All Levels of Providers Can Effectively and Efficiently Teach Pelvic Floor Strength Assessment at Time of Pelvic Examination

Abstract

Objective In women who undergo provider-guided vaginal biofeedback of pelvic floor muscle strength, we sought to determine whether the level of the provider correlates with the patient’s ability to achieve adequate pelvic floor muscle contractions (PFMCs). Methods From August 2017 to April 2018, patients from 2 urogynecology clinics were recruited to participate in an institutional review board–approved, prospective study examining PFMCs. Pelvic examination and teaching session were done by providers who had specific training on how to assess pelvic floor muscle strength using the validated, modified Oxford scale. Patients were asked to perform a baseline PFMC during a 2-digit pelvic examination. Thereafter, patients were counseled to relax their muscles, identify the levator ani muscles during provider teaching, and perform 3 consecutive provider-guided PFMCs. The strength of each PFMC was measured, and the time-to-teach (TTT) was recorded. The level of provider and TTT were correlated with PFMC1 to PFMC3 using Spearman correlation coefficient. Results One hundred women participated. Obstetrics/gynecology (OB/GYN) residents (post-graduate years 1–4) evaluated 20 patients; female pelvic medicine and reconstructive surgery fellowship trainees (post-graduate years 5–7), 38 patients; OB/GYN nurse practitioners, 18 patients; generalist OB/GYN faculty, 9 patients; and female pelvic medicine and reconstructive surgery faculty, 15 patients. There was no correlation between level of provider and TTT or between level of provider and strength of PFMC1, PFMC2, or PFMC3. Conclusions At the time of pelvic floor muscle assessment, the level of provider does not impact teaching time or PFMC1 to PFMC3. Teaching pelvic floor muscle exercise is a cost-effective, low-resource tool to improve patient care, and providers of any level should be encouraged to teach pelvic floor muscle exercise to patients at the time of office examination.

Exploring pelvic floor muscle function in men with and without pelvic floor symptoms: A population‐based study

“…Indeed, some studies have shown that females were either unable or had difficulty performing correct deep pelvic floor musculature contraction during the assessment. 19 The heatmaps revealed comparable results for the EAS and the PRM at the item level for "voluntary relaxation," "tone," and "maximum voluntary contraction." The literature reveals no strict consensus about the relationship between the EAS and the PRM, though several studies have found connections between the two muscles.…”

“…The difference in function between muscles could be explained by the difficulty to contract the PRM due to its location within the pelvis. Indeed, some studies have shown that females were either unable or had difficulty performing correct deep pelvic floor musculature contraction during the assessment 19 …”

“…Indeed, some studies have shown that females were either unable or had difficulty performing correct deep pelvic floor musculature contraction during the assessment. 19 …”

Sexual Dysfunction in Female Patients with Inflammatory Bowel Disease: An Overview

“…Research has shown that patient teaching of pelvic floor exercises led by OB/GYN specialists may serve as a cost-effective, low-resource tool to improve patient symptoms of pelvic floor dysfunction. 63 …”