Skip to main content
Top
Published in: International Urogynecology Journal 5/2018

01-05-2018 | Original Article

Urogynaecology providers’ attitudes towards postnatal pelvic floor dysfunction

Authors: Carly Marjorie Cooke, Orfhlaith E. O’Sullivan, Barry A. O’Reilly

Published in: International Urogynecology Journal | Issue 5/2018

Login to get access

Abstract

Introduction and hypothesis

Postnatal pelvic floor dysfunction (PFD) has a high prevalence and morbidity amongst parturient women. Women should be counselled regarding postnatal PFD. Our aim was to determine urogynaecology providers’ knowledge of risk and protective factors for postnatal PFD, and to assess their practice patterns in postnatal PFD counselling.

Methods

An electronic survey was distributed to members of the European Urogynaecology Association (EUGA) and International Urogynaecology Association (IUGA). Data were collected on urogynaecology providers’ demographics, awareness of pregnancy-related PFD risk and protective factors, beliefs surrounding PFD risk–estimate tools, practice patterns in PFD counselling, and personal or spousal preferences for using caesarean section (CS) as a means of postnatal PFD prevention.

Results

Overall, 372 healthcare providers responded to the survey, 84 from the EUGA and 288 from the IUGA. Most reported practicing as a urogynaecologist (67%) and or obstetrician (44%). An overwhelming majority of respondents were aware of the major risk and protective factors for PFD, and almost 60% believed that risk–estimate tools for PFD could be clinically useful. Many denied enquiring about symptoms of PFD prenatally and postnatally (33% and 25% respectively), and reported not routinely counselling on prevention of postnatal PFD (39%). Nearly 25% reported that they would prefer CS for themselves or their spouse for prevention of postnatal PFD.

Conclusion

Urogynaecology providers are aware of risk and protective factors for postnatal PFD, but many fail to educate patients on the topic. The development of an easy-use risk-estimate tool for postnatal PFD could improve counselling rates in the future.
Appendix
Available only for authorised users
Literature
1.
go back to reference Haylen BT, de Ridder D, Freeman RM, Swift SE, Berghmans B, et al. An International Urogynecological Association (IUGA)/International Continence Society (ICS) joint report on the terminology for female pelvic floor dysfunction. Int Urogynecol J. 2010;21:5–26.CrossRefPubMed Haylen BT, de Ridder D, Freeman RM, Swift SE, Berghmans B, et al. An International Urogynecological Association (IUGA)/International Continence Society (ICS) joint report on the terminology for female pelvic floor dysfunction. Int Urogynecol J. 2010;21:5–26.CrossRefPubMed
2.
go back to reference MacLennan AH, Taylor AW, Wilson DH, Wilson D. The prevalence of pelvic floor disorders and their relationship to gender, age, parity and mode of delivery. BJOG. 2000;107(12):1460–70.CrossRefPubMed MacLennan AH, Taylor AW, Wilson DH, Wilson D. The prevalence of pelvic floor disorders and their relationship to gender, age, parity and mode of delivery. BJOG. 2000;107(12):1460–70.CrossRefPubMed
3.
go back to reference Nygaard I, Barber MD, Burgio KL, Kenton K, Meikle S, Schaffer J, et al. Prevalence of symptomatic pelvic floor disorders in US women. JAMA. 2008;300(11):1311–6.CrossRefPubMedPubMedCentral Nygaard I, Barber MD, Burgio KL, Kenton K, Meikle S, Schaffer J, et al. Prevalence of symptomatic pelvic floor disorders in US women. JAMA. 2008;300(11):1311–6.CrossRefPubMedPubMedCentral
4.
go back to reference Dietz HP, Schierlitz L. Pelvic floor trauma in childbirth—myth or reality? Aust N Z J Obstet Gynaecol. 2005;45(1):3–11.CrossRefPubMed Dietz HP, Schierlitz L. Pelvic floor trauma in childbirth—myth or reality? Aust N Z J Obstet Gynaecol. 2005;45(1):3–11.CrossRefPubMed
5.
go back to reference Rortveit G, Daltveit AK, Hannestad YS, Hunskaar S, Norwegian EPINCONT Study. Urinary incontinence after vaginal delivery or caesarean section. N Engl J Med. 2003;348(10):900.CrossRefPubMed Rortveit G, Daltveit AK, Hannestad YS, Hunskaar S, Norwegian EPINCONT Study. Urinary incontinence after vaginal delivery or caesarean section. N Engl J Med. 2003;348(10):900.CrossRefPubMed
6.
go back to reference Lukacz ES, Lawrence JM, Contreras R, Nager CW, Luber KM. Parity, mode of delivery, and pelvic floor disorders. Obstet Gynecol. 2006 Jun;107(6):1253–60.CrossRefPubMed Lukacz ES, Lawrence JM, Contreras R, Nager CW, Luber KM. Parity, mode of delivery, and pelvic floor disorders. Obstet Gynecol. 2006 Jun;107(6):1253–60.CrossRefPubMed
7.
go back to reference Handa VL, Blomquist JL, Knoepp LR, Hoskey KA, McDermott KC, Muñoz A. Pelvic floor disorders 5–10 years after vaginal or caesarean childbirth. Obstet Gynecol. 2011;118(4):777–84.CrossRefPubMedPubMedCentral Handa VL, Blomquist JL, Knoepp LR, Hoskey KA, McDermott KC, Muñoz A. Pelvic floor disorders 5–10 years after vaginal or caesarean childbirth. Obstet Gynecol. 2011;118(4):777–84.CrossRefPubMedPubMedCentral
8.
go back to reference Handa VL, Blomquist JL, McDermott KC, Friedman S, Muñoz A. Pelvic floor disorders after vaginal birth: effect of episiotomy, perineal laceration, and operative birth. Obstet Gynecol. 2012;119(2 Pt 1):233–9.CrossRefPubMedPubMedCentral Handa VL, Blomquist JL, McDermott KC, Friedman S, Muñoz A. Pelvic floor disorders after vaginal birth: effect of episiotomy, perineal laceration, and operative birth. Obstet Gynecol. 2012;119(2 Pt 1):233–9.CrossRefPubMedPubMedCentral
9.
go back to reference Durnea CM, Khashan AS, Kenny LC, Tabirca SS, O’Reilly BA. An insight into pelvic floor status in nulliparous women. Int Urogynecol J. 2014;25(3):337–45.CrossRefPubMed Durnea CM, Khashan AS, Kenny LC, Tabirca SS, O’Reilly BA. An insight into pelvic floor status in nulliparous women. Int Urogynecol J. 2014;25(3):337–45.CrossRefPubMed
10.
go back to reference Durnea CM, Khashan AS, Kenny LC, Durnea UA, Smyth MM, O’Reilly BA. Prevalence, etiology and risk factors of pelvic organ prolapse in premenopausal primiparous women. Int Urogynecol J. 2014;25(11):1463–70.CrossRefPubMed Durnea CM, Khashan AS, Kenny LC, Durnea UA, Smyth MM, O’Reilly BA. Prevalence, etiology and risk factors of pelvic organ prolapse in premenopausal primiparous women. Int Urogynecol J. 2014;25(11):1463–70.CrossRefPubMed
11.
go back to reference Durnea CM, Khashan AS, Kenny LC, Tabirca SS, O’Reilly BA. The role of prepregnancy pelvic floor dysfunction in postnatal pelvic morbidity in primiparous women. Int Urogynecol J. 2014;25(10):1363–74.CrossRefPubMed Durnea CM, Khashan AS, Kenny LC, Tabirca SS, O’Reilly BA. The role of prepregnancy pelvic floor dysfunction in postnatal pelvic morbidity in primiparous women. Int Urogynecol J. 2014;25(10):1363–74.CrossRefPubMed
12.
go back to reference Boyle R, Hay-Smith EJ, Cody JD, Mørkved S. Pelvic floor muscle training for prevention and treatment of urinary and fecal incontinence in antenatal and postnatal women. Cochrane Database Syst Rev. 2012;10:CD007471.PubMed Boyle R, Hay-Smith EJ, Cody JD, Mørkved S. Pelvic floor muscle training for prevention and treatment of urinary and fecal incontinence in antenatal and postnatal women. Cochrane Database Syst Rev. 2012;10:CD007471.PubMed
13.
go back to reference Wilson D, Dornan J, Milsom I, Freeman R. UR-CHOICE: can we provide mothers-to-be with information about the risk of future pelvic floor dysfunction? Int Urogynecol J. 2014;25(11):1449–52.CrossRefPubMed Wilson D, Dornan J, Milsom I, Freeman R. UR-CHOICE: can we provide mothers-to-be with information about the risk of future pelvic floor dysfunction? Int Urogynecol J. 2014;25(11):1449–52.CrossRefPubMed
14.
go back to reference Jelovsek JE, Piccorelli A, Barber MD, Tunitsky-Bitton E, Kattan MW. Prediction models for postpartum urinary and fecal incontinence in primiparous women. Female Pelvic Med Reconstr Surg. 2013;19(2):110–8.CrossRefPubMed Jelovsek JE, Piccorelli A, Barber MD, Tunitsky-Bitton E, Kattan MW. Prediction models for postpartum urinary and fecal incontinence in primiparous women. Female Pelvic Med Reconstr Surg. 2013;19(2):110–8.CrossRefPubMed
15.
go back to reference Grobman WA, Lai Y, Landon MB, et al. Can a prediction model for vaginal birth after cesarean also predict the probability of morbidity related to a trial of labor? Am J Obstet Gynecol. 2009;200(1):56.e1–6.CrossRef Grobman WA, Lai Y, Landon MB, et al. Can a prediction model for vaginal birth after cesarean also predict the probability of morbidity related to a trial of labor? Am J Obstet Gynecol. 2009;200(1):56.e1–6.CrossRef
16.
go back to reference Constantine MM, Fox K, Byers BD, Mateus J, Ghulmiyyah LM, Blackwell S, et al. Validation of the prediction model for success of vaginal birth after caesarean delivery. Obstet Gynecol. 2009;114(5):1029–33.CrossRef Constantine MM, Fox K, Byers BD, Mateus J, Ghulmiyyah LM, Blackwell S, et al. Validation of the prediction model for success of vaginal birth after caesarean delivery. Obstet Gynecol. 2009;114(5):1029–33.CrossRef
17.
go back to reference Berzuk K, Shay B. Effect of increasing awareness of pelvic floor muscle function on pelvic floor dysfunction: a randomized controlled trial. Int Urogynecol J. 2015;26(6):837–44.CrossRefPubMed Berzuk K, Shay B. Effect of increasing awareness of pelvic floor muscle function on pelvic floor dysfunction: a randomized controlled trial. Int Urogynecol J. 2015;26(6):837–44.CrossRefPubMed
18.
go back to reference Geoffrion R, Robert M, Ross S, et al. Evaluating patient learning after an educational program for women with incontinence and pelvic organ prolapse. Int Urogynecol J Pelvic Floor Dysfunct. 2009;20(10):1243–52.CrossRefPubMed Geoffrion R, Robert M, Ross S, et al. Evaluating patient learning after an educational program for women with incontinence and pelvic organ prolapse. Int Urogynecol J Pelvic Floor Dysfunct. 2009;20(10):1243–52.CrossRefPubMed
19.
go back to reference Chiarelli P, Campbell E. Incontinence during pregnancy. Prevalence and opportunities for continence promotion. Aust N Z J Obstet Gynaecol. 1997;37(1):66–73.CrossRefPubMed Chiarelli P, Campbell E. Incontinence during pregnancy. Prevalence and opportunities for continence promotion. Aust N Z J Obstet Gynaecol. 1997;37(1):66–73.CrossRefPubMed
20.
go back to reference Howell EA. Lack of patient preparation for the postpartum period and patients’ satisfaction with their obstetric clinicians. Obstet Gynecol. 2010;115(2 Pt 1):284–9.CrossRefPubMed Howell EA. Lack of patient preparation for the postpartum period and patients’ satisfaction with their obstetric clinicians. Obstet Gynecol. 2010;115(2 Pt 1):284–9.CrossRefPubMed
21.
go back to reference Sandi-Flaghpeykar H, Mozayeni P, Young A, Fine PM. Stress urinary incontinence and counseling and practice of pelvic floor exercises postpartum in low-income Hispanic women. Int Urogynecol J Pelvic Floor Dysfunct. 2008;19(3):361–5.CrossRef Sandi-Flaghpeykar H, Mozayeni P, Young A, Fine PM. Stress urinary incontinence and counseling and practice of pelvic floor exercises postpartum in low-income Hispanic women. Int Urogynecol J Pelvic Floor Dysfunct. 2008;19(3):361–5.CrossRef
22.
go back to reference Nguyen K, Hunter KF, Wagg A. Knowledge and understanding of urinary incontinence: survey of family practitioners in northern Alberta. Can Fam Physician. 2013;59(7):330–7. Nguyen K, Hunter KF, Wagg A. Knowledge and understanding of urinary incontinence: survey of family practitioners in northern Alberta. Can Fam Physician. 2013;59(7):330–7.
23.
go back to reference Mazloomdoost D, Westermann LB, Crisp CC, Oakley SH, Kleeman SD, Pauls RN. Primary care providers’ attitudes, knowledge, and practice patterns regarding pelvic floor disorders. Int Urogynecol J. 2016;28(3):447–53.CrossRefPubMed Mazloomdoost D, Westermann LB, Crisp CC, Oakley SH, Kleeman SD, Pauls RN. Primary care providers’ attitudes, knowledge, and practice patterns regarding pelvic floor disorders. Int Urogynecol J. 2016;28(3):447–53.CrossRefPubMed
24.
go back to reference Boblin S, Skelly J. Health-care providers’ knowledge, attitudes and decision about incontinence care. Clin Eff Nurs. 1999;3:156–62.CrossRef Boblin S, Skelly J. Health-care providers’ knowledge, attitudes and decision about incontinence care. Clin Eff Nurs. 1999;3:156–62.CrossRef
25.
go back to reference Auwad W, Steggles P, Bombieri L, Waterfield M, Wilkin T, Freeman R. Moderate weight loss in obese women with urinary incontinence: a prospective longitudinal study. Int Urogynecol J Pelvic Floor Dysfunct. 2008;19(9):1251–9.CrossRefPubMed Auwad W, Steggles P, Bombieri L, Waterfield M, Wilkin T, Freeman R. Moderate weight loss in obese women with urinary incontinence: a prospective longitudinal study. Int Urogynecol J Pelvic Floor Dysfunct. 2008;19(9):1251–9.CrossRefPubMed
26.
go back to reference Kudish BI, Iglesia CB, Sokol RJ, Cochrane B, Richter HE, Larson J, et al. Effect of weight change on natural history of pelvic organ prolapse. Obstet Gynecol. 2009 Jan;113(1):81–8.CrossRefPubMedPubMedCentral Kudish BI, Iglesia CB, Sokol RJ, Cochrane B, Richter HE, Larson J, et al. Effect of weight change on natural history of pelvic organ prolapse. Obstet Gynecol. 2009 Jan;113(1):81–8.CrossRefPubMedPubMedCentral
27.
go back to reference Al-Mufti R, McCarthy A, Fisk NM. Survey of obstetricians’ personal preference and discretionary practice. Eur J Obstet Gynecol Reprod Biol. 1997;73(1):1–4.CrossRefPubMed Al-Mufti R, McCarthy A, Fisk NM. Survey of obstetricians’ personal preference and discretionary practice. Eur J Obstet Gynecol Reprod Biol. 1997;73(1):1–4.CrossRefPubMed
28.
go back to reference Dessie SG, Hacker MR, Dodge LE, Elkadry EA. Do obstetrical providers, counsel women about postpartum pelvic floor dysfunction? J Reprod Med. 2015;60(5–6):205–10.PubMedPubMedCentral Dessie SG, Hacker MR, Dodge LE, Elkadry EA. Do obstetrical providers, counsel women about postpartum pelvic floor dysfunction? J Reprod Med. 2015;60(5–6):205–10.PubMedPubMedCentral
29.
go back to reference Lee A. ‘Bolam’ to ‘Montgomery’ is a result of evolutionary change of medical practice towards ‘patient-centred care’. Postgrad Med J. 2017;93(1095):46–50.CrossRefPubMed Lee A. ‘Bolam’ to ‘Montgomery’ is a result of evolutionary change of medical practice towards ‘patient-centred care’. Postgrad Med J. 2017;93(1095):46–50.CrossRefPubMed
Metadata
Title
Urogynaecology providers’ attitudes towards postnatal pelvic floor dysfunction
Authors
Carly Marjorie Cooke
Orfhlaith E. O’Sullivan
Barry A. O’Reilly
Publication date
01-05-2018
Publisher
Springer London
Published in
International Urogynecology Journal / Issue 5/2018
Print ISSN: 0937-3462
Electronic ISSN: 1433-3023
DOI
https://doi.org/10.1007/s00192-017-3419-z

Other articles of this Issue 5/2018

International Urogynecology Journal 5/2018 Go to the issue