Can a Leaflet with Brief Verbal Instruction Teach Nepali Women How to Correctly Contract Their Pelvic Floor Muscles?

Abstract

INTRODUCTIONPelvic organ prolapse (POP) is a common condition for women globally and is one of the most widespread reproductive health problems in Nepal.1,2 POP occurs when the pelvic floor muscles (PFM) and supporting tissues are stretched, weakened or damaged allowing the bladder, uterus or bowel to descend into the vagina. 3Women who have weak or damaged PFMs have 4-11 times the risk of developing a POP when compared to women with good PFM function. 4 Strengthening the PFMs is the first line conservative treatment option for POP and can improve symptoms, quality of life (QOL) and severity.5 However, teaching women to correctly exercise their PFMs is challenging and up to 50% may still do it incorrectly even after verbal instruction. 6 The aim of this pilot study was to investigate whether brief verbal instruction in conjunction with an illustrated leaflet resulted in Nepali women being able to correctly contract their PFMs. METHODSIn February 2016, a pilot study of parous women aged 18 years and above was conducted. The women were attending two gynecology outpatient clinics run by the Public Health Concern Trust: Kathmandu Model Hospital and Kirtipur Hospital, Nepal.Women attending the hospital outpatient clinics were invited to participate in the study by their doctor. Initially, the doctor performed the Pelvic Organ Prolapse Quantification scale (POP-Q) to assess for POP. Following their clinical examination, a demographic questionnaire containing questions about their age, educational Background: Pelvic organ prolapse is a common disorder for women in Nepal causing symptoms and reduced quality of life. Pelvic floor muscle exercise is a conservative treatment option for pelvic organ prolapse but the effective way to teach women in Nepal is not known. The objective of this pilot study was to determine if an illustrative leaflet with brief verbal instruction could teach Nepali women to correctly contract their pelvic floor muscles. Methods:Fifteen parous women attending two outpatient gynecology clinics in Kathmandu Valley were interviewed to assess their knowledge of pelvic organ prolapse and pelvic floor muscles exercise. Following verbal instruction and an illustrative leaflet on how to contract their pelvic floor muscles, the transabdominal real time ultrasound was applied to assess the muscle contraction. Results:The median age of 15 participants was 45 years (range 18-75 years) and 10 women had pelvic organ prolapse. Some of the participants (9/15) knew about pelvic organ prolapse but none were aware of the pelvic floor muscles. After being taught how to contract their pelvic floor muscle, only 4 of 14 correctly contracted the pelvic floor muscle. Conclusions:This study highlighted the low knowledge of the pelvic floor muscle, and brief verbal instruction with an illustrative leaflet is also not sufficient in teaching Nepali women how to correctly contract their pelvic floor muscle. Further research is needed to determine how to teach a correct pelvic floor muscle contraction for women with low...

What is the most effective verbal instruction for correctly contracting the pelvic floor muscles?

“…Diverse verbal instructions as to how to correctly contract PFMs may influence the displacement of the pelvic floor. However, it is still being debated in the literature as to which recruitment strategy optimizes the displacement of the pelvic floor . For example, should all regions of the pelvic floor musculature around the urethra, vagina, and rectum be mentioned in the instruction; should only one region that is, the anus or the urethra be mentioned or should the transversus abdominis and correct breathing also be utilized?…”

The immediate effectiveness of mobile game-based instruction with an extracorporeal biofeedback device for an exercise program to improve pelvic floor muscle contraction in healthy subjects

“…Voluntary contraction of the PFM is performed accurately at less than 50% of the time when training and exercises are performed with verbally guided instructions [3]. Caagbay et al [4] reported that verbal explanations using leaflets on how to contract the PFM were ineffective in subjects with low literacy, limited resources, and or those living in poor settings. The biofeedback method is effective and useful for promoting awareness and control of PFM contraction.…”

Conhecimento de mulheres sobre os músculos do assoalho pélvico e sua relação com a capacidade de contração e sintomas de incontinência urinária: estudo transversal

“…Segundo Talasz et al (2008) A prevalência de IU pode variar entre 24 e 41% em mulheres de 65 anos (BRESEE et al, 2014;GOODE et al, 2008), já em um estudo nacional, foi verificado uma prevalência de 27% em mulheres com idade média de 51 anos (AMARO et al,2009). Em um segundo estudo nacional conduzido por Silva e Lopes (2009) CAAGBAY et al, 2017, JACKSON et al, 2017NEELS et al, 2016aNEELS et al, , 2016b BROWN et al, 1996;LASSERRE et al, 2009;LUO et al, 2017;NYGAARD;BARBER, 2008;ROGERS, 2008).…”

“…A IU acomete mulheres de várias idades, gerando impacto na qualidade de vida e ainda é vista como um "tabu" por essa população (ALMOUSA; VAN LOON, 2017;CARLS, 2007;SHAW et al, 2006 (BØ, 2004;DOSHANI et al, 2007;SMITH et al, 2011). Alguns estudos na literatura demonstram um baixo conhecimento acerca dos MAP entre mulheres (BATISTA, 2017;BERZUK;SHAY, 2015;CAAGBAY et al, 2017;JACKSON et al, 2017;NEELS et al, 2016aNEELS et al, , 2016b. Outros autores já demonstraram que de modo geral a função dos MAP não é boa entre as mulheres (VASCONCELOS, 2017;TALASZ et al, 2005TALASZ et al, , 2008TIBAEK;DEHLENDORFF, 2014).…”