Read Full Text: Pelvic Floor Dysfunction After Childbirth: Occupational Impact and Awareness of Available Treatment (You may need to pay for full access to this article, but will still felt it was important to cover.)
Journal: OTJR: Occupation, Participation and Health
Year Published: 2020
CEU Podcast: Pelvic Health & OT with Lindsey Vestal
Today’s article calls pelvic floor dysfunction a significant and neglected public health issue.
And, I have to say that my story—and the story of many women I know—backs that up!
Unfortunately, we’ll see something disheartening in the research: despite pelvic floor dysfunction impacting around 25% of women in the US, there is a profound lack of understanding of the disorder and how to treat it.
The good news is that OTs are perfectly poised to help meet the needs of pelvic health patients! We used this article to jumpstart our understanding of pelvic rehab, and had guest Lindsey Vestal of the Functional Pelvis on to the OT Potential Podcast. We discussed the research and Lindsey shared how OTs can support this population.
Let’s dive in.
What is the pelvic floor?
The pelvic floor is composed of three layers of muscles and connective tissue. It is designed to support the functions of the:
- Bladder
- Rectum
- Female reproductive system
Both men and women have a pelvic floor (picture below), and all genders can experience dysfunction.
What is pelvic floor dysfunction?
Pelvic floor dysfunction (PFD) occurs when you have difficulty coordinating the pelvic floor muscles. This can result in:
- Pelvic pain
- Urinary incontinence
- Fecal incontinence
- Pelvic organ prolapse
The article we are looking at focuses specifically on PFD in women. Approximately 25% of women in the US have at least one pelvic floor disorder. That’s crazy!
Here’s what is even crazier: there are plenty of treatment options for PFD, such as surgery, pelvic floor rehab, and lifestyle modifications. However, previous studies indicate that there is simply an overall lack of understanding of both PFD and its treatment options.
Which leads us to this article…
What was the goal of this paper?
The authors sought to look at PFD from an occupational therapy lens. They wanted to know, for women who had experienced PFD after childbirth:
- What was the impact of PFD on occupations?
- How severely did PFD impact their daily lives?
- What was the level of awareness of daily treatment options?
What were the authors’ methods?
This was a pretty simple study design, as it involved the distribution of an online survey. Inclusion criteria included:
- Women ages 18-45
- Given birth to at least one child (and not currently pregnant)
- Lives in the US
The survey the authors created was 31 questions on a 4-point scale. There was also one qualitative question. The survey was distributed to organizations, associations, and Facebook groups that supported women following the birth of a child.
What were the results?
224 eligible participants completed at least a portion of the survey.
To be honest, I would have liked to have seen the results laid out a little more clearly, but I did my best to summarize them below. I converted everything to percentage points when possible to make it easier to read.
Pelvic floor symptoms and participation in rehab
Pelvic floor symptoms ever experienced
- Leakage of urine with movement 69%
- Pain during sexual intercourse 53%
- Urgency to use the bathroom 50%
- Pain near your hips or abdominals 44%
- Feeling as if you still have to urinate after using the restroom 40%
- Feelings of heaviness, bulging, or pressure in the vaginal area 30%
- Leakage of stool 8%
- Unable to control bowel movements 7%
Pelvic floor symptoms with the most impact on day
- Leakage of urine with movement 37%
- Pain near your hips or abdominals 17%
- Pain during sexual intercourse 11%
- Urgency to use the bathroom 11%
- Feelings of heaviness, bulging, or pressure in vaginal area 5%
- Unable to control bowel movements 4%
- Feeling as if you still have to urinate after using the restroom 3%
- Leakage of stool 2%
Pelvic floor symptom duration
- 0-3 months 23%
- 4-6 months 10%
- 7-12 months 12%
- 1 year or longer 55%
Resolution of pelvic floor symptoms
- Yes 23%
- No 77%
Rehabilitation for pelvic floor dysfunction
- Participation in occupational or physical therapy 24%
- No rehabilitative or surgical treatment 60%
Impact on daily activities
Participants were requested to indicate whether PFD symptoms impacted their daily activities. Here’s the breakdown of which activities the participants indicated were impacted:
- Exercise 58%
- Sexual activity 54%
- Self-care activities 33%
- Care for children 29%
- Leisure activities 27%
- Rest and sleep 22%
- Shopping and running errands 20%
- Caring for a home 15%
- Job requirements or volunteering 10%
- Social participation 9%
- Driving 6%
Level of Awareness
The majority (133 of the participants) indicated they had never received information regarding pelvic floor rehabilitation as an option for the treatment of PFD symptoms.
Of the small percentage that did find information, here were their sources:
- Obstetrician/gynecologists (n = 18)
- Internet (n =15)
- Family or friends (n = 20)
Only four participants had attended OT for PFD.
Discussion and conclusion
The results indicated that PFD after child birth may hinder a woman’s ability to fully engage in meaningful occupations. As you saw above, the two areas that were most impacted were sexual activity and exercise.
Despite a reported impact on daily life, over half of the participants reported seeking no treatment, and only a small percentage of treatment came from a medical provider.
The lack of reporting of signs and symptoms suggests that women may be undereducated about treatment options. (I thought it was particularly telling that women learned about treatment options from friends more often than doctors.)
The authors end with calling for more research and advocacy in the field of OT to increase the public’s awareness of PFD rehabilitation.
Takeaways for OT practitioners
(Please note: these are my personal takeaways and were not mentioned specifically in the article.)
1.) We are just at the beginning of OT research in this practice area!
This article represents very early-stage research, but I think it really opens the path forward for more research like it. It seems pretty clear that this is an overall neglected diagnosis for women. And, that OTs bring a needed perspective and skillset to serving these patients.
Thanks to leaders like Lindsey Vestal (next week’s podcast guest), there is also more passion and focus within the OT community regarding pelvic health.
2.) Increased public awareness is needed.
This research really showcased that increasing public awareness needs to be part of any plan to offer more services for PFD.
If you are looking at offering pelvic health services in your area, part of your plan will need to be educating fellow health providers and your community, since PFD is discussed more among friends than in the doctor’s office.
I’m excited to talk with you in the comments regarding how we can spread the word among our fellow OTs (and our local communities)!
Here’s the full APA citation for this article:
Burkhart, R., Couchman, K., Crowell, K., Jeffries, S., Monvillers, S., &; Vilensky, J. (2020). Pelvic floor dysfunction after childbirth: Occupational impact and awareness of available treatment. OTJR: Occupation, Participation and Health, 41(2), 108–115.
Earn one hour of continuing education by listening to the podcast on this article!!
In this podcast episode, we dive even deeper into this topic, with OT (and Club member!), Lindsey Vestal. You may be eligible for continuing education credit for listening to this podcast. Please read our course page for more details!