر قرار دهند. در ایران، به دلیل عوامل فرهنگی و اجتماعی، این اختلالات اغلب تشخیص داده نمی‌شوند یا تحت درمان قرارنمی‌گیرند. این مرور نظام‌مند با هدف شناسایی عوامل مرتبط با PFD در زنان ایرانی انجام شد.
روش‌ها: در این مرور نظام‌مند، مطالعات در راستای هدف مطالعه در پایگاه‌های اطلاعاتی Web of Science، PubMed،Scopus ، SID، Magiran، Irandoc با موتور جست‌وجوی Google Scholar و محدود به مقاله‌های فارسی و انگلیسی زبان منتشر شده تا 31 می سال 2025 بررسی شد. ارزیابی کیفیت مطالعات با استفاده از چک‌لیست نیوکاسل اتاوا (NOS) انجام شد.
یافته‌ها: 30 مطالعه (26 مقطعی، 2 کوهورت، 1 مورد-شاهدی، 1 طولی) شامل 20,641 زن بررسی شدند. شیوع PFD بین 12/5 تا 89 درصد متغیر بود (شایع‌ترین انواع آن نیز بی‌اختیاری ادراری (12/5-57/7 درصد) و پرولاپس اندام‌های لگنی (13-80/8 درصد) بود). زایمان واژینال، سن بالا، شاخص توده‌ی بدنی بالا و یبوست قوی‌ترین عوامل خطر بودند، در حالی که زایمان سزارین و تحصیلات بالا عوامل محافظ بودند.
نتیجه‌گیری: شیوع بالای PFD در زنان ایرانی، نیازمند مداخلات پیشگیرانه مانند غربالگری منظم، آگاهی رسانی و آموزش زنان در مورد تمرینات کف لگن، و مدیریت تغذیه‌ای یبوست است. بهبود دسترسی به مراقبت‌های بهداشتی و تحقیقات بیشتر در مورد تعیین کننده‌های اجتماعی- اقتصادی توصیه می‌شود.

تازه های تحقیق

فریناز رحیمی: PubMed ,Google Scholar 

معصومه مبارکی: Google Scholar

عاطفه شولی بر: Google Scholar

نسترین صفوی اردبیلی: PubMed ,Google Scholar

فاطمه عبدی: PubMed ,Google Scholar

فاطمه السادات رهنمائی: PubMed ,Google Scholar

کلیدواژه‌ها

موضوعات

عنوان مقاله [English]

Associated Factors with Pelvic Floor Disorders Among Iranian Women: A Systematic Review

نویسندگان [English]

  • Farinaz Rahimi 1
  • Masoumeh Mobaraki 2
  • Atefeh Sholibor 3
  • Nastaran Safavi Ardabili 4
  • Fatemeh Abdi 5
  • Fatemeh Alsadat Rahnemaei 6
1 Department of Reproductive Health and Midwifery, Faculty of Medical Sciences, Tarbiat Modares University, Tehran, Iran
2 Department of Midwifery, School of Medicine, Iranshahr University of Medical Sciences, Iranshahr, Iran
3 Iran Hospital, Iranshahr University of Medical Sciences, Iranshahr, Iran
4 Department of Midwifery, Ardabil Branch, Islamic Azad University, Ardabil, Iran
5 Nursing and Midwifery Care Research Center, Health Management Research Institute, Iran University of Medical Sciences, Tehran, Iran
6 Student Scientific Research Center (SSRC), Tehran University of Medical Sciences, Tehran, Iran
چکیده [English]

Background: Pelvic floor disorders (PFDs) are common health problems among women that can significantly impact quality of life. In Iran, due to cultural and social factors, these conditions are often underdiagnosed or undertreated. This systematic review aimed to identify the factors associated with PFDs among Iranian women.
Methods: This systematic review identified relevant studies through a comprehensive search of the Web of Science, PubMed, Scopus, SID, Magiran, Irandoc databases, and the Google Scholar search engine, limited to Persian and English articles published up to May 31, 2025. The methodological quality of the included studies was assessed using the Newcastle-Ottawa Scale (NOS).
Findings: A total of 30 studies (26 cross-sectional, 2 cohort, 1 case-control, and 1 longitudinal) involving 20,641 women were reviewed. The prevalence of PFDs ranged from 12.5% to 89%, with the most common types being urinary incontinence (12.5%–57.7%) and pelvic organ prolapse (13%–80.8%). Vaginal delivery, older age, higher BMI, and constipation were identified as the strongest risk factors, whereas cesarean delivery and higher educational degree were found to be protective factors.
Conclusion: The high prevalence of PFDs among Iranian women highlights the need for preventive interventions such as routine screening, public awareness, education on pelvic floor exercises, and nutritional management of constipation. Enhancing access to healthcare services and conducting further research on socioeconomic determinants are also recommended.

کلیدواژه‌ها [English]

  • Pelvic floor disorders
  • Urinary incontinence
  • Fecal incontinence
  • Pelvic organ prolapse
  • Women
  • Iran
  • Menopause
  • Vaginal delivery
  • Prevalence

مراجع

  1. Rodríguez NMP, Torres JdCM, Delgado JÁG, Adams EMR, Lara HR. Dysfunction of pelvic and sexual floor in women. Invest Medicoquirúrgicas 2019; 11(S1): 1-25.
  2. Al-Badr A, Saleem Z, Kaddour O, Almosaieed B, Dawood A, Al-Tannir M, et al. Prevalence of pelvic floor dysfunction: a Saudi national survey. BMC Womens Health 2022; 22(1): 27.
  3. Wu JM, Vaughan CP, Goode PS, Redden DT, Burgio KL, Richter HE, et al. Prevalence and trends of symptomatic pelvic floor disorders in US women. Obstet Gynecol 2014; 123(1): 141-8.
  4. Hong M-K, Ding D-C. Current treatments for female pelvic floor dysfunctions. Gynecol Minim Invasive Ther 2019; 8(4): 143-8.
  5. Direkvand-Moghadam A, Ghazanfari Z, Montazeri A, Delpisheh A, Direkvand-Moghadam A. Risk factors of pelvic organ prolapse in Iranian women: a cross-sectional study. Int J Epidemiol Res 2014; 1(1): 29-34.
  6. Rashidi Fakari F, Hajian S, Darvish S, Alavi Majd H. Predictors of help-seeking behaviors in women with urinary incontinence: Based on Iranian women’s lens. PLoS One 2023; 18(8): e0289785.
  7. Alizadeh A, Montazeri M, Shabani F, Bani S, Hassanpour S, Nabighadim M, et al. Prevalence and severity of urinary incontinence and associated factors in Iranian postmenopausal women: a cross-sectional study. BMC Urol 2023; 23(1): 18.
  8. Sharifiaghdas F, Narouie B, Hanafi Bojd H, Dadpour M, Rostaminejad N, Motevalli Amini SK, et al. Risk factors for pelvic organ prolapse, a case-control study in a tertiary hospital in Iran. Urologia 2025; 92(3): 517-24.
  9. Zare-Bidaki M, Nadjafi Semnani M, Nadjafi Semnani A, Ghanbarzadeh N. Epidemiologic study of female urinary incontinence in South Khorasan, Iran. J Obstet Gynecol Cancer Res 2021; 6(3): 134-42.
  10. Daneshpajooh A, Naghibzadeh‐Tahami A, Najafipour H, Mirzaei M. Prevalence and risk factors of urinary incontinence among Iranian women. Neurourol Urodyn 2021; 40(2): 642-52.
  11. Najafi Z, Morowatisharifabad MA, Jambarsang S, Rezaeipandari H, Hemayati R. Urinary incontinence and related quality of life among elderly women in Tabas, South Khorasan, Iran. BMC Urol 2022; 22(1): 214.
  12. Good MM, Solomon ER. Pelvic floor disorders. Obstet Gynecol Clin North Am 2019; 46(3): 527-40.
  13. Verbeek M, Hayward L. Pelvic floor dysfunction and its effect on quality of sexual life. Sex Med Rev 2019; 7(4): 559-64.
  14. Dheresa M, Worku A, Oljira L, Mengiste B, Assefa N, Berhane Y. One in five women suffer from pelvic floor disorders in Kersa district Eastern Ethiopia: a community-based study. BMC Womens Health 2018; 18: 1-8.
  15. Hadizadeh-Talasaz Z, Khadivzadeh T, Ebrahimipour H, Ghaebi NK. The experiences of women who live with pelvic floor disorders: a qualitative study. Int J Community Based Nurs Midwifery 2021; 9(2): 159-71.
  16. Rashidi Fakari F, Hajian S, Darvish S, Alavi Majd H. Explaining factors affecting help-seeking behaviors in women with urinary incontinence: a qualitative study. BMC Health Serv Res 2021; 21(1): 60.
  17. Mirzaie M, Darabi S. Population aging in Iran and rising health care costs [in Persian]. Salmand: Iranian Journal of Ageing 2017; 12(2): 156-69.
  18. Jafarizadeh H, Maghsoudi Z, Namadi F, Mohammadpour Y, Moradi Y. The effect of pelvic floor muscles training, bladder exercises and lifestyle modification on urinary incontinence in elderly men. J Nephropathol 2022; 11(1): e8 .
  19. Pollock A, Berge E. How to do a systematic review. Int J Stroke 2018; 13(2): 138-56.
  20. Page MJ, McKenzie JE, Bossuyt PM, Boutron I, Hoffmann TC, Mulrow CD, et al. The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. BMJ 2021; 372: n71.
  21. Luchini C, Stubbs B, Solmi M, Veronese N. Assessing the quality of studies in meta-analyses: Advantages and limitations of the Newcastle Ottawa Scale. World J Meta-Anal 2017; 5(4): 80-4.
  22. Stang A. Critical evaluation of the Newcastle-Ottawa scale for the assessment of the quality of nonrandomized studies in meta-analyses. Eur J Epidemiol 2010; 25(9): 603-5.
  23. Harati PG, Hosseini SM, Javaheri A, Manshadi FD, Baghban AA, Hoseini M, et al. Prevalence of Lower Urinary Tract Symptoms in Pregnant Women in Yazd, Iran: A Cross-Sectional Study. Cureus 2025; 17(5): e84190 .
  24. Rashidi F, Mirghafourvand M. Frequency of pelvic floor disorders and related socio-demographic and obstetric determinants in reproductive aged women in Tabriz city, 2021-2022. Iran J Obstet Gynecol Infertil 2024; 27(2): 36-46.
  25. Ghanbari Z, Asadi F, Amirlatifi S, Shariat M, Eftekhar T, Deldar M, et al. Correlation Between Apical, Anterior, and Posterior Vaginal Wall Prolapse With Voiding Dysfunction: A Single Center Retrospective Cohort Study. J Family Reprod Health 2024; 18(2): 115-21.
  26. Sodagar N, Ghaderi F, Ghanavati T, Ansari F, Jafarabadi MA. Related risk factors for pelvic floor disorders in postpartum women: a cross-sectional study. Int J Womens Health Reprod Sci 2022; 10(1): 51-6.
  27. Karami H, Abedinzadeh M, Khanizadeh M, Ahrari M, Ayatollahi A, Alipor H. Prevalence of Urinary incontinence in women referred to urology clinics in Yazd City in 2019-2020 [in Persian]. J Shahid Sadoughi Univ Med Sci 2022; 30(4): 4740-50.
  28. Abbaspoor Z, Sadeghi M, Saki A, Nikbakhat R, Miryan M. The relationship between serum 25-hydroxyvitamin D and urinary incontinence in Iranian reproductive-aged women: a cross-sectional study. Family Medicine & Primary Care Review 2022; 24(1): 7-12.
  29. Hakimi S, Aminian E, Mohammadi M, Alizadeh SM, Bastani P, Houshmandi S. Prevalence and risk factors of urinary/anal incontinence and pelvic organ prolapse in healthy middle-aged Iranian women. J Menopausal Med 2020; 26(1): 24-8.
  30. Komeilifar R, Javadifar N, Afshari P, Haghighizade MH, Honarmandpour A. The prevalence, subtypes and obstetric risk factors of urinary incontinence in reproductive age women referred to community health care centers of Dezful, Iran-2015. Int J Community Based Nurs Midwifery 2017; 5(3): 275-83.
  31. Vakili M, Amoqadiri M, Mohammadi M, Modaressi M. Prevalence and Factors Associated with Stress Urinary Incontinence after Childbirth in Yazd in 2015 [in Persian]. J Shahid Sadoughi Univ Med Sci 2016; 24(9): 716-23.
  32. Vahdatpour B, Zargham M, Chatraei M, Bahrami F, Alizadeh F. Potential risk factors associated with stress urinary incontinence among Iranian women. Adv Biomed Res 2015; 4: 205.
  33. Dehghan Manshadi F, Ghanbari Z, Jabbari Z, Miri E. Urinary incontinence, its related disorders and risk factors in women [in Persian]. Journal of School of Public Health and Institute of Public Health Research 2013; 11(2): 53-63.
  34. Basirat Z, Bakhtiari A, Payandeh P. Postpartum stress urinary incontinence and some related factors [in Persian]. Babol Univ Med Sci 2008; 10(5): 41-7.
  35. Sobhgol SS, Charandabee SM. Related factors of urge, stress, mixed urinary incontinence and overactive bladder in reproductive age women in Tabriz, Iran: a cross-sectional study. Int Urogynecol J Pelvic Floor Dysfunct 2008; 19(3): 367-73.
  36. Taimoori B, Roudbari M. The prevalence of symptoms of pelvic floor disorders in women that referred to the clinic of gynecology in Ali-ebn-Abitaleb Hospital, Zahedan, Iran [in Persian]. Zahedan J Res Med Sci. 2006; 8(3): e94890.
  37. Akhlaghi F. Study of the prevalence of pelvic floor disorders in patients referred to the gynecology clinic of Hazrat Zainab Hospital in Mashhad in 2003 [in Persian]. Iranian Journal of Obstetrics, Gynecology and Infertility 2004; 7(1): 25-31.
  38. Behdani R, Rezaei E. The frequency of urinary stress incontinence after delivery in primiparous women and the related factors [in Persian]. Tehran Univ Med J 2001; 59(5): 23-8.
  39. Savari M, Rahmatipanah M, Miraj S, Mohammadbeigi A. Study of the relationship between mediolateral episiotomy in vaginal delivery and pelvic organ prolapse in pregnant mothers. Eur J Transl Myol 2025; 35(2): 13822.
  40. Rashidi F, Mirghafourvand M. Pelvic floor disorder and relevant factors in Iranian women of reproductive age: a cross-sectional study. BMC Women's Health 2023; 23(1): 71.
  41. Moradi M, Niazi A, Shariat Moghani BS, Mohammadzadeh F, Afiat M, Mazloumi E. The relationship between mode of delivery and pelvic organ prolapse in women: A cross-sectional study. Iran J Obstet Gynecol Infertil 2022; 24(13): 41-50.
  42. Direkvand-Moghadam A, Ghazanfari Z, Sayehmiri K. Predictive factors for pelvic organ prolapse (POP) in Iranian women’s: an ordinal logistic approch. J Clin Diagn Res 2014; 8(1): 96-9.
  43. Direkvand Moghadam A. Investigating on relationship between birth weight and prevalence and severity of pelvic organ prolapse [in Persian]. Iranian Journal of Obstetrics, Gynecology and Infertility 2012; 15(16): 13-9.
  44. Ayati S, Vhid F, Esmaeili H. Investigating factors affecting pelvic floor laxity [in Persian]. Journal of the Medical System Organization of the Islamic Republic of Iran 2007; 24(4): 343-9.
  45. Garshasbi A, Faghihzadeh S, Falah N, Abasi S. The status of pelvic supporting organs in a population of Iranian women 18–68 years of age and possible related factors. Arch Iranian Med 2006; 9(2): 124-8.
  46. Afshari P, Dabagh F, Iravani M, Abedi P. Comparison of pelvic floor muscle strength in nulliparous women and those with normal vaginal delivery and cesarean section. Int Urogynecol J 2017; 28(8): 1171-5.
  47. Moradi M, Mohammadzadeh F, Niazi A, Afiat M. The relationship between women’s sexual function and type of delivery and pelvic organ prolapse: A cross-sectional study. Health Care Women Int 2025; 46(2): 149-61.
  48. Ghanbari Z, Asadi F, Amirlatifi S, Shariat M, Eftekhar T, Deldar M, et al. Correlation Between Apical, Anterior, and Posterior Vaginal Wall Prolapse With Voiding Dysfunction: A Single Center Retrospective Cohort Study. J Family Reprod Health. 2024; 18(2): 115-21.
  49. Islam RM, Oldroyd J, Rana J, Romero L, Karim MN. Prevalence of symptomatic pelvic floor disorders in community-dwelling women in low and middle-income countries: a systematic review and meta-analysis. Int Urogynecol J 2019; 30(12): 2001-11.
  50. Elbiss HM, Rafaqat W, Khan KS. Prevalence of pelvic floor disorders in the Eastern Mediterranean region: A meta-analysis. Saudi Med J 2023; 44(2): 128-36.
  51. Peinado-Molina RA, Hernández-Martínez A, Martínez-Vázquez S, Rodríguez-Almagro J, Martínez-Galiano JM. Pelvic floor dysfunction: prevalence and associated factors. BMC Public Health 2023; 23(1): 2005.
  52. Kenne KA, Wendt L, Brooks Jackson J. Prevalence of pelvic floor disorders in adult women being seen in a primary care setting and associated risk factors. Sci Rep 2022; 12: 9878.
  53. Mannella P, Palla G, Bellini M, Simoncini T. The female pelvic floor through midlife and aging. Maturitas 2013; 76(3): 230-4.
  54. Robinson D, Toozs-Hobson P, Cardozo L. The effect of hormones on the lower urinary tract. Menopause Int 2013; 19(4): 155-62.
  55. Allafi AH, Al-Johani AS, Babukur RM, Fikri J, Alanazi RR, Ali SDMH, et al. The link between menopause and urinary incontinence: a systematic review. Cureus 2024;16(10): e71260.
  56. Milsom I, Gyhagen M. The prevalence of urinary incontinence. Climacteric 2019; 22(3): 217-22.
  57. Quaghebeur J, Petros P, Wyndaele J-J, De Wachter S. Pelvic-floor function, dysfunction, and treatment. Eur J Obstet Gynecol Reprod Biol 2021; 265: 143-9.
  58. Grimes WR, Stratton M. Pelvic floor dysfunction. In: StatPearls. Treasure Island (FL): StatPearls Publishing; 2025.
  59. Bajwa A, Emmanuel A. The physiology of continence and evacuation. Best Pract Res Clin Gastroenterol 2009; 23(4): 477-85.
  60. Shang X, Fu Y, Jin X, Wang C, Wang P, Guo P, et al. Association of overweight, obesity and risk of urinary incontinence in middle-aged and older women: a meta epidemiology study. Front Endocrinol (Lausanne) 2023; 14: 1220551.
  61. Zenebe CB, Chanie WF, Aregawi AB, Andargie TM, Mihret MS. The effect of women’s body mass index on pelvic organ prolapse: a systematic review and meta analysis. Reprod Health 2021; 18(1): 45.
  62. Ballard AC, Richter HE. The impact of obesity and weight loss on urinary and bowel incontinence symptoms in women. Menopausal Med 2011; 19(3): S1-s7.
  63. Greer WJ, Richter HE, Bartolucci AA, Burgio KL. Obesity and pelvic floor disorders: a systematic review. Obstet Gynecol 2008; 112(2 Part 1): 341-9.
  64. Dumoulin C, Hunter KF, Moore K, Bradley CS, Burgio KL, Hagen S, et al. Conservative management for female urinary incontinence and pelvic organ prolapse review 2013: Summary of the 5th International Consultation on Incontinence. Neurourol Urodyn 2016; 35(1): 15-20.
  65. Jou IM, Lai KA, Shen CL, Yamano Y. Changes in conduction, blood flow, histology, and neurological status following acute nerve‐stretch injury induced by femoral lengthening. J Orthop Res 2000; 18(1): 149-55.
  66. DeLancey JO, Masteling M, Pipitone F, LaCross J, Mastrovito S, Ashton-Miller JA. Pelvic floor injury during vaginal birth is life-altering and preventable: what can we do about it? Am J Obstet Gynecol 2024; 230(3): 279-94. e2.
  67. Wong KW, Okeahialam N, Thakar R, Sultan AH. Obstetric risk factors for levator ani muscle avulsion: A systematic review and meta-analysis. Eur J Obstet Gynecol Reprod Biol 2024; 296: 99-106.
  68. de Araujo CC, Coelho SA, Stahlschmidt P, Juliato CR. Does vaginal delivery cause more damage to the pelvic floor than cesarean section as determined by 3D ultrasound evaluation? A systematic review. Int Urogynecol J 2018; 29(5): 639-45.
  69. Daly D, Cusack C, Begley C. Learning about pelvic floor muscle exercises before and during pregnancy: a cross-sectional study. Int Urogynecol J 2019; 30(6): 965-75.
  70. Gholampour S, Ghanbarpour A, Bouzari Z, Naeimi Rad M, Yazdani S. Comparison of maternal and neonatal outcomes in vaginal birth after caesarean section. J Babol Univ Med Sci 2024; 26: e23.
  71. Baicker K, Buckles KS, Chandra A. Geographic variation in the appropriate use of cesarean delivery: do higher usage rates reflect medically inappropriate use of this procedure? Health Aff (Millwood) 2006; 25(5): W355-67.
مجله دانشکده پزشکی اصفهان
دوره 43، شماره 833
هفته 1، آذر
آذر و دی 1404
صفحه 1247-1270

فایل ها

سابقه مقاله

  • تاریخ دریافت: 16 خرداد 1404
  • تاریخ پذیرش: 10 آبان 1404

هم رسانی

ارجاع به این مقاله

آمار