Knowledge and Symptoms of Pelvic Floor Disorders in Women Undergoing Hysterectomy

Objectives: The primary objective was to assess the baseline knowledge of pelvic floor disorders (PFD) in women undergoing hysterectomy for benign or oncologic indications.

Methods: This is a prospective study of a cohort of women undergoing hysterectomy for either benign gynecologic disorders or for diagnosis or workup for a gynecologic malignancy at a single large academic medical center. After obtaining approval from the institutional review board, patients were recruited between November 2021 to February 2023. All patients over the age of 18 presenting for pre-operative visit prior to hysterectomy were eligible to participate. Exclusion criteria included women who were not literate in English or Spanish, were undergoing hysterectomy for a PFD or having a concomitant pelvic floor procedure at the time of their hysterectomy. Knowledge of urinary incontinence (UI) and pelvic organ prolapse (POP) was assessed using the previously validated Prolapse Incontinence Knowledge Questionnaire (PIKQ). Pre-operative symptoms of PFD was assessed using the previously validated Pelvic Floor Distress Inventory (PFDI). Demographics, co-morbidities, and details of procedures were collected. T-tests and Wilcoxon tests were used for continuous variables, while Chi-square and Fisher's exact tests were used for categorical variables.

Results: During the study period, 101 patients were enrolled. The majority of patients were English speaking (92%) and non-Hispanic or Latino (55%). 74 (73%) patients had a hysterectomy performed by general gynecologist and 27 (27%) had a hysterectomy performed by gynecologic oncologist. Patients with hysterectomy by a general gynecologist were more likely to be employed (p=0.03) and younger (p=0.0006). Demographics were otherwise similar between the two groups.

Based on the previously recommended criteria for PIKQ, 31% of patients with hysterectomy by general gynecologist and 22% of patients with hysterectomy by gynecologic oncologist were proficient regarding UI, scoring an 80% or greater on the UI portion of the questionnaire (p=0.38). Similarly, 38% of patients with hysterectomy by general gynecologist and 26% of patients with hysterectomy by gynecologic oncologist were proficient regarding POP, scoring a 60% or greater on the POP portion of the questionnaire (p=0.25). PFDI score was not significantly correlated with patient proficiency on the UI portion of the questionnaire (p=0.23) or with patient proficiency on the POP portion of the questionnaire (p=0.83). Additionally, 25% of all patients did not know that they could speak to a physician about urinary leakage or a bulge in their vagina.

Conclusions: Pelvic floor disorders are prevalent in our society though baseline knowledge regarding these disorders is low in both women undergoing hysterectomy by a general gynecologist or a gynecologic oncologist. Further research on how to better educate women in the community about pelvic floor disorders is needed, particularly so women eligible for concurrent pelvic floor procedures at time of hysterectomy can advocate for their health and receive this care.