The Effect of Training Based on the Transtheoretical Model on Pelvic Floor Muscle Strength

The pelvic floor is a complex anatomical structure composed of nerve, muscle, fascia, and connective tissue components. Working in conjunction with other muscles associated with the pelvic girdle, the pelvic floor is a vital component responsible for stabilizing the entire body. The primary functions of the pelvic floor and its components include providing support to intra-abdominal structures such as the bladder, urethra, prostate, vagina, uterus, anus, and rectum; supporting continence by enabling the voluntary initiation and cessation of urination and defecation, thus preventing incontinence; preventing pelvic organ prolapse; playing an active role during childbirth; and maintaining sexual function .

Pelvic floor dysfunction (PFD) manifests with various complex symptoms such as urinary incontinence (UI), pelvic organ prolapse (POP), fecal incontinence (FI), sexual problems, and chronic pelvic pain, alongside damage, weakening, and impairment of the pelvic floor's function and morphological structure. affecting women's daily activities, psychosocial status, and overall health perception . Pelvic floor dysfunction is a common problem worldwide, occurring at rates ranging from 1.9% to 46.5%, and is underdiagnosed. In Turkey, the prevalence of pelvic organ prolapse is 30-50%, urinary incontinence is 26.3-71.5%, and fecal/anal incontinence is reported in the literature as 2-3%. it is reported that this rate increases with age, exceeding 10%, and that the rate of sexual dysfunction in women ranges from 20% to 73% stated in their article that approximately 10% of women face pelvic floor problems requiring surgery . Although it varies between countries and societies, the prevalence of pelvic floor dysfunction in women generally ranges between 20-40% .These rates indicate that pelvic floor dysfunction is a significant public health issue.

The treatment and care interventions for pelvic floor dysfunction are a preventive health service that healthcare professionals, particularly midwives in primary healthcare institutions, should prioritize. Providing education on pelvic floor strengthening is important both in preventing misconceptions and in increasing women's knowledge and awareness levels.

A systematic review conducted to determine the effectiveness of health promotion interventions based on behavioral change models for modifying lifestyle factors (physical activity, diet, alcohol, and smoking) in adults receiving primary health care found that the Transtheoretical Model was the most frequently used intervention for these purposes. The Transtheoretical Model was developed by Prochaska and Diclemente to guide individuals in accepting problematic behaviors in their lives and changing these behaviors with positive expectations and desire. This model aims to change the individual's behavior intentionally. It is recommended that the Transtheoretical Model be used to facilitate individuals' adaptation to lifestyle changes and to provide effective education also stated in their studies that care provided in conjunction with pelvic floor training prevents pelvic floor dysfunction and improves quality of life .