Hypothesis / aims of study
Pelvic floor symptoms (PFS) are common and impact daily functioning, yet help-seeking remains limited (1). This study examined the association between domain-specific symptom impact and help-seeking behaviour and assessed sex differences in help-seeking, using self-reported and routine primary care data.
Study design, materials and methods
Data were derived from the prospective population-based Coevorden Study (2), and linked routine general practice data from the Academic General Practitioner Development Network. In total, 11,724 individuals aged ≥16 years were invited, of whom 566 men and 839 women with complete data were included.
PFS were categorized into urinary, bowel, sexual, pelvic pain, and prolapse domains. Symptom impact on daily life was assessed using domain-specific numeric rating scales (NRS, 0–10). Help-seeking behaviour was defined as self-reported consultation with a healthcare provider (GP, pelvic physiotherapist, or medical specialist). Routine care data were additionally used to identify GP-consultations based on ICPC codes and to examine co-consultations.
Multivariable logistic regression analyses were conducted to examine the association between domain-specific symptom impact and help-seeking behaviour (yes/no), adjusted for age and sex. Analyses were restricted to individuals with complete data on the variables included in each model.
Results
In total 297 men (53%) and 596 women (71%) reported experiencing symptoms in one or more pelvic floor domain, of which 292 men and 591 women had information available on help-seeking. Among both men and women, those who sought help were significantly older than those who did not seek help (see Table 1).
Higher symptom impact was consistently associated with increased odds of help-seeking across most PFS domains, including urinary (OR 1.18, 95% CI 1.10–1.27), bowel (OR 1.33, 95% CI 1.17–1.52), sexual (OR 1.14, 95% CI 1.02–1.27), and pelvic pain symptoms (OR 1.44, 95% CI 1.24–1.66). No significant association was observed for prolapse symptoms. Sex differences were generally not observed, although women were less likely to seek help for urinary symptoms than men (OR 0.59, 95% CI 0.38–0.90). Increasing age was associated with higher odds of help-seeking in urinary and prolapse domains.
Approximately 30% of PFS consultations occurred as part of a double consultation, in which a pelvic floor complaint was discussed alongside another issues, with similar patterns in men (29.7%) and women (28.9%).
Interpretation of results
Symptom impact was a determinant of help-seeking, suggesting that individuals seek care when symptoms interfere with daily functioning and exceed a personal threshold of tolerability. This pattern was consistent across most domains, indicating a shared mechanism of symptom appraisal, although prolapse symptoms appeared to follow a different pattern.
In addition, frequent double consultations indicates that help-seeking for PFS often takes place alongside other health concerns rather than as a primary reason for consultation. This suggests that individuals may not always present these symptoms directly, but instead disclose them speculatively, potentially contributing to delayed recognition or management.
Sex differences were not consistently observed across domains, however, men appeared more likely to seek help for urinary symptoms than women, indicating the presence of domain-specific sex differences that may reflect barriers discouraging women from seeking care for these symptoms. Clinically, these findings emphasize the need for proactive enquiry and normalization of discussion around urinary symptoms in women, as well as targeted education to reduce stigma and support earlier help-seeking.