Unveiling Pelvic Floor Health: Understanding Awareness, Perspectives and Habits in Pakistani Women of Reproductive Age

, The pelvic �oor, a crucial anatomical structure supporting pelvic organs, is vital in various physiological functions. Pelvic Floor Dysfunction (PFD) encompasses disorders affecting pelvic �oor muscles and is a signi�cant health concern globally. Pelvic �oor muscle training (PFMT) has been advocated for managing PFD, especially in women post-childbearing. However, there is a lack of awareness and understanding regarding PFMT in Pakistani women. Objective: To assess the Knowledge, Attitude, and Practice (KAP) towards PFMT among women of childbearing age in a rural health centre in Haripur, Pakistan. Methods: A cross-sectional study was conducted at a Rural Health Center in Haripur, Pakistan, involving 158 women aged 20 to 50. A structured questionnaire covered KAP's details regarding PFMT. Data analysis employed SPSS 26.0, utilizing mean and standard deviation. Results: The study revealed a response rate of 52.6%, with a mean age of 30±7.3 years for participants. Notably, 29.1% of women reported an inability to control their urine. Knowledge assessment showed that 54.9% of participants knew pelvic exercises and their potential bene�ts. Attitude towards PFMT was positive in 41.8% of women, while only 20.5% practised PFMT regularly. Pregnant women exhibited a higher prevalence of urinary incontinence. Conclusions: The study concludes that a substantial proportion of women in Pakistan lack awareness of PFMT bene�ts, leading to inadequate practice. This underscores the importance of implementing awareness programs and training sessions targeting women of childbearing age to address the challenges posed by PFD effectively.

especially during the postpartum period [6].PFMT involves practising different contracting and relaxing pelvic oor muscle exercises in various combinations and time durations to strengthen the control and coordination of this group of muscles [7].During exercise, the pelvic oor muscle lifts upwards and squeezes around the urinary ori ce, suppressing detrusor activity.PFMT strengthens pelvic oor muscles and has been observed to improve the fecal urinary continence and overall sexual health of women [8].Most studies were conducted in Western countries to analyze women's practices, attitudes and Knowledge (PAK) about PFD.The data on these studies from the Pakistani population is very scarce as most of the time, it goes undiagnosed due to a lack of awareness of this disorder [9].Therefore, the present study was conducted in the Gynecology and Obstetrics department at Rural Health Center, Haripur, Pakistan, to analyze PAK about PFD among women of reproductive age in Islamabad, Pakistan.
This cross-sectional study was performed at the Rural Health Center, Haripur, Pakistan.The study was conducted from 1 November 2023 to 15 December 2023 for a duration of 1.5 months.In total, 158 female inpatients and outpatients of reproductive age were included in the study by convenience sampling [10].The inclusion criterion included (i) women aged 20 to 50 and (ii) consent of participation in the study.The exclusion criterion included patients who could not complete the questionnaire because of (i) lack of ability to read or write and (ii) psychological issues.Written consent was obtained from all study participants before the questionnaire's completion [11].Investigators designed the questionnaire based on four categories reported in a previous study and consisting of 17 questions.The four categories comprised personal questions (5 questions), questions on Knowledge (4 questions), attitude (4 questions) and practice (4 questions).The gravity of the problem and general understanding of PFMT were analyzed by asking one fundamental question: (i) Can you control your urine?The Knowledge, attitude, and practice levels were analyzed using the questions in the table below (Table 1).The response rate of this study was 52.6%, as only 158 women out of 300 were willing to participate.The mean age of all willing participants was 30±7.3 years.Responding to one basic question asked by participants, we found that 29.1% of women cannot control their urine.Most women were well-educated, non-pregnant and had 2-4 children.
Table 2 shows the characteristics of participants in this study.
"Yes" was awarded 1 point for each question, while "No" was given 0. The hardcopy questionnaire was distributed among patients after receiving their formal consent when they visited the gynaecology department of Shifa International Hospital.The patients willing to participate in the study were provided a quiet and comfortable place to complete the questionnaire.In the light of this study, the results are reported as a bar graph.As demonstrated in Figure 1, from the knowledge aspect, 53.8% of women thought PFMT could improve their uterus health (A), 38.7% of women knew that PFMT could enhance their sexual health 48.1% of women thought they have to perform pelvic exercises (C) and 79.1% knew that PFMT could bring positive change in their life (D).
Overall, the respondents had 54.9% knowledge of pelvic exercises and their promising effects.
Figure 2 shows response to questions highlighting the attitude of participants towards PFMT, and it was observed that 81.6% of women hold their urine for a long time (E), 27.2% agreed that it should be part of daily routine exercise(F), 53.7% believed in taking oral medicine for PFD (G), while 48.1 % were of opinion that exercise is less effective than oral medicine (H).Overall, 41.8% of participants had a positive attitude towards practising and believing in the health bene ts of PFMT.
As shown in gure 3, for the practice part of the survey, only 6.3% performed PFMT exercises once a week (I), 62% were aware of their normal sitting posture (J), 10.1% followed instructions provided by a gynaecologist to improve pelvic health (K) and only 3.79% participants ever received PFMT in their life.Overall, 20.5% of the practice level for pelvic exercises was observed in participants.We analyzed that the majority of women who were suffering from urinary belonged to the age bracket of 36 ± 6 years (p>0.05),belonged to the working class and that problems related to urinary incontinence did not signi cantly increase with parity (p>0.05).Urinary incontinence was more common in pregnant women as compared to non-pregnant women (p>0.05).In pregnant women, it has been reported that PFMT has a pivotal role both in the antenatal and postnatal period, and it is imperative to educate all women about its promising effects [17].Unfortunately, most women were unaware of these exercises and the bene ts they can bring to their health.Most of these participants were very optimistic about practising their exercises when they were educated on the bene ts they could gain from PFMT.Our ndings are relevant to observations reported by another study conducted to carry out KAP analysis on pregnant women visiting the Gynecology Department KRL (Kahuta Research Laboratories), Islamabad.Most of these women were unaware of PFMT, and those who had Knowledge about PFMT did not know how to perform these exercises to gain the maximum healthy outcome

Figure 1 :Figure 2 :
Figure 1: Bar graph for questionnaire data on participants' Knowledge of PFMT

Sr. No. Questions Knowledge
Do you know pelvic exercise will improve your uterus health?A Do you think PFMT can improve your sexual health?B Do you think you have to perform PFMT?C Do you know pelvic exercise can bring positive change in your life?D Attitude E Do you often hold your urine for a long time?F Do you think exercise should be part of your daily routine?G Do you believe in taking oral medicine?H Do you believe exercise is less effective than oral medicine?

Table 2 :
Characteristics of study participants, including education level, parity, pregnancy status and no children.

Table 3 :
Questions asked from participants and the percentage of their positive response regarding each question