Roughly one quarter of US women affected by pelvic floor disorders

Nearly 24 percent of US women are affected with one or more pelvic floor disorders, report researchers funded by the National Institutes of Health. Their analysis is the first to document in a nationally representative sample the extent of pelvic floor disorders, a cluster of health problems that causes physical discomfort and limits activity.

The study also revealed that the frequency of pelvic floor disorders increases with age, affecting more than 40 percent of women from 60 to 79 years of age, and about 50 percent of women 80 and older.

Pelvic floor disorders result when the muscles and connective tissue within the pelvic cavity weaken or are injured. These muscles and ligaments form a sling across the opening of a woman’s pelvis, holding the bladder, uterus, bowel, and rectum in place. The three main pelvic floor disorders are urinary incontinence, faecal incontinence, and pelvic organ prolapse. Pelvic organ prolapse results when pelvic organs such as the uterus, bladder and bowel, collapse onto the vagina. The resulting pressure may cause a bulge or protrusion through the vaginal canal. This protrusion may be uncomfortable, may make physical activity difficult, and may interfere with sexual functioning.

The study results appear in the September 17, 2008 Journal of the American Medical Association.

"The study results underscore the need to identify the causes of pelvic floor disorders and the means to prevent and treat them." said Duane Alexander, MD, director of the NIH’s Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD). "The NIH Pelvic Floor Disorders Network is conducting studies to provide much needed answers."

Funding was provided by the NICHD, the National Institute of Diabetes and Digestive and Kidney Diseases and the Office of Research on Women’s Health (ORWH), all at the NIH, and by the National Center for Health Statistics (NCHS) of the Centers for Disease Control and Prevention.

The study’s first author was Ingrid Nygaard, MD, MS, of the University of Utah School of Medicine, Salt Lake City. 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.

To conduct the study, the researchers submitted questions on pelvic floor disorders for inclusion in the 2005-2006 National Health and Nutrition Examination Survey (NHANES), a periodic survey of the US population conducted by the NCHS.

"Before our study, there were no comprehensive national prevalence estimates for pelvic floor disorders," said Susan Meikle, MD, MSPH, Project Scientist for the NIH Pelvic Floor Disorders Network.

The 1961 women who participated in the survey answered questions about symptoms of pelvic floor disorders. The women were age 20 and older and were not pregnant. Overall, 23.7 percent of the women had symptoms of at least one pelvic floor disorder: 15.7 percent had urinary incontinence, 9.0 percent had faecal incontinence, and 2.9 had symptoms of pelvic organ prolapse.

The proportion of women who reported at least one pelvic floor disorder increased with age: 9.7 percent of women aged 20 to 39 years, 26.5 percent of women aged 40 to 59 years, 36.8 percent of women aged 60 to 79 years, and 49.7 percent of women 80 or older.

Underweight and normal weight women were less likely to have a pelvic floor disorder (15.1 percent) than were overweight women (26.3 percent) and obese women (30.4 percent).
The prevalence of pelvic floor disorders also varied with the number of times a woman had given birth: 12.8 percent for women who had never given birth, 18.4 percent of women who had one child, 24.6 percent of women who had two children, and 32.4 percent 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 behavioural therapies, exercises to strengthen muscles, vaginal devices to hold up the bladder or other pelvic organs, medications, or surgery.

In 2006, researchers in the Pelvic Floor Disorders Network published study results describing a successful surgery to reduce the urinary incontinence caused by pelvic organ prolapse: http://www.nichd.nih.gov/news/releases/surgery_reduces_incontinence.cfm.

(Source: Journal of the American Medical Association: National Institutes of Health: September 2008)