Knowledge of Pelvic Floor Disorders in the Antepartum Period

Objectives: To evaluate baseline knowledge of antepartum patients related to pelvic floor disorders (PFDs) and the effect of pregnancy on the these PFDs.

Methods: This was a cross-sectional survey of pregnant Spanish or English-speaking patients seen at a single-site community clinic. Surveys were distributed at the 28-week visit or when OGTT performed (approximately from 20w-34w gestation) between August and October 2021. Participants completed the 36-question survey containing the validated 24-item Prolapse and Incontinence Knowledge Questionnaire (PIKQ), 10 demographic questions, and 3 fecal incontinence questions. The survey was modified to a 7^th grade reading level and translated into Spanish. Responses were graded to determine a raw accuracy. Proficiency was defined as correct answers in >80% for Urinary Incontinence (UI) questions and >50% for Pelvic Organ Prolapse (POP) questions.

Results: 276 surveys were complete and analyzed. The overall percent accuracy was 27.5%. The overall percent accuracy for UI questions was 34.5% and 21.4% for POP questions. When analyzed based on language of completion, the percent accuracy for the UI and POP questions was 26.9% and 19.5%, respectively, for Spanish speakers, and 49.2% and 25.2% respectively for English speakers. There was a significant difference in proficiency on the UI section but not the POP section based on language of completion (UI English 21.7%, Spanish 1.2% (P< 0.001); POP English 22.9%, Spanish 17.7% (P=0.339). For the UI questions, there was no significant difference in proficiency based on age, gravity, or personal history of UI symptoms. There was a significant difference on proficiency for UI questions based on race/ethnicity (Hispanic 4.7%, White 60%, Black/African American 14.9%, and Asian 0%, P< 0.001) and level of education (8^th grade or less 0%, some high school 5.1%, high school or GED 6.7%, and some college 22%; P< 0.001). For the POP questions, there was no significant difference in proficiency based on age, race/ethnicity, education, gravity, or personal history of POP symptoms. The 3 fecal incontinence questions in this study are not part of the validated PIKQ; however, of interest, 78% of participants answered that they agreed with or were unsure about the statement: “Other than pads or diapers, nothing can be done to treat leakage of stool.”

Conclusions: Overall, our antepartum clinic patients had low baseline knowledge of PFDs. There were marginally better proficiency scores for the POP section than the UI section. Spanish speakers demonstrated lower proficiency on the UI section compared with English speakers but had similar, low proficiency on the POP questions. Our study demonstrates that, despite being symptomatic, overall antepartum patient knowledge on PFD is low in our urban resident clinic. Antepartum visits present an opportunity to remedy this knowledge gap in both Spanish and English speakers by providing pelvic floor literature in the patient’s native language.