The Impact of Pelvic Floor Physical Therapy on Bladder and Bowel Function After Obstetric Anal Sphincter Injury

Abstract

ImportanceWomen with obstetric anal sphincter injury (OASI) are at increased risk of pelvic floor disorders. No standard of care exists for management of pelvic floor dysfunction after OASI.ObjectivesThe aims of this study were to evaluate the impact of pelvic floor physical therapy (PFPT) on bladder and bowel function after OASI and to describe adherence to PFPT.Study DesignA retrospective cohort study of women with OASI presenting at a postpartum care clinic from 2017 to 2021 was conducted. Women were grouped according to PFPT attendance. Urinary Distress Inventory 6 (UDI-6) and Fecal Incontinence Severity Index (FISI) were administered at baseline and 6 months.ResultsA total of 430 women with OASI presented to a postpartum care clinic, of which 137 (31.9%) attended PFPT, and 293 (68.1%) did not attend. Baseline and 6-month questionnaires were completed by 169 women: 52 (30.8%) in the PFPT group and 117 (69.2%) in the non-PFPT group. Baseline UDI-6 and FISI scores were higher in the PFPT group. Improvement in UDI-6 was not different between groups (−5.8 ± 14.9 vs −3.7 ± 10.8, P = 0.36). The non-PFPT group had greater worsening of FISI compared with PFPT group (9.8 ± 15.2 vs 1.1 ± 11.5, P < 0.001). Sixty-six percent (n = 136) of women referred to PFFT attended at least 1 session, of which 32.4% (n = 44) completed all sessions. Completely adherent women were referred to PFPT earlier (18.5 vs 28.5 days postpartum, P = 0.027).ConclusionsWomen in both the PFPT and non-PFPT groups reported improvement in bladder leakage 6 months after OASI. Women who did not attend PFPT had significant worsening of bowel leakage. Early referral to PFPT in women with pelvic floor dysfunction following OASI should be considered.

Sexual Function in Women at 6 and 12 Months After Obstetric Anal Sphincter Injury: Is Pelvic Floor Physical Therapy Associated With Improved Outcomes?

“…Other patient characteristics were similar between groups (Table 1) and were comparable to those of the primary cohort. 14 The non-PFPT group rated their sexual function at 6 months postpartum as being approximately the same as their baseline prepregnancy sexual function (median score 3.0) on all PPFBQ domains, except for SA (Table 2). The PFPT group rated their sexual function at 6 months postpartum as being worse than their baseline prepregnancy sexual function (median score <3.0) in domains of PFMI, SA, and sexual arousal and orgasm (Table 2).…”

“…This was a secondary analysis of a retrospective cohort study of postpartum women with OASI 14 . All women with OASI who presented for initial consultation to the Postpartum Care Clinic (PPCC) at Cleveland Clinic from November 2017 to November 2021 were included.…”

“…This was a secondary analysis of a retrospective cohort study of postpartum women with OASI. 14 All women with OASI who presented for initial consultation to the Postpartum Care Clinic (PPCC) at Cleveland Clinic from November 2017 to November 2021 were included. Some of the patients with OASI who presented to the PPCC were symptomatic and referred for management, whereas others were asymptomatic and referred primarily for counseling and education.…”

“…Details regarding PFM evaluation and therapeutic interventions following a standardized protocol are reported in our primary study. 14 This was approved by the Cleveland Clinic Institutional Review Board (IRB #18-225).…”

“…Questionnaires evaluating bladder and bowel function were administered during the initial visit; these results have been previously reported. 14 Sexual function questionnaires were not administered during the initial visit due to nonresumption of intercourse among participants. The Postpartum Pelvic Floor and Birth Questionnaire (PPFBQ) and Female Sexual Function Index (FSFI) were administered at 6 and 12 months, respectively, to evaluate postpartum sexual function.…”