In a survey of 1111 working women, Temple University researchers were surprised to learn that while the majority, 72 percent, reported suffering from one or more pelvic floor disorders, 70 percent had not sought medical help. And further, that by the time they did see the doctor, usually triggered by the onset of incontinence, they were suffering from multiple urogynecological problems.
According to one of the researchers, Jack Mydlo, M.D., professor and chair of urology at Temple University School of Medicine, of all pelvic floor disorders, it is incontinence that brings most women to the doctor. "They cannot tolerate leaking urine and the disruption to their daily lives. But incontinence is usually just the tip of the iceberg. Many are also suffering from such pelvic floor disorders as uterine or rectal prolapse."
Among the study participants, significant risks for PFD were older age, high body mass index, number of vaginal births, and the use of forceps.
Minor incontinence and other PFDs usually begin after a woman gives birth. Then, as women age, the bladder stretches and pelvic muscles weaken, especially if they don't exercise. Uterine or rectal prolapse and incontinence can often ensue.
The first course of action is medicine to treat the incontinence and Kegel exercises to strengthen the muscles around the bladder and sphincter. The next option is inipramine, an anti-depressant that stimulates the closure of the bladder neck.
"When medications don't help, we first try a conservative measure: the injection of a bulking agent into the bladder neck. This is usually pretty effective. And lastly, when all else has failed, a sling is surgically inserted to hold up the bladder neck," said Mydlo. "When multiple PFDs are involved, it's important for a multi-disciplinary team of experts to work together on solutions."
Based on this survey, which was presented at this year's American Urological Association meeting, the researchers recommend that pelvic floor disorders be part of routine physical exams for all women.