Determinants of Healthcare Seeking Patterns in Women With Pelvic Floor Disorders.

Abstract

Objective: To determine if sociodemographic and health determinants of women with pelvic floor disorders (PFDs) affect health-seeking behavior, and whether this varies by disease subtype and severity.

Materials and methods: We conducted a retrospective cohort study of women with PFDs at an academic urogynecology practice between January 2021 and May 2022. Groups were compared across sociodemographic and clinical variables and by pelvic organ prolapse (POP) stage and urinary incontinence (UI) subtype/severity. The primary outcomes of interest were POP stage and UI severity at initial presentation with duration of symptoms as a key determinant. Statistical significance was set at p < 0.05.

Results: The study included 684 [307 POP (44.9%) and 377 UI (55.1%)] women. Of those with POP, 190 (61.9%) presented with stages I/II and 117 (38.1%) with stages III/IV. In women with UI, 188 (49.9%) had mild-moderate UI and 179 (47.5%) had severe UI. Approximately 76% of women reported PFD symptoms for over 6 months and 47% for 2 years or more upon presentation. Women with advanced-stage POP had 1.27 increased odds (95% CI: 1.01-1.61) of delaying care for > 24 months, were older (1.07 adjusted OR, 95% CI: 1.03-1.11), and had fewer healthcare visits (0.95 adjusted OR, 95%: CI: 0.91-0.98) in the prior year. Women with severe UI had 1.88 increased odds (95% CI: 1.52-2.35) of delaying care > 24 months, 1.20 odds with government insurance (CI: 1.01-1.32), and 1.18 odds of other comorbidities (CI: 1.02-1.40).

Conclusion: Most women with PFD reported symptoms for over 6 months at presentation. Women with advanced POP or severe UI were more likely to seek care over 24 months after the onset of symptoms.