Screening for Stress Urinary Incontinence at the 6-week Postpartum Visit

Abstract

Background: Stress urinary incontinence, or involuntary loss of urine on effort/physical exertion, sneezing, or coughing, affects approximately 25% of women during the first three months postpartum. Although not life-threatening, this problem has profound negative effects on a woman’s hygiene, social/work life, sleep and sexual satisfaction, and increases the risk of anxiety and depression. Unfortunately, this common postpartum problem is frequently underreported and under-treated; only about half of women diagnosed with urinary incontinence discuss this issue with their provider.

Local Problem: At a women’s health clinic in northern Virginia, it was determined that there was no standardized stress urinary incontinence screening program at the 6-week postpartum visit. The purpose of this Doctor of Nursing Practice Project was to implement a screening tool for stress urinary incontinence in postpartum women, and a follow-up plan to be used by providers.

Interventions: A standardized process for screening and diagnosing stress urinary incontinence was created for the the 6-week postpartum visit. Providers in the Women’s Health Clinic were trained on how to interpret and document the Questionnaire for Urinary Incontinence DiagnosisStress Scale at the clinic’s monthly staff meeting, the weekly provider meeting, or one-on-one. The pelvic floor physical therapist instructed on proper pelvic floor exercises for patients with stress urinary incontinence to standardize patient teaching. The scale was then printed in a bright yellow box on the Women’s Health Clinic Postpartum Questionnaire for patients to fill-out when they checked-in. The providers interpreted the scale to identify those patients with stress urinary incontinence, and provided those patients with the Postpartum Pelvic Floor Exercises Handout, which detailed the follow-up plan suggested by the pelvic floor physical therapist at the site.

Results: During the 10-week pre-implementation period, there were 99 6-week postpartum visits, zero patients were screened for stress urinary incontinence, and only one patient was diagnosed with stress urinary incontinence. During the 10-week implementation period, there were 103 6-week postpartum visits, 77 patients were screened for stress urinary incontinence, and 22 patients were diagnosed with stress urinary incontinence. Therefore, screening increased from 0% to 74.8%, and diagnosis increased from 1% to 21.4%. The results of the Z-tests to compare sample proportions screened and diagnosed pre- and post-implementation were both statistically significant and indicated rejecting the null hypothesis that the sample proportions were equal.

Conclusions: Implementing a screening tool for stress urinary incontinence at the 6-week postpartum visit increased the proportion of patients diagnosed with this condition. The shortterm goals of this Doctor of Nursing Practice Project, to help providers identify more women with stress urinary incontinence at 6-weeks postpartum and to set-up an appropriate follow-up plan for these women, were met. This postpartum screening program has the potential to improve communication between patients and providers, who have under-reported and undertreated stress urinary incontinence in the past. Increased identification of this condition allows for treatment of patients who previously suffered in silence.