Abstract

Patient-defined goals for the treatment of fecal incontinence: a qualitative analysis among women attending a urogynecology clinic

Int Urogynecol J. 2020 Nov 20. doi: 10.1007/s00192-020-04579-9. Online ahead of print.

Gabriela E Halder 1, Lauren Caldwell 2, Gena G Dunivan 3, Daksha Bilagi 2, Maura R Ronquillo 2, Amanda B White 2, Rebecca G Rogers 4

 
     

Author information

  • 1Department of Women's Health, University of Texas Austin Dell Medical School, Medical Park Tower, 1301 W. 38th St., Suite 705, Austin, TX, 78705, USA. gabriela.halder@ascension.org.
  • 2Department of Women's Health, University of Texas Austin Dell Medical School, Medical Park Tower, 1301 W. 38th St., Suite 705, Austin, TX, 78705, USA.
  • 3Division of Female Pelvic Medicine and Reconstructive Surgery, Department of Obstetrics and Gynecology, University of New Mexico, Albuquerque, NM, USA.
  • 4Department of Obstetrics and Gynecology, Albany Medical Center, Albany, NY, USA.

Abstract

Introduction and hypothesis: Fecal incontinence treatment goals are understudied and are not described for women presenting to care. Our objective was to explore patient-reported goals for fecal incontinence management among women presenting for care at a pelvic floor disorders clinic and develop a conceptual framework that captures the range of desired treatment outcomes.

Methods: A qualitative analysis of patient-reported goals for women with fecal incontinence attending a pelvic floor disorders clinic from October 2017-November 2019 was conducted. A team-based approach was used to identify themes and emerging concepts and develop a conceptual framework.

Results: One hundred patients met the inclusion criteria. Mean age was 58 ± 14 years; 67% were White and 46% non-Hispanic. Seventy-nine percent of women had diagnosis(es) of prolapse, urinary complaints, or another pelvic floor disorder. From 230 unique goals identified, five thematic categories emerged: Emotional Status, Functional Status, Concurrent Pelvic Floor Disorders, Care Seeking, and Treatment Aspirations. Thematic domains not previously represented in other qualitative work include patients' focus on treatment for global pelvic health rather than solely on fecal incontinence and treatment aspirations ranging from improvement to cure. Our model captures the close relationship between all pelvic floor disorders and emotion, which in return affects all facets of care.

Conclusions: Women with fecal incontinence report a range of treatment goals from improvement to complete resolution of symptoms. Focusing treatment on patient goals by addressing global pelvic health and negotiating realistic treatment outcomes may improve care in this population.

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