The psychology of a healthy pelvic floor
Prof Beth Alder <[email]>
Napier University, Edinburgh
Dr Heather Whitford <[email]>
University of Dundee
Background Postnatal urinary stress incontinence is reported by about a third of women during pregnancy and between 5 and 24% following delivery. It may be prevented by exercises which contract and relax the pelvic floor muscles. These are commonly taught at antenatal classes. A revised version of the Theory of Planned Behaviour (TPB) was used to explore the determinants and barriers to the performance of pelvic floor exercises during pregnancy.
Method Women over the age of 16 in the third trimester of pregnancy were recruited from women attending antenatal clinics in Dundee. In a cross sectional interview survey, women were asked about information about pelvic floor exercises during pregnancy, practice of pelvic floor exercises, prevalence of incontinence and determinants and barriers to the practice of pelvic floor exercises. Those who had any knowledge about pelvic floor exercises were then asked to complete a further questionnaire about pelvic floor exercises (based on the revised TPB). All women were sent a postal questionnaire 6 – 12 months after delivery to determine behaviour and morbidity following childbirth.
Results 289 (82.9%) were interviewed. Of these 260 (90.0%) women knew about pelvic floor exercises, but they were practised by only 156 (54%). Younger women, those from lower socio-economic groups and less educated women were significantly less likely to report receiving information or practising pelvic floor exercises. There was no difference between primigravidae and parous women in reported practice of the exercises although they were less likely to know about them. Women reporting severe current incontinence were significantly more likely to report practising the exercises. Intention to perform pelvic floor exercises was predicted by Attitude to pelvic floor exercises (_ = .41), Subjective Norm _ = .28), and Self-efficacy (_ = .19). Attitude to current behaviour did not predict intention. All the independent variables made a unique and statistically significant contribution to the prediction of intentions. When past behaviour was added into a hierarchical multiple regression, the model was improved by 4%.