Barriers and enablers of pelvic floor rehabilitation behaviours in pregnant women with stress urinary incontinence: a qualitative analysis using the theoretical domains framework

Abstract

Background Stress urinary incontinence during pregnancy is closely related to the occurrence of postpartum and long-term urinary incontinence. Early pelvic floor management is of great significance in promoting the recovery of pelvic floor tissues in pregnant women. However, effective management of urinary incontinence is far from achievable owing to the low adherence of pregnant women in partaking in pelvic floor rehabilitation. As a comprehensive framework for behavioural theory, the Theoretical Domain Framework allows for comprehensive identification of behavioural determinants. Using Theoretical Domain Framework, this study aimed to identify barriers and enablers of pelvic floor rehabilitation behaviours in pregnant women with stress urinary incontinence. Methods A descriptive, qualitative design was used in this study. Face-to-face semi-structured interviews were conducted with pregnant women with stress urinary incontinence based on the Theoretical Domain Framework. The data were analysed using a combination of inductive and deductive methods. Results Twenty pregnant women with stress urinary incontinence were interviewed. Seven themes were summarised and used to explain the pelvic floor rehabilitation behaviours of pregnant women with stress urinary incontinence. The seven themes were (1) individual knowledge and experience of pelvic floor management, (2) judgments about expected outcomes, (3) interactions of interpersonal situations, (4) environment, resources, and decision-making processes, (5) personal goal-setting and efforts towards behaviour change, (6) emotional influences on decision-making, and (7) personal characteristics. Besides the "Optimism" domain, 13 of the 14 Theoretical Domains Framework domains were found to influence pregnant patients' pelvic floor rehabilitation behaviours after deductive mapping of themes to the Theoretical Domains Framework. In addition, the inductive analysis generated a theme of personal characteristics that did not map to any of the Theoretical Domains Framework domains. Conclusions The pelvic floor rehabilitation behaviours of pregnant women with stress urinary incontinence are complex and are affected by many factors. The findings confirm the need for multiple interventions to support pelvic floor management in pregnant women with stress urinary incontinence, focusing on enhancing knowledge and skills in pelvic floor care and using appropriate behaviour change techniques (such as prompts) to provide a supportive environment.

Dubens Dugno Disfunkcija Nėštumo Laikotarpiu: Etiologija Ir Patofiziologija

“…Nėštumo metu padidėjęs intraabdominalinis spaudimas bei hormoniniai svyravimai sukelia papildomą naštą dubens dugno raumenims ir jungiamajam audiniui, didindami dubens dugno organų disfunkcijos riziką [1]. Dažniausia disfunkcijos atsiradimo priežastis -susilpnėję dubens dugno raumenys dėl biocheminių organizmo pokyčių arba nervų šakelių kompresinis pažeidimas, sutrikdantis dubens dugno raumenų inervaciją bei tinkamą funkciją [2].…”

“…Dubens dugno raumenų pažeidimas gali būti mechaninis arba sukeltas ilgalaikės nervų šakelių kompresijos [2]. Dažniausios dubens dugno pažeidimo sąlygotos disfunkcijos -šlapimo, išmatų nelaikymas ir dubens dugno organų prolapsas [3].…”