Pelvic floor disorders in women: an overview

Urinary incontinence affects 10% to 58% of community-dwelling women and up to 50% of nursing home residents. Prevalence of incontinence appears gradually to increase during young adult life, has a broad peak around middle age, and then a steady increase in the elderly. It has been shown to affect a person's social, clinical, and psychological well-being. The majority of women with incontinence do not seek medical help. The estimated annual direct cost of urinary incontinence alone in women in the United States (in U.S. dollars) is 12.4 billion. The proportion of the United States population over age 75 was 22% in the year 1999 and is expected to grow substantially during the coming decades. Pelvic floor disorders such as urinary incontinence, fecal incontinence, and pelvic organ prolapse affect older women disproportionately. Because of this relationship, it is estimated that the growth in demand for services to care for female pelvic floor disorders will increase at twice the rate of growth of the population over the next 30 years. Approximately 10% of women have surgery for pelvic organ prolapse or urinary incontinence in their lifetime and nearly 30% of these operations are for recurrent disease. This fact suggests that failure rates after surgery for pelvic floor disorders are high, in spite of the introduction of many new surgical diagnostic techniques, tools and operations. Numerous techniques have been developed to evaluate the type and extent of urinary and fecal incontinence and prolapse. A number of treatment options exist, ranging from behavioral to medical and surgical approaches. This document will discuss some of the general issues related to pelvic floor disorders and suggest areas for future research.