How common is pelvic floor disorder? The answer’s complicated. Actually, that’s an understatement. It’s really really complicated.
First, the term is broad and encompasses many different disorders, ranging from occasional urinary incontinence to constipation to pelvic organ prolapse, among others.
Next, studies struggle with defining a threshold at which symptoms become a disorder and with finding a representative population willing to talk about their vaginas and submit to physical examinations or pad tests. Some studies look at women who seek treatment, but those women are not a representative sample. Other studies rely on questionnaires, which are notoriously unreliable.
Admittedly, a precise answer to this question is fairly meaningless from an individual standpoint. Either you have a problem and want treatment, or you don’t. The rarity or ubiquity of the disorder doesn’t change your individual experience. However, sometimes it’s nice to know, right?
The Prevalence of Pelvic Floor Disorder in the United States
I don’t know how nor have the time to do an unofficial systematic review. Instead, I’ll focus on the United States because I’m a nationalist narcissistic and because I stumbled across a good study in The Journal of the American Medical Association. Plus, the study is free.
The authors analyzed a 2005–06 survey of 1,961 non-pregnant women over the age of 20. The participants were interviewed at home and then examined in a mobile center. They were asked about urinary incontinence, fecal incontinence, and pelvic organ prolapse. Interestingly, pelvic pain wasn’t included in the questionnaire, revealing how hard it is to get accurate statistics about that particular disorder.
Because of the huge age range and the inclusion of women who had and hadn’t given birth, the overall statistics give a good bird’s eye view, but the numbers become more interesting when broken down by age and parity.
First, the bird’s eye view: The prevalence of at least one pelvic floor disorder was 23.7%, and the prevalence of urinary incontinence, fecal incontinence, and prolapse were 15.7%, 9%, and 2.9%, respectively. This means roughly 1 in 4 women complained of at least one PFD.
As a side-note, prolapse was under-counted because the number of women reporting prolapse was much lower than the prevalence found on internal exams. That can be read as good news or bad news: Good news if we assume most prolapse is asymptomatic, bad news if we assume early intervention in asymptomatic prolapse is a good idea. Frankly, I’m not sure, but I’m leaning towards bad news.
I appreciate that the researchers broke the numbers down by age and parity. Let’s take a peek at the specifics. For example, the rate of urinary incontinence increased markedly with age. The rate for women under 39 averaged 6.9%, but the rate for women over 80 averaged 31.7%. It also increased by parity. 6.5% of women without any births reported urinary incontinence (which still seems high), while 23.9% of women who had given birth three or more times did.
Other correlations were found between PFD and body mass index and income. 21.1% of women with a BMI greater than 30 reported incontinence compared to 8.1% of women with a BMI less than 25. To put that in context, a 5 foot 4 inch woman would need to weigh less than 145 pounds to have a BMI less than 25 and would need to weigh more than 174 pounds to have a BMI greater than 30. 21.1% versus 8.1% is a huge difference. In fact, obesity is probably the biggest modifiable risk factor (I promise I didn’t intend that pun).
Additionally, lower income slightly correlated with higher rates of PFD (28.8% of women below the poverty threshold versus 20.8% of women 2 fold above the threshold). The income correlation is interesting and consistent with previous surveys. Basically all health outcomes, including PFD, are worse at lower income levels. It would be interesting to hypothesize about why this is, but I won’t do that right now. Other smart people have connected access to health care, average number of children, physical labor, and weight. Higher rates of pelvic floor disorder among the poor are likely influenced by these numerous factors.
Childbirth also matters. 12.8% of nulliparous women had at least one pelvic floor disorder compared to 18.4%, 24.6%, and 32.4% for women with 1, 2, and 3+ deliveries, respectively. I thought this was interesting. Childbirth is not the only causal factor for urinary and fecal incontinence or prolapse since more than 1 in 10 women who had never given birth suffered from it. But, clearly the big increase in rates among the most procreative means childbirth is an important factor.
Overall, the largest increase in the prevalence of disorder was connected to parity, age, and body mass index. So ladies, stop having kids, stop aging, and go on a diet. Kidding. Sorta.
The news from the survey is pretty sobering. The study authors saw it that way too. In their conclusion they wrote:
Nearly one-quarter of all women and more than one-third of older women reported symptoms of at least 1 pelvic floor disorder…. Furthermore, our prevalence estimates are likely underestimates for several reasons: (1) they do not reflect symptoms of women who have undergone successful treatment for pelvic floor disorders; (2) we used conservative definitions; and (3) symptom-based diagnosis underestimates the true prevalence of pelvic organ prolapse diagnosed by physical examination.
My Takeaway: Pelvic floor disorder, at least as defined as urinary incontinence, fecal incontinence, and pelvic organ prolapse, is fairly common in America. None of these conditions are life-threatening, but they dramatically influence a woman’s quality of life.
I also suspect a majority of women don’t seek treatment for PFD. I had to practically demand options from my doctors and midwives. They weren’t incompetent. I’ve been lucky to have great doctors and they were all receptive to my requests. Nevertheless, in order to get care, I forced myself to become comfortable discussing my body with strangers, and I devoted many hours to research, including digesting academic physical therapy texts. More importantly, all of that effort would have been useless without good health insurance. Luckily, I have that (thank you, United States Military).
In other words, I devoted years to my pelvic floor. Who does that? Most women can’t and don’t. If my experience is at all representative of options in America, I’m pretty sure lots and lots of women are slipping through the cracks, which is sad.
If I had my way, more primary health providers would ask pointed questions at routine visits, and more moms would talk about it informally. I’m pretty hard to embarrass and even I had trouble discussing my issues with other moms. It’s just not talked about.
The more women can talk about their experiences, encourage medical attention, and learn how to exercise both to manage weight and to strengthen the pelvic floor, the more likely women are to live comfortably in their bodies. Maybe I’ll write the “Pelvic Floor Monologues.” Watch out Eve Ensler…
- “Prevalence of Symptomatic Pelvic Floor Disorders in US Women,” The Journal of the American Medical Association, Sept. 17 2008, Vol 300, No 11. ↩
- http://www.cancer.org/cancer/cancercauses/dietandphysicalactivity/bodyweightandcancerrisk/body-weight-and-cancer-risk-adult-bmi ↩