Healthcare Disparities in the Treatment of Pelvic Floor Disorders

Long-term health outcomes and quality of life in women with untreated pelvic floor dysfunction: a single-center cohort study

Objective

This study aimed to evaluate the long-term health outcomes and quality of life (HRQoL) associated with untreated pelvic floor dysfunction (PFD) in women, and to identify key factors contributing to symptom severity.

Methods

A cohort of 1,651 women aged 18 years and older with untreated PFD were recruited between June 2018 and August 2023. Data on sociodemographic, lifestyle factors, and clinical history were collected via questionnaires and clinical assessments. The Pelvic Floor Distress Inventory (PFDI-20) and Short Form-12 (SF-12) were used to assess symptom severity and HRQoL.

Results

The study found that 56% of participants experienced urinary incontinence (UI), 52% had pelvic organ prolapse (POP), and 47% reported gynecological disorders. Sleep apnea (OR: 18.3, p < 0.001) and menopause (OR: 2.48, p < 0.001) were significantly associated with higher symptom severity, while postpartum complications had a protective effect (OR: 0.01, p < 0.001). Obesity was inversely associated with symptom severity (OR: 0.3, p < 0.001). HRQoL scores showed that 97.6% of participants had high physical functioning (mean PF: 67.36 ± 11.62), but vitality (VT) was notably lower, with 27.8% scoring below 50 (mean VT: 54.84 ± 6.60). FI (p = 0.006) and pelvic pain (p = 0.001) were linked to significantly poorer physical functioning and higher bodily pain.

Conclusion

Untreated PFD has a profound impact on HRQoL, especially in women with sleep apnea, menopause, and pelvic pain. Early diagnosis and intervention are critical to mitigating these effects and improving long-term outcomes. These findings highlight the urgent need for targeted public health strategies to address untreated PFD.

Urinary Incontinence Care-Seeking Barriers Among Latina Patients: What Are We Missing?

IMPORTANCE

The Latina population is the largest growing ethnic group in the United States with high levels of health disparities in urinary incontinence (UI) treatment and complications rates, which may be due to disproportionately high barriers to UI care-seeking among Latinas.

OBJECTIVES

The objectives of this study were to compare barriers to UI care-seeking among Latina, non-Latina Black, and non-Latina White patients by utilizing the Barriers to Incontinence Care Seeking Questionnaire (BICS-Q) total scores, and to compare specific barriers utilizing BICS-Q subscales.

STUDY DESIGN

In this cross-sectional study, patients accessing primary care were recruited to complete the BICS-Q, International Consultation on Incontinence Questionnaire-Short Form, and Prolapse and Incontinence Knowledge Questionnaire-Urinary Incontinence. The BICS-Q total and subscale scores were compared among ethnic/racial groups.

RESULTS

A total of 298 patients were included in the study with 83 Black, 144 Latina, and 71 White participants per self-identified ethnicity/race. The total BICS-Q score was highest for Latina participants, followed by White and Black participants (11.2 vs 8.2 vs 4.9, respectively, P < 0.0001). Latina participants had significantly higher BICS-Q subscale scores compared with Black participants with no significant differences between Latina and White participants. After controlling for potential confounders, Latina ethnicity/race was still associated with a higher BICS-Q score when compared to Black ethnicity/race (P = 0.0077), and lower Prolapse and Incontinence Knowledge Questionnaire-Urinary Incontinence scores remained independently associated with higher BICS-Q scores (P = 0.0078).

CONCLUSIONS

In our study population, Latina patients and patients with lower UI knowledge experience higher barriers to UI care-seeking compared with Black patients and patients with higher UI knowledge. Addressing these barriers may increase care-seeking and improve health equity in the field.

Lost in Translation: Misconceptions and Miscommunications Among Spanish-Speaking Latinas with Pelvic Floor Disorders

This review sought to identify impediments to disease understanding among Spanish-speaking Latinas with pelvic floor disorders (PFDs). Five databases were queried and reference lists were searched for relevant articles, 14 were included. Thematic analysis identified 10 themes composed of 52 findings. Three synthesized findings were established: patient-related, provider-related, and system-related barriers to care. We identified that Spanish-speaking Latinas with PFDs face multiple, interacting healthcare barriers related to language and culture at the level of the patient, provider, and healthcare system. Emerging themes identified in this review provide insights for clinical practice as well as hypotheses and directions for future research.