Comprehensive Nonsurgical Management of Women with Symptoms of Pelvic Floor Dysfunction: A Prospective Study

Objective: Women with symptoms of pelvic floor dysfunction (PFD) often consult with many different health care providers, increasing the potential for duplication and treatment delay. Multiple referrals can result in increased cost of care and decreased patient satisfaction. Nurse Practitioners (NPs) in a female continence center are uniquely positioned to provide comprehensive, nonsurgical care for women with urinary, defecatory, and pelvic pain complaints. The aim of this study was to determine immediate and long term effectiveness of comprehensive pelvic floor rehabilitative administered by an NP.   

Methods:This study is a single arm, prospective clinical trial. All adult women presenting to an academic urogynecology clinic seeking nonsurgical management for symptoms of PFD from 02/01/13 to 03/31/16 were offered enrollment. Subjects completed up to five treatment sessions with an NP which included pelvic muscle biofeedback, vaginal electrogalvanic stimulation, behavior modification, bowel symptom management, home pelvic floor exercise program; and (when appropriate) pessary fitting and pharmacologic intervention. Data were collected at baseline; end of treatment; and at 6 and 12 months following completion: validated QOL instruments (PFDI-20 and PFIQ-7) and patient global impression of improvement (PGI-I) measured by visual analog scale.

Results: To date, 428 women have been enrolled with 406 having complete data sufficient for analysis. These subjects had a median age of 51 and parity of two. Forty eight percent reported a history of third or fourth degree obstetrical injury. Subjects experienced clinical and statistically significant improvement in QOL (p 0.0005), which was durable at one year.  PGI-I data revealed an 80% improvement in urinary, defecatory, and pain symptoms. Significant improvement in symptoms of nocturia (p 0.01) and urinary frequency (p 0.009) were also detected.

Conclusion: Comprehensive nonsurgical management of women with symptoms of PFD by an NP is efficacious and results in improved QOL which is durable to one year.