Pelvic floor disorders, including urinary and fecal incontinence as well
as prolapse, affect 1 in 4 non‑pregnant women. Not surprisingly, the incidence
increases with age from 10% in their 20’s to almost 50% in their
80’s, and also with bodyweight. Specifically, 1 in 6 women report
concerns about bladder control. A recent study reported that incontinent
women spend on average $900 per year on protective pads or laundry. Yet,
most afflicted women remain silent because of embarrassment.
Kegel exercises are the foundation of most pelvic floor rehabilitation programs for incontinence,
yet are challenging for women to perform long term. Over the past decade,
urethral slings have become the gold standard for surgical correction of
stress urinary incontinence (SUI), which is when a person loses urine with activities like coughing,
sneezing, laughing, or lifting. Because these outpatient, minimally invasive
procedures improve or resolve over 85% of cases and allow women to return
to regular activities in just a few days, they have become very appealing
solutions for women, whether busy mothers or elderly adults.
An abundance of
overactive bladder (OAB) medications are now available to treat the most common cause of
urinary incontinence. These women classically experience leakage after
urgency or without exertion as is typical of SUI. Helping women understand
reasonable goals, like improvement by an objective measure, such as discipline
use of a one-week
bladder diary (70% in one study), and empowering them about dose escalation during the
first month of treatment; have been shown to improve compliance with continuing
with these medications.
However little can be done to improve a women’s quality of life until
a she voices her concerns about these embarrassing problems to her doctor.