2025

Kuutti, Mari

Among women, pelvic floor disorders include common symptoms, such as urinary incontinence, fecal incontinence, constipation and defecation difficulties, and pelvic organ prolapse. The prevalence of pelvic floor disorders increases as women approach their menopausal years. Estrogen deprivation during menopause, natural aging, an individual’s reproductive history, and factors increasing intra-abdominal pressure may lead to structural and functional failure in the pelvic floor. In addition, lifestyle choices regarding physical activity and eating behavior, as well as body composition, may have significant effects on the mechanisms of pelvic floor disorders. The data used in this dissertation were derived from the cross-sectional Estrogenic Regulation of Muscle Apoptosis (ERMA) study (n=1,098) and its follow-up study, called Estrogen, MicroRNAs and the Risk of Metabolic Dysfunction (EsmiRs) (n=494). The women who participated in these studies were aged 47–55 years at baseline. Over half of them had symptoms of pelvic floor disorders. Physical activity, eating behaviors, and demographic and gynecologic factors were self-reported. Body composition was measured using a multifrequency bioelectrical impedance analyzer, dual-energy x-ray absorptiometry, and anthropometry. Middle-aged women with early adulthood histories of competitive sports were more likely to experience the symptoms of urgency urinary incontinence. Similarly, women with histories of regular physical activity were more likely to experience the symptoms of fecal incontinence in midlife. Women with a disordered eating style were more prone to experience the symptoms of pelvic floor disorders compared to women with a normal eating style. Current total fat mass, trunk fat mass, android fat mass, visceral fat area, body mass index, and waist circumference were associated with the symptoms of stress urinary incontinence. Awareness of the impact of modifiable life habits on the functional ability of the pelvic floor may lead to a significant reduction in both the economic and human burdens caused by the disorders in question, as well as to improvements in the overall health of middle-aged women.