Development and Validation of a Questionnaire for the Assessment of Pelvic Floor Disorders and Their Risk Factors During Pregnancy and Post PartumArticle in several languages: English | deutsch
received 01 December 2016
revised 29 January 2017
accepted 30 January 2017
26 April 2017 (online)
Introduction The aim of this study was to develop and validate a questionnaire for the assessment of pelvic floor disorders, their symptoms and risk factors in pregnancy and after birth including symptom course, severity and impact on quality of life.
Methods The validated German pelvic floor questionnaire was modified and a new risk factor domain developed. The questionnaire was initially completed by 233 nulliparous women in the third trimester of pregnancy and at six weeks (n = 148) and one year (n = 120) post partum. Full pyschometric testing was performed. The clinical course of symptoms and the influence of risk factors were analysed.
Results Study participants had a median age of 31 (19–46) years. 63 % had spontaneous vaginal deliveries, 15 % operative vaginal deliveries and 22 % were delivered by caesarean section. Content validity: Missing answers never exceeded 4 %. Construct validity: The questionnaire distinguished significantly between women who reported bothersome symptoms and those who did not. Reliability: Cronbachʼs alpha values exceeded 0.7 for bladder, bowel and support function, and 0.65 for sexual function. The test-retest analysis showed moderate to almost complete concordance. The intraclass coefficients for domain scores (between 0.732 and 0.818) were in acceptable to optimal range. Reactivity: The questionnaire was able to track changes significantly with good effect size for each domain. Risk factors for pelvic floor symptoms included familial predisposition, maternal age over 35 years, BMI above 25, nicotine abuse, subjective inability to voluntarily contract the pelvic floor musculature and postpartum wound pain.
Conclusion This pelvic floor questionnaire proved to be valid, reliable and reactive for the assessment of pelvic floor disorders, their risk factors, incidence and impact on quality of life during pregnancy and post partum. The questionnaire can be utilised to assess the course of symptoms and treatment effects using a scoring system.
- 1 Hunskaar S, Lose G, Sykes D. et al. The prevalence of urinary incontinence in women in four European countries. BJU Int 2004; 93: 324-330
- 2 Teleman P, Lidfeldt J, Nerbrand C. et al. Lower urinary tract symptoms in middle-aged women–prevalence and attitude towards mild urinary incontinence: a community-based population study. Acta Obstet Gynecol Scand 2005; 84: 1108-1112
- 3 Tennstedt SL, Fitzgerald MP, Nager CW. et al. Quality of life in women with stress urinary incontinence. Int Urogynecol J Pelvic Floor Dysfunct 2007; 18: 543-549
- 4 Rortveit G, Daltveit AK, Hannestad YS. et al. Urinary incontinence after vaginal delivery or cesarean section. N Engl J Med 2003; 348: 900-907
- 5 MacLennan AH, Taylor AW, Wilson DH. et al. The prevalence of pelvic floor disorders and their relationship to gender, age, parity and mode of delivery. BJOG 2000; 107: 1460-1470
- 6 Avery KN, Bosch JL, Gotoh M. et al. Questionnaires to assess urinary and anal incontinence: review and recommendations. J Urol 2007; 177: 39-49
- 7 Soderquist J, Wijma B, Thorbert G. et al. Risk factors in pregnancy for post-traumatic stress and depression after childbirth. BJOG 2009; 116: 672-680
- 8 Laursen M, Johansen C, Hedegaard M. Fear of childbirth and risk for birth complications in nulliparous women in the Danish National Birth Cohort. BJOG 2009; 116: 1350-1355
- 9 Baessler K, Kempkensteffen C. [Validation of a comprehensive pelvic floor questionnaire for the hospital, private practice and research]. Gynakol Geburtshilfliche Rundsch 2009; 49: 299-307
- 10 Baessler K, OʼNeill SM, Maher CF. et al. A validated self-administered female pelvic floor questionnaire. Int Urogynecol J 2010; 21: 163-172
- 11 Baessler K, Junginger B. [Validation of a pelvic floor questionnaire with improvement and satisfaction scales to assess symptom severity, bothersomeness and quality of life before and after pelvic floor therapy]. Aktuelle Urol 2011; 42: 316-322
- 12 Revicki DA, Osoba D, Fairclough D. et al. Recommendations on health-related quality of life research to support labeling and promotional claims in the United States. Qual Life Res 2000; 9: 887-900
- 13 Kazis LE, Anderson JJ, Meenan RF. Effect sizes for interpreting changes in health status. Med Care 1989; 27: S178-S189
- 14 Guyatt GH, Osoba D, Wu AW. et al. Methods to explain the clinical significance of health status measures. Mayo Clin Proc 2002; 77: 371-383
- 15 Koch GG, Landis JR, Freeman JL. et al. A general methodology for the analysis of experiments with repeated measurement of categorical data. Biometrics 1977; 33: 133-158
- 16 Shrout PE, Fleiss JL. Intraclass correlations: uses in assessing rater reliability. Psychol Bull 1979; 86: 420-428
- 17 Landis JR, Koch GG. The measurement of observer agreement for categorical data. Biometrics 1977; 33: 159-174
- 18 Katz JN, Larson MG, Phillips CB. et al. Comparative measurement sensitivity of short and longer health status instruments. Med Care 1992; 30: 917-925
- 19 Thom DH, Rortveit G. Prevalence of postpartum urinary incontinence: a systematic review. Acta Obstet Gynecol Scand 2010; 89: 1511-1522
- 20 Svare JA, Hansen BB, Lose G. Prevalence of anal incontinence during pregnancy and 1 year after delivery in a cohort of primiparous women and a control group of nulliparous women. Acta Obstet Gynecol Scand 2016; 95: 920-925
- 21 Hansen BB, Svare J, Viktrup L. et al. Urinary incontinence during pregnancy and 1 year after delivery in primiparous women compared with a control group of nulliparous women. Neurourol Urodyn 2012; 31: 475-480
- 22 MacArthur C, Glazener CM, Wilson PD. et al. Obstetric practice and faecal incontinence three months after delivery. BJOG 2001; 108: 678-683
- 23 Wilson PD, Herbison RM, Herbison GP. Obstetric practice and the prevalence of urinary incontinence three months after delivery. Br J Obstet Gynaecol 1996; 103: 154-161