The aims of this study are to identify screening, treatment, and referral practices of primary care physicians (PCPs) for patients with pelvic floor disorders (PFDs) and evaluate awareness of the Female Pelvic Medicine and Reconstructive Surgery (FPMRS) subspecialty.
We conducted a cross-sectional survey of PCPs using a random sample of 1005 American College of Physicians members, stratified by demographic region. Electronic survey content included awareness of FPMRS certification, comfort diagnosing and treating PFDs, and PFD referral patterns for PCPs.
The 399 survey respondents were predominately male and of diverse ages, geographic distribution, and experience level.
Forty-eight percent were aware of the FPMRS subspecialty, 31% of FPMRS board certification, and 25% of American Urogynecologic Society. Less than one third screened for PFDs, only two thirds were comfortable diagnosing urinary complaints, and even fewer felt comfortable diagnosing pelvic organ prolapse and fecal incontinence (FI).
Eighty-five percent recommended pelvic floor exercises for stress urinary incontinence and referred to urology (29%) or FPMRS (25%) as second-line therapy, whereas 55% recommended medication/fiber for FI and referred to gastroenterology/colorectal surgery (31%) and FPMRS (2%) as second-line therapy.
Primary care physicians referred to colorectal surgery for FI (60%), to Ob/Gyn for obstetric anal sphincter injury (38%) and pelvic organ prolapse (57%), and to urology for microscopic hematuria (80%), overactive bladder (60%), recurrent urinary tract infection (75%), stress urinary incontinence (48%), and voiding dysfunction (84%).
Most PCPs do not routinely screen for PFDs, and fewer feel comfortable treating. The majority is unaware of FPMRS and American Urogynecologic Society and more commonly refers PFD patients to other specialists.
As part of an “awareness” project for AUGS Leadership Program 2016, we developed a survey for primary care physicians to (1) determine their comfort with diagnosing, treating, and referring patients with PFD; (2) determine the resources primary care physicians routinely used to update their clinical knowledge; and (3) determine knowledge of FPMRS subspecialty.
From the *Department of Obstetrics and Gynecology, the University of Arkansas for Medical Sciences, Little Rock, AR; †Division of Female Pelvic Medicine and Reconstructive Surgery, TriHealth, Cincinnati, OH; ‡Department of Women's Health, Dell Medical School at the University of Texas at Austin, Austin, TX; §Valley Urogynecology Associates, University of Arizona, Phoenix, AZ; and ∥Department of Obstetrics and Gynecology, Northwestern Medicine, Chicago, IL.
Correspondence: Susan A. Barr, MD, Department of Obstetrics and Gynecology, the University of Arkansas for Medical Sciences, 4301 West Markham St, No. 518 Little Rock, Arkansas 72205. E-mail: SABarr@uams.edu.
The authors have declared they have no conflicts of interest.
This article was accepted at PFD Week 2017 for AUGS for an oral poster presentation held at Providence, RI, October 3 to 7, 2017.