Younger Age is Associated with Pelvic Floor Muscle Dysfunction in Women with LUTS

Objectives: To evaluate if younger age is associated with pelvic floor muscle dysfunction (PFMD) in women with lower urinary tract symptoms (LUTS).

Methods: This retrospective cohort study included women seeking an initial outpatient urogynecology evaluation for LUTS at an urban academic center from 8/2018 to 2/2022. The study used ICD-10 codes from billing records to identify participants. The primary outcome was presence of PFMD, defined as exam findings and/or a diagnosis of levator myalgia or spasm. Age was dichotomized into two groups: < 40 or ≥ 40. Multivariable logistic regression was used to evaluate if young age was associated with PFMD while controlling for other associated factors.

Results: The study included 421 women with LUTS, of whom 115 (27.3%) were diagnosed with PFMD. Women who presented with PFMD were 13 years younger, had lower BMIs, and were more likely to have commercial or Medicaid health insurance (all p < .05, Table 1). There were no differences in PFMD diagnosis based on race/ethnicity or residence. Women with PFMD were less likely to have hypertension, diabetes, or a vaginal birth compared to those without PFMD (all p < 0.05). There were no differences in other major medical or surgical history.



Women with PFMD were less likely to report urinary incontinence (UI) (60% vs 71.9%, p = .026), urge UI (8.7% vs 17.3%, p = .04), and pad wearing (28.7% vs 45.1%, p = .002). There was no difference in reported urgency, frequency, nocturia, stress UI, nocturnal enuresis, completely emptying the bladder, hesitancy, or dribbling urine.



Women with PFMD were more likely to report recurrent urinary tract infections ( ≥ 3 UTIs in the last year, 24.3% vs 14.4%, p =.023) and more pain symptoms: dysuria (19.1% vs 9.5%, p = .012), dyspareunia (39% vs 7.5%, p < 0.001), vulvodynia (11.3% vs 2.3%, p < 0.001), and pelvic pain (25.2% vs 7.2%, p < 0.001). Women with PFMD were less likely to be postmenopausal (47.8% vs 87.1%, p < 0.001) and have vaginal prolapse symptoms (9.6% vs 19.3%, p = 0.025).



Using multivariable logistic regression, we found that the odds of PFMD diagnosis in younger women, < 40 years old, was 2.34 times greater than women ≥ 40 years old, after adjusting for other factors (aOR 2.341, 95% CI [1.102, 4.972], Table 2).

Conclusions: Younger women with LUTS were significantly more likely to have PFMD compared to older women with similar symptoms, even after controlling for other associated characteristics. Our results suggest that pelvic floor muscle assessment should be routinely performed in the evaluation of LUTS, especially in younger women, as it has the potential to direct patient care decisions and improve patient outcomes.