Strengths and limitations
The present study had several strengths and limitations which we have already discussed in our previous paper investigating the associations of past and current physical activity with symptoms of pelvic floor disorder in this same study population.11 Now we were able to utilize knowledge gained from the previous study in considering potential confounding factors, i.e., to control also for past and current physical activity in addition to demographical and gynaecological factors. Overall, extend of this study is exceptional, since we were able to study five different symptoms of pelvic floor disorders among the large homogenous cohort of Caucasian women.
The experienced symptoms of pelvic floor disorders were asked in an early stage of the study, which may result in underreporting, especially when the subject may be considered sensitive. The questionnaire used was not validated, however, it is simplistic and commonly used in clinics. Unhealthy eating habits and pelvic floor disorders have both been associated with higher BMI,18,19,20,21 however, women with BMI>35 kg/m2 were excluded from the study, thus the results cannot be generalized to individuals with severe obesity. In addition, the assessment of eating behaviour based on self-reporting can be biased by social desirability,22i.e., the tendency to assess one’s own eating styles critically, which affects women more than men.23 This may cause respondents to overestimate healthy behaviors and underestimate the undesirable ones.24,25 The study was cross-sectional and cannot therefore reveal women’s long-term eating habits and whether they have a causal effect on the development of the symptoms of pelvic floor disorders or if reverse causality exists.