Prevalence and Impact of Pelvic Floor Dysfunction in a Large Cohort of Patients with Endometriosis: The Hidden Link.

INTRODUCTION AND HYPOTHESIS: Endometriosis may contribute to the onset of pelvic floor dysfunction (PFD) but data on urologic and bowel symptoms in endometriosis patients are scant. The aim of this study is to determine the prevalence of PFD in women with endometriosis and their impact on quality of life. METHODS: This is a cross-sectional study. A web survey was distributed throughout Italy from November 2022 to November 2023 to fertile age women with a self-reported diagnosis of endometriosis made by a specialist gynecologist or through surgery, assessing: medical history, pregnancies, endometriosis-related pain, urinary symptoms, bowel symptoms, sexual function, and quality of life. The informed consent was signed by 1149 women. Out of 820 eligible, 525 participants completed all questionnaires (64.0%). RESULTS: Of the participants, 440 (83.8%) had sexual dysfunction, 346 (65.9%) moderate/severe urinary symptoms, 348 (66.3%) moderate/severe bowel symptoms, 361 (68.8%) moderate to very severe constipation, and 404 (77.0%) mild symptoms of fecal incontinence. The reported symptoms were mainly indicative of high bladder and bowel sensitivity and voiding dysfunction. History of pregnancy did not affect urinary and bowel function, except for incontinence symptoms and rectal prolapse. Medical treatment or previous surgery for endometriosis were not associated with different urinary and bowel function scores. Urinary Distress Inventory 6 and Colorectal-Anal Distress Inventory 8 were correlated with a worse score in all domains of the Endometriosis Health Profile 30 (all rho > 0.28, p < 0.001). CONCLUSIONS: PFD is unexpectedly extremely common in women with endometriosis and affects sexual, urinary, and bowel function. This seems to be a potentially underestimated and underdiagnosed condition, with a severe negative impact on quality of life.