‘Making sense’ of urinary incontinence: A qualitative study investigating women’s pelvic floor muscle training adherence

Urinary incontinence is common and disabling. Pelvic floor muscle training is recommended as first-line therapy for uncomplicated urinary incontinence. The effects of such behavioural therapies depend in part on adherence. We explored women’s experiences of incontinence treatment and training adherence in a longitudinal qualitative design. Six women (40–80 years) with stress, urgency or mixed urinary incontinence symptoms were interviewed twice; once at the start of treatment and again after discharge about 3 months later. Interviews were transcribed and analysed using principles of Interpretative Phenomenological Analysis. Experiences were represented by four themes: Past experiences and meanings of leakage; the supervised treatment period; going on and looking ahead; and the relationship with and experience of others. Variable adherence was explained by how women ‘made sense of it all’. Women with the least difficulty in making sense of their incontinence and in overcoming training inertia had the best self-reported outcomes. Conversely, variable adherence, poorer self-reported outcomes, and ambivalence about engaging in treatment were characteristic of women who struggled to make sense of their apparently intermittent or unpredictable condition. Helping women make sense of incontinence and overcome inertia and ambivalence could improve adherence, but this may be a prolonged process.