Preventing Pelvic Floor Disorders: A Scoping Review of Public Health Programs

Area of Science:

• Public Health
• Women's Health
• Preventive Medicine

Background:

• Pelvic floor disorders (PFDs) affect many adult women, encompassing conditions like urinary incontinence, pelvic organ prolapse, and chronic pelvic pain.
• Preventive programs are crucial for managing and reducing the incidence of PFDs, but large-scale, publicly funded initiatives are scarce.

Purpose of the Study:

• To conduct a scoping review of existing literature on publicly funded programs for PFD prevention.
• To evaluate the implementation, practicality, and outcomes of these programs.
• To identify knowledge gaps in the field of PFD prevention.

Main Methods:

• A comprehensive literature search was performed across multiple databases (MEDLINE, Embase, CINAHL, Web of Science, Scopus, Cochrane, LILACS) and gray literature.
• Studies focusing on population-based preventive programs for PFDs in adult women were included; exclusion criteria involved chronic conditions, pediatric, or male populations.
• A total of 1862 studies were screened, with 24 full-text articles meeting the inclusion criteria for the scoping review.

Main Results:

• The review found no large-scale, publicly funded PFD prevention programs, though smaller studies suggest potential effectiveness.
• Urinary incontinence (UI) is the most frequently addressed PFD in prevention research.
• Effective programs often incorporate pelvic floor muscle training (PFMT) with virtual and in-person components, particularly during pregnancy. Barriers include patient-related factors (time, knowledge, stigma) and systemic issues (funding, staffing, recruitment).

Conclusions:

• Significant gaps exist in research on publicly funded, population-based PFD prevention programs.
• Key gaps include the absence of large-scale implementation studies, underrepresentation of pelvic organ prolapse and fecal incontinence, limited cost-effectiveness data, and insufficient strategies to overcome participation barriers.
• Further research is needed in implementation science, economic evaluations, and equity-focused studies to guide public health policy for PFD prevention.