The presence or absence of pelvic floor disorders was evaluated at the enrollment visit. Symptoms of pelvic floor disorders were assessed using the Epidemiology of Prolapse and Incontinence Questionnaire, a validated self-administered questionnaire (14 (link)). This questionnaire generates scores for four pelvic floor disorders: stress urinary incontinence (SUI), overactive bladder (OAB), anal incontinence and pelvic organ prolapse (POP). In each case, a validated threshold is used to define women who meet criteria for the disorder. Scores greater than these threshold values have been shown to correspond to significant bother from pelvic floor symptoms (14 (link)). In this research, we used the published thresholds (14 (link)) to distinguish women with and without each pelvic floor disorder.
In addition to the research questionnaire, a gynecological examination was performed to assess pelvic organ support, using the Pelvic Organ Prolapse Quantification examination system (15 (link)). The examination was performed by physicians and a research nurse, each of whom demonstrated competency in performing the research examination prior to the study; competency was reconfirmed throughout the study. Women were classified as having objective evidence of prolapse if the most dependent point of the vaginal wall or the cervix came to or beyond the hymen (13 (link),16 (link),17 (link)).
At enrollment into our cohort study, participants were asked about prior treatment for pelvic floor disorders, including surgery. Participants were also asked about current therapy, including medications for urinary incontinence or current pessary use for treatment of prolapse. We also considered current or prior pelvic muscle exercises, but only if the program was supervised by a therapist. For the purposes of this analysis, women who reported prior surgery, prior supervised pelvic muscle exercises, or any current therapy for a specific pelvic floor disorder were considered to have that condition, regardless of current symptoms.
In addition to the research questionnaire, a gynecological examination was performed to assess pelvic organ support, using the Pelvic Organ Prolapse Quantification examination system (15 (link)). The examination was performed by physicians and a research nurse, each of whom demonstrated competency in performing the research examination prior to the study; competency was reconfirmed throughout the study. Women were classified as having objective evidence of prolapse if the most dependent point of the vaginal wall or the cervix came to or beyond the hymen (13 (link),16 (link),17 (link)).
At enrollment into our cohort study, participants were asked about prior treatment for pelvic floor disorders, including surgery. Participants were also asked about current therapy, including medications for urinary incontinence or current pessary use for treatment of prolapse. We also considered current or prior pelvic muscle exercises, but only if the program was supervised by a therapist. For the purposes of this analysis, women who reported prior surgery, prior supervised pelvic muscle exercises, or any current therapy for a specific pelvic floor disorder were considered to have that condition, regardless of current symptoms.
