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Thangarajah F, Soff J, Lenz C, Jeschke J, Kössendrup J, Papior D, Hagenbeck C, Kirn V, Scholten N. Care needs and self-induced measures of women with postpartum pelvic floor disorder- Results of a social media-based survey of 2930 women. Arch Gynecol Obstet 2024; 309:1467-1473. [PMID: 38353721 PMCID: PMC10894144 DOI: 10.1007/s00404-024-07369-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2023] [Accepted: 01/02/2024] [Indexed: 02/25/2024]
Abstract
INTRODUCTION Pelvic floor disorders (PFD) occur in about 40% of women after delivery. Less is known about the intervention and care needs of women with postpartum PFD. The aim of this analysis was to analyze care needs and self-initiated measures to strengthen the pelvic floor in postpartum women in relation to incontinence and sexual dysfunction. Furthermore, influencing factors for self-initiated measures were evaluated. PATIENTS AND METHODS An anonymous online survey (via LimeSurvey) was conducted between September and October 2022 and distributed via social media (Instagram and Facebook). The survey explicitly addressed mothers with and without pelvic floor disorders up to 5 years postpartum (inclusion criteria). Validated instruments were employed to assess incontinence (ICIQ-SF) and sexual functioning (PISQ-IR: Condition Impact). The questions on the use of services and preventive measures, as well as on the interaction with a gynecologist, were based on self-developed items. RESULTS In total, 49.4% of the participants of the survey showed symptoms of urinary incontinence (UI). Furthermore, only 40.3% (n = 241) of women were actively asked by their gynecologists for the occurrence of UI or PFD among those who suffered from PFD. Overall, 79.3% of the participants of the survey with UI underwent measures to deal with the complaints. The ICIQ-SF Score was significantly associated with all self-induced measures. High School diplomas and academic degrees were associated with the use of love balls (p < 0.05). CONCLUSION The results of the study show the unmet needs of postpartum women. PFD should be addressed more frequently in the outpatient setting. Furthermore, more systematic information about the treatment of PFD could help to address unmet information needs and improve interventions.
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Affiliation(s)
- Fabinshy Thangarajah
- Department of Gynecology and Obstetrics, Medical Faculty, Hufelandstr. 55, 45147, Essen, Germany.
- Department of Gynecology and Obstetrics, Medical Faculty, Kerpener Str. 34, 50931, Cologne, Germany.
| | - Johannes Soff
- Faculty of Medicine and University Hospital Cologne, Institute of Medical Sociology, Health Services Research and Rehabilitation Science, Chair of Health Services Research, University of Cologne, Cologne, Germany
| | - Caroline Lenz
- Department of Gynecology and Obstetrics, Medical Faculty, Kerpener Str. 34, 50931, Cologne, Germany
| | - Janice Jeschke
- Department of Gynecology and Obstetrics, Medical Faculty, Kerpener Str. 34, 50931, Cologne, Germany
| | - Jan Kössendrup
- Faculty of Medicine and University Hospital Cologne, Institute of Medical Sociology, Health Services Research and Rehabilitation Science, Chair of Health Services Research, University of Cologne, Cologne, Germany
| | - David Papior
- Department of Gynecology and Obstetrics, Medical Faculty, Hufelandstr. 55, 45147, Essen, Germany
| | - Carsten Hagenbeck
- Clinic for Gynecology and Obstetrics, Heinrich-Heine-University Düsseldorf, Moorenstr. 5, 40225, Düsseldorf, Germany
| | - Verena Kirn
- Breast Center at the Department of Obstetrics and Gynecology, Heilig Geist Krankenhaus/Teaching Hospital of the University of Cologne, Cologne, Germany
| | - Nadine Scholten
- Faculty of Medicine and University Hospital Cologne, Institute of Medical Sociology, Health Services Research and Rehabilitation Science, Chair of Health Services Research, University of Cologne, Cologne, Germany
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Nzinga Luzolo AM, Dilu Mabiala E, Bilo Mbaki I, Ngereza Kibimbi P, Bope Matshinga N, Kasonga RS. Epidemiological Profile and Attitudes of Pregnant Women Toward Urinary Incontinence: A Single-Center Cross-Sectional Study. Int Urogynecol J 2024; 35:521-526. [PMID: 38189851 DOI: 10.1007/s00192-023-05718-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2023] [Accepted: 12/08/2023] [Indexed: 01/09/2024]
Abstract
OBJECTIVE The objective was to highlight the epidemiological and clinical profile of urinary incontinence in pregnant women during the first trimester and to determine their knowledge and attitudes toward this condition in Kinshasa. METHODS We carried out a descriptive cross-sectional study among 127 pregnant women who came for prenatal consultations in the first trimester from January to March 2022 at the LISANGA Medical Centre in Kinshasa. A questionnaire was developed containing the Urinary Symptom Profile (USP) scale. Kolmogorov-Smirnov normality tests were used to determine the normality of the distribution of the study variables. Inferential statistics were performed. The significance level was 0.05. RESULTS The mean age was 29.7±5.5 years. Thirty-eight women (29.9%) were primigravida. The median age of pregnancy was 6 weeks of amenorrhoea. The prevalence of urinary incontinence was 73.2%, with 31.2% of urge urinary incontinence and 16.1% of stress incontinence. In 61.4% of cases, overactive bladder was associated with urinary incontinence. Among the incontinent pregnant women, 3.2% had consulted a doctor while accepting that this condition is a health problem, 13.4% knew they had a pelvic floor muscle, 4.7% had knowledge of its rehabilitation, and 8.7% had benefited from gymnastics during pregnancy. CONCLUSIONS Urinary incontinence was frequent in the first trimester of pregnancy with a predominance of urgency. It was hardly discussed during prenatal consultations and pregnant women were not aware of the pelvic floor muscle, its rehabilitation, and of gymnastics during pregnancy.
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Affiliation(s)
- Andy-Müller Nzinga Luzolo
- Pelvic floor Re-education Unit, Department of Physical Medicine and Rehabilitation, University Clinics of Kinshasa, Faculty of Medicine, University of Kinshasa, Kinshasa, Democratic Republic of Congo.
- Laboratory of Functional Anatomy, Faculty of Motor Sciences, Université Libre de Bruxelles, Brussels, Belgium.
| | - Elie Dilu Mabiala
- Pelvic floor Re-education Unit, Department of Physical Medicine and Rehabilitation, University Clinics of Kinshasa, Faculty of Medicine, University of Kinshasa, Kinshasa, Democratic Republic of Congo
| | - Inès Bilo Mbaki
- Pelvic floor Re-education Unit, Department of Physical Medicine and Rehabilitation, University Clinics of Kinshasa, Faculty of Medicine, University of Kinshasa, Kinshasa, Democratic Republic of Congo
| | - Patient Ngereza Kibimbi
- Pelvic floor Re-education Unit, Department of Physical Medicine and Rehabilitation, University Clinics of Kinshasa, Faculty of Medicine, University of Kinshasa, Kinshasa, Democratic Republic of Congo
| | - Nene Bope Matshinga
- Pelvic floor Re-education Unit, Department of Physical Medicine and Rehabilitation, University Clinics of Kinshasa, Faculty of Medicine, University of Kinshasa, Kinshasa, Democratic Republic of Congo
| | - Ra-Shin Kasonga
- Pelvic floor Re-education Unit, Department of Physical Medicine and Rehabilitation, University Clinics of Kinshasa, Faculty of Medicine, University of Kinshasa, Kinshasa, Democratic Republic of Congo
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Pizzoferrato AC, Deparis J, Fritel X, Rousseau M, Blanchard V. Impact of educational workshops to increase awareness of pelvic floor dysfunction and integrate preventive lifestyle habits. Int J Gynaecol Obstet 2024; 164:596-604. [PMID: 37723985 DOI: 10.1002/ijgo.15130] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Revised: 08/08/2023] [Accepted: 08/29/2023] [Indexed: 09/20/2023]
Abstract
OBJECTIVES Our objectives were to evaluate the impact of group pelvic floor education workshops on participants' knowledge, their satisfaction, and the modification of their urinary and digestive behaviors, and to compare health care providers' (HCP) knowledge with that of the general population. METHODS For this prospective observational study, group pelvic floor education workshops were proposed between May 2021 and June 2022 in a web-conference format. Each workshop covered pelvic floor anatomy and physiology, urinary and digestive physiology as well as risk factors of PFD and preventive measures. At the start and the end of the workshops, participants completed a questionnaire on their knowledge and their beliefs about the pelvic floor. Questions about their satisfaction were asked at the end of the workshops. A 2-month questionnaire assessed changes in urinary and digestive habits and whether participants had talked about the workshop around them. RESULTS A total of 856, with an average age 40.1 years, participated and completed the questionnaires before and after the workshops; 694 responded at 2 months. The education workshops significantly improved knowledge about the pelvic floor in the "HCP" and "non-HCP" groups. At 2 months, 591 participants (85.2%) 85.2% had talked about the workshop content; 557 (80.3%) reported having changed, or planned to change, their urinary behaviors and 495 (71.3%) their defecatory behaviors. CONCLUSIONS Pelvic floor education workshops can increase level of knowledge and thus limit risky behaviors for the pelvic floor. The high rate of participation and the satisfaction of the participants shows the interest for the theme.
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Affiliation(s)
- Anne-Cécile Pizzoferrato
- Department of Obstetrics and Gynecology, Université de Poitiers, CIC-Inserm, DECLAN, CHU de Poitiers, Poitiers, France
| | - Julia Deparis
- Department of Obstetrics and Gynecology, Université de Poitiers, CIC-Inserm, DECLAN, CHU de Poitiers, Poitiers, France
| | - Xavier Fritel
- Department of Obstetrics and Gynecology, Université de Poitiers, CIC-Inserm, DECLAN, CHU de Poitiers, Poitiers, France
| | - Marion Rousseau
- Department of Obstetrics and Gynecology, Caen University Hospital, Caen, France
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Yohay NZ, Cohen R, Hasan M, Daya K, Weiss A, Abukaf H, Yohay Z, Weintraub AY, Eshkoli T. Condition-specific validation of the Arabic version of the Prolapse and Incontinence Knowledge Questionnaire (PIKQ) among parturient. Int Urogynecol J 2023; 34:1529-1539. [PMID: 36592172 DOI: 10.1007/s00192-022-05417-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2022] [Accepted: 11/17/2022] [Indexed: 01/03/2023]
Abstract
INTRODUCTION AND HYPOTHESIS Pregnancy and mode of delivery have a major effect on pelvic floor disorders (PFD). Assessing knowledge regarding PFD is essential not only for making more informed decisions regarding mode of delivery, but also for seeking help when PFD appear. The Prolapse and Incontinence Knowledge Questionnaire (PIKQ) is a validated tool that assesses women's knowledge regarding urinary incontinence (UI) and pelvic organ prolapse (POP). Validation of the Arabic version of the PIKQ had never been carried out. The purpose of this study was to conduct a condition specific validation among parturients of the PIKQ in the Arabic language. METHODS Translation of the PIKQ to the Arabic language was carried out according to international recommended guidelines. A cross-sectional study of pregnant women was conducted from June to September 2020 at the Soroka University Medical Center, Israel. The recommended 10:1 ratio between the number of subjects and the number of items in the questionnaire (n=24) was maintained. A total of 244 third trimester pregnant women have completed the Arabic version of the PIKQ. In addition to the validation of the psychometric characteristics, construct validity, criterion validity, and reliability were tested as well. RESULTS Initially, exploratory factor analysis (EFA) was conducted, resulting in two 12-item scales representing UI and POP. Then, to validate the scale construct we conducted confirmatory factor analysis (CFA). Results of the CFA demonstrated that the PIKQ displayed construct validity, with standardized factor loadings ranging from 0.30 to 0.62. Finally, Cronbach's alpha indicated a good internal reliability for the two factors UI and POP. Criterion validity further supported the validity of the scale. CONCLUSIONS The Arabic version of the PIKQ is a new, reliable, consistent, and valid instrument to examine the level of knowledge regarding UI and POP in Arabic speaking pregnant women. This instrument may be used to assess women's knowledge about PFD and to direct the need for educational interventions that may empower women to make informed decisions regarding perinatal care.
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Affiliation(s)
- Neriya Zion Yohay
- Department of Military Medicine and "Tzameret", Faculty of Medicine, Medical Corps, Israel Defense Forces, Hebrew University of Jerusalem, Jerusalem, Israel.
- Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel.
| | - Rinat Cohen
- School of Education, Achva Academic College, Arugot, Israel
| | - Mahmod Hasan
- Department of Obstetrics and Gynecology, Soroka University Medical Center, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheba, Israel
| | - Kochav Daya
- Department of Obstetrics and Gynecology, Soroka University Medical Center, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheba, Israel
| | - Ari Weiss
- Shaare Zedek Medical Center, Affiliated with the Hebrew University School of Medicine, Jerusalem, Israel
| | - Hanaa Abukaf
- Department of Obstetrics and Gynecology, Soroka University Medical Center, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheba, Israel
| | - Zehava Yohay
- Department of Obstetrics and Gynecology, Soroka University Medical Center, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheba, Israel
| | - Adi Y Weintraub
- Department of Obstetrics and Gynecology, Soroka University Medical Center, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheba, Israel
| | - Tamar Eshkoli
- Department of Obstetrics and Gynecology, Soroka University Medical Center, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheba, Israel
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Wu X, Yi X, Zheng X, Chen Z, Liu J, Dai X. Knowledge, attitudes, and practice of pelvic floor dysfunction and pelvic floor ultrasound among women of childbearing age in Sichuan, China. Front Public Health 2023; 11:1160733. [PMID: 37234767 PMCID: PMC10206020 DOI: 10.3389/fpubh.2023.1160733] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Accepted: 04/17/2023] [Indexed: 05/28/2023] Open
Abstract
Objective Pelvic floor dysfunction (PFD) is highly prevalent among women. Pelvic floor ultrasound (PFU) is a critical method for assessing PFD. This study examined the knowledge, attitudes, and practice (KAP) of women of childbearing age regarding PFD and PFU. Methods This cross-sectional study was conducted between August 18, 2022, and September 20, 2022, in Sichuan, China. A total of 504 women of childbearing age participated in this study. A self-administered questionnaire was developed to assess KAP regarding PFD and PFU. Univariable and multivariable logistic regression analyses were conducted to assess the association between demographic characteristics and KAP. Results The average scores for knowledge, attitudes, and practice were 12.53, 39.98, and 16.51 out of 17, 45, and 20, respectively. Despite adequate knowledge of PFD symptoms, aging-related risks, and PFD harms (correct rates > 80%), participants showed poor knowledge about the benefits of PFU, PFU types, and Kegel exercise (correct rates < 70%). High scores in knowledge and attitude (odds ratio = 1.23 and 1.11, P < 0.001 and P = 0.005, respectively) were independent predictors of good practice, while never having been pregnant (odds ratio = 0.10, P < 0.001), alcohol consumption (odds ratio = 0.09, P = 0.027), and not being diagnosed with PFD or an unclear diagnosis independently predicted poor practice (both odds ratio = 0.03, both P < 0.001). Conclusion Women of childbearing age in Sichuan, China, showed moderate knowledge, positive attitude, and good practice regarding PFD and PFU. Knowledge, attitude, pregnancy history, alcohol consumption, and PFD diagnosis are associated with practice.
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Does the Contractile Capability of Pelvic Floor Muscles Improve with Knowledge Acquisition and Verbal Instructions in Healthy Women? A Systematic Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19159308. [PMID: 35954665 PMCID: PMC9368630 DOI: 10.3390/ijerph19159308] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Revised: 07/26/2022] [Accepted: 07/27/2022] [Indexed: 12/10/2022]
Abstract
Seventy percent of women with pelvic floor dysfunctions (PFDs) are estimated to present deficient consciousness of their pelvic floor muscles (PFMs) and poor ability to contract them. Improving the proprioception of PFMs, defined as the capacity to know the status and position of each body part, and adequately contracting them could be a protective factor to prevent the appearance of PFDs in the general female population. This study aimed to identify the effectiveness of educational interventions and verbal instructions on how to contract and exercise the PFMs to improve the proprioception of the PFMs in women. A systematic search of studies published in the last 20 years until March 2022 was conducted in the PubMed, Cochrane Library, Web of Science, Scopus, PEDro, Lilacs, and Dialnet databases. A meta-analysis could not be performed due to the heterogeneity in the types of studies and included populations. This review followed the PRISMA guidelines for the design, search, and reporting of studies. The methodological quality was analysed via the PEDro and the Newcastle–Ottawa scales in the case of randomised clinical trials and non-randomised studies, respectively, while the quality of evidence was determined using the SIGN grading system for evidence-based guidelines. Descriptive and experimental studies published in English, Spanish, or Portuguese that evaluated the contractile capability of the PFMs in healthy women or women without a previous diagnosis of PFD were included. Seven articles that included a total of 2507 women were found, three of which were clinical trials with PEDro scores between 5 and 9 points out of 10 and four of which were non-randomised studies with NOS scores between 6 and 8 points out of 10. The outcomes were measured through vaginal palpation, visual observation, questionnaires for PFD symptoms, and self-perception reports. This review discriminated between two types of intervention, educational programmes and verbal instructions, and evaluated the changes observed in PFM strength and knowledgeability and the symptoms of PFDs. The findings showed that educational interventions and verbal instructions improve the proprioception of PFMs in women of all ages that are healthy or without a previous diagnosis of PFDs as well as their knowledge about the pelvic floor, healthy lifestyle habits, and symptoms that are potentially indicative of PFDs. Further high-quality randomised clinical trials are warranted to draw definitive conclusions about the effectiveness of educational interventions to improve the proprioception of the PFMs in women considered healthy or with mild symptoms that may be indicative of PFDs.
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Hou Y, Tong B. Three-year follow-up of a self-administered Australian pelvic floor questionnaire validated in Chinese pregnant and postpartum women. Int Urogynecol J 2022; 33:3077-3084. [PMID: 35037976 PMCID: PMC9569312 DOI: 10.1007/s00192-022-05077-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2021] [Accepted: 12/23/2021] [Indexed: 10/27/2022]
Abstract
INTRODUCTION AND HYPOTHESIS The aim of this study was to verify whether the Chinese version of the self-administered Australian Pelvic Floor Questionnaire (APFQ) can assess the changes in symptoms over a long time period (responsiveness) and to verify the reliability and validity of the questionnaire after 3 years of follow-up. METHODS The questionnaire was completed by 146 women using the WeChat platform after 3 years of follow-up. Reliability was assessed through internal consistency (Cronbach's alpha). Construct validity was evaluated by significantly distinguished differences in symptom scores between women who did and did not subjectively suffer bothersome symptoms. Responsiveness was evaluated in 146 women. The effect size (ES) and standardized response mean (SRM) were used to assess the degree of responsiveness. RESULTS Of the 146 women, all completed the questionnaire through the WeChat platform without missing any items. Reliability, Cronbach's alpha for the four domains and total APFQ were: bladder function 0.78, bowel function 0.71, pelvic organ prolapse 0.78, sexual function 0.68 and total APFQ 0.84. Concerning construct validity, the APFQ significantly distinguished the symptom scores between women who did and did not subjectively suffer from bothersome symptoms, and the score difference was 1.1-1.6 points, 1.2 points, 2.0-3.7 points and 1.4 points, respectively. For responsiveness, three domains showed slight (bowel domain) to moderate (bladder domain, sex domain) sensitivity to change. ES and SRM ranged from 0.21 to 0.75 and 0.16 to 0.60, respectively. CONCLUSIONS The Chinese version of the self-administered APFQ is reliable and valid and can monitor the changes in symptoms over time.
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Affiliation(s)
- Yuqing Hou
- Gynecology Department, Women's Hospital School of Medicine Zhejiang University, No.1 Xueshi RoadZhejiang Province, Hangzhou, 310006, China.
| | - Baoqin Tong
- Gynecology Department, Women's Hospital School of Medicine Zhejiang University, No.1 Xueshi RoadZhejiang Province, Hangzhou, 310006, China
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Berujon E, Blanchard V, Fauvet R, Nyangoh-Timoh K, Pizzoferrato AC. [Benefits of group pelvic floor education sessions: satisfaction and improvement of women's knowledge]. Prog Urol 2021; 31:1201-1208. [PMID: 34417091 DOI: 10.1016/j.purol.2021.07.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2021] [Revised: 07/11/2021] [Accepted: 07/25/2021] [Indexed: 11/18/2022]
Abstract
INTRODUCTION Pelvic floor dysfunctions are an important health-care issue however there are no primary prevention programs for perineal health. This study aims to evaluate the impact of perineal education group sessions on women's urinary and digestive behaviors and their satisfaction with these sessions. MATERIAL Perineal education sessions were proposed to women working in a gynecology department. Each session covered perineal physiology and anatomy, urinary and digestive physiology as well as risk situations for the pelvic floor. At the beginning and end of the sessions, participants completed a questionnaire on their knowledge about the pelvic floor and questions concerning their satisfaction were asked at the end of the session. A 2-month questionnaire assessed changes in urinary and digestive habits as well as the dissemination of information. RESULTS One hundred and sixty-three women, average age 38, participated in these sessions; 107 responded at 2 months. The education sessions significantly improved pelvic floor fonctions knowledge. After the sessions, 81.3% of women reported changing their urinary habits and 60.7% their defecatory habits. Participants found the sessions very useful (rating 9.7/10), all participants recommended these sessions to a friend and the dissemination of the information was important. CONCLUSION Perineal education sessions improve women's knowledge and limit risky behaviors for the pelvic floor. The satisfaction of women who received information is important and the dissemination of information strong. LEVEL OF EVIDENCE 4.
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Affiliation(s)
- E Berujon
- Service de gynécologie-obstétrique, CHU de Caen Normandie, avenue Côte de Nacre, 14033 Caen cedex 9, France
| | - V Blanchard
- Cabinet de rééducation périnéale, Chanceaux-Sur-Choisille, France
| | - R Fauvet
- Service de gynécologie-obstétrique, CHU de Caen Normandie, avenue Côte de Nacre, 14033 Caen cedex 9, France; Unité de Recherche Interdisciplinaire pour la Prévention et le Traitement des Cancers, Axe 2 : biologie et Thérapies Innovantes des Cancers Localement Agressifs (BioTICLA), Université de Caen Normandie, Inserm U1086 « ANTICIPE », 3, avenue général Harris BP 45026, 14076 Caen cedex 5, France
| | - K Nyangoh-Timoh
- Laboratoire d'Anatomie, hôpital universitaire de Rennes 1, université de Rennes, Rennes, France
| | - A-C Pizzoferrato
- Service de gynécologie-obstétrique, CHU de Caen Normandie, avenue Côte de Nacre, 14033 Caen cedex 9, France.
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