Introduction

We report on women with a variety of complex, often pain-based pelvic floor conditions managed in a comprehensive multidisciplinary Women’s Urology Center (WUC) that offers urological, gynecological, colorectal, psychological, pelvic floor physical therapy and integrative medicine treatments.

Methods

Women presenting 2011-2015 were reviewed. Descriptive statistics were performed. A mailed survey to patients presenting in 2013-2014 assessed current status and satisfaction with treatment. Baseline and follow up Pelvic Floor Distress Inventory (PFDI-20) overall and subscale scores (Pelvic Organ Prolapse Distress Inventory (POPDI-6), Colorectal and Anal Distress Inventory (CRADI-8) and Urinary Distress Inventory (UDI-6)) were analyzed.

Results

693 new patients were seen in the specified time period. Mean age was 51 (range 17-91). Most common chief complaints were pelvic pain (219/687, 32%), urine incontinence (110/687, 16%), and overactive bladder (75/687, 11%). WUC treats women with complicated pelvic floor issues, provides 30-90 minute appointments including multidisciplinary care, yet even with this careful, tailored personal management only 89/567 (16%) patients returned the follow up survey. 85% (71/84) of responders were satisfied with the care and 35% (31/88) were still managed at the WUC. Of those who did not return, 44% (19/43) were improved / satisfied and did not need to return, 49% (21/43) had logistical reasons (live out of area, insurance issues, or inconvenient appointment times) and only7% (3/43) were unhappy with their care. Compared to non-responders, survey respondents had similar age and chief complaint, were more educated (p=0.02), and were less likely to smoke (p<0.01) but more likely to have diabetes (p=0.04). Rates of anxiety and depression were similar between groups (p=0.25, p=0.67). Most common treatments included pelvic floor physical therapy (55%), pelvic floor trigger point injections (15%), medications (24%), and coping strategies (58%). Mean PFDI-20 scores improved (82 to 64), all subscale scores improved (POPDI-6 from 24 to 17, CRADI-8 from 19 to 17 UDI-6 from 37 to 29) however, only the CRADI-8 met the minimally important difference.

Conclusions

Complex pelvic floor issues are difficult. Many patients were outside our catchment area, had seen multiple providers and were refractory to standard therapies. Although survey response was low, the majority of patients were pleased with their care. A multidisciplinary clinic providing individualized, comprehensive care is effective for pelvic floor symptoms.

Funding

None