It Takes a Village: The First 100 Patients Seen in a Multidisciplinary Pelvic Floor Clinic

Abstract

Objective This study aimed to assess the characteristics of patients assessed and treated at a multidisciplinary pelvic floor program that includes representatives from multiple specialties. Our goal is to describe the process from triaging patients to the actual collaborative delivery of care. This study examines the factors contributing to the success of our multidisciplinary clinic as evidenced by its ongoing viability. Methods This is a descriptive study retrospectively analyzing a prospectively maintained database that included the first 100 patients seen in the Program for Abdominal and Pelvic Health clinic between December 2017 and October 2018. We examined patient demographics, their concerns, and care plan including diagnostic tests, findings, treatments, referrals, and return visits. Results The clinic met twice monthly, and the first 100 patients were seen over the course of 10 months. The most common primary symptoms were pelvic pain (45), constipation (30), bladder incontinence (27), bowel incontinence (23), high tone pelvic floor dysfunction (23), and abdominal pain (23); most patients had more than one presenting symptom (76). The most common specialties seen at the first visit to the clinic included gastroenterology (56%), followed by physical medicine and rehabilitation (45%), physical therapy (31%), female pelvic medicine and reconstructive surgery (25%), behavioral health (19%), urology (18%), and colorectal surgery (13%). Eleven patients were entirely new to our hospital system. Most patients had diagnostic tests ordered and performed. Conclusions A multidisciplinary clinic for abdominal and pelvic health proves a sustainable model for comprehensive treatment for patients with pelvic floor dysfunction, including difficulties with defecation, urination, sexual dysfunction, and pain.

Overactive Bladder and Cognitive Impairment: The American Urogynecologic Society and Pelvic Floor Disorders Research Foundation State-of-the-Science Conference Summary Report

“…The National Institute for Health and Care Excellence Urinary Incontinence guideline 2013 has recommended that multidisciplinary treatment (MDT) for UI should consist of urogynecologists, urologists, colorectal surgeons, geriatricians, physiotherapists, and specialist nurses 128 . Although MDT care in UI has been recommended and clinical pathways reported, 129,130 the evidence on best practices and approaches are sparse 131,132 …”

“…128 Although MDT care in UI has been recommended and clinical pathways reported, 129,130 the evidence on best practices and approaches are sparse. 131,132 Multidisciplinary treatment management of OAB in older women includes components of care that are not routine to female pelvic floor practices. Factors such as frailty, functional and cognitive impairment, multimorbidity, polypharmacy, and remaining life expectancy must be considered when evaluating and managing OAB in older women.…”