How to Best Measure and Characterize Symptoms of Patients with Pelvic Floor Disorders

Abstract

Pelvic floor disorders (PFDs) are common and can be associated with various symptoms, including fecal incontinence, constipation, urinary incontinence, lower urinary tract symptoms, sexual dysfunction, and pelvic pain. Characterizing symptoms can be challenging due to limitations in patient reporting, provider ability to collect data, and the instruments used to collect the data. Symptoms are assessed using patient-reported outcome measures (PROMs), instruments that can be generic or disease-specific. Here, we describe the frequently used and recommended instruments for assessing symptoms of PFDs. We review the Pelvic Floor Disorders Consortium (PFCD) consensus document called IMPACT (Initial Measurement of Patient-reported Pelvic Floor Complaints Tool), a collection of recommended instruments in their unaltered form as well as within a consolidated short form. A multidisciplinary approach to patient care and interpretation of data is important to best characterize symptoms of PFDs. Future steps should include further collaborating across specialties and with patients to develop more condition-specific and patient-centered PROMs.

Keywords

pelvic floor - patient-reported outcomes - colorectal - genitourinary

Publication History

Article published online:
05 March 2025

• References

• 1 Good MM, Solomon ER. Pelvic floor disorders. Obstet Gynecol Clin North Am 2019; 46 (03) 527-540
• 2 Peinado-Molina RA, Hernández-Martínez A, Martínez-Vázquez S, Rodríguez-Almagro J, Martínez-Galiano JM. Pelvic floor dysfunction: prevalence and associated factors. BMC Public Health 2023; 23 (01) 2005
• 3 Cichowski S, Grzybowska ME, Halder GE. et al. International Urogynecology Consultation: Patient Reported Outcome Measures (PROs) use in the evaluation of patients with pelvic organ prolapse. Int Urogynecol J 2022; 33 (10) 2603-2631
• 4 Hunt CW, Cavallaro PM, Bordeianou LG. Metrics used to quantify fecal incontinence and constipation. Clin Colon Rectal Surg 2021; 34 (01) 5-14
• 5 Ruseckaite R, Jayasinghe R, Bavor C, Dean J, Daly O, Ahern S. Evaluation and acceptability of patient-reported outcome measures in women following pelvic organ prolapse procedures. BMC Health Serv Res 2023; 23 (01) 624
• 6 Habashy E, Mahdy AE. Patient-reported outcome measures (PROMs) in pelvic floor disorders. Curr Urol Rep 2019; 20 (05) 22
• 7 Simren M, Palsson OS, Whitehead WE. Update on rome IV criteria for colorectal disorders: implications for clinical practice. Curr Gastroenterol Rep 2017; 19 (04) 15
• 8 Bordeianou LG, Anger JT, Boutros M. et al; Members of the Pelvic Floor Disorders Consortium Working Groups on Patient-Reported Outcomes. Measuring Pelvic Floor Disorder Symptoms Using Patient-Reported Instruments: Proceedings of the Consensus Meeting of the Pelvic Floor Consortium of the American Society of Colon and Rectal Surgeons, the International Continence Society, the American Urogynecologic Society, and the Society of Urodynamics, Female Pelvic Medicine and Urogenital Reconstruction. Dis Colon Rectum 2020; 63 (01) 6-23
• 9 Jorge JM, Wexner SD. Etiology and management of fecal incontinence. Dis Colon Rectum 1993; 36 (01) 77-97
• 10 Vaizey CJ, Carapeti E, Cahill JA, Kamm MA. Prospective comparison of faecal incontinence grading systems. Gut 1999; 44 (01) 77-80
• 11 Rockwood TH, Church JM, Fleshman JW. et al. Patient and surgeon ranking of the severity of symptoms associated with fecal incontinence: the fecal incontinence severity index. Dis Colon Rectum 1999; 42 (12) 1525-1532
• 12 Pescatori M, Anastasio G, Bottini C, Mentasti A. New grading and scoring for anal incontinence. Evaluation of 335 patients. Dis Colon Rectum 1992; 35 (05) 482-487
• 13 Rockwood TH, Church JM, Fleshman JW. et al. Fecal Incontinence Quality of Life Scale: quality of life instrument for patients with fecal incontinence. Dis Colon Rectum 2000; 43 (01) 9-16 , discussion 16–17
• 14 Bug GJ, Kiff ES, Hosker G. A new condition-specific health-related quality of life questionnaire for the assessment of women with anal incontinence. BJOG 2001; 108 (10) 1057-1067
• 15 Varma MG, Wang JY, Berian JR, Patterson TR, McCrea GL, Hart SL. The constipation severity instrument: a validated measure. Dis Colon Rectum 2008; 51 (02) 162-172
• 16 Agachan F, Chen T, Pfeifer J, Reissman P, Wexner SD. A constipation scoring system to simplify evaluation and management of constipated patients. Dis Colon Rectum 1996; 39 (06) 681-685
• 17 Frank L, Kleinman L, Farup C, Taylor L, Miner Jr P. Psychometric validation of a constipation symptom assessment questionnaire. Scand J Gastroenterol 1999; 34 (09) 870-877
• 18 McMillan SC, Williams FA. Validity and reliability of the Constipation Assessment Scale. Cancer Nurs 1989; 12 (03) 183-188
• 19 Marquis P, De La Loge C, Dubois D, McDermott A, Chassany O. Development and validation of the Patient Assessment of Constipation Quality of Life questionnaire. Scand J Gastroenterol 2005; 40 (05) 540-551
• 20 Wang JY, Hart SL, Lee J, Berian JR, McCrea GL, Varma MG. A valid and reliable measure of constipation-related quality of life. Dis Colon Rectum 2009; 52 (08) 1434-1442
• 21 Bharucha AE, Locke III GR, Seide BM, Zinsmeister AR. A new questionnaire for constipation and faecal incontinence. Aliment Pharmacol Ther 2004; 20 (03) 355-364
• 22 Osterberg A, Graf W, Karlbom U, Påhlman L. Evaluation of a questionnaire in the assessment of patients with faecal incontinence and constipation. Scand J Gastroenterol 1996; 31 (06) 575-580
• 23 Haylen BT, de Ridder D, Freeman RM. et al. An International Urogynecological Association (IUGA)/International Continence Society (ICS) joint report on the terminology for female pelvic floor dysfunction. Int Urogynecol J 2010; 21 (01) 5-26
• 24 Avery K, Donovan J, Peters TJ, Shaw C, Gotoh M, Abrams P. ICIQ: a brief and robust measure for evaluating the symptoms and impact of urinary incontinence. Neurourol Urodyn 2004; 23 (04) 322-330
• 25 Lemack GE, Zimmern PE. Predictability of urodynamic findings based on the Urogenital Distress Inventory-6 questionnaire. Urology 1999; 54 (03) 461-466
• 26 Brookes ST, Donovan JL, Wright M, Jackson S, Abrams P. A scored form of the Bristol Female Lower Urinary Tract Symptoms questionnaire: data from a randomized controlled trial of surgery for women with stress incontinence. Am J Obstet Gynecol 2004; 191 (01) 73-82
• 27 Barry MJ, Fowler Jr FJ, O'Leary MP. et al; The Measurement Committee of the American Urological Association. The American Urological Association symptom index for benign prostatic hyperplasia. J Urol 1992; 148 (05) 1549-1557 , discussion 1564
• 28 Grzybowska ME, Wydra D. Responsiveness of two sexual function questionnaires: PISQ-IR and FSFI in women with pelvic floor disorders. Neurourol Urodyn 2021; 40 (01) 358-366
• 29 Rogers RG, Rockwood TH, Constantine ML. et al. A new measure of sexual function in women with pelvic floor disorders (PFD): the Pelvic Organ Prolapse/Incontinence Sexual Questionnaire, IUGA-Revised (PISQ-IR). Int Urogynecol J 2013; 24 (07) 1091-1103
• 30 Rosen R, Brown C, Heiman J. et al. The Female Sexual Function Index (FSFI): a multidimensional self-report instrument for the assessment of female sexual function. J Sex Marital Ther 2000; 26 (02) 191-208
• 31 Rosen RC, Riley A, Wagner G, Osterloh IH, Kirkpatrick J, Mishra A. The international index of erectile function (IIEF): a multidimensional scale for assessment of erectile dysfunction. Urology 1997; 49 (06) 822-830
• 32 Rosen RC, Cappelleri JC, Smith MD, Lipsky J, Peña BM. Development and evaluation of an abridged, 5-item version of the International Index of Erectile Function (IIEF-5) as a diagnostic tool for erectile dysfunction. Int J Impot Res 1999; 11 (06) 319-326
• 33 Hoque SS, Ahern S, O'Connell HE, Romero L, Ruseckaite R. Comparing patient-reported outcome measures for pain in women with pelvic floor disorders: a scoping review. J Pain 2024; 25 (06) 104454
• 34 Ralphsmith M, Ahern S, Dean J, Ruseckaite R. Patient-reported outcome measures for pain in women with pelvic floor disorders: a systematic review. Int Urogynecol J 2022; 33 (09) 2325-2334
• 35 Maspero M, Hull T. Patient-reported outcomes in colorectal surgery. Clin Colon Rectal Surg 2023; 36 (04) 240-251
• 36 Balci B, Leventoglu S, Osmanov I, Erkan B, Irkilata Y, Mentes B. Laparoscopic ventral mesh rectopexy vs. transperineal mesh repair for obstructed defecation syndrome associated with rectocele: comparison of selectively distributed patients. BMC Surg 2023; 23 (01) 359
• 37 Keane C, Fearnhead NS, Bordeianou LG. et al; LARS International Collaborative Group. International consensus definition of low anterior resection syndrome. Dis Colon Rectum 2020; 63 (03) 274-284
• 38 Cavallaro PM, Fearnhead NS, Bissett IP. et al; PROPS Delphi Study Expert Panels. Patients Undergoing Ileoanal Pouch Surgery Experience a Constellation of Symptoms and Consequences Representing a Unique Syndrome: A Report from the Patient-Reported Outcomes After Pouch Surgery (PROPS) Delphi Consensus Study. Dis Colon Rectum 2021; 64 (07) 861-870