Women's experience of doing long-term pelvic floor muscle exercises for the treatment of pelvic organ prolapse symptoms

Abstract

Pelvic organ prolapse (POP) is a common condition affecting women. POP symptoms are associated with perineal, abdominal and pelvic discomfort, bladder and bowel disorders and psychological distress. POP is often treated with pelvic floor muscle exercises (PFME) and/or surgery. It is known that women with POP have problems with long-term adherence to PFME and, therefore, investigating PFME adherence in women with POP will provide information that may help improve future treatment outcomes.

Five women participated in the current study, all of whom had previously taken part in the intervention arm of a randomised controlled trial of PFME for POP called the Pelvic Organ Prolapse Physiotherapy (POPPY) trial. The aim of the current qualitative study was to explore the experiences of these women regarding their on-going practice of PFME. The five participants were interviewed using a semi-structured approach by the researcher who had been their physiotherapist in the original trial. The interviews were transcribed verbatim, then analysed using an Interpretative Phenomenological Analysis (IPA) approach. Three core themes were identified in the analysis, namely, (1) Patterns of PFME Behaviour, (2) PFME Maintenance Cycles and (3) Family as Priority. The first theme named 'Patterns of PFME Behaviour', describes exercise characteristics and behaviours. The second theme, named 'PFME Maintenance Cycles' captured the participantsʼ responses to and evaluations of their exercise experience and related to PFME self-efficacy. The third theme, named 'Family as Priority' was expressed in terms of either putting family first at the expense of caring for ones self, or successfully combining the priorities of family and self . The three identified themes are discussed in relation to the literature on POP, and the generalised health behaviour models of the transtheoretical model of change (TTM) and the health action process approach (HAPA). In summary, PFME behaviours were identified as having shared and eclectic patterns and routines. PFME maintenance cycles were discussed in terms of the participantsʼ responses to and evaluation of doing PFME, and also concepts about self-efficacy. Family was identified as a priority affecting the womenʼs adherence to PFME for POP. The experiences of women in this study were congruent with other qualitative studies in finding that routines were helpful in establishing PFME behaviours and declining PFME behaviours over time were common; a main difference was the substantive theme around family as priority which is not so evident in prior studies about pelvic floor muscle exercise adherence. Clinically this suggests that health professionals could include questions about the family in assessment and consider in what way the family might influence exercise behaviours.