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

This study's aim was to perform a scoping review of the current literature on the implementation, practicality, and outcome of publicly funded programs for pelvic floor disorders (PFDs) prevention and to determine knowledge gaps that exist in this field.

A review of the currently available literature was conducted using a wide range of keywords and MeSH/search terms. Databases assessed included MEDLINE, Embase, CINAHL, Web of Science, Scopus, Cochrane, LILACS, as well as gray literature. Studies were included if they evaluated population-based preventive programs and interventions for pelvic floor disorders (pelvic organ prolapse, urinary incontinence, fecal incontinence, dyspareunia, or chronic pelvic pain) in adult women; studies focused on chronic conditions (e.g., neurogenic bladder), pediatric or male populations were excluded. Title and abstract review were completed for 1862 studies, and 24 full text articles met inclusion criteria for our scoping review.

Our review demonstrates that there are no large-scale publicly funded programs for the prevention of PFDs and instead focused on smaller studies which may provide a basis for such studies in the future. On the basis of the reviewed studies, interest in PFDs has increased in recent years, with most of the focus being on urinary incontinence (UI). Qualitative analysis of the included studies demonstrated that PFDs prevention programs could be effective, especially when implemented during pregnancy. Many successful programs involve pelvic floor muscle training (PFMT) and have both a virtual and in-person component. Patient specific barriers found include lack of time, lack of knowledge about PFDs, and societal stigma. Systemic barriers include obtaining funding, providing program staffing, and patient recruitment.

Our study identified critical gaps in the literature on publicly funded, population-based preventive programs for PFDs, including: (1) absence of large-scale implementation studies, (2) underrepresentation of pelvic organ prolapse and fecal incontinence in prevention research, (3) limited evidence on cost-effectiveness of prevention programs, and (4) insufficient data on strategies to overcome patient and systemic barriers to program participation. These gaps highlight the need for implementation research, economic evaluations, and equity-focused studies to inform public health policy.