Factors Affecting Care Seeking Patterns in Women with Pelvic Floor Disorders

Objectives: We aim to determine if sociodemographic and health determinants of women with pelvic floor disorders (PFDs) affect the time to presentation, and whether this varies by subtype and severity. We hypothesize that most women with pelvic organ prolapse (POP) or urinary incontinence (UI) delay care seeking, resulting in more severe symptoms at presentation.

Methods: We conducted a retrospective chart review of women >18 years old presenting to an academic urogynecology practice with POP or UI between January 1, 2021 and May 31, 2022. Both groups were compared across sociodemographic variables and women were further compared by POP stage and UI severity. The primary outcome of interest was symptom duration prior to presentation. A logistic regression controlling for potential confounding variables was used to evaluate the effect of POP stage or UI severity on symptom duration. P-value < 0.05 was considered statistically significant.

Results: A total of 684 [307 POP (44.9%) and 377 UI (55.1%)] women with a PFD chief complaint were included in the study. In women with POP, 190 (61.9%) had stage I/II and 117 (38.1%) had stage III/IV. In women with UI, 188 (49.9%) had mild-moderate UI and 179 (47.5%) had severe UI. Approximately 76% of women had PFD symptoms for more than 6 months and 47% for 2 years or more upon presentation. Women with advanced stage POP had an adjusted 1.27 increased odds (95% CI: 1.01-1.61) of delaying care for >24 months, and were more likely to be older (1.07 adjusted OR, 95% CI: 1.03-1.11), and had a lower median number of healthcare visits (0.95 adjusted OR, 95%: CI: 0.91-0.98)) in the past year compared to women with early stage POP (Table 1). Women with severe UI had an adjusted 1.88 increased odds (95% CI: 1.52-2.35) of delaying care >24 months, and were more likely be with Medicare or Medicaid insurance (1.20 adjusted OR, CI: 1.01-1.32), and have higher age-adjusted Charlson Comorbidity Index (1.18 adjusted OR, CI: 1.02-1.40) compared to women with mild-moderate UI (Table 2).

Conclusions: Most women with POP and UI report PFD symptoms for more than 6 months at presentation. Women with stage III/IV POP or severe UI are more likely to seek care over 24 months after onset of symptoms. Factors contributing to this delay include older age, comorbidities, government insurance, and fewer prior healthcare visits. The nature of PFDs and patients’ knowledge and perceptions of their condition may be contributing to this delay. Determinants of delayed care in women with PFDs should be further investigated to educate women about their conditions, especially at the primary care level.