Symptomatic Distribution And TCM Syndromes Of Female Pelvic Floor Dysfunction Patients With Complaint As Chief Complaint

Objective:1.To observe the multiple symptoms distribution,severity and quality of life of female pelvic floor dysfunction(FPFD)patients with constipation as the chief complaint.2.To observe the quantitative relationship between TCM syndrome distribution and severity in patients with female pelvic floor dysfunction(FPFD)with constipation as the main complaint.Methods:Collecting 100 cases of FPFD patients with constipation as the chief complaint of Specific Outpatient Clinic,Pelvic Floor Center of Nanjing Municipal Hospital of Chinese Medicine from September 2015 to February 2017.To conduct a comprehensive medical history and questionnaire survey and then systematically evaluate severity and quality of life of patients with constipation.The scales include:Constipation Scoring System Scale(CSS)and Patient-Assessment of Constipation Quality of Life Questionnaire(PAC-QOL);if combined with chronic functional anal rectal pain,fill in the pain Visual Analogue Scale(VAS)and Short Form-36 Questionnaire(SF-36);if combined with urinary incontinence,fill in the International Consultation on Incontinence Questionnaire-Short Form(ICIQ-SF)and Urinary Incontinence Quality of Life Questionnaires(I-QOL);if combined with fecal incontinence,fill in Fecal Incontinence Severity Score Scale(Wexner-FIS)and Fecal Incontinence Quality of Life Questionnaire(FI-QOL).If other symptoms found through physical examination,laboratory and imaging examination,such as rectum protrusion,pelvic floor hernia,uterine prolapse,etc,marking in the pelvic floor disease diagnosis system diagram.All data are filled into a dedicated pelvic floor information database.The distribution of multiple symptoms,severity and quality of life,and the quantitative relationship between the distribution of TCM syndromes and severity will be observed by statistical analysis.Results:1.Observation on distribution,severity and quality of life of multiple symptoms:The age of 100 FPFD patients with constipation was(24?89)(57.9 ± 13.9)years old,and the course of disease was(0.5?40.0)(7.0 ± 8.2)years.The severity of constipation was(6?22)(13.89±3.79)points and the quality of life was(45?133)(87.13±18.57)points.The characteristics of 100 patients with combined symptoms are as follows:Anorectal Pain(75 cases),Urinary incontinence(70 cases),Rectal protrusion(37 cases),Nocturia(19 cases),Frequent urination(11 cases),Fecal incontinence(11cases),etc.20%patients with only one symptom(20 cases),combined with 2 or more symptoms accounted for 80%(80 cases).Pelvic floor relaxation syndrome patients were dominant(58%,58cases).2.The relationship between the distribution of TCM syndromes and the quantification of severity:(1)The distribution of TCM syndromes in 100 patients with constipation-induced FPFD:spleen-kidney yang deficiency(n=31,31%)>hepatosplenic disorder(n=28,28%)>deficiency of liver-yin and kidney-yin(n=23,23%)>deficiency of lung-Qi and spleen-Qi(n=18,18%).(2)Severity of each TCM syndrome of 100 patients with constipation-induced FPFD:spleen-kidney yang deficiency(15.26±3.93,P<0.05)score VS hepatosplenic disorder(13±3.47,P<0.05)score VS deficiency of liver-yin and kidney-yin(13.04±3.77)score VS deficiency of lung-Qi and spleen-Qi(14±3.6)score.There was statistical difference between the syndrome of spleen-kidney yang deficiency and and the syndrome of hepatosplenic disorder(P=0.021,P<0.05).There was no statistical difference between the remaining groups(P>0.05).(3)Quality of life of each TCM syndrome of 100 patients with constipation-induced FPFD:spleen-kidney yang deficiency(84.48 ± 16.22)score VS hepatosplenic disorder(82.82 ± 19.87)score VS deficiency of liver-yin and kidney-yin(92.48 ± 20.62)score VS deficiency of lung-Qi and spleen-Qi(91.56±16.26)score.There was no significant difference among the groups(P>0.05).(4)The distribution of TCM syndromes in each subtype of 100 cases of constipation-based FPFD:the type of pelvic floor relaxation(n=58,58%):spleen-kidney yang deficiency(n=17,29.3%)>hepatosplenic disorder(n=16,27.6%)>deficiency of liver-yin and kidney-yin(n=14,24.1%)>deficiency of lung-Qi and spleen-Qi(n= 11,19.0%)VS the type of pelvic floor malaise(n=35,35%):spleen-kidney yang deficiency(n=12,34.3%)>hepatosplenic disorder(n= 10,28.6%)>deficiency of liver-yin and kidney-yin(n=8,22.8%)>deficiency of lung-Qi and spleen-Qi(n=5,14.3%)VS mixed type(n=7,7%):spleen-kidney yang deficiency(n=2,28.6%)=hepatosplenic disorder(n=2,28.6%)=deficiency of lung-Qi and spleen-Qi(n=2,28.6%)>deficiency of liver-yin and kidney-yin(n=1,14.2%).There was no significant difference among the groups(P>0.05).(5)Severity of each TCM syndromes in every subtype of 100 cases of constipation-based FPFD:the type of pelvic floor relaxation:spleen-kidney yang deficiency(14.24±3.51)score VS hepatosplenic disorder(13.19±3.23)score VS deficiency of liver-yin and kidney-yin(12.71±3.97)score VS deficiency of lung-Qi and spleen-Qi(13.64±2.84)score.There was no significant difference among the groups(P>0.05).the type of pelvic floor malaise:spleen-kidney yang deficiency(16±4.20)score VS hepatosplenic disorder(13.2±3.9)score VS deficiency of liver-yin and kidney-yin(13.75±3.81)score VS deficiency of lung-Qi and spleen-Qi(12.4±3.36)score.There was no significant difference among the groups(P>0.05).mixed type:spleen-kidney yang deficiency(19.5±3.54)score VS hepatosplenic disorder(10.5±3.54)score VS deficiency of liver-yin and kidney-yin(12 score)VS deficiency of lung-Qi and spleen-Qi(20±2.83)score.There was no significant difference among the groups(P>0.05).(6)Quality of life of each TCM syndromes in every subtype of 100 cases of constipation-based FPFD:the type of pelvic floor relaxation:spleen-kidney yang deficiency(83.06±17.15)score VS hepatosplenic disorder(80.691±18.20)score VS deficiency of liver-yin and kidney-yin(88.5±22.75)score VS deficiency of lung-Qi and spleen-Qi(88.64±16.87)score.There was no significant difference among the groups(P>0.05).the type of pelvic floor malaise:spleen-kidney yang deficiency(84.25± 15.89)score VS hepatosplenic disorder(87.4±20.46)score VS deficiency of liver-yin and kidney-yin(99±17.15))score VS deficiency of lung-Qi and spleen-Qi(89.8±15.42)score.There was no significant difference among the groups(P>0.05).mixed type:spleen-kidney yang deficiency(98±2.83)score VS hepatosplenic disorder(77±39.60)score VS deficiency of liver-yin and kidney-yin(96 score)VS deficiency of lung-Qi and spleen-Qi(112±5.66)score.There was no significant difference among the groups(P>0.05).(7)Severity of each subtypes of 100 cases of constipation-based FPFD patients were mainly severe and with poor quality of life.There was no significant difference between the subtypes and the severity(mild to moderate)groups(P>0.05).There was no significant difference between each subtype and the quality of life(good to moderate difference)(P>0.05).Conclusion:1.The symptoms of FPFD patients with constipation as the chief complaint are overlapping,often associated with analrectal pain,urinary incontinence,etc.,which seriously affect the quality of life of patients.Multidisciplinary cooperation is needed in clinical practice.2.:There were more spleen-kidney yang deficiency and hepatosplenic disorder in FPFD patients with constipation as the main complaint,and these two syndromes were related to severity,quality of life was poor.The main subtype of FPFD was spleen-kidney yang deficiency,and the TCM syndromes of each subtype were not related to severity and quality of life.