Pelvic Floor Symptoms Research Articles

Female Sexual Dysfunctions Related to Pain: When and How to Treat Pelvic Floor Symptoms

Female Sexual Dysfunctions Related to Pain: When and How to Treat Pelvic Floor Symptoms

Development and Validation of a Questionnaire for the Assessment of Pelvic Floor Disorders and Their Risk Factors During Pregnancy and Post Partum.

Introduction The aim of this study was to develop and validate a questionnaire for the assessment of pelvic floor disorders, their symptoms and risk factors in pregnancy and after birth including symptom course, severity and impact on quality of life. Methods The validated German pelvic floor questionnaire was modified and a new risk factor domain developed. The questionnaire was initially completed by 233 nulliparous women in the third trimester of pregnancy and at six weeks (n = 148) and one year (n = 120) post partum. Full pyschometric testing was performed. The clinical course of symptoms and the influence of risk factors were analysed. Results Study participants had a median age of 31 (19-46) years. 63 % had spontaneous vaginal deliveries, 15 % operative vaginal deliveries and 22 % were delivered by caesarean section. Content validity: Missing answers never exceeded 4 %. Construct validity: The questionnaire distinguished significantly between women who reported bothersome symptoms and those who did not. Reliability: Cronbach's alpha values exceeded 0.7 for bladder, bowel and support function, and 0.65 for sexual function. The test-retest analysis showed moderate to almost complete concordance. The intraclass coefficients for domain scores (between 0.732 and 0.818) were in acceptable to optimal range. Reactivity: The questionnaire was able to track changes significantly with good effect size for each domain. Risk factors for pelvic floor symptoms included familial predisposition, maternal age over 35 years, BMI above 25, nicotine abuse, subjective inability to voluntarily contract the pelvic floor musculature and postpartum wound pain. Conclusion This pelvic floor questionnaire proved to be valid, reliable and reactive for the assessment of pelvic floor disorders, their risk factors, incidence and impact on quality of life during pregnancy and post partum. The questionnaire can be utilised to assess the course of symptoms and treatment effects using a scoring system.

Pelvic floor symptoms and quality of life changes during first pregnancy: a prospective cohort study.

We describe pelvic floor function in nulliparous pregnant women. Nulliparous midwifery patients completed the Incontinence Severity Index (ISI), Pelvic Floor Impact Questionnaire (PFIQ-7), Wexner Fecal Incontinence Scale (W), and answered questions about sexual activity and perineal pain at baseline during the first (T1), second (T2), or third trimester (T3) and repeated in late T3. They also underwent a Pelvic Organ Prolapse Quantification (POP-Q) exam at their baseline visit. Data were compared across trimesters. Analysis of variance (ANOVA) and logistic regression accounted for repeated measures and was controlled for age and education. We recruited 627 women. In T1, 124 women gave baseline data and completed questionnaires; in T2, 403; and in early T3, 96 (496 repeated questionnaires in later T3). Besides an increase in genital hiatus and perineal body (all adjusted p<.05), physical exam measures did not differ between trimesters. As pregnancy progressed, urinary incontinence (UI) (T1=33, T2=44, T3=69% women with ISI >0, all comparisons p<.02) and Incontinence Impact Questionnaire (IIQ-7) scores increased. Fecal incontinence (FI) increased (T1=8, T2=15, T3=16% from T2 to T3, p=.04); the Colorectal-Anal Impact Questionnaire (CRAIQ-7) scores did not. Perineal pain increased (T1=17, T2=18 and T3=40%, all adjusted p<.001), and sexual activity decreased (T1=94, T2=90, T3=77% sexually active, T1 vs T3 and T2 vs T3, p<.001) as pregnancy progressed. During pregnancy, women experience worsening UI, FI, and perineal pain. UI symptoms are associated with a negative impact on quality of life (QoL). Sexual activity decreased and POP-Q stage did not change.

3D/4D ultrasound findings compared to pelvic floor symptoms in women diagnosed with obstetric anal sphincter tear

3D/4D ultrasound findings compared to pelvic floor symptoms in women diagnosed with obstetric anal sphincter tear

Is the hymen a suitable cut-off point for clinically relevant pelvic organ prolapse?

ObjectivesThe primary objective was to evaluate the ability of different anatomic cut-off points, as established in specialist urogynecology populations, to identify clinically relevant prolapse in a population of postmenopausal women with pelvic floor symptoms recruited from primary care. Study designCross-sectional study among 890 women (≥55 years) screened for pelvic floor symptoms. Main outcome measuresThe Pelvic Floor Distress Inventory 20 was used to measure symptoms, and the Pelvic Organ Prolapse Quantification (POP-Q) system was used to assess prolapse. Areas under the curves, sensitivity, and specificity were calculated for the hymen as a cut-off point for symptomatic prolapse of the anterior and posterior vaginal wall. For the apical compartment, a cut-off point of −5cm relative to the hymen was used. ResultsVaginal bulging was the only symptom reported more often with increasing POP-Q stages. Areas under the curves (95% confidence intervals) to discriminate between women with and without vaginal bulging symptoms were 0.66 (0.61–0.72), 0.56 (0.50–0.63), and 0.61 (0.55–0.66) for the anterior (Ba), posterior (Bp) and apical (C) compartment, respectively. When the hymen was used as the cut-off point, Ba had a sensitivity of 38.1% and a specificity of 82.4%, and Bp had a sensitivity of 13.3% and a specificity of 96.5%. For C, the cut-off point of −5cm relative to the hymen had a sensitivity of 37.9% and a specificity of 73.1%. ConclusionsThe anatomic cut-off points for clinically relevant prolapse established in the specialist urogynecology population cannot adequately identify symptomatic prolapse in a population of postmenopausal women with pelvic floor symptoms recruited from primary care.

Does Stage of Pelvic Organ Prolapse Affect Female Sexual Functions? A Retrospective Study

ABSTRACTObjectives: The objective of this study was to investigate the effect of pelvic organ prolapse stage on sexual function in women. Methods: Prolapse stages, muscle strength, sexual function, and pelvic floor symptoms were assessed by Pelvic Organ Prolapse Quantification, by vaginal pressure measurement, by the Pelvic Organ Prolapse/Urinary Incontinence Sexual Function Questionnaire (PISQ-12), and the Pelvic Floor Distress Inventory-20 (PFDI-20), respectively. Results: There was no difference between pelvic floor muscle strength, PISQ-12 subscales and PISQ-12 total scores based on prolapse stages (p > 0.05). When the Pelvic Organ Prolapse Distress Inventory and PFDI-20 scores of the women with stage 3/4 prolapse were compared with Stage 1 and Stage 2, there was a difference found between them (p < 0.001). Conclusions: Sexual function and muscular strength were not affected by prolapse stages.

Norwegian translation, and validation, of the Pelvic Floor Distress Inventory (PFDI-20) and the Pelvic Floor Impact Questionnaire (PFIQ-7).

The goal was to translate into Norwegian, and validate, short versions of the Pelvic Floor Distress Inventory (PFDI-20) and the Pelvic Floor Impact Questionnaire (PFIQ-7) using a sample of women with symptomatic pelvic organ prolapse and pelvic floor dysfunction. Modified European Organization for Research and Treatment of Cancer Guidelines were used for translation and cultural adaptation. Of 212 eligible Norwegian women who consented to participate, 205 completed the questionnaires, of whom 50 were retested after 1-3weeks, and 76 were tested 6months after surgery. Reliability, validity and responsiveness were evaluated. Additionally, interpretability, the smallest detectable change, the standard error of measurement, floor and ceiling effects, and the percentages of missing items are reported. Reliability ranged from 0.66 to 0.93 and intraclass correlation coefficients from 0.85 to 0.94. Both construct validity and responsiveness were found to be adequate. The responsiveness of the PFDI-20 was further supported by areas under the curve above 0.70. Estimates were lower for the PFIQ-7. The smallest detectable changes at the individual level were 15-21% and 17-27% for the PFDI-20 and PFIQ-7, respectively. The absolute values of the minimal important changes in the total scores were 48 and 47, respectively. No floor or ceiling effects were evident in the distributions of the PFDI-20 and PFIQ-7 total scores. The translated questionnaires provided adequate reliability, validity and good responsiveness to change. These short versions of the PFDI and PFIQ are robust measuring instruments that will enable symptom severity and health-related quality of life to be evaluated in the Norwegian context.

Physical and cultural determinants of postpartum pelvic floor support and symptoms following vaginal delivery: a protocol for a mixed-methods prospective cohort study

IntroductionPelvic floor disorders (PFDs), including pelvic organ prolapse (POP), stress and urgency urinary incontinence, and faecal incontinence, are common and arise from loss of pelvic support. Although severe disease often...

Application of a Mixed Material Graft to Posterior Intravaginal Slingoplasty Procedure: Preliminary Pilot Series.

Good anatomic outcomes have been achieved with transvaginal synthetic materials in pelvic organ prolapse, but mesh-related complications are a major health concern. Therefore, developing new synthetic or biological materials with increased tissue strength and decreased complications are major challenges. This paper presents preliminary pilot series of Posterior Intravaginal Slingoplasty (PIVS) procedure performed with mixed material graft containing both autologous tissue and a synthetic material. Six women with symptomatic Utero-Vaginal Prolapse (UVP) ≥ stage 2 underwent the PIVS procedure. Pelvic floor symptoms were assessed with the Pelvic Organ Prolapse Quantification (POP-Q) system, Pelvic Floor Distress Inventory (PFDI), and the Pelvic Floor Impact Questionnaire (PFIQ) both before the procedure and 36 months after the surgery. There were no mesh-related complications or recurrence and all the patients had good functional and anatomic outcomes. These preliminary results are promising, but further long-term studies with a larger series are needed.

Comparison of sexual function between sacrocolpopexy and sacrocervicopexy.

ObjectiveTo compare sexual function before and 12 months after between sacrocolpopexy and sacrocervicopexy.MethodsThis retrospective study examined a cohort of 55 sexually active women who underwent either supracervical hysterectomy with sacrocervicopexy (n=28) or total abdominal hysterectomy with sacrocolpopexy (n=27) for stage II to IV pelvic organ prolapse. Pelvic floor support was measured with Pelvic Organ Prolapse-Quantification examination. Pelvic floor function was measured with the Pelvic Floor Distress Inventory-Short Form 20 and sexual function was measured with Pelvic Organ Prolapse/Urinary Incontinence Sexual Function Questionnaire-Short Form 12 (PISQ-12).ResultsBaseline pelvic floor symptoms, demographics and PISQ-12 questionnaire scores were similar between the two groups. Overall improvements in sexual function were seen based on PISQ-12 scores in both groups, but were not statistically significant. No differences were seen in PISQ-12 scores regardless of sparing the cervix or surgical route. Responses to the PISQ-12 question of avoiding sexual intercourse because of vaginal bulging showed significant improvement in both group. No recurrences of prolapse occurred.ConclusionIn women with pelvic organ prolapse, sexual function after either sacrocolpopexy or sacrocervicopexy was not different. Sexual dysfunction in terms of avoidance of sexual activity because of vaginal bulging was greatly improved in both groups with statistical significance.

Prevalence of Symptomatic Pelvic Floor Disorders among Japanese Women

Objective: There is little epidemiological data regarding pelvic organ prolapse (POP) in Japan, despite it being recognized as a disease can be treated in the outpatient or inpatient settings. Our aim was to estimate the prevalence of symptomatic POP among Japanese women. Methods: This cross-sectional study evaluated 8,407 randomly selected women (20-90 years old) who were employed at the Japanese Agriculture Group. Trained research assistants distributed a Japanese self-administered questionnaire that was specifically designed for this study. The participants were asked to provide information regarding their demographic characteristics and symptoms of POP or urinary incontinence (UI). The potential risk factors included age, body mass index, self-reported conditions or comorbid diseases, parity, heavy lifting at work, perceived health status, and occupation. Results: The weighted prevalence of POP was 5.64% (95% Cl: 5.15-6.13%), the prevalence of UI was 44.25% (95% CI: 43.19-45.31%), and at least one pelvic floor disorder was reported by 46.15% of the women (95% Cl: 45.09-47.22%). The proportion of women who reported having symptomatic POP generally increased with age and peaked at the age of 70-79 years (20-29 years old: 0.86%, 30-39 years old: 3.45%, 40-49 years old: 3.59%, 50-59 years old: 5.79%, 60-69 years old: 6.12%, 70-79 years old: 6.27%, and ≥80 years old: 5.37%; p<0.001). Conclusion: The present study provided the first population-based estimate of the prevalence of POP among Japanese women. The prevalence of symptomatic POP increased with age and peaked at 70–79 years. Approximately half of adult Japanese women reported experiencing symptoms of at least one pelvic floor disorder (POP and/or UI).

Pelvic Symptoms, Body Image, and Regret after LeFort Colpocleisis: A Long-Term Follow-Up

Study ObjectiveTo evaluate the impact of LeFort colpocleisis on body image, regret, and pelvic floor symptoms long-term after surgery. DesignRetrospective study (Canadian Task Force classification II-2). SettingTertiary university-affiliated hospital. PatientsBetween April 2011 and April 2015, 334 patients underwent LeFort colpocleisis. InterventionLeFort colpocleisis. Measurement and Main ResultsPatient characteristics (e.g., age, body mass index, parity, blood loss, and length of operation), comorbidities, and complications were obtained from medical records. The Chinese version of the Pelvic Floor Distress Inventory Questionnaire (PFDI-20) was used to evaluate self-perceived quality of life. A modified body image scale was used to assess self-image. Regret was assessed by the following question: “Do you regret choosing to undergo colpocleisis for pelvic organ prolapse (yes or no)?” In total, 278 women responded and were considered for statistical evaluation. Of these women, 234 (84%) had at least 1 comorbid condition. After a median 3-year follow-up (range, 1.5–4.5), only 1 woman had experienced recurrent prolapse and required a second surgery. The mean and total body image scores improved significantly from preoperation (p < .001). Approximately 97% of the patients were satisfied with their decision to undergo surgery, and none of the patients regretted their decision. Pelvic symptoms improved significantly from baseline (i.e., preoperation) to follow-up according to the following measures: PFDI-20, 67.5 ± 23.1 versus 23.8 ± 15.0 (p < .001); Pelvic Organ Prolapse Distress Inventory-6, 33.2 ± 19.6 versus 11.4 ± 10.6 (p < .001); Colorectal-Anal Distress Inventory-8, 10.8 ± 10.3 versus 3.6 ± 5.3 (p < .001); and Urinary Distress Inventory-6, 23.5 ± 18.5 versus 8.8 ± 9.7 (p < .001). ConclusionsLeFort colpocleisis is a highly effective surgical treatment option for pelvic organ prolapse that improves both pelvic floor symptoms and body image. The high satisfaction and low regret in the long term after surgery indicate that LeFort colpocleisis is an excellent option for appropriate patients.

Effectiveness and cost-effectiveness of pessary treatment compared with pelvic floor muscle training in older women with pelvic organ prolapse: 2-year follow-up of a randomized controlled trial in primary care.

We investigated the effectiveness and cost-effectiveness of pessary treatment compared with pelvic floor muscle training (PFMT) in women with pelvic organ prolapse over a 2-year period. Randomized controlled trial with women (≥55 y) with symptomatic pelvic organ prolapse, identified by screening. Participants were recruited from 20 primary care practices (October 2009-December 2012). Primary outcome was the difference in change of pelvic floor symptoms (PFDI-20 score) between groups over 24 months. Secondary outcomes included prolapse, urinary, and anorectal symptoms; quality of life; costs; sexual functioning; prolapse stage; pelvic floor muscle function; and participants' perceived symptom improvement. There was a nonsignificant difference in the primary outcome between pessary treatment (n = 82) and PFMT (n = 80) with a mean difference of -3.7 points (95% CI, -12.8 to 5.3; P = 0.42) in favor of pessary treatment. A significantly greater improvement in the prolapse symptom score was, however, seen with pessary treatment (mean difference -3.2 points [95% CI, -6.3 to -0.0; P = 0.05]). Direct medical costs over the 2-year study were $309 and $437 per person for pessary treatment and PFMT, respectively. In older women with symptomatic prolapse, there was no significant difference between pessary treatment and PFMT in reducing pelvic floor symptoms, but specific prolapse-related symptoms did improve more with pessary treatment. Pessary treatment was preferable in the cost-effectiveness analysis. When counseling women for prolapse treatment it should, however, be taken into account that pessary fitting fails in a considerable portion of women and that pessary treatment was associated with more side effects compared with PFMT.

Hypoactive sexual desire dysfunction in community-dwelling older women.

To determine the prevalence of hypoactive sexual desire dysfunction (HSDD) and its associated factors in women aged 65 to 79 years. A questionnaire-based, cross-sectional study was conducted amongst community-dwelling older women. Participants were recruited between April and August 2014 from a national database based on electoral rolls. Sexual function and sexual distress were assessed by the Female Sexual Function Index and the Female Sexual Distress Scale-Revised, respectively. HSDD was defined as the presence of both low sexual desire and sexually related personal distress. The mean ± SD age of the 1,548 women was 71 ± 3.4 years and 52.6% were partnered. Among the participants, 88.0% (95% confidence interval [CI], 86.3%-89.6%) had low sexual desire, 15.5% (95% CI, 13.8%-17.4%) had sexually related personal distress, and 13.6% (95% CI, 11.9%-15.4%) had HSDD. The HSDD was more common among partnered than among unpartnered women (23.7% vs 5.9%; P < 0.001). Being partnered (adjusted odds ratio [AOR] = 4.21; 95% CI, 2.50-7.07), having vaginal dryness during intercourse (AOR = 2.37; 95% CI, 1.58-3.55), having symptomatic pelvic floor dysfunction (AOR = 1.92; 95% CI, 1.29-2.92), and having moderate-to-severe depressive symptoms (AOR = 4.15; 95% CI, 2.16-7.96) were independently associated with having HSDD. In a subanalysis, HSDD was more common among sexually active than sexually inactive women (31.5% vs 17.3%; P < 0.001). Furthermore, 32% (95% CI, 27.7%-38.3%) of partnered sexually active women had HSDD, as did 22% (95% CI, 11.5%-37.8%) of unpartnered sexually active women. HSDD is common and associated with potentially modifiable risk factors in older women. It should not be assumed that unpartnered older women are sexually inactive or are not distressed by low sexual desire.

Barriers to urogynecological care in a population of gynecological oncology patients.

The objective was to identify barriers to urogynecological evaluation in a population of new patients presenting to a gynecological oncology practice with symptoms of pelvic floor dysfunction. A pelvic floor dysfunction screening questionnaire was given to new patients presenting to a university-based gynecological oncology practice between 1 August 2010 and 31 August 2012. Patients indicating symptoms related to pelvic floor dysfunction in the survey were offered urogynecological evaluations. Charts of those patients declining further evaluation were reviewed. Results of the pelvic floor dysfunction questionnaires were assessed. Reasons provided for not desiring further evaluation were extracted from the questionnaire and stratified. A total of 549 surveys were reviewed. Two hundred and thirty-six patients (42.0%) of the patients surveyed reported being bothered by pelvic floor dysfunction symptoms. Only 6.7% (16 out of 236) wanted a referral for an urogynecological evaluation; 93.2% declined an evaluation. Of patients reporting moderate to severe bother from pelvic floor symptoms, the most frequently cited barrier to care was feeling overwhelmed with the current medical situation (28%). Other reasons for declining an urogynecological evaluation included a previous evaluation (14%), financial concerns (6.9%), and believing that oncological treatment would cure pelvic floor symptoms (6%). Quality of life after cancer treatment is important. The ability to provide treatment for gynecological cancer and pelvic floor disorders concomitantly has the potential to improve the quality of life in this patient population. Understanding barriers to care of gynecological oncology patients seeking evaluation for conditions affecting their quality of life is essential in alleviating fears, preventing misconceptions, and for making informed decisions.

Colpoteres suspension procedure: an alternative Graft Colpopexy

Colpoteres suspension procedure: an alternative Graft Colpopexy

The Effect of Perineal Lacerations on Pelvic Floor Function and Anatomy at 6 Months Postpartum in a Prospective Cohort of Nulliparous Women.

To determine the effect of perineal lacerations on pelvic floor outcomes, including urinary and anal incontinence, sexual function, and perineal pain in a nulliparous cohort with low incidence of episiotomy. Nulliparous women were prospectively recruited from a midwifery practice. Pelvic floor symptoms were assessed with validated questionnaires, physical examination, and objective measures in pregnancy and 6 months postpartum. Two trauma groups were compared, those with an intact perineum or only 1st degree lacerations and those with second-, third-, or fourth-degree lacerations. Four hundred and forty-eight women had vaginal deliveries. One hundred and fifty-one sustained second-degree or deeper perineal trauma and 297 had an intact perineum or minor trauma. Three hundred and thirty-six (74.8%) presented for 6-month follow-up. Perineal trauma was not associated with urinary or fecal incontinence, decreased sexual activity, perineal pain, or pelvic organ prolapse. Women with trauma had similar rates of sexual activity; however, they had slightly lower sexual function scores (27.3 vs 29.1). Objective measures of pelvic floor strength, rectal tone, urinary incontinence, and perineal anatomy were equivalent. The subgroup of women with deeper (> 2 centimeter) perineal trauma demonstrated increased likelihood of perineal pain (15.5% vs 6.2%) and weaker pelvic floor muscle strength (61.0% vs 44.3%) compared with women with more superficial trauma. Women having second-degree lacerations are not at increased risk for pelvic floor dysfunction other than increased pain, and slightly lower sexual function scores at 6 months postpartum.

The Australian Pelvic Floor Questionnaire is a valid measure of pelvic floor symptoms in patients following surgery for colorectal cancer.

This study evaluated the construct validity of the Australian Pelvic Floor Questionnaire against two alternative measures of the severity of bladder and bowel symptoms. This was an exploratory analysis of data from two prospective studies. Patients who had undergone surgery for colorectal cancer were analysed. Bladder and bowel symptoms were measured using three validated questionnaires: the Australian Pelvic Floor Questionnaire, the International Consultation on Incontinence Questionnaire Short Form Questionnaire for urinary incontinence and the International Consultation on Incontinence Questionnaire-Bowel Module post-cancer treatment. The study sample consisted of 44 participants, including 25 men and 19 women. The Australian Pelvic Floor Questionnaire bladder and bowel domain scores demonstrated moderate positive correlations with the International Consultation on Incontinence Questionnaire Short Form Questionnaire for urinary incontinence (r = 0.74, P < 0.01) and the International Consultation on Incontinence Questionnaire-Bowel Module (r = 0.69-0.78, P < 0.01). Similar results were obtained in each gender subgroup. This study suggested that the Australian Pelvic Floor Questionnaire may be a valid measurement tool for use in colorectal cancer populations in clinical trials and practice. Future research using larger cohorts is warranted.

The prevalence of symptomatic pelvic floor disorders in women in Bangladesh

Objective: To investigate the prevalence of, and risk factors for, pelvic floor disorders (PFDs) in women in Bangladesh.Methods: A nationally representative sample of 1590 Bangladeshi women, aged 30–59 years, was recruited using a multistage cluster sampling technique, between September 2013 and March 2014. Urinary incontinence (UI), fecal incontinence (FI) and pelvic organ prolapse (POP) were assessed using validated questionnaires. The weighted prevalence and the factors associated with each PFD were investigated using multivariable weighted logistic regression.Results: The weighted prevalence of UI was 23.7% (95% confidence interval (CI) 21.3–26.0%), FI 5.3% (95% CI 4.0–6.6%), POP 16.2% (95% CI 14.2–18.2%), and having at least one PFD 35.3% (95% CI 32.6–37.9%). Women were more likely to have at least one PFD if aged 40–49 years (adjusted odds ratio (AOR) 1.46, 95% CI 1.02–2.08; p = 0.040) or 50–59 years (AOR 2.39, 95% CI 1.59–3.58; p < 0.0001), compared with women aged 30–39 years. Having at least one PFD was positively associated with having three or more versus fewer children (AOR 1.61, 95% CI 1.14–2.27; p = 0.007), being in the middle (AOR 3.05, 95% CI 1.72–5.41; p < 0.0001), second lowest (AOR 2.49, 95% CI 1.39–4.47; p = 0.002) or lowest (AOR 3.13, 95% CI 1.68–5.86; p < 0.0001) wealth quintile compared with the highest, and self-reporting diabetes (AOR 2.55, 95% CI 1.54–4.23; p < 0.0001).Conclusions: One-third of Bangladeshi women aged 30–59 years had at least one symptomatic PFD. Risk factors included greater age, higher parity, lower wealth status and self-reported diabetes. The diagnosis, treatment, and prevention of PFDs in Bangladesh need greater attention, as the prevalence of these disabling conditions is likely to increase with the aging of the population.

Minimal important change in the pelvic floor distress inventory-20 among women opting for conservative prolapse treatment

The Pelvic Floor Distress Inventory-20 is used to evaluate symptoms and treatment effects in women with pelvic floor disorders. To interpret changes in the scores of this inventory, information is needed about what patients and clinicians perceive as the minimal important (meaningful) change. Although this change in the inventory score has been investigated previously in women who have undergone pelvic floor surgery, the results could not be generalized to women with milder symptoms (ie, lower scores) who often require only conservative treatment. We aimed to estimate the minimal important change in the Pelvic Floor Distress Inventory-20 that was needed to demonstrate clinical improvement in women who qualify for conservative pelvic floor treatment. The data of 214 women aged ≥55 years were used. All participants were from 2 randomized controlled trials that compared conservative prolapse treatments in primary care in The Netherlands. The degree of prolapse was assessed with the use of the Pelvic Organ Prolapse Quantification system; participants completed the Pelvic Floor Distress Inventory-20 at baseline and at 12 months, with a global perception of improvement question at 12 months. To assess both the patient perspective and the clinical perspective, 2 anchors were assessed: (1) the global perception of improvement was considered the anchor for the patients' perspective, and (2) the difference in the degree of prolapse was considered the anchor for the clinical perspective. Provided that the anchors were correlated by at least 0.3 to the Pelvic Floor Distress Inventory-20 change scores, we estimated the following minimal important changes: (1) the optimal cutoff-point of the receiver operating characteristics curve that discriminates between women with and without improvement in the global perception of improvement scale and (2) the mean Pelvic Floor Distress Inventory-20 change score of participants who improved 1 assessment stage. We then calculated the smallest detectable change to check whether the minimal important change was larger than the measurement error of the questionnaire. Using the global perception of improvement as the anchor, we found a minimal important change for improvement of 13.5 points (95% confidence interval, 6.2-20.9). The Pelvic Organ Prolapse Quantification change scores correlated poorly to the Pelvic Floor Distress Inventory-20 change scores and therefore could not be used as an anchor. The smallest detectable change at the group level was 5.5 points. Thus, the minimal important change was larger than the smallest detectable change at the group level. In women with relatively mild pelvic floor symptoms, an improvement of 13.5 points (or a 23% reduction) in the Pelvic Floor Distress Inventory-20 score can be considered clinically relevant. This minimal important change can be used for clinical trial planning and evaluation of treatment effects in women whose condition is considered suitable for conservative treatment.