Up the radar for pelvic floor disorders
Are you talking to your patients about pelvic floor disorders (PFDs)? You should. Results from a study of 4,000 U.S. women ages 25-84 indicate one-third of them reported one or more pelvic floor disorders.1 The high co-occurrence of these conditions suggests that clinicians who see women seeking treatment for stress urinary incontinence, overactive bladder, pelvic organ prolapse, or anal incontinence should inquire about symptoms of other disorders, researchers say.
The study, conducted by Kaiser Permanente, was designed to assess the effect of age on the prevalence of pelvic floor disorders and report the co-occurrence of these conditions. Of the 4,000 women surveyed, 25% reported anal incontinence, 15% noted stress urinary incontinence, 13% reported overactive bladder, and 6% experienced pelvic organ prolapse, researchers note.
It is estimated that more than 15 million women in the United States have stress urinary incontinence and 16 million women have an overactive bladder.2,3 One in 10 women suffers from anal incontinence, with one in 15 experiencing moderate to severe symptoms.4 Over a woman's lifetime, 11% are likely to have pelvic surgery for urinary incontinence and/or prolapse, while 29% will have multiple surgeries for PFDs.5
What are some of the factors that come into play when it comes to the high prevalence of pelvic floor disorders in U.S. women? Factors that were associated with pelvic floor disorders in the Kaiser Permanente study were vaginal births, use of hormone therapy, having had a hysterectomy, and being obese, says Jean Lawrence, ScD, MPH, MSSA, lead author of the report and a research scientist at Kaiser Permanente's Department of Research and Evaluation in Southern California.
"Because of the cross-sectional nature of our analysis — we learned about the conditions and the potential risk factors at the same time — we cannot determine whether the hormone therapy or hysterectomy occurred before or after the PFD," she says. "While women who had vaginal births were more likely to have PFD than women who had cesarean deliveries only or did not give birth, cesarean deliveries are associated with the risk of other medical complications, and women should not request a cesarean delivery solely to reduce their likelihood of having a PFD without considering all the risks associated with a surgical delivery for both themselves and their babies."
The Kaiser Permanente study also found that obesity, independent of having diabetes, was significantly associated with having a PFD, notes Lawrence. "This is a modifiable risk factor, and losing weight and maintaining a healthy weight has health benefits that go far beyond reducing a woman's risk for PFD," she states.
Bring up the subject
What are some of the reasons pelvic floor disorders are underreported by patients? These conditions, as a rule, are seen by patients as embarrassing and are not discussed with even close friends and family, says study co-author Karl Luber, MD, a urogynecologist in the Department of Obstetrics and Gynecology at Kaiser Permanente San Diego Medical Center. Many myths are associated with PFDs, such as, "It's an inevitable result of aging," "There is nothing that can be done to help," "The only way to help is to have a big surgery," and "It's natural, and it's my burden to live with," he notes.
"The reality is that although pelvic floor disorders are very common, they are also very treatable," says Luber. "And equally important, treatment often does not mean surgery, and if surgery might be helpful, surgeries today are much less invasive and easier to go through than they were even 10 years ago."
Many clinicians are in the dark when it comes to current diagnosis and treatment modalities, he says. If patients do bring up the issue, some clinicians may not give good advice or care, because they are not well versed on these issues, Luber states.
The National Association for Continence, a national nonprofit organization dedicated to improving the quality of life of people with incontinence, and the American Urogynecologic Society, a professional society dedicated to research and education in urogynecology, offer educational resources, as well as lists of providers who can aid in diagnosis and treatment of pelvic floor disorders.
"A big message for patients is that there is help, and once they get treated, they are often amazed at how much their quality of life is improved," says Luber.
References
- Lawrence JM, Lukacz ES, Nager CW, et al. Prevalence and co-occurrence of pelvic floor disorders in community-dwelling women. Obstet Gynecol 2008; 111:678-685.
- Fantl JA, Newman DK, Coiling J, et al. Urinary Incontinence in Adults: Acute and Chronic Management. Rockville, MD: U.S. Dept of Health and Human Services, Public Health Service, Agency for Health Care Policy and Research; 1996.
- Stewart WF, Van Rooyen JB, Cundiff GW, et al. Prevalence and burden of overactive bladder in the United States. World J Urol 2003; 20:327-336.
- Bharucha AE, Zinsmeister AR, Locke GR, et al. Prevalence and burden of fecal incontinence: A population-based study in women. Gastroenterology 2005; 129:42-49.
- Olsen AL, Smith VG, Bergstrom JO, et al. Epidemiology of surgically managed pelvic organ prolapse and urinary incontinence. Obstet Gynecol 1997; 89:501-506.
Resources
- The American Urogynecologic Society offers many patient resources at its web site, www.augs.org. Under "Information for Women," click on "Diagnostic and Treatment Information" for such resources as a voiding diary and a "Talking with your Doctor" checklist. Contact information: 2025 M St. N.W., Suite 800, Washington, DC 20036-3309. Telephone: (202) 367-1167. Fax: (202) 367-2167. E-mail: [email protected].
- The National Association for Continence has educational information on its web site, www.nafc.org. Click on "Bladder and Bowel Health" for information on such subjects as "What is Incontinence?" and "Prolapse." The site also lists a toll-free telephone number, 800-BLADDER [(800) 252-3337] to receive information on specialists in your area. Contact information: P.O. Box 1019, Charleston, SC 29402-1019. Telephone: (843) 377-0900. Fax: (843)377-0905. E-mail: [email protected].
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