Evaluating Patient Learning After An Educational Program For Women With Incontinence And Pelvic Organ Prolapse

Main Category: Women's Health / Gynecology
Also Included In: Urology / Nephrology
Article Date: 01 Nov 2009 - 3:00 PST

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UroToday.com - Pelvic floor disorders such as incontinence and prolapse are common bothersome conditions that can be initially and successfully addressed with conservative patient-initiated methods such as pelvic floor muscle and bladder retraining exercises. Women need to be well informed regarding these treatment options. Unfortunately, previous research shows that many women do not have the necessary knowledge to initiate treatments for optimal pelvic floor health.

Our goal was to study an educational intervention enabling women to improve their pelvic floor health. We examined immediate and three-month impact on women's knowledge, behavioural changes and condition-specific quality of life.

Our 2.5-hour educational workshop is run by a nurse continence advisor and is advertised to the general public and to patients at our urogynecology clinic. Topics covered in the workshop include normal anatomy and physiology, incidence, prevalence and symptoms of common pelvic floor disorders and treatment options. Options discussed include the sustained practice of pelvic floor muscle exercises (PFME), bladder training and urge control techniques, diet and fluid intake modification, smoking cessation and body weight control. Pessary use, medications and surgery are briefly mentioned as options if initial conservative methods fail.

One hundred twenty five women consented to participate, provided demographic data and completed a symptom and behaviour questionnaire, a focused knowledge questionnaire, the Pelvic Floor Impact Questionnaire - Short Form 7 (PFIQ-7) and the Pelvic Floor Distress Inventory - Short Form 20 (PFDI-20) prior to the workshop. Immediately after the workshop women again completed the focused knowledge questionnaire. The follow-up packages, mailed at three months following each workshop, included the same pre-workshop questionnaires without repeating demographic data.

Participant response rate for questionnaire completion at 3 months was 83% (104 women). All women who participated in the study had various pelvic floor symptoms. We showed significant improvement in knowledge scores immediately post-workshop (p<0.01) and three months post (p<0.01) when compared with knowledge scores pre-workshop. Symptom and quality of life scores significantly improved from baseline to three months (Pelvic Floor Impact Questionnaire: mean difference=14.2, p=0.005, 95% CI 4.7-23.8; Pelvic Floor Distress Inventory: mean difference=17.4, p<0.001, 95% CI 8.3-26.5).

Our study documents the positive impact of a group educational intervention on women with pelvic floor symptoms. Although the overall outcome was positive, women did not adhere to all educational interventions we suggested. For example, despite significant emphasis placed on PFME performance, there was no significant change in the number of women performing PFME before and three months after the workshop. However, there was increased adherence to a bladder training schedule, which suggests that urinary symptom improvement in our cohort may be related to bladder training strategies. More research is needed to delineate methods to facilitate adherence to suggested interventions.

In summary, self-management is important in pelvic floor health and therefore education in a public forum may be particularly well suited for patients with pelvic floor diseases.

Written by Roxana Geoffrion MD, et al. as part of Beyond the Abstract on UroToday.com

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