Pelvic floor dysfunction and quality of life in women with spinal cord injury

Lisa A Hughes, The University of Texas School of Public Health


Purpose: I investigated pelvic floor dysfunction and quality of life of women with spinal cord injury (SCI). I used previously published instruments designed to quantify pelvic floor dysfunction and participation in and satisfaction with social roles, anxiety, depression, and sexual function. I also examined the lived experience of women with SCI regarding their strategies and techniques to manage bladder health. Methods: This was a cross-sectional pilot study. Data were collected anonymously through an online survey from women with SCI. All women resided in the United States. A subset of women who completed the survey volunteered to participate in telephone interviews for the phenomenologic, qualitative portion of the study. Sample: Of the 45 women who participated in the online questionnaire, 31 mostly White, well-educated, middle to upper income women, ranging in age from 23 to 70 years (M=47, SD=13) provided sufficient data to complete the quantitative analysis. Eleven of the women volunteered to participate in an additional telephone interview. Instruments: I used the following survey instruments: (1) The Pelvic Floor Distress Inventory-20 (PFDI-20); (2) Pelvic Floor Impact Questionnaire-7 (PFIQ-7); (3) The PROMIS SF v2.0 – Ability to Participate in Social Roles and Activities; (4) The PROMIS SF v2.0 - Satisfaction with Roles and Activities; (5) The PROMIS SF v1.0 Emotional Distress Anxiety; (6) The PROMIS SF v1.0 Emotional Distress Depression; (7) PROMIS Sexual Function Profile v1.0 – Female (PSxFBP); (8) Researcher developed Demographic Profile; and (9) Scripted interview questions. Results of Quantitative Investigation: Although 31 women completed The PROMIS Sexual Function Profile, 45% indicated they did not have sexual activity in the past 30 days. No sexual activity is given a value of zero resulting in no score for the subscales with that answer. Up to half of the women answered The Pelvic Floor Distress Inventory-20 as inappropriate, not applicable or confusing. These two instruments were ineffective in this population of women with SCI. Pelvic Floor Impact, was significantly associated with ability to participate in social roles, dissatisfaction with social roles, and depression. There was a weak association between Pelvic Floor Impact and anxiety No correlation was found between pelvic floor impact and interest in sex. Results of Qualitative Investigation: Two main categories were identified under the core theme of Bladder Management: Quality of Life and Constantly on My Mind. Sub-themes that emerged were Prevention, Independence, Social Activity, and Support System. Conclusions: There is a need for instruments that accurately measure pelvic floor dysfunction and impact on the health related quality of life and well-being in women with SCI. Existing instruments do not address the neurological deficits and secondary complications in women with SCI. Women reported that bladder management intrudes on and often dominates all aspects of their lives. The women expressed the importance of having health care providers work with them to create individualized care strategies that address the challenges they face related to bladder management, sexual health, depression, anxiety, and ability to participate in social roles, all of which have an impact on their quality of life.

Subject Area

Public health|Behavioral Sciences

Recommended Citation

Hughes, Lisa A, "Pelvic floor dysfunction and quality of life in women with spinal cord injury" (2016). Texas Medical Center Dissertations (via ProQuest). AAI10126216.