Pelvic-floor disorders, including incontinence and prolapse, are "exceedingly common" among women. And the incidence increases with age and weight gain, according to a University of Utah study in the Journal of the American Medical Association published this week.
Nearly one-fourth of women surveyed and more than one-third of older women say they have at least one pelvic floor disorder, according to the researchers, led by Dr. Ingrid Nygaard of the U. School of Medicine. Nygaard is a professor of urogynecology and pelvic reconstructive surgery. Pelvic disorders include urinary and bowel incontinence, voiding problems and others related to the urological and gynecologic system.
It's a common set of problems that doesn't get discussed and often goes undiagnosed, according to Nygaard. Women know something's wrong, but because of the nature of the problem and reluctance to say anything, fears don't get addressed. A woman may worry that something's going to fall out or that she has cancer or that she's the only one experiencing what is genuinely both common and correctable.
"Nobody should suffer in silence," Nygaard said.
Pelvic floor disorders involve bladder, uterus, rectum or vagina. They can be treated with various tools, including behavioral therapy, medication or surgery, Nygaard said. But women are reluctant to talk about them, much less seek help. And most women have no idea how common the disorders are.
Nygaard and her colleagues looked back at responses of 1,961 nonpregnant women, 20 or older, who had participated in the 2005-2006 National Health and Nutrition Examination Survey. They were interviewed at home and then had standardized physical examinations.
Overall, 23.7 percent said they had at least one pelvic floor disorder: 15.7 percent urinary incontinence, 9 percent fecal incontinence and 2.9 percent symptomatic pelvic organ prolapse. As the women got older, the numbers went up, starting with 9.7 percent overall in women age 20 to 39 years and increasing to 26.5 percent in women age 40 to 59 years, 36.8 percent in women age 60 to 79 years and 49.7 percent in women age 80 years or older.
Women who were overweight or obese were more likely to have at least one pelvic floor disorders. Prevalence in normal or underweight women was 15.1 percent, but it rose to 26.3 percent for overweight and 30.4 percent for obese women. The number of children a woman had given birth to also increased the likelihood. The researchers did not find a link to race/ethnicity or education level.
Most women leak a drop of urine on rare occasion with the right provocation, such as jumping on a trampoline, Nygaard said. The researchers were interested in more frequent problems. For urinary incontinence, they looked for women who experienced it weekly or in larger volume. For stool incontinence, they focused on those who experience it once a month or more.
"I find it distressing that almost one in 10 women lose stool monthly," she said.
In measuring pelvic floor prolapse, they asked if women could feel or see a bulge. Even women who cannot may have prolapse and research is looking to see if strengthening pelvic floor muscles of women with mild symptoms can prevent it or at least delay it, said Nygaard.
Surgery is the typical treatment for prolapse and it's usually delayed until the patient experiences discomfort or annoying symptoms like discharge, she said. Although it's not curative, vaginal devices called pessaries can temporarily hold the tissue in place and prevent symptoms, allowing women to avoid or delay surgery.Many women don't know where to go for help, Nygaard said. They can start with a primary care provider or OB/GYN. They can also learn about providers in their areas who are knowledgeable about the conditions by visiting mypelvichealth.org and using the specialist locator.