Attitudes and barriers to pelvic floor muscle exercises of women with stress urinary incontinence.

BACKGROUND: Pelvic floor muscle exercise (PFME) is a first-line treatment for stress urinary incontinence (SUI), but adherence to PFME is often problematic. The aim of this study was to better understand the attitudes and barriers to practicing pelvic floor muscle exercise among women with SUI. METHODS: We conducted a qualitative study using semi-structured interviews. Purposive sampling was used to approach eligible participants. The interview included questions focused on women's perceptions regarding SUI and PFME, sources of information, support, and barriers and motivators of PFME. In-depth interviews were conducted until data saturation occurred. After several readings of written interview transcripts, codes were retrieved, and thematic analysis was conducted. RESULTS: Seven women participated in the study (average age 53.2 years), and most (4/7) were retired. Three salient themes emerged from the data: (1) perception of SUI, (2) barriers to PFME, and (3) motivators to exercise. Participants highlighted various barriers to PFME: (1) lack of self-discipline owing to both intrinsic and extrinsic factors, (2) lack of confidence in how to perform the exercises properly, and (3) skepticism regarding the efficacy of treatment according to women's direct and indirect experiences. Achievement of desired outcomes, symptom severity, women's expectations, and fear of surgery were motivators to regularly perform PFME. CONCLUSIONS: The main barriers to regular PFME were inadequate self-discipline, knowledge, and confidence in performing the exercises, and a poor perception about the effectiveness of PFME.

Validation of the Thai version of the Female Genital Self-Image Scale (FGSIS).

BACKGROUND: Female genital self-image is associated with sexual health, sexual behavior, and gynecologic health behavior. The Female Genital Self-Image Scale (FGSIS) is a simple, validated instrument that quantifies genital self-image in women. The study aim was to translate the original English FGSIS into Thai and test its psychometric properties among Thai-speaking women. METHODS: A cross-sectional, psychometric study of sexually active women attending a health check-up clinic at a university hospital in Thailand was conducted. On a volunteer basis and convenience sampling, 90 sexually active women were recruited between December 2020 and January 2021. Translation and transcultural adaptation of the English FGSIS into Thai were performed. The validity and reliability of the Thai FGSIS were assessed by examining content validity, face validity, internal consistency, construct validity, and test-retest reliability. The content validity of the Thai FGSIS was evaluated by assessing missing values, and internal consistency was evaluated using Cronbach's alpha. Scores on the FGSIS and the Female Sexual Function Index (FSFI) were compared to examine convergent validity (using Pearson correlations). Confirmatory factor analysis (CFA) was also conducted. Test-retest reliability was measured by re-administering the Thai FGSIS to the same group of respondents after a 2-week interval. RESULTS: The final Thai FGSIS was developed and assessed by a panel of experts. Data were examined for 86 respondents with average age of 32.5 ± 9.11 years. Content validity assessed using the level of missing data demonstrated no missing items. The overall internal consistency was high (Cronbach's alpha: 0.847). Strong correlations (r = 0.61-0.83) between FSFI and FGSIS total scores (p < 0.01) were demonstrated. In addition, five domains of sexual functioning and the FSFI total score showed high correlations ranging from r = 0.089 to r = 0.383 (p < 0.05), which confirmed convergent validity. CFA identified a two-factor structure for the Thai FGSIS. The test-retest reliability for 38 participants was 0.937 (p < 0.05). CONCLUSION: The Thai FGSIS was found to be a highly valid and reliable instrument with which to measure female genital self-image in Thai-speaking women.

Validation of the Thai version of the Prolapse and Incontinence Knowledge Questionnaire (PIKQ).

INTRODUCTION AND HYPOTHESIS: The Prolapse and Incontinence Knowledge Questionnaire (PIKQ) was developed and validated to assess women's knowledge regarding etiology, diagnosis and treatment of pelvic organ prolapse (POP) and urinary incontinence (UI). We aimed to translate and validate a Thai version of the PIKQ to use as a tool to evaluate knowledge of POP and UI among Thai-speaking women. METHODS: The English PIKQ, which comprises the PIKQ-POP and PIKQ-UI sections, was translated into Thai. Psychometric properties of the final version of the Thai PIKQ were tested for content validity, construct validity, internal consistency and test-retest reliability among 168 women attending a gynecology clinic and 150 nurses. RESULTS: Regarding content validity of the final Thai PIKQ, the number of missing items was 0. Participants in the nurse group were more likely than those in the patient group to select the correct answer for all items for the POP scale and UI scale (P < 0.001). For internal consistency testing, Cronbach's alpha coefficient was 0.745 for the PIKQ-POP and 0.754 for the PIKQ-UI scales, suggesting that the items had relatively high internal consistency. The item-total correlation values ranged from 0.204 to 0.539, showing an adequate correlation of each item with the scale overall. The correlation coefficients between the test and retest for PIKQ-POP and PIKQ-UI were 0.685 and 0.735, respectively (P < 0.001). CONCLUSIONS: The Thai PIKQ is a simple instrument which shows good validity and high reliability and could be a useful tool for assessing knowledge regarding POP and UI in clinical practice.

Vaginal ring pessary use for pelvic organ prolapse: continuation rates and predictors of continued use.

OBJECTIVES: The aim of the study was (1) to evaluate continuation rates of vaginal ring pessary for pelvic organ prolapse (POP), and (2) to identify predictors for continued pessary use. METHODS: This retrospective chart review study was conducted in a tertiary center. Women who had a ring with support pessary successfully fitted between January 2009 and December 2013 and had completed up to 3 years of follow-up care were included in the analysis. Demographic and obstetric data, body weight, pelvic organ prolapse stage, and associated symptoms were evaluated. All the women were followed until February 28, 2017, unless surgery to correct POP surgery was required, pessary use was discontinued, or the women died. RESULTS: A total of 289 women with symptomatic POP (stages II, III, and IV) were evaluated. The median age was 71 years (range 34-83 y), and the median parity was 3 (range 0-8). Among the women with a successful initial fitting, the failure rate was 5.88% (17/289) at 6 months with most of these women choosing to have surgical intervention. This analysis indicates that the probability of the successful continuation of pessary use after 1, 2, 3, 4, and 5 years was 83.0%, 78.2%, 71.3%, 65.3%, and 61.7%, respectively, reported using a Kaplan-Meier plot. The main cause for discontinuation of pessary use before 3 years was the election for surgical intervention. With regard to predictors for continued pessary use, self-care was the only factor that influenced compliance rates after treatment of 3 years. CONCLUSION: A ring with support pessary can be used successfully to alleviate symptoms of advanced stage prolapse for 3 years or longer. In addition, proper self-management was found to be a strong predictor for prolonged pessary use.

Effect of Colpexin Sphere on pelvic floor muscle strength and quality of life in women with pelvic organ prolapse stage I/II: a randomized controlled trial.

INTRODUCTION AND HYPOTHESIS: Colpexin Sphere was effective for advanced pelvic organ prolapse. The aim of this study was to assess the effect of Colpexin Sphere in women with pelvic organ prolapse (POP) stage I or II on pelvic floor muscle strength, quality of life, and POP stage. METHODS: Women were randomly divided into Colpexin Sphere with pelvic floor muscle exercise group and exercise only group for a 16-week period. They had Colpexin pull test and digital test every 4 weeks. Quality of life and POP stage were re-evaluated at the end of treatment. RESULTS: Ninety-one women were recruited and 85 completed. Colpexin Sphere plus pelvic floor exercise improved pelvic floor muscle strength. There was no significant difference between both groups. Vaginal symptom score decreased in both groups while the stages of prolapse did not change. CONCLUSIONS: Colpexin Sphere plus pelvic floor exercise and exercise alone improved pelvic floor muscle strength.

Effect of colpexin sphere on pelvic floor muscle strength in women with pelvic organ prolapse: a randomized controlled trial (a preliminary report).

OBJECTIVE: The aim of this study was to assess the effect of Colpexin Sphere with pelvic floor exercise in women with stage I and II pelvic organ prolapse on improving pelvic floor muscle strength compared with the pelvic floor exercise only. METHODS: The women were divided into two groups: one group used Colpexin Sphere with pelvic floor muscle exercise, and the other group did pelvic floor exercise only for a 16-week period. The efficacy was evaluated at baseline and 16-week for comparison of pelvic floor muscle strength. RESULTS: A total of 50 women were enrolled and 48 women completed the full 16-week assessment. A statistically significant improvement in pelvic floor muscle strength as compared with baseline values and at 16 weeks was shown in both groups, with mean difference pull test contraction values of 2.25 + 3.28 N (P < 0.05) in the study group and 1.38 + 2.17 N (P < 0.05) in the control group. There was no statistically significant difference in improving pelvic floor muscle strength between the study and the control groups. CONCLUSION: Even though Colpexin Sphere plus pelvic floor exercise improved pelvic floor muscle strength, the improvement was not statistically different from exercise alone.

Prevalence and risk factors of anorectal dysfunction in women with urinary incontinence.

PURPOSE: To evaluate the prevalence and risk factors of anorectal dysfunction among women with urinary incontinence. METHOD: This cross-sectional study was conducted among women attending the urogynecology clinic. Women with symptoms of urinary incontinence were requested to complete a structured questionnaire. RESULTS: Four hundred and thirteen women participated in the study and 43.8% had at least one anorectal symptom. The prevalence rates of anal incontinence, constipation, and difficult defecation were 8.0, 38.0, and 25.7%, respectively. The risk factors associated with anorectal dysfunction were age and number of parity. CONCLUSION: Anorectal dysfunction was prevalent among women with urinary incontinence; age and number of parity were the risk factors. All women with symptoms of urinary incontinence should be evaluated about anorectal symptoms.

The characteristics and satisfaction of the patients using vaginal pessaries.

OBJECTIVE: To study the characteristics of pelvic organ prolapse (POP) patients that used a pessary. DESIGN: Prospective, descriptive study. SETTING: Urogynecology Clinic, Ramathibodi Hospital, Faculty of Medicine, Mahidol University. MATERIAL AND METHOD: The authors conducted a prospective, observational study. The average age, parity, average body mass index, menopausal age, pessary type, and reasons for pessary use were collected in the present study. The symptoms, satisfaction, complication, and continuation rates after use were recorded. RESULTS: For the 40 subjects, the average age was 70.4 years, the average of parity, body mass index, and menopausal age were 4, 24.5 kg/m2, and 22 years, respectively. The reasons for choosing a pessary included mostly risks and reluctance to undergo surgery. The complications from using a pessary were vaginal erosion, which was found in one case. Thirty-seven patients (92.5%) were satisfied and continued to use pessaries. CONCLUSION: Most POP patients had a favorable outcome in terms of satisfaction with the pessary use and continued to use pessaries.

Lower urinary tract symptoms in Thai women attending the menopause clinic: prevalence and associated factors.

OBJECTIVE: To determine the prevalence of lower urinary tract symptoms and associated factors in women attending the menopause clinic. METHOD: Nine hundred and fifty-six women attending the menopause clinic, Ramathibodi Hospital were interviewed regarding their general health issues and lower urinary tract symptoms by means of an anonymous questionnaire. Demographic data, obstetric history, and underlying diseases were analysed by using Student t-test, Chi-square and Fisher exact test. P < 0.05 was considered as a level of significance. RESULTS: A total of 956 women, mean age 52.89 +/- 5.80 years, completed the questionnaire. The prevalence of stress incontinence, nocturia, urgency, frequency, and urge incontinence were 58.3%, 40.3%, 33.9%, 22.7%, and 6.6%, respectively. Lower urinary tract symptoms was found to be associated with marital status, coexisting medical diseases, menopausal status, previous term delivery, and vaginal delivery (P < 0.05). CONCLUSIONS: Lower urinary tract symptoms was a common problem among women attending the menopause clinic. Marital status, coexisting medical diseases, menopausal status, parity, and mode of delivery were associated with this problem.