S. Regis1, T. Patel2, E. Rockenbach1, E. Brown3, M. Philp4, J. L. Poggio4, J. Vu4 1Temple University, Lewis Katz School Of Medicine, Philadelpha, PA, USA 2Temple University, Department Of Surgery, Philadelpha, PA, USA 3University Of Michigan, Department Of Surgery, Ann Arbor, MI, USA 4Temple University, Department Of Surgery, Division Of Colorectal Surgery, Philadelpha, PA, USA
Introduction: Pelvic floor disorders are associated with childbearing and vaginal delivery and can be severely life-limiting, affecting almost 25% of women. Men are less commonly affected but can also experience symptoms, especially after pelvic surgery. Colorectal surgeons serve as the primary treating clinician for many of these conditions, such as fecal incontinence, pelvic constipation, or rectal prolapse. Pelvic floor physical therapy (PT) can be an effective nonsurgical treatment for pelvic floor dysfunction. However, patient utilization of pelvic floor PT remains limited, with insurance noncoverage, geographic constraints, and lack of availability identified as barriers. We sought to evaluate factors influencing pelvic floor PT access in Philadelphia, PA, a large metropolitan city with considerable socioeconomic diversity.
Methods: We used internet searches to identify pelvic floor PT locations in Philadelphia and contacted each by telephone using a semi-structured script. For the geographic analysis, we used census tracts, or small geographic units designed to reflect relatively homogeneous socioeconomic characteristics. We obtained income and census tract data from the US Census. We used linear regression to evaluate the relationship between income and distance between census tract and the nearest pelvic floor PT location, adjusting for population of each census tract.
Results: Nineteen locations offered pelvic floor PT, and these were primarily located in areas of higher median household income (Figure). As median income increased, distance to pelvic floor PT decreased. Patients from the lowest quartile of income ($27,276) lived farthest from a pelvic floor PT location (2.1 miles), compared to patients from the highest quartile ($101,396, 1.0 miles, p<0.001). Nine locations had 2 or more pelvic floor therapists supporting a mean (SD) volume of 28 (17) patients per week. Fifteen locations (79%) accepted insurance and nine (47%) were direct access (no referral needed). Locations primarily treated urogynecologic or postpartum conditions, while treatment for fecal incontinence or constipation was less common. Nine locations (47%) offered biofeedback therapy. Median wait time for an appointment was 8 days (range 1-69 days). All locations offered weekday availability with 2 sites providing limited weekend availability.
Conclusion: Although pelvic floor PT benefits many colorectal surgery patients, it remains underutilized and primarily focused on urogynecologic and postpartum conditions. In Philadelphia, many locations offer pelvic floor PT with appointments available within weeks, but the majority of locations are in areas of high income, and patients with lower income live significantly farther from PT locations.
