Women’s Knowledge of Pelvic Floor Disorders and Its Determinants in the Gurage Zone,Central Ethiopia: A Community-Based Cross-Sectional Study

Abstract

Introduction

Pelvic floor disorders (PFDs) are common conditions that negatively affect women’s quality of life, particularly in low-resource settings where awareness is often limited. Although knowledge of PFDs remains low in many developing settings, evidence from Ethiopia is limited, and the extent and determinants of women’s knowledge have not been well explored. Therefore, this study aimed to assess the knowledge of pelvic floor disorders and its determinants among women in Gurage Zone, Central Ethiopia.

Methods

A community-based cross-sectional study design was utilized, employing a multistage sampling technique to select 844 women. Data were collected through face-to-face, interviewer-administered questionnaires. The data were entered into EpiData version 3.1 and exported to SPSS version 26 for analysis. Bivariate and multivariable logistic regression analyses were used to identify factors associated with knowledge of pelvic floor disorders (PFDs). Statistical significance was declared at a p-value of less than 0.05 with a 95% confidence interval (CI).

Results

In this study, the overall prevalence of women’s knowledge of pelvic floor disorders was found to be 40.5% (95% CI: 37.1, 43.7). Higher educational status (AOR = 3.28; 95% CI: 2.02, 7.54), being an urban resident (AOR = 2.51; 95% CI: 1.37, 14.03), being multiparous (AOR = 2.43; 95% CI: 1.08, 5.47), being grand multiparous (AOR = 4.21; 95% CI: 1.81, 11.1), and having awareness of pelvic organ prolapse (POP) as a medical condition (AOR = 2.91; 95% CI: 1.57, 5.40) were identified as determinants of women’s knowledge of pelvic floor disorders.

Conclusion

Only two in five women were knowledgeable about PFD in this study area, which is considered low. These findings underscore the need for targeted educational interventions to bridge knowledge gaps, particularly among populations with lower educational attainment and those living in rural areas.

Keywords

pelvic floor disorders determinants knowledge women Gurage zone

Introduction

Pelvic floor disorders (PFDs) encompass a broad range of conditions affecting the vagina, lower urinary tract, and bowel, which impair the structure and/or function of the female genital organs. The three most prevalent types of PFDs are urinary incontinence (UI), fecal incontinence (FI), and pelvic organ prolapse (POP).^1,2 The International Urogynaecological Association (IUGA) and the International Continence Society (ICS) jointly define urinary incontinence (UI) as the involuntary loss of urine and fecal incontinence (FI) as the involuntary loss of solid or liquid stool. According to the combined IUGA and ICS definition, pelvic organ prolapse (POP) is characterized by a descent of the posterior vaginal wall, anterior vaginal wall, or vaginal apex (or vaginal vault after hysterectomy) due to weakened pelvic floor support or dysfunction.^3,4

According to the World Health Organization (WHO), preventing pelvic floor disorders (PFDs) involves primary, secondary, and tertiary measures, targeting onset prevention, early symptom management, and reduction of existing symptoms or relapses.^4,5 However, many women lack adequate knowledge about PFDs, pelvic organ prolapse (POP), and fecal incontinence (FI), making it difficult to implement preventive measures.^6,7 Even due to a lack of public information on common PFDs, delays healthcare seeking until the dysfunction has progressed, making it more difficult.^8-10

Pelvic floor disorders are prevalent gynecological conditions affecting a substantial proportion of women worldwide. Studies show that 1.9% to 46.5% of women globally suffer from PFD.^11,12 Anal incontinence (AI) affects approximately 0.2% to 13%,^13,14 pelvic organ prolapse (POP) affects about 3%–64.6%,¹⁵ and urinary incontinence (UI) has a prevalence of approximately 1.7% to 35.5%, making them the most common types of PFD.¹⁶

The prevalence of PFDs among women in Ethiopia has been reported to be over 20%.^12,17 In the Gurage Zone, 41.1% of women reported PFDs, with the majority experiencing urinary incontinence (32.8%), followed by pelvic organ prolapse (25.5%) and fecal incontinence (4.2%).¹⁸

The development of PFDs is multifactorial and can affect women of any age.¹⁹ Modifiable risk factors include childbirth trauma from improper birthing practices by unskilled attendants, operative vaginal delivery, prolonged second stage of labor, third- and fourth-degree lacerations, and vaginal delivery of large or malpositioned babies.²⁰ Other contributing factors include poor socioeconomic status, malnutrition, adolescent pregnancy, lack of rest during and immediately after pregnancy, early marriage, multiparity, and lack of puerperal rehabilitation.^21,22 This is further complicated by chronic illnesses such as chronic obstructive pulmonary disease, pulmonary tuberculosis, and obesity.²¹ Several factors commonly found throughout Ethiopia that can contribute to PFDs include early marriage, grand multiparity, obstructed labor, and a lack of fully developed maternal healthcare infrastructure.^13,23,24

Pelvic floor disorders have serious implications for the safety of affected women, as well as for their families, caregivers, and society at large. They cause significant social, economic, physical, and psychological issues, dramatically reducing women’s quality of life and productivity.^25,26 PFDs lead to disability and embarrassment, impair social activities, and result in withdrawal from physical activity and sports, social isolation, reduced performance, and loss of personal relationships and intimacy.^26,27

PFDs have significant financial implications for both healthcare systems and patients. For example, American women with severe incontinence spend around $7032 annually on routine care,¹⁹ and over $16 billion is spent each year globally on PFDs, mostly (70%) for routine care such as incontinence products.^19,28 Healthcare use for PFDs is expected to rise with an aging population,^29,30 yet less than half of women with severe symptoms seek care. In the Kersa district, eastern Ethiopia, only 32% of women with PFDs accessed healthcare services.¹² Hence, studies on preventive strategies are crucial to improve individual well-being and reduce economic burden.

The evidence revealed that lack of care-seeking is linked to misconceptions about these conditions. For example, the study found that 81% of women do not consider urinary incontinence (UI) abnormal and believe that PFDs are a normal part of childbirth and aging.^31,32 Moreover, other barriers include personal embarrassment, concealment of the condition, which can lead to issues such as domestic violence and lack of awareness that PFDs are a medical disorder, and unawareness of available medical treatments.^33,34 The study also indicates that a low level of knowledge about pelvic floor dysfunction is associated with a higher incidence of the conditions.³⁵ While PFDs are widespread in Ethiopia, there is little or no published data on women’s knowledge of these disorders.³⁶

Numerous studies have shown that women’s knowledge of pelvic floor disorders can be influenced by factors such as age, occupation, education, lack of awareness of PFDs as a medical condition, parity, no history of care-seeking for PFDs, age at first childbirth, and age at marriage.^36,37 Despite this, little is known about women’s knowledge of pelvic floor disorders in Ethiopia, particularly in the study area. Therefore, this study aims to assess knowledge of pelvic floor disorders and its determinants among women in the Gurage Zone, Central Ethiopia.

The objective of this study is to assess knowledge of pelvic floor disorders and its determinants among women in the Gurage Zone, Central Ethiopia, in 2024.

Methods and Materials

Study Setting, Design, and Period

A community-based analytical cross-sectional study was conducted in the Gurage Zone, Central Ethiopia, from March 1 to 30, 2024. The zone borders the Oromia Region to the north and east, Kebena Special Woreda to the northwest, Hadiya and Yem Zones to the southeast, and Silte to the southeast. Administratively, it comprises five towns and ten woredas, each further divided into kebeles. According to the 2007 National Household Census, the zone has an estimated population of 1,280,483, including 657,568 women.³⁸ The Gurage Zone was selected as the study area based on the study’s objectives and feasibility.

Population

All women in the Gurage Zone constituted the source population. The study population consisted of all women selected from the chosen kebeles.

Eligibility Criteria

Women residing in the Gurage Zone for at least six months and willing to participate were eligible, whereas critically ill women were excluded.

Sample Size Determination

The researcher determined the sample size for this study using a single population proportion formula, considering the following assumptions: a 95% confidence level; the proportion of women with good knowledge about POP and UI, which were 24.1% and 27%, respectively,³⁶ a 50% population proportion for women’s knowledge of FI, since no prior research exists on this topic in Ethiopia; and a 5% margin of error.

Sample Size Determination for the Women Who had Good Knowledge of POP

n 1 = \frac{{(Z_{\frac{α}{2}})}^{2} * P (1 - P)}{d^{2}} n 1 = \frac{{(1.96)}^{2} * 0.241 (1 - 0.241)}{{(0.05)}^{2}} = 281

Where n1 = the required sample size for women who had good knowledge about POP, α\alphaα = level of significance, z = standard normal distribution value for a 95% confidence level (1.96), p = proportion of women with good knowledge of POP, and d = margin of error. After accounting for a 10% non-response rate, the total sample size was 309 for n1.

Sample Size Determination for the Women Who had Good Knowledge of UI

n 2 = \frac{{(Z_{\frac{α}{2}})}^{2} * P (1 - P)}{d^{2}} n 2 = \frac{{(1.96)}^{2} * 0.27 (1 - 0.27)}{{(0.05)}^{2}} = 303

Where n2 = the required sample size for women who had good knowledge about UI, α\alphaα = level of significance, z = standard normal distribution value for a 95% confidence level (1.96), p = proportion of women with good knowledge of UI, and d = margin of error. After accounting for a 10% non-response rate, the total sample size was 333 for n2.

Sample Size Determination for the Women Who had Good Knowledge of FI

n 3 = \frac{{(Z_{\frac{α}{2}})}^{2} * P (1 - P)}{d^{2}} n 2 = \frac{{(1.96)}^{2} * 0.5 (1 - 0.5)}{{(0.05)}^{2}} = 384

Where n3 = the required sample size for women who had good knowledge about FI, α = level of significance, z = standard normal distribution value for a 95% confidence level (1.96), p = proportion of women with good knowledge of FI (assumed to be 50% due to lack of prior studies in Ethiopia), and d = margin of error. After accounting for a 10% non-response rate, the total sample size was 422 for n3.

The sample size calculated for n3 was greater than that of n1 and n2. Therefore, n3, which is 422, was used for this study. After applying a design effect of 2, the final sample size was 844. The design effect of 2 was applied based on standard recommendations for community-based studies in similar settings, as a conventional approach to increase the sample size and improve the precision of estimates in the absence of prior intra-cluster correlation estimates for this population.

Sampling Techniques and Procedures

A multistage sampling technique was applied to select a total of 844 women. The Gurage Zone has ten woredas and five administrative towns. Five woredas (Gumer, Ezha, Abeshge, Geta, and Edegagn) and three administrative towns (Gunchure, Wolkite, and Arakit) were randomly selected using a lottery method. From each selected woreda and administrative town, three and two kebeles were chosen at random, respectively. The final sample size was distributed proportionately based on the number of households in each kebele. Eligible women were then recruited from each household using a systematic random sampling technique, with the sampling frame derived from Health Extension Worker (HEW) registration records and kebele administrative records. When multiple women meeting the eligibility criteria were identified in a selected household, one woman was chosen using a lottery method. Two attempts were made to reach selected households if they were closed or if the women were absent during data collection. If both attempts were unsuccessful, the household was recorded as “absent.”

Data Collection Tool and Procedures

Data were collected through face-to-face, interviewer-administered questionnaires conducted at the participants’ homes. Only one woman was interviewed at a time. The data collection tool was adapted from previous studies conducted on a similar outcome of interest.^39-43 The Prolapse and Incontinence Knowledge Questionnaire (PIKQ) was used to assess women’s knowledge of PFDs.^42-44 The PIKQ was developed in the United States in 2008 as a valid instrument to evaluate patient knowledge about pelvic organ prolapse, urinary and fecal incontinence, and overall knowledge of pelvic floor disorders. Its validity and reliability were found to be satisfactory in studies conducted among gynecologic and urogynaecological patient populations. The tool consists of two 12-item subscales for POP and UI, and an additional 10 items assessing fecal incontinence (FI). Each item has two response options (Agree/Disagree), with one point awarded for each correct response. The total score for each subscale was obtained by summing correct responses. For the PIKQ-POP and FI subscales, a score of ≥50% was considered good knowledge, while for the PIKQ-UI subscale, a score of ≥80% was considered good knowledge.⁴⁴

For the overall assessment, a 34-item composite PFD knowledge scale was constructed by combining items from the POP, UI, and FI domains. The total score ranged from 0 to 34. Participants scoring ≥50% were classified as having good overall knowledge of PFDs, while those scoring below 50% were considered to have poor knowledge, based on cutoffs used in previous studies.^42,43,45

The questionnaire also included items on women’s socio-demographic characteristics, obstetric variables, awareness of pelvic floor disorders (PFDs), diagnosis-related questions, and questions assessing knowledge of PFDs. To ensure cultural and contextual appropriateness, the questionnaire was forward–backward translated into Amharic and Guragigna by language experts to ensure semantic and conceptual equivalence. The translated versions were reviewed by a panel of experts, including a gynecologist, an epidemiologist, and an assistant professor in maternity and reproductive health nursing, to assess face and content validity. Content validity was ensured using the content validity index and content validity ratio, as evaluated by local experts, to confirm the relevance and essentiality of the items. Based on local expert feedback, minor modifications were made to improve clarity and cultural relevance. A pretest was conducted on a sample of women outside the study area to assess the clarity, understandability, and flow of the questionnaire. Necessary adjustments were made based on the pretest findings. Furthermore, the internal consistency reliability of the final tool was assessed using Cronbach’s alpha, which yielded a value of 0.89, indicating good reliability.

For data collection, eight personnel who were fluent in English and the local languages (Amharic and Guragigna) were recruited. These included eight BSc midwives and two MSc nurses who served as data collectors and supervisors. Two days of training were provided on the overall objectives of the study, questionnaire clarification, sampling strategies, ethical considerations, and procedures for facilitating and supervising the data collection process. This study was reported in accordance with the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) guidelines for cross-sectional studies.⁴⁶

Variables of the Study

Dependent Variable

Knowledge of pelvic floor disorders (PFDs).

Independent Variables

The variables included age of the respondent, residence, religion, marital status, educational status, occupational status, income, age at marriage, parity, age at first childbirth, awareness of PFDs, and diagnosis of PFDs.

Operational Definitions

Overall Pelvic Floor Disorders (PFDs) Knowledge Score

In this study, good knowledge of PFDs was assessed using 34 items measuring women’s overall knowledge of pelvic floor disorders (PFDs). Each correct response received one point, while each incorrect response received zero points. A total score, ranging from 0 to 34, was obtained by summing all item scores. Good knowledge was defined as achieving ≥50% correct answers on the PFD knowledge questionnaire, whereas women who scored less than 50% were considered to have poor knowledge.^42,43,45

Domain-specific Women’s Knowledge Scores

Good knowledge of POP and UI: The PIKQ questionnaire, consisting of 24 questions, was used to assess knowledge of POP and UI. Twelve questions are related to the epidemiology, pathophysiology, diagnosis, and treatment of UI (PIKQ-UI), and the remaining twelve are related to POP (PIKQ-POP). Only correct responses were counted, with each correct answer receiving one point.^42,43,45

Good knowledge:Defined as achieving ≥50% correct answers on the PIKQ-POP and ≥80% correct answers on the PIKQ-UI. Poor knowledge: Women who scored less than 50% correct answers on the PIKQ-POP and less than 80% correct answers on the PIKQ-UI were classified as having poor knowledge.^42-45 UI knowledge: An adapted cutoff of ≥80% was used, based on prior studies where UI knowledge items were more detailed and on the greater specificity of the items to reflect adequate understanding.

Good knowledge of FI: There were 10 items used to measure women’s overall knowledge of fecal incontinence (FI). Each correct response received one point, while each incorrect response received zero points. A total possible score (ranging from 0 to 10) was obtained by summing the scores for all items. Good knowledge was defined as achieving ≥50% correct answers on the FI knowledge questionnaire. Poor knowledge: Women who scored less than 50% correct answers were considered to have poor knowledge. Different thresholds account for variation in subscale items and align with established methods from prior studies, especially in urinary incontinence knowledge assessments using PIKQ-based and adapted KAP approaches.^42-45 Subscale scores were analyzed separately for descriptive and exploratory purposes only. Awareness: Participants were classified as being aware of PFD if they responded “Yes” to the question, “Have you ever heard of PFD?”

Data Quality Control

To ensure data quality, language experts translated the questionnaire into Amharic and Guragigna. The tool was ensured to be relevant and understandable to the local context, and the translation was accurate and conceptually equivalent to the original tool. Two days of training were provided for data collectors, including one day of theoretical instruction and one day of practical exercises. The training covered the study objectives, data collection tools and procedures, respondent approach, and confidentiality measures. The principal investigators reviewed all completed questionnaires daily to ensure completeness and consistency. A pretest was conducted on 5% of the sample (42 participants) to evaluate the clarity and appropriateness of the questions. Necessary revisions were made to improve wording, sequencing, and comprehension, and the average time required for data collection was estimated. Each questionnaire was assigned a unique identification code and double-entered into EpiData. All data files were securely stored and accessible only to the principal investigator.

Data Processing and Analysis

After data collection, the questionnaires were coded, checked for completeness, and entered into EpiData before being exported to the Statistical Package for the Social Sciences (SPSS) Version 26 for analysis. Descriptive statistics, including frequencies, percentages, means, and standard deviations, were used to describe the study population with respect to relevant variables. In the present study, the overall PFD knowledge score (≥50% cutoff) was used as the primary dependent variable for the main outcome analysis and regression models. Subscale scores were analyzed separately for descriptive and exploratory purposes only. Bivariate and multivariable logistic regression analyses were conducted to assess the association between independent and dependent variables. Variables with a p-value < 0.25 in the bivariate analysis were included in the multivariable logistic regression model. A p-value < 0.05 was considered statistically significant in the multivariable analysis. The Hosmer–Lemeshow goodness-of-fit test (p = 0.389) was used to assess model fitness. Multicollinearity was examined using the variance inflation factor (VIF) and standard errors to identify potential linear associations among independent variables with no collinearity issues. Finally, the findings were presented in narration, tables, and figures.

Ethical Clearance and Consent to Participate

Ethical clearance was obtained from the Institutional Health Research Ethics Review board of Wolkite University (Ref. No. RCSUILC/19031/16 EC). The study was conducted based on the ethical standards of the Declaration of Helsinki. The ethical letter was given to Gurage Zone town, Woredas, and each kebele to initiate the permission process to collect data. The purpose of the study, participants’ right to refuse, confidentiality, and voluntary participation were explained in detail to the study participants, and informed written consent was obtained. Moreover, consent from participants with no formal education was obtained after the information sheet was read aloud in the local language and documented by thumb impression with a witness. Additionally, written informed consent was obtained from the legally authorized representatives of all participants under the age of 18 years before enrollment. Coding was implemented to remove respondents’ names and other personal identifiers throughout the study to ensure participant confidentiality.

Results

From a total of 844 study participants, 835 study participants were enrolled in the study. The results were presented as follows: 835 study participants were interviewed, and gave a response rate of 98.9% and the results were presented.

Socio-Demographic Characteristics of Participants

The mean age of the participants was 44 years (44±16.16 SD). The majority of participants were aged 30–39 years (37.8%), belonged to the Gurage ethnic group (59.9%), and identified as Orthodox Christians (49.7%). Additionally, 20.4% had no formal education, 80.1% were married, and 42.5% were housewives. Regarding socioeconomic characteristics, 30.8% reported a monthly household income of 3000–4999 ETB, and 70.2% resided in rural areas (Table 1).

Table 1.

Socio-Demographic Characteristics of Women Who Participated in the Study in Gurage Zone, Central Ethiopia, in 2024 (n = 835)

Study variable	Category	Frequency	Percent (%)
Age of respondents	15-29	144	17.2
	30-39	316	37.8
	40-49	109	13.1
	50-59	91	10.9
	60-69	90	10.8
	≥70	85	10.2
Ethnicity	Gurage	500	59.9
	Amhara	125	15
	Kabena	110	13.2
	Oromo	56	6.7
	Others*	44	5.2
Religion	Orthodox	415	49.7
	Muslim	336	40.2
	Protestant	84	10.1
Level of Education	No Formal Education	167	20.0
	Primary(1-8)	292	35.0
	Secondary(9-12)	183	21.9
	College and Above	193	23.1
Marital Status	Married	681	81.6
	Single	80	9.6
	Widowed	35	4.2
	Divorced	39	4.7
Occupation	Housewife	355	42.5
	Farmer	232	27.8
	Employee	73	8.7
	Merchant	121	14.5
	Others**	54	6.5
Monthly household income (ETB)	<2000	244	29.2
	2000-2999	171	20.5
	3000-4999	257	30.8
	>5000	163	19.5
Residence	Urban	286	34.3
Residence	Rural	549	65.7

*Others: Students, daily laborer.

**Others: Hadiya and Wolayita; ETB: Ethiopian birr.

Obstetric and Other Characteristics of the Study Participants

In the present study, the prevalence of grand multiparity was 29.1%. Among the participants, 33.1% were married before the age of 18, and 22.8% had their first childbirth before the age of 18. Additionally, 57.5% reported a birth interval of less than two years, and 19.9% had a history of miscarriage (Table 2).

Table 2.

Obstetric Characteristics of Women Who Participated in the Study in Gurage Zone, Central Ethiopia, in 2024 (n = 835)

Study variable	Category	Frequency	Percent (%)
Parity	Nulliparous	106	12.7
	1-4	486	58.2
	≥ 5	243	29.1
Age at 1^st menstruation (in years)	<12	170	20.4
	13-14	416	49.8
	≥15	249	29.8
Age at marriage (in years) n=755	<18	250	33.1
Age at marriage (in years) n=755	≥18	502	66.9
Age at 1^st childbirth (in years) n=729	<18	166	22.8
Age at 1^st childbirth (in years) n=729	≥18	563	77.2
Birth spacing of child (in years) n =729	<2	419	57.5
Birth spacing of child (in years) n =729	≥2	310	42.5
History of miscarriage	Yes	166	19.9
History of miscarriage	No	669	80.1

The Prevalence of Knowledge of Pelvic Floor Disorders

In this study, the magnitude of women’s knowledge of pelvic floor disorders (PFDs) among the study participants was found to be 338 (40.5%; 95% CI: 37.1, 43.7) (Figure 1).

Figure 1.

Magnitude of women’s knowledge of pelvic floor disorders among women in Gurage Zone, Central Ethiopia, 2024 (n = 835)

Domain-specific Women’s Knowledge

Regarding subscale knowledge analysis, 383 participants (45.9%) demonstrated good knowledge of pelvic organ prolapse (POP), while 176 participants (21.1%) demonstrated good knowledge of urinary incontinence (UI), and 489 participants (58.6%) demonstrated good knowledge of fecal incontinence (FI).

Pelvic Floor Disorders Diagnosis and Awareness

The present study revealed that 50.3% of the participants had heard about pelvic floor disorders (PFDs). Among them, 49.5% reported healthcare providers as their main source of information. Awareness of PFDs as medical conditions was 49.3% for fecal incontinence (FI), 60.3% for urinary incontinence (UI), and 70.2% for pelvic organ prolapse (POP). Additionally, 20.1% of participants reported having UI, 31.0% had POP, and 15.2% had FI (Table 3).

Table 3.

Pelvic Floor Disorders Awareness and Diagnosis History of Women Who Participated in the Study in Gurage Zone, Central Ethiopia, in 2024 (n = 835)

Study variable	Category	Frequency	Percent (%)
Have you ever heard of PFD	Yes	420	50.3
Have you ever heard of PFD	No	415	49.7
Sources of information	Health care providers	413	49.5
	Internet	172	20.6
	Television	163	19.5
	Friends	87	10.4
Awareness of Urinary incontinence as a medical condition	Yes	504	60.4
Awareness of Urinary incontinence as a medical condition	No	331	39.6
Ever had a problem with urine leakage (Diagnosis of Urinary Incontinence)	Yes	168	20.1
	No	667	79.9
Awareness of POP as a medical condition	Yes	586	70.2
Awareness of POP as a medical condition	No	249	29.8
Ever had a problem with POP (Diagnosis of POP?	Yes	259	31.0
Ever had a problem with POP (Diagnosis of POP?	No	576	69.0
Awareness of fecal incontinence as a medical condition	Yes	412	49.3
Awareness of fecal incontinence as a medical condition	No	423	50.7
Diagnosis of fecal incontinence	Yes	127	15.2
Diagnosis of fecal incontinence	No	708	84.8

Determinants of Women’s Knowledge of Pelvic Floor Disorders

Bivariate logistic regression analysis was conducted to identify the determinants of the outcome variable. Age of respondents, educational status, miscarriage, residence, parity, PFDs awareness, and diagnosis were selected as candidate variables for multivariate analysis at a p-value less than <0.25. In the multivariable logistic regression analysis, educational status, residence, parity, and PFDs awareness were found to be significantly associated with PFDs knowledge at a p-value of <0.05.

Accordingly, women who had attended college or higher education were 3.28 times more likely to be proficient in PFDs knowledge than those with no formal education (AOR = 3.28; 95% CI: 2.02,7.54). Women in urban areas were about 2.51 times more likely to be proficient in PFDs knowledge compared to women in rural areas (AOR= 2.51; 95% CI: 1.37, 14.03). Multiparous women were 2.43 times more likely (AOR = 2.43; 95% CI: 1.08, 5.47), and grand multiparous women were about 4.21 times more likely (AOR = 4.21, 95% CI: 2.81, 11.1) to be proficient in PFDs knowledge compared to nulliparous women. Women who were aware that pelvic organ prolapse (POP) is a medical condition were 2.91 times more likely to possess knowledge about pelvic floor disorders (PFDs) compared to their counterparts (AOR = 2.91; 95% CI: 1.57,5.40) (Table 4).

Table 4.

Bivariate and Multivariable Analysis of Determinants of Knowledge of PFDs Among Women Who Participated in the Study in Gurage Zone, Central Ethiopia, in 2024 (n = 835)

Study variables	Knowledge of pelvic floor disorders		COR (95% CI)	AOR (95% CI)	P-value
Study variables	Poor	Good	COR (95% CI)	AOR (95% CI)	P-value
Age of respondents
15-29	106	38	1	1
30-39	142	174	3.42 (2.22, 5.26)	2.54 (0.14,12.34)	0.09
40-49	61	48	2.21 (1.29,3.73)	1.32 (0.28,3.68)	0.50
50-59	88	3	0.09 (0.03,0.32)	1.15 (0.07,8.94)	0.91
60-69	55	35	1.78 (1.01, 3.12)	1.28 (0.37, 4.68)	0.45
>70	45	40	2.48 (1.41, 4.36)	0.40 (0.01,3.09)	0.13
Education Status
No Formal Education	97	70	1	1
Primary(1-8)	216	76	0.49 (0.33,0.73)	0.35 (0.14, 2.63)	0.43
Secondary(9-12)	135	48	0.49 (0.37,1.57)	0.21 (0.18, 2.67)	0.14
College and above	49	144	4.07 (1.31,8.05)	3.28 (2.02,7.54)**	0.005
Residence
Rural	408	141	1	1
Urban	89	197	6.40 (1.25, 10.22)	2.51(1.37, 14.03)**	0.03
Parity
Nulliparous	80	26	1	1
1-4	204	282	4.25 (1.14, 7.97)	2.43 (1.08, 5.47)**	0.01
≥ 5	97	146	4.63 (2.13, 9.89)	4.21 (2.81, 8.11)**	0.001
History Miscarriage
No	373	296	1	1
Yes	124	42	0.43 (0.29, 0.63)	0.26 (0.18, 2.73)	0.089
Awareness of UI as a medical condition
No	252	79	1	1
Yes	245	259	3.37 (2.48, 4.59)	0.17 (0.13, 2.59)	0.23
Diagnosis of UI
No	371	296	1	1
Yes	126	42	0.42 (0.29, 0.61)	0.2 (0.14, 1.12)	0.057
Awareness of POP as a medical condition
No	204	45	1	1
Yes	293	293	4.53 (3.16,6.51)	2.91 (1.57,5.40)**	0.002

Note. COR: crude odds ratio, AOR: adjusted odds ratio, 1: Reference.

**Indicates significant association.

Discussions

This is the first study to examine the knowledge of PFDs among Ethiopian women of all ages. The results indicated that 40.5% (95% CI: 37.1, 43.7) of the respondents have good knowledge of pelvic floor disorders (PFDs). This result is lower than that reported in studies conducted in England and Texas, United States, where 45%⁴⁷ and 63%⁴⁸ of the study participants had good knowledge of pelvic floor disorders, respectively. This finding is lower than reports from England and the United States. This difference may be explained by evidence from Ethiopian studies showing generally low awareness and knowledge of pelvic floor disorders and related preventive measures. Recent studies in Ethiopia reported that only about one-third of women have good knowledge of pelvic floor muscle exercises, and overall awareness of pelvic floor conditions remains low. This may be due to limited access to health information, lower educational status, and inadequate integration of pelvic health education into routine maternal care. Furthermore, pelvic floor disorders are often under-recognized and influenced by sociocultural factors and stigma, which may further limit discussion and awareness.^49,50

On the contrary, the results of the present study are higher than those of studies conducted in Connecticut, United States, where only 25.8%⁵¹ of participants showed proficiency in knowledge of pelvic floor disorders (PFDs), and in India, where 15.6%⁵² of participants were found to be proficient in PFD knowledge. The possible justification may stem from differences in study settings and participant socio-demographics. For instance, studies conducted in England and the United States focused on pregnant and postpartum women, who may receive antenatal and postnatal education, whereas our study concentrates on the general female population. Furthermore, the observed difference may be explained by recent improvements in maternal health education in Ethiopia, particularly through antenatal care services and community-based health education programs, which may have contributed to increased awareness of pelvic floor disorders compared to earlier studies conducted in other settings.⁴⁹

In the subscale analysis of pelvic floor disorder (PFD) knowledge, the lowest proficiency score was observed for urinary incontinence (UI) (21%), followed by pelvic organ prolapse (POP), with 45% of respondents demonstrating proficiency in knowledge of POP. This result is consistent with findings from previous studies conducted in Malaysia⁵³ and Baltimore, Maryland, United States, and New Haven County, Connecticut, United States.^41,54 However, the findings of the present study contradict studies conducted in Singapore, South Asia,⁵⁵ Spain,⁵⁶ and Northwest Ethiopia,³⁶ where the majority of participants had adequate knowledge of urinary incontinence (UI). This may be attributed to the normalization of urinary leakage and pelvic organ prolapse, rather than recognition of these conditions as medical disorders. Therefore, raising awareness about the signs, symptoms, treatment, and preventive measures of PFD could enhance knowledge, reduce the risk of developing PFDs, and promote timely healthcare-seeking behavior ⁵¹.

In this study, higher educational status, parity, residence, and awareness of POP as a medical condition were determinants of women’s knowledge of pelvic floor disorders. Women who had attended college or higher education were 3.28 times more likely to be proficient in PFDs knowledge than those with no formal education.

This finding is supported by studies conducted in China,⁵⁷ England,⁴⁷ New Haven County, Connecticut, United States,⁵⁴ Singapore, South Asia,⁵⁵ and Malaysia,⁵³ which indicate that higher education levels are associated with greater proficiency in PFDs. One possible explanation is that women from higher socioeconomic backgrounds tend to have greater health literacy.⁵⁸ Furthermore, a recent study conducted in Ethiopia indicated that as educational status increases, the level of knowledge about pelvic floor disorders and preventive measures, such as pelvic floor exercises, also increases.⁴⁹

Moreover, the present study found a significant association between residency and knowledge about pelvic floor disorders. Women living in urban areas were 2.51 times more likely to be proficient in PFD knowledge compared to those living in rural areas. This finding aligns with studies conducted in China⁵⁷ and Canada,⁵⁹ which showed a positive correlation between urban residency and higher levels of PFDs knowledge among participants. This implies that women living in urban areas may have better access to educational resources and healthcare services that can help them better understand pelvic floor disorders. Consequently, they may be able to recognize their symptoms earlier and seek prompt medical attention, thereby improving their health outcomes. Therefore, PFDs-directed educational campaigns in rural settings may bridge the knowledge awareness gap and promote patient empowerment to seek relevant care. Evidence from sub-Saharan African countries suggests that women residing in urban areas tend to have better health-related knowledge, including awareness of pelvic floor disorders, largely due to improved access to education, media, and healthcare services.²²

Women who were aware of pelvic floor disorders (PFDs) were more knowledgeable about PFDs. Those who knew that pelvic organ prolapse (POP) is a medical condition were 2.91 times more likely to possess knowledge about PFDs compared to their counterparts. This finding is supported by studies conducted in Baltimore, Maryland, United States, and New Haven County, Connecticut, United States^41,54 and China,⁵⁷ which reported that self-reported awareness of POP as a medical condition was the strongest predictor of PFDs knowledge proficiency. Based on this finding, healthcare providers could consider asking women whether they are aware that urinary incontinence (UI), fecal incontinence (FI), and pelvic organ prolapse (POP) are medical conditions with available treatment options, rather than normal parts of aging or childbearing, as part of a basic screening strategy during antenatal care (ANC). If a woman is not aware, healthcare providers can give her a brief explanation of these conditions, provide educational resources, and emphasize that both effective non-surgical and surgical treatments are available. Evidence from Nigeria and Ethiopia indicates that lack of awareness of pelvic floor disorders is strongly associated with poor knowledge and represents a major barrier to both knowledge acquisition and care-seeking.^23,60

Knowledge of pelvic floor disorders was significantly associated with parity. Compared to nulliparous women, multiparous women were 2.43 times more likely to be proficient in PFDs knowledge, while grand multiparous women were nearly 4.21 times more likely to have adequate knowledge of pelvic floor disorders.

The findings of this study are supported by research from Singapore, South Asia,⁵⁵ and Denmark,⁵⁸ which found that multiparous women had better knowledge of PFDs than nulliparous women. Possibly, women may have learned about pelvic floor disorders through antenatal education from a previous pregnancy. Additionally, the previous study conducted in China showed that nulliparous women had a better awareness of PFDs than multiparous women.⁵⁷ This result does not match those observed from this study. This could be because increasing parity does not mean increasing knowledge, since knowledge might be hindered by the need for a mother to pay much attention to child-caring. Moreover, early childbearing age may correlate with lower education level and employment opportunities for women.⁶¹ Therefore, these findings reveal significant gaps in women’s knowledge of pelvic floor disorders in the Gurage Zone of Central Ethiopia. Improving awareness could help reduce maternal morbidity related to PFDs. The study also identified key determinants of knowledge and underscores important policy and health system implications, including strengthening provider training, integrating PFD education into maternal health services, and enhancing community, antenatal, and postnatal health education to improve maternal health outcomes.

Strengths and Limitations of the Study

The study employed a community-based cross-sectional design with a large sample size, enhancing the reliability and representativeness of the findings. Potential biases were minimized through clear objectives, pretested questionnaires, training of data collectors and supervisors, random sampling, and statistical adjustments for confounding variables. Ethical guidelines were followed to ensure unbiased participation. However, several limitations should be acknowledged. Although multistage sampling was used, clustering was not accounted for in the analysis, which may have affected standard errors. The wide confidence interval for urban residence suggests limited precision, likely due to category imbalance and small cell sizes, and should be interpreted cautiously. The study may be subject to social desirability bias, recall bias, cultural stigma affecting self-reporting, and interviewer-administered response bias. In addition, since this is a cross-sectional study, it does not show cause-and-effect relationships.

Conclusions

In the present study, only two in five women were knowledgeable about pelvic floor disorders, which is considered low. Higher educational status, urban residence, awareness of POP as a medical condition, and being multiparous were identified as determinants of women’s knowledge of pelvic floor disorders.

These findings encouraged targeted educational interventions to bridge knowledge gaps, particularly among women with lower educational attainment and those living in rural areas. Increasing awareness through community-based programs and healthcare initiatives could significantly empower women with the essential knowledge needed to prevent, recognize, and manage pelvic floor disorders more effectively.

Recommendations

The following recommendations were given based on the findings to the concerned bodies:

Healthcare Providers

It is encouraged to educate women about PFDs during routine visits, especially those with low education and from rural areas, by using simple and local language.

Gurage Zone Health Bureau

It is better to integrate PFD education into existing maternal and reproductive health programs. Furthermore, launch community-based PFD awareness campaigns targeting rural populations. Moreover, train frontline health workers to deliver PFD information effectively, and prioritize resource allocation for underserved areas.

For Researchers

It is encouraged to evaluate the effectiveness of various educational interventions to increase knowledge of PFDs. Further investigate the impact of knowledge on prevention and care-seeking behavior and apply survey-adjusted analytical methods to improve the precision and robustness of estimates.

Supplemental Material

Supplemental Material - Women’s Knowledge of Pelvic Floor Disorders and Its Determinants in the Gurage Zone, Central Ethiopia: A Community-Based Cross-Sectional Study

Supplemental Material for Women’s Knowledge of Pelvic Floor Disorders and Its Determinants in the Gurage Zone, Central Ethiopia: A Community-Based Cross-Sectional Study by Tolesa Gemeda Gudeta, Ayele Sahile Abdo, Aberash Beyene Derribow, Hirut Dinku Jiru, Ayana Benti Terefe, Girma Teferi Mengistu, Seboka Abebe Sori and Mangistu Abera in INQUIRY: The Journal of Health Care Organization, Provision, and Financing.

Footnotes

Acknowledgments

The authors would like to thank Wolkite University for allowing us to conduct the research and for granting ethical approval. Authors also extend our gratitude to the study participants, data collectors, and the supervisor for their unreserved efforts and willingness to participate in this research study.

ORCID iDs

Hirut Dinku Jiru

Seboka Abebe Sori

Mangistu Abera

Author Contributions

T.G.G, S.A.S, A.B.D, H.D.J, A.S.A, A.B.T, and M.A participated in conception and design, acquisition of data, analysis and interpretation of data, and took part in drafting the article. S.A.S, A.B.D, H.D.J, A.S.A, A.B.T, and M.A participated in the sequence alignment and design of the study and performed the statistical analysis. T.G.G., M.A., and S.A.S conceived the study and participated in its design and coordination, and helped with editing the English language. S.A.S, G.T.M, T.G.G, and M.A critically reviewed and revised the manuscript for important intellectual content and participated in the revision. All authors made substantial contributions to the work, critically reviewed the manuscript, approved the final version for publication, and agree to be accountable for all aspects of the work.

Funding

The authors received no financial support for the research, authorship, and/or publication of this article.

Declaration of Conflicting Interests

The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Data Availability Statement

Data that support the findings are available from the corresponding author upon a reasonable request.*

Supplemental Material

Supplemental material for this article is available online.

Appendix

References

Al-Badr

Saleem

Kaddour

, et al. Prevalence of pelvic floor dysfunction: a Saudi national survey. BMC Women's Health. 2022;22(1):27.

Hong

Ding

. Current treatments for female pelvic floor dysfunctions. Gynecol Minim Invasive Ther. 2019;8(4):143-148.

Haylen

De Ridder

Freeman

, et al. An International Urogynecological Association (IUGA)/International Continence Society (ICS) joint report on the terminology for female pelvic floor dysfunction. Journal of the Association of Chartered Physiotherapists in Women's Health. 2012;110:33.

Martinez-Galiano

Peinado-Molina

Martinez-Vazquez

Hita-Contreras

Delgado-Rodriguez

Hernandez-Martinez

. Influence of pelvic floor disorders on sexuality in women. Int J Gynaecol Obstet. 2024;164(3):1141-1150.

Who

. WHO recommendations on maternal and newborn care for a positive postnatal experience. https://www who int/publications/i/item/9789240045989. 2022.

Parden

Griffin

Hoover

, et al. Prevalence, awareness, and understanding of pelvic floor disorders in adolescent and young women. Female Pelvic Med Reconstr Surg. 2016;22(5):346-354.

Mandimika

Murk

McPencow

, et al. Racial Disparities in knowledge of pelvic floor disorders among community-dwelling women. Female Pelvic Med Reconstr Surg. 2015;21(5):287-292.

Freitas

Bø

Fernandes

ACNL

Uechi

Duarte

Ferreira

CHJ

. Pelvic floor muscle knowledge and relationship with muscle strength in Brazilian women: a cross-sectional study. Int Urogynecol J. 2019;30(11):1903-1909.

Fante

Silva

Mateus-Vasconcelos

ECL

Ferreira

CHJ

Brito

LGO

. Do women have adequate knowledge about pelvic floor dysfunctions? A Systematic Review. Rev Bras Ginecol Obstet. 2019;41(8):508-519.

10.

Neels

Wyndaele

Tjalma

WAA

De Wachter

Wyndaele

Vermandel

. Knowledge of the pelvic floor in nulliparous women. J Phys Ther Sci. 2016;28(5):1524-1533.

11.

Malaekah

al Medbel

al Mowallad

al Asiri

Albadrani

Abdullah

. Prevalence of pelvic floor dysfunction in women in Riyadh, Kingdom of Saudi Arabia: a cross-sectional study. Women’s Health. 2022;18:174550652110722.

12.

Dheresa

Worku

Oljira

Mengiste

Assefa

Berhane

. One in five women suffer from pelvic floor disorders in Kersa district, Eastern Ethiopia: a community-based study. BMC Women's Health. 2018;18(1):95.

13.

Hambisa

Birku

Gedamu

. Magnitude of Symptomatic Pelvic Floor Dysfunction and Associated Factors Amongst Women in Western Ethiopia: A Cross-Sectional Study. Inquiry. 2023;60:469580231171309.

14.

Gyhagen

Åkervall

Milsom

. Clustering of pelvic floor disorders 20 years after one vaginal or one cesarean birth. International Urogynecology Journal. 2015;26(8):1115-1121.

15.

Masenga

Shayo

Rasch

. Prevalence and risk factors for pelvic organ prolapse in Kilimanjaro, Tanzania: A population-based study in a Tanzanian rural community. PloS one. 2018;13(4).

16.

Ghandour

Minassian

Al-Badr

Ghaida

Geagea

Bazi

. Prevalence and degree of bother of pelvic floor disorder symptoms among women from primary care and specialty clinics in Lebanon: an exploratory study. IntUrogynecol J; 2016.

17.

Berhe

Alamer

Negash

Assefa

. Urinary incontinence and associated factors among pregnant women attending antenatal care in public health facilities of Mekelle city, Tigray, Ethiopia. Women's Health. 2020;16:1745506520952009.

18.

Beketie

Tafese

Assefa

, et al. Symptomatic pelvic floor disorders and their associated factors in South-Central Ethiopia. PLoS ONE. 2021;16(7):e0254050.

19.

Datar

Pan

McKinney

Goss

Pulliam

. Healthcare resource use and cost burden of urinary incontinence to United States payers. Neurourol Urodyn. 2022;41(7):1553-1562.

20.

Pant

Pradhan

Aryal

. Risk Profile of Uterovaginal Prolapse. JKAHS. 2018;2:42-46.

21.

Nwafor

Obi

, et al. Knowledge and determinants of postpartum family planning use among postpartum women in Abakaliki, South-East Nigeria. Int J Current Research. 2019;11:3582-3587.

22.

Lee

Negera

Sento

, et al. Pelvic floor disorders and associated factors among women in sub-Saharan Africa: A systematic review and meta-analysis protocol. Plos One. 2025;20(3).

23.

Tennfjord

Kassie

Gashaw

, et al. Pelvic floor disorders and pelvic floor muscle exercise: a survey on knowledge, attitude, and practice among pregnant women in Northwest Ethiopia. International Journal of Environmental Research and Public Health. 2023;20(5):4201.

24.

Negera

Sento

Nenko

, et al. Pelvic floor disorders and associated factors among women in sub-Saharan Africa: A systematic review and meta-analysis protocol. Plos one. 2025;20(3):e0319972.

25.

Zhang

Liu

Yang

Hong

. The causal effect of reproductive factors on pelvic floor dysfunction: a Mendelian randomization study. BMC Women's Health. 2024;24(1):74.

26.

Rodríguez-Almagro

Hernández Martínez

Martínez-Vázquez

Peinado Molina

Bermejo-Cantarero

Martínez-Galiano

. A Qualitative Exploration of the Perceptions of Women Living with Pelvic Floor Disorders and Factors Related to Quality of Life. J Clin Med. 2024;13(7):1896.

27.

Shinkwin

Brown

Scourfield

Cornish

. How Much Knowledge and Awareness of Faecal Incontinence Is There in Primary Care. Surgeries. 2021;2(2):150-156.

28.

Bordeianou

Thorsen

Keller

, et al. The American Society of Colon and Rectal Surgeons clinical practice guidelines for the management of fecal incontinence. Diseases of the Colon & Rectum. 2023;66(5):647-661.

29.

Sung

Washington

Raker

. Costs of ambulatory care related to female pelvic floor disorders in the United States. Am J Obstet Gynecol. 2010;202(5):483-484.

30.

Hallock

Handa

. The Epidemiology of Pelvic Floor Disorders and Childbirth: An Update. Obstet Gynecol Clin North Am. 2016;43(1):1-13.

31.

Geta

Ejigu

Seyoum

, et al. Prevalence and risk factors for pelvic floor disorders in Ethiopian women: Systematic review and meta-analysis. Journal of Endometriosis and Pelvic Pain Disorders. 2024:22840265251343445.

32.

Mostafa

Ahmed

Mohamed

. Women's knowledge and practices regarding urinary incontinence. BMC Public Health. 2025;25(1):3812.

33.

Good

Korbly

Kassis

Society of Gynecologic Surgeons Fellows Pelvic Research Network . Prolapse-related knowledge and attitudes toward the uterus in women with pelvic organ prolapse symptoms. Am J Obstet Gynecol. 2013;209(481):e1-e6.

34.

Howard

Steggall

. Urinary incontinence in women: quality of life and help-seeking. Br J Nurs. 2010;19:748–749.

35.

Wieslander

Alas

Dunivan

, et al. Misconceptions and miscommunication among Spanish-speaking and English_speaking women with pelvic organ prolapse. Int Urogynecol J. 2015;26(4):597-604.

36.

Tennfjord

Kassie

Gashaw

, et al. Pelvic Floor Disorders Survey on Knowledge, Attitude, and Practice among Pregnant Women in Northwest Ethiopia. Int. J. Environ. Res. Public Health. 2023;20:4201.

37.

Hines

Seng

Messer

Raghunathan

Diokno

Sampselle

. Adherence to a behavioral program to prevent incontinence. West J Nurs Res. 2007;29:36-56.

38.

Central Statistical Agency(CSA) . Population and Household Census of Ethiopia; 2007.

39.

Anozie

Nwafor

Esike Chidi

, et al. Knowledge and Associated Factors of Pelvic Organ Prolapse among Women in Ebonyi State, Nigeria. Journal of Women’s Health and Development. 2020;3:101-113.

40.

Singh

Lama

Maharjan

. Knowledge on risk factors of uterine prolapse among reproductive age group women of Bajrabarahi Municipality of Lalitpur, Nepal. Int J Reprod Contracept Obstet Gynecol. 2016;5:3343-3348.

41.

Chen . Knowledge of pelvic floor disorders in women seeking primary care: a cross-sectional study. BMC Family Practice. 2019;20:70.

42.

Shetty

Rodrigues

Thomas

. Assessment of the knowledge of urinary incontinence and pelvic organ prolapse in postpartum women-A cross-sectional study. Pelviperineology: A Multidisciplinary Pelvic Floor Journal. 2024.

43.

Szatmári

Makai

Prémusz

, et al. Hungarian women’s health care seeking behavior and knowledge of urinary incontinence and pelvic organ prolapse: a cross-sectional study. Urogynecology. 2023;29(11):907-913.

44.

Shah

Massagli

Kohli

Rajan

Braaten

Hoyte

. A reliable, valid instrument to assess patient knowledge about urinary incontinence and pelvic organ prolapse. Int. Urogynecol. J. Pelvic Floor Dysfunct. 2008;19:1283-1289.

45.

Mandimika

. Knowledge of urinary incontinence and pelvic organ prolapse in community-dwelling women; 2014.

46.

Von

Altman

Egger

Pocock

Gøtzsche

Vandenbroucke

. The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement: guidelines for reporting observational studies. The Lancet. 2007;370(9596):1453-1457.

47.

O'Neill

Hockey

O'Brien

, et al. Knowledge of pelvic floor problems: a study of third-trimester, primiparous women. Int Urogynecol J. 2017;28(1):125-129. doi:10.1007/s00192-016-3087-4. Epub 2016 Aug 10. PMID: 27511379.

48.

Stewart Nv

Redmon

Nguyen

Jackson

Lee

Kilic

. Knowledge of pelvic floor disorders and pelvic floor exercises among reproductive-aged women: a cross-sectional study. 2022;226(3).

49.

Senbeta

Derribow

Belay

Terefe

Abera

. Pelvic floor muscle exercise practice and its determinants among postpartum women in Central Ethiopia: as a strategy for preventing pelvic floor disorders. Scientific Reports. 2025;15(1):42129.

50.

Keno

Hassen

Hiwot

Tirkena

Negesa

Mizana

. Antenatal pelvic floor muscle exercises knowledge and practice in Ethiopia: a cross-sectional study in Jimma Zone public hospitals. BMC Pregnancy and Childbirth. 2026.

51.

McKay

Lundsberg

Miller

, et al. Knowledge of Pelvic Floor Disorders in Obstetrics. Female Pelvic Med. Reconstr. Surg. 2019;25:419-425.

52.

Arati

MZP

. Knowledge and Awareness of Pelvic Floor Disorders and Rehabilitation in Postpartum Women: An Observational Study. Thieme Medical and Scientific Publishers. 2024;9(3):1-5.

53.

Mukhtar Nur Farihan BKN Phon

Azlin

MIN

Azurah

AGN

Lim

. Prevalence, Knowledge, and Awareness of Pelvic Floor Disorder among Pregnant Women in a Tertiary Centre, Malaysia. nt J Environ Res Public Health. 2022(1-11).

54.

Mandimika

Murk

Mühlhäuser McPencow

, et al. Knowledge of pelvic floor disorders in a population of community-dwelling women. Am J Obstet Gynecol. 2014;210:165.

55.

Liu

Tan

Han

. Knowledge of pelvic floor disorders in pregnancy. Int Urogynecol J. 2019;30(6):991-1001. doi:10.1007/s00192-019-03891-3. Epub 2019 Feb 19. PMID: 30783706.

56.

Elisa

B-DEVM

Juan

CF-D

González-Trujillo

Andreu

S-M

Natalia

R-F

. Symptomatology and knowledge regarding pelvic floor dysfunctions and the influence of gender stereotypes in female athletes. Scientific Reports. 2024;14:1-9.

57.

Zheng

Chen

Liu

Dai

. Knowledge, attitudes, and practice of pelvic floor dysfunction and pelvic floor among women of childbearing age in Sichuan, China. Front Public Health. 2023;11:1-11.

58.

Svendsen

Bak

Sorensen

, et al. Associations of health literacy with socioeconomic position, health risk behavior, and health status: a large national population-based survey among Danish adults. BMC Public Health. 2020;20:565. doi:10.1186/s12889-020-08498-8.

59.

Roa

Kent

Yaskina

Schulz

Poirier

. Knowledge of pelvic floor disorders amongst immigrant women in Canada. Int Urogynecol J. 2021;32(11):3077-3084. doi:10.1007/s00192-020-04662-1. Epub 2021 Feb 23. PMID: 33620531.

60.

Akobundu

Onuzulu

Obiekwe

, et al. Prevalence of urinary incontinence and knowledge of pelvic floor muscle training among older women in a Nigerian suburban community. Women's Health (Lond). 2024;20:17455057241276255.

61.

Khan

Khanam

Khan

MMA

Billah

Akter

. Exploring the impact of perceived early marriage on women’s education and employment in Bangladesh through a mixed-methods study. Scientific Reports. 2024;14(1):21683.

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