The State of Urogynecology in Thailand

Current Situation of Pelvic Floor Dysfunction and Care

Urinary incontinence (UI), fecal incontinence (FI), and pelvic organ prolapse (POP) are common and cause significant morbidity for women in terms of well-being, quality of life, and sexual function. In Thailand, community-based reports noted the prevalence of UI of 16.2%- 36.5%, while the hospital survey reported a prevalence of 38.9%-75.3%. The prevalence of POP has been described to vary between 43.3% and 70.0% in menopausal and elderly Thai women, respectively. The prevalence of FI in the general population has not been documented in Thailand. Nevertheless, the prevalence rate of anal incontinence was 8.0% among women with UI.

Gynecologists and family doctors in Thailand initially provide conservative modalities, medical therapy, and supportive measures for PFD to control the symptoms. When further investigation or management is indicated, women will be referred to urogynecologists, urologists, colorectal surgeons, or physiatrists/physiotherapists.

Currently, the most commonly performed surgery for stress urinary incontinence is the mid-urethral sling, either a retropubic or transobturator approach. Antimuscarinic agents and β- 3 agonists are indicated as a medical treatment for urgent urinary incontinence. Previous studies revealed that a pessary can provide a positive effect on the quality of life of Thai women with POP, with high satisfaction and continuation rates. In women who have failed or declined non-surgical treatments, the surgical approach may be transvaginal or abdominal, with the latter being feasible by open or laparoscopic techniques. Obliterative procedures are widely accepted as a first-line surgical treatment for women with significant medical comorbidities who do not desire future vaginal intercourse. The awareness of obstetric anal sphincter injuries and anal incontinence has increased among urogynecologists and OB&GYNs. Recently, endoanal and transperineal ultrasounds have been introduced to detect anal sphincter defects, but these techniques are associated with limitations with respect to the availability of machines and the examiner’s expertise.

Urogynecology Service and Training

Regarding pelvic floor specialists in Thailand, a two-year official training in Female Pelvic Medicine and Reconstructive Surgery (FPMRS) was established in 2015. Currently, there are around 30 urogynecologists taking care of women with PFD throughout Thailand. However, services provided by specialists, cross-specialty consultations, or single-center care are insufficient in delivering healthcare services, including promotion and prevention. Public awareness, family and community support, and non-specialized services by gynecologists, family doctors, nurses, and allied health professionals are all necessary components of an overall approach to effectively managing PFD.

Conclusion

Thailand is among the fastest-aging countries in the world. Higher prevalence of PFD amongst women and the elderly, longer life expectancy, and rapid increase in the absolute size of the older population contributes to a pressing need for Thailand to become aware of the impact of PFD. As urogynecologists and members of the Thai Urogynecologists Association (Thailand), the healthcare needs of women with PFD are our primary focus to improve the quality of life of Thai women.