USE OF A NEW PELVIC DIARY TO DETECT UROGENITAL AND BOWEL DYSFUNCTIONS IN HEALTHY FEMALE ATHLETES

Introduction The frequency-volume chart or micturition diary records a patient’s voiding pattern during normal daily activities. In some women it may be therapeutic as it provides them with insight into their bladder behaviour. Since there is no a standardized voiding diary, this deficiency also embraces the pelvic dysfunctions that, especially in the female gender, are often associated with lower urinary tract symptom, such as pelvic abnormalities, urogenital pain syndromes, changes in bowel habit, and genital dysfunctions. The aim of this study was to formulate a comprehensive pelvic diary testing it on a selected population of healthy young female athletes in order to discover possible hidden pelvic dysfunctions. Matherials and methods The pelvic diary was designed after a structured literature review carried out from 1966 to December 2010 using MEDLINE via PubMed. In order to test this 7-day pelvic diary in a healthy control group a pilot observational prospective cohort study was planned, involving healthy young female athletes. Moreover all participants had to fill out the following validated symptom and health-related quality of life (HR-QoL) questionnaires: ICI-Q SF, OAB-q Short Form, P-QOL, Wexner score. Continuous variables were reported as the mean value and standard deviation (SD). Results From January 2012 to March 2012 a 7-day pelvic diary and the validated questionnaires were mailed to 422 female athletes by post. Replies were received from 284 of them. The mean age was 24.9 years with a mean body mass index of 20.9. Most of them were either volleyball (60.4%) or basketball (26.4%) players. Mean urinary frequency was 5.4 ± 1.7. Mean compiled days were 6.4 ± 1.5 days. Mean daily urine volume was 1119 ± 600.9. Overall 46 subjects reported urinary incontinence episodes and 66 urgency. Moreover 12 athletes reported voiding problems. Concerning bowel symptom, 18 had faecal incontinence (77.8% gas incontinence) and 6 complained of pain during defecation. Regarding sexual and genital problems, 6 complained of dyspareunia and 10 had a “feeling of heaviness in the vaginal area”. The mean Wexner score was 6.01; the mean OAB-q SF score was 6.2. Concerning P-OQL domains we recorded the following mean score values: general health 30.1 ± 10.18; prolapse impact 15.8 ± 12.4; role limitation 15.2 ± 13.0; physical limitation 14.9 ± 12.8; personal relationships 6.5 ± 11.2; emotions 15.4 ± 14.3; sleep/energy 14.5 ± 12.6; severity measures 15.6 ± 14. Discussion In the literature at least three different forms of diary were described, namely the “micturition time chart”, “the frequency volume chart”, and “the bladder diary. Increasing either the complexity of the diary or duration of recording is associated with poorer compliance. Despite the responsiveness of our study population was only 58.7%, most of the women who replied have completed all seven days of our pelvic diary. The low responsiveness could be due to the large amount of questionnaires to be filled out. Our diary allowed us to discover hidden pelvic dysfunctions that would otherwise have remained unrecognized, because of their low HR-QoL impact. Conclusion Our comprehensive pelvic diary allowed us to detect hidden pelvic dysfunctions in young healthy women like validated symptom questionnaries. Because a validated urinary diary does not currently exist in order to corroborate our preliminary results future steps will be to compare our pelvic questionnaire against an adequate gold standard such as the above mentioned validated symptom questionnaires.