Patients with pelvic floor dysfunction commonly present with urinary and co-existing bowel symptoms that require multidisciplinary care. The combined pelvic floor clinic (CPFC) service was initiated in a tertiary women’s hospital in September 2020 providing joint care by dedicated urogynaecologist and colorectal surgeons.  

This study aims to characterize patients seen at the combined pelvic floor clinic (CPFC) established at a tertiary women’s hospital in Singapore. Study goals include identification of local patterns of symptom clusters and review of management strategies offered in comparison to international care standards, improvement of local understanding of complex female pelvic floor dysfunction, and guidance of future development of clinical and ancillary support.

This is a single-centre, retrospective cohort study of medical case record review for all patients seen at the CPFC between the 1st of September 2020 and 17th of January 2024. All patients seen in the CPFC during this study period were included for analysis. Data was deidentified and aggregated with analysis performed for descriptive and summary statistics using SPSS. Institutional Review Board approval was obtained with waiver of informed consent.

A total of 155 patients were referred to CPFC, with 9 patients defaulting their appointment, leaving 146 patients included in this study. They were seen over 49 clinic sessions over 41 months with a median waiting time of 34 days from time of referral, and were most commonly referred by Urogynaecology (n=104, 71.2%). Post-menopausal women (n=85, 58.2%) made up the majority of the study group, and baseline characteristics of our study group included age (median=60.5 years, range=63), parity (median=2, range=6) and BMI (mean=24.8, SD= 5.1). 

The most common presenting complaint was faecal or flatus incontinence (FI), severe constipation or defecatory dysfunction and rectal prolapse (table 1), with most patients having ≥1 reason for referral (n=105, 71.9%).  

In this study group, 74.0% patients (n=108) were referred for combined colorectal and urogynaecological conditions, and 79.5% (n=116) were later diagnosed with combined colorectal and urogynaecological conditions. The urogynaecological conditions diagnosed include Pelvic Organ Prolapse (POP) (57, 39.0%), Stress Urinary Incontinence (SUI) (30, 20.5%), Overactive bladder (OAB) (23, 15.8%), Mixed Urinary Continence (MUI) (21, 14.4%), Urinary Tract Infection (UTI) (14, 9.6%) 

CPFC patients were managed according to their symptoms and severity. 32.1% (n=47) were discharged after the 1st visit, and 42.5% (n=67) attended ≥ 1 follow-up. Conservative management included biofeedback, physiotherapy, counseling, lifestyle, medications and pessary. Surgical management included 46 offered surgeries, and 11.0% surgeries (n=16) performed by time of collection - 37.5% of which being combined surgeries (n=6). This is summarised in table 2.

The provision of a combined multidisciplinary service for such patients is beneficial, with a reduced need for multiple clinic visits, reduced surgical interventions and recovery time, efficient - short time from referral to being seen.

Hence, we continue to recommend referrals to the CPFC for patients who can benefit from this. We advocate more studies to be performed to evaluate the long-term outcomes of a combined multidisciplinary service and patient experience.

Kapoor, D. S., Sultan, A. H., Thakar, R., Abulafi, M. A., Swift, R. I., & Ness, W. (2008). Management of complex pelvic floor disorders in a multidisciplinary pelvic floor clinic. Colorectal disease : the official journal of the Association of Coloproctology of Great Britain and Ireland, 10(2), 118–123. https://doi.org/10.1111/j.1463-1318.2007.01208.x
Dieter, A. A., Wilkins, M. F., & Wu, J. M. (2015). Epidemiological trends and future care needs for pelvic floor disorders. Current opinion in obstetrics & gynecology, 27(5), 380–384. https://doi.org/10.1097/GCO.0000000000000200