title: Experiences during the first four years of a postpartum perineal clinic in the USA.
abstract: OBJECTIVE
  To assess the characteristics of patients seen at a postpartum perineal clinic in the USA during the first 4 years of its existence, and to identify factors contributing to the clinic's success.
  
  
  METHODS
  In a retrospective study, the charts of patients presenting to the clinic between July 1, 2007, and June 30, 2011, were reviewed for presenting complaint, findings, treatment, number of visits, and referral source. Strategies that led to successful clinic implementation were reviewed.
  
  
  RESULTS
  A total of 247 patients were seen during the 4-year period. Indications for referral included lacerations, pain, urinary and fecal incontinence, and fistulas. The most common referral indication was a third- or fourth-degree laceration, which affected 154 (62.3%) patients. Overall, 53 (21.5%) patients required a procedure, of whom 20 (8.1%) underwent surgery. Most women were counseled about pelvic floor exercises, and 39 (15.8%) were referred for pelvic floor physical therapy. Nurse-led triage, patient education, and follow-up were key to the success of the program.
  
  
  CONCLUSIONS
  The postpartum perineal clinic is sustainable and offers an opportunity for early assessment and treatment of pelvic floor dysfunction after a complicated vaginal delivery.
authors.affiliation: Division of Female Pelvic Medicine and Reconstructive Surgery, Loyola University, Chicago, IL, USA.
authors.forename: Cynthia
authors.initials: C
authors.lastname: Brincat
authors.affiliation: Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, MI, USA.
authors.forename: Erin
authors.initials: E
authors.lastname: Crosby
authors.affiliation: School of Nursing, University of Michigan, Ann Arbor, MI, USA.
authors.forename: Anne
authors.initials: A
authors.lastname: McLeod
authors.affiliation: Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, MI, USA. Electronic address: deef@med.umich.edu.
authors.forename: Dee E
authors.initials: DE
authors.lastname: Fenner
mesh_terms: D001003:Anal Canal / Q000293:injuries / Q000601:surgery; D036861:Delivery, Obstetric / Q000009:adverse effects*; D037001:Directive Counseling; D005081:Exercise Therapy; D005242:Fecal Incontinence / Q000209:etiology; D005260:Female; D006801:Humans; D022125:Lacerations / Q000209:etiology / Q000628:therapy*; D010044:Outpatient Clinics, Hospital; D010146:Pain / Q000209:etiology; D059408:Pain Management; D010353:Patient Education as Topic; D059952:Pelvic Floor Disorders / Q000209:etiology / Q000628:therapy; D010502:Perineum / Q000293:injuries* / Q000601:surgery; D011181:Postnatal Care; D057184:Practice Patterns, Nurses'; D011644:Puerperal Disorders / Q000209:etiology / Q000628:therapy*; D012006:Rectovaginal Fistula / Q000209:etiology* / Q000601:surgery; D012017:Referral and Consultation / Q000706:statistics & numerical data; D012189:Retrospective Studies; D015599:Trauma Severity Indices; D014218:Triage; D014481:United States; D014549:Urinary Incontinence / Q000209:etiology
keywords: Incontinence; Lacerations; Pelvic floor dysfunction; Postpartum perineal clinic; Vaginal delivery