The pelvic floor is formed by a group of muscles, fascia, and ligaments that support the pelvic organs. Reduced function of these structures can lead to Pelvic Floor Dysfunctions (PFD), such as urinary incontinence, fecal incontinence, and pelvic organ prolapse, which are common conditions in the female population. Pregnancy and vaginal delivery are significant risk factors for the onset or exacerbation of PFD. Among the available treatments, physiotherapy plays an essential role and can be performed during prenatal care as a preventive measure for PFD or during the postpartum period for pelvic muscle strengthening and bladder training. Despite the relevance of these diseases, a significant proportion of patients with PFD have limited understanding of their conditions, treatment options and medical terminologies for PFD (1)(2). Additionally, although there is a gradual increase in medical information published by healthcare professionals, they still represent a minority compared to the quantity of pelvic floor content on websites, which generally proves to be of low quality (3). 

Given the scarcity of academic articles addressing the impact of social media usage on PFD knowledge, the aims of this study are to evaluate how pregnant women and postpartum women use social media as a tool for seeking health information, understand the perceived reliability of this content, and assess the impact of media on patients' understanding of PFD and physiotherapy treatment.

An observational, cross-sectional and qualitative study was conducted, enrolling a total of 150 adult women, comprising 75 pregnant and 75 postpartum women. Eligible participants were required to be over 18 years old and in any stage of pregnancy or up to one year postpartum. Exclusion criteria included patients diagnosed with cognitive impairment and those who were not native Portuguese speakers. Pregnant women were approached in person at the outpatient clinic of the Obstetrics Department while awaiting their medical appointments, while postpartum women were recruited from a maternity hospital. All participants provided written and informed consent and completed a form with sociodemographic data, gynecological, and obstetric history. 

Participants were also asked to complete a printed questionnaire with 16 questions. The first section pertains to the use of social media among pregnant and postpartum women, covering topics such as interest in seeking health-related content on social media, perception of the reliability of health posts, habits related to verifying information sources, and interest in content produced by obstetrician-gynecologists. 

The second part of the questionnaire focuses on Pelvic Floor Dysfunction (PFD) and addresses complaints that may suggest pelvic floor dysfunctions. It also assesses participants' recognition of medical terms associated with PFD, such as urinary incontinence, fecal incontinence, and prolapse. Additionally, participants were queried about their access to posts on PFD and physiotherapy for prevention and treatment.

Responses collected in the questionnaires were transferred via the Google Forms application and organized into spreadsheets in the Google Sheets application. Descriptive statistical analysis of the data was also performed using JAMOVI software version 2.3.13.

The results were separated by pregnant (P) and postpartum women (PP). It was observed that the sample consisted of young participants (mean P:31.1 years-old, mean PP:28.1 years-old), predominantly of brown color (P:41.3%, PP:46.7%), single (P:36%, PP:53.3%) and with completed high school education (P:43%, PP:42.7%), indicating a low socioeconomic status.

The social media platforms with the highest number of accounts were WhatsApp, Facebook, Instagram, and YouTube. The majority of women used their social media every day (P:85.3%, PP:84%). Moreover, many women reported the habit of using their social media to research health-related posts (P:86.7%, PP:88%) (FIGURE 1).

They had used social media many times to research a disease they had (P:68%, PP:73.3%). YouTube was the most chosen social media platform among pregnant and postpartum women as a tool for health research (P:58.7%, PP:49.3%). Most patients stated they checked the sources of information in health-related posts (P:73.3%, PP:74.7%). However, while the majority of pregnant women believed that health posts were generally reliable (57.3%), only 49.3% of postpartum women shared this perception. 49.33% of pregnant women followed their obstetrician-gynecologist, in contrast to 65.33% of postpartum women. Despite this, the majority of patients reported being interested in following these physicians on social media (P:88%, PP:90.7%) (FIGURE 2).

Participants were asked if they were familiar with the terms "urinary incontinence", "fecal incontinence", and "prolapse". "Urinary incontinence" was the term most recognized by patients (P:34.7%, PP:30.7%). Nevertheless, the percentage of patients who recognized any of these terms was low, considering the number of participants with complaints that may be suggestive of PFD. Although 65.3% of pregnant women reported urinary complaints, only 34.7% of them knew the term “urinary incontinence”. Furthermore, few patients claimed to have been diagnosed with urinary incontinence (P:12%, PP:8%), and the distribution of fecal incontinence and pelvic organ prolapse was much lower (FIGURE 3).

Access to social media posts on the topic pelvic floor was also scarce (P:18.7%, PP:22.7%). Despite this, the majority also expressed interest in learning more about a social media page dedicated to this topic (P:65.3%, PP:61.3%). Meanwhile, the importance of physiotherapy for pregnancy, childbirth, and postpartum was not known by 54.7% of patients, and most had never seen posts on this topic (P:70.7%, PP:66.7%). The role of physiotherapy in the prevention and treatment of PFD was also relatively unknown (P and PP: 54.7%), and few patients had contact with posts on this topic (P:13.3%, PP:14.7%) (FIGURE 3).

As expected, it was observed that social media serves as platforms for seeking health information and YouTube was one of the most frequently used tools for this purpose. Furthermore, low knowledge about health information was observed, especially regarding PFD and physiotherapy as its prevention and treatment. Therefore their dissemination and elucidation by healthcare professionals should be strengthened, considering that the quantity of medical content produced by professionals is still low. Although many patients believed health information was reliable, the accuracy of these contents should still be further investigated by other studies.

As social media has increasingly become an important source of health information, promoting posts related to PFD is an engaging method to raise awareness about conditions that remain unfamiliar to many. Although posts may create a perception of reliability in many women, their accuracy is still questionable. Nevertheless, it is up to professionals to guide patients with accurate medical information.

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