(1) To describe participation in a study pilot-testing a continence self-management website, including demographics, symptoms, and website engagement 
(2) To describe changes in symptoms, behaviors, and condition severity from baseline to 4-month follow-up among participants who provided baseline and follow-up data

An email to female employees age >50 at a large US Midwest university invited women to pilot-test a continence self-management website. Women completed electronic questionnaires at baseline and 4 months; no incentives were provided for participation. At baseline, participants provided information about demographics, current bladder and bowel symptoms and related behaviors (fluid intake, fiber intake, pelvic floor muscle exercises, pad use). Similar information was assessed at 4 months, as well as the global ratings of patient satisfaction and perceptions of improvement with treatment (1). The International Consultation on Incontinence – Urinary Incontinence Short Form (ICIQ-UI) (2) and the Vaizey Incontinence Questionnaire (3) described bladder and bowel incontinence severity and impact. 

Google Analytics captured data about time spent on the continence website, number of webpages visited within the website, and device(s) used to access the website. 

Descriptive analyses evaluated respondents’ demographics, bowel and bladder symptoms, behaviors, symptom severity, and website utilization and compared those who did and did not provide follow-up data using Chi-square testing for categorical variables and t-testing or Mann-Whitney U testing for continuous variables. Among participants who provided both baseline and follow-up data, changes in bowel and bladder symptoms, behaviors, and symptom severity of women from baseline to 4 months were described using Mc-Nemar’s test for categorical variables and paired t-tests or Wilcoxon Signed Rank Test for continuous variables. A p-value ≤ .05 was considered significant.

Among 3,647 valid emails sent, 260 women completed the baseline survey and 111 provided 4-month follow-up data. Overall, respondents were predominately white and highly educated, and approximately two-thirds had incontinence (Table 1). Those who did and did not provide follow-up data did not differ significantly in demographics, baseline symptoms and behaviors, or website utilization patterns. 

For the 233 (90%) women for whom Google Analytics data were available, time spent on the website ranged from 0 to 269 minutes (median 5.2 minutes) and number of pages visited ranged from 1 to 172 (median 3). Just over one-third (86, 37%) visited a single webpage within the website; 69 (30%) visited 2-6 webpages, and 78 (33%) visited more than 6 pages, suggesting that they advanced beyond the program introduction. Similarly, 88 (38%) spent fewer than 3 minutes total on the website; 76 (33%) 3 - 12 minutes, and 69 (30%) more than 12 minutes. 

Table 2 presents changes from baseline to four months in bowel and bladder symptoms, behaviors and symptom severity among women who provided follow-up data. There were statistically significant changes in the proportion who reported doing pelvic floor muscle exercises often or always (8% to 28%) and in median Vaizey score (median remained 1 but interquartile range decreased). Among 97 women who completed the global ratings of improvement and satisfaction questions, 42% reported improvement in symptoms (6% much better, 36% better); 58% reported symptoms were about the same. Regarding satisfaction with progress in the program, 34% were completely satisfied, 60% somewhat satisfied, and 6% not at all satisfied. Eighty women estimated their improvement in symptoms, which ranged from 0 to 100% (median 20%, interquartile range 0 – 50%).

Women recruited from a university staff mailing list who opted to participate in a study pilot-testing a continence website were predominantly white and highly educated, and about two-thirds had some incontinence at baseline. While most spent little time and visited few pages on the website, the proportion who reported performing pelvic floor muscle exercises often or always significantly increased from baseline to 4 months, and 42% reported symptom improvement. Change in Vaizey score, while statistically significant, was not clinically meaningful.

Even with limited engagement, a continence self-management website appears to increase frequency of pelvic floor muscle exercises among interested women. Future work will intentionally recruit a more diverse sample of women and will further explore the impact of website engagement on behavior change and symptom improvement.

Burgio KL; Goode PS; Richter HE; Locher JL; Roth DL. Global ratings of patient satisfaction and perceptions of improvement with treatment for urinary incontinence: validation of three global patient ratings. Neurourol Urodyn.  2006; 25(5):411-7 (ISSN: 0733-2467)
Avery, K., Donovan, J., Peters, T. J., Shaw, C., Gotoh, M., & Abrams, P. (2004). ICIQ: a brief and robust measure for evaluating the symptoms and impact of urinary incontinence. Neurourology and urodynamics, 23(4), 322–330. https://doi.org/10.1002/nau.20041
Vaizey, C. J., Carapeti, E., Cahill, J. A., & Kamm, M. A. (1999). Prospective comparison of faecal incontinence grading systems. Gut, 44(1), 77–80. https://doi.org/10.1136/gut.44.1.77