Pelvic floor disorders affect about 1 in 4 women

Nearly 24% of U.S. women are affected with one or more pelvic floor disorders, report researchers funded by the National Institutes of Health (NIH).1 The analysis is the first to document the extent of such conditions in a nationally representative sample.

Pelvic floor disorders occur when the pelvic muscles and connective tissue, which hold the bladder, uterus, bowel, and rectum in place, are weakened or injured. Such disorders include urinary incontinence, fecal incontinence, and pelvic organ prolapse, which results when pelvic organs such as the uterus, bladder, and bowel collapse onto the vagina.

The study of nearly 2,000 women in seven U.S. cities found that the proportion of women who reported at least one pelvic floor disorder increased with age: 9.7% of women ages 20-39, 26.5% of women ages 40-59, 36.8% of women ages 60-79, and 49.7% of women 80 or older.

The study was conducted by researchers in NIH's Pelvic Floor Disorders Network, which seeks to improve diagnosis, treatment, and prevention of pelvic floor disorders in women.

The 1,961 women who participated in the survey answered questions about symptoms of pelvic floor disorders. The women were ages 20 and older and were not pregnant. Overall, 23.7% of the women had symptoms of at least one pelvic floor disorder: 15.7% had urinary incontinence, 9% had fecal incontinence, and 2.9% had symptoms of pelvic organ prolapse.

Underweight and normal weight women were less likely to have a pelvic floor disorder (15.1%) than were overweight women (26.3%) and obese women (30.4%), researchers report. The prevalence of pelvic floor disorders also varied with the number of times a woman had given birth: 12.8% for women who had never given birth, 18.4% of women who had one child, 24.6% of women who had two children, and 32.4% for women who had three or more children.

The researchers did not find any differences in pelvic floor disorders based on race, ethnicity, or level of education achieved. The researchers noted that their study focused on moderate to severe forms of pelvic floor disorders, and so did not include women with mild symptoms.

Treatment for pelvic floor disorders varies with the severity of symptoms. Treatment may involve behavioral therapies, exercises to strengthen muscles, vaginal devices such as pessaries to hold up the bladder or other pelvic organs, medications, or surgery. Physicians with expertise in caring for pelvic floor disorders offer a variety of nonsurgical and surgical treatments that can significantly improve the quality of life for patients with those problems, says Joseph Schaffer, MD, professor of obstetrics and gynecology at University of Texas Southwestern Medical Center and a co-author of the current research. Patients with pelvic floor disorders should be encouraged to seek care from health care providers, particularly those with expertise in pelvic floor medicine and surgery, he says.

The Pelvic Floor Disorders Network recently completed a large clinical trial comparing the use of pessary with and without pelvic floor muscle training for the treatment of urinary incontinence. Those results will be available in 2009, says Susan Meikle, MD, MSPH, network project scientist. Other ongoing studies include testing different surgical procedures to correct pelvic floor prolapse, evaluating strategies patients have adapted when they have fecal incontinence, and a trial of surgical prophylaxis of stress urinary incontinence including patient preferences for treatments, she reports.

Network researchers published evidence in 2006 indicating that by performing two surgical procedures during the same operation, the incidence of urinary incontinence in women with pelvic organ prolapse is halved.2

To treat patients with pelvic organ prolapse, providers traditionally have recommended a single surgical procedure known as sacrocolpopexy, whereby surgical mesh and sutures are used to anchor the vagina to the sacrum. However, after sacrocolpopexy, many women experience incontinence, which makes them candidates for a second surgical procedure, known as the Burch colposuspension. This procedure calls for additional sutures to be sewn through the wall of the vagina and anchored to ligaments inside the pelvic cavity, near the pubic bone.

Network investigators undertook the study to determine if proactively performing the Burch colposuspension at the same time as sacrocolpopexy might prove effective at preventing incontinence in women with prolapse who did not have symptoms of stress incontinence before surgery. In women without stress incontinence who were undergoing abdominal sacrocolpopexy for prolapse, Burch colposuspension significantly reduced postoperative symptoms of stress incontinence without increasing other urinary tract symptoms, researchers report.2

References

  1. Nygaard I, Barber MD, Burgio KL, et al. Prevalence of symptomatic pelvic floor disorders in U.S. women. JAMA 2008; 300:1,311-1,316.
  2. Brubaker L, Cundiff GW, Fine P, et al. Abdominal sacrocolpopexy with Burch colposuspension to reduce urinary stress incontinence. N Engl J Med 2006; 354:1,557-1,566.