Many women suffer in silence from treatable pelvic floor problems

Many women suffer in silence from treatable pelvic floor problems

Many women assume that pelvic floor health issues are simply their fate - part of a vaginal birth, aging, weight gain, or entering menopause. Perhaps they have witnessed their mothers and grandmothers living with symptoms such as urinary incontinence and pain. Although pelvic floor disorders occur when the muscles and tissues that support the bladder, intestines, and uterus weaken or fail to function properly, they are not a normal part of aging.

But the misconception that nothing can be done prevents women from seeking help.

"There are so many people who suffer from it, but people don't talk about it and are often embarrassed," said Dr. Larissa Rodríguez, chair of the Department of Urology and James J. Colt Professor of Urology at Weill Cornell Medicine and senior urologist at NewYork-Presbyterian/Weill Cornell Medical Center.

Part of the problem is making sure women know there are treatment options: pelvic floor physical therapy, behavioral strategies, medications, devices, procedures and vaginal estrogen that can reduce urinary tract infections and improve urgency symptoms. In the absence of a well-known speaker who can raise awareness of pelvic floor disorders and encourage donations for research, Dr. Rodríguez spends time educating women and giving them the opportunity to talk to their doctors and seek treatment.

“I'm trying to play a role nationally and in New York City to stimulate policy discussions and highlight the importance of this issue,” she said. “We give talks in libraries and other public places, but we need to elevate this to a national agenda.” Through research and advocacy, Dr. Rodríguez is working to change the perception of this disorder, which affects one in three women during their lifetime.

Cultural impact

Recently published Dr. Rodríguez wrote an article that showed that a message may not resonate with all women. Cultural differences impact how women view pelvic floor problems. Their study showed that many Latina women in Los Angeles experience symptoms of pelvic floor disorders such as urine leakage, vaginal prolapse or bowel problems, but most do not realize that these symptoms indicate a treatable disease.

Although 63% had at least one symptom, only 15% recognized that they may have a pelvic floor disorder. The researchers found that cultural factors — such as prioritizing family over self, strong religious values ​​and high stress — along with a lower sense of independence made women less likely to identify their symptoms as a medical problem.

We have a population that has this condition at higher rates, goes to the doctor later, presents with more advanced disease, has a lower rate of surgical repair or treatment, and has poor outcomes.”

Dr. Larissa Rodríguez, chair of the Department of Urology and James J. Colt Professor of Urology, Weill Cornell Medicine

The barriers researchers observed were related to cultural factors, such as Latina women's roles as caregivers, that could lead them to minimize symptoms and delay treatment.

These findings suggest that culturally sensitive education and outreach are essential to help Latina women recognize symptoms earlier and seek timely help. Beyond expanding knowledge, Dr. Rodríguez and her colleagues are identifying the factors that help women recognize when a symptom is a medical problem that requires medical evaluation.

Risk factors require comprehensive care

Vaginal deliveries are one of the main risk factors for pelvic floor disorders. However, because women often have children in their 20s and 30s, they are surprised when symptoms appear decades later, in their 50s and 60s.

In many European countries, pelvic floor physiotherapy is part of pregnancy care and is covered by health insurance. This is not the case in the United States, where treatment options often go unmentioned in routine care. "We need to develop programs that train physicians who have access to this younger population to provide strategies to prevent some of these disorders later in life," said Dr. Rodriguez.

During routine checkups, doctors don't ask about pelvic floor health, in part because they're busy asking about other chronic conditions, including mental health, cardiovascular problems, and metabolic disorders. “Because physicians may not ask about these issues during primary care visits, it is important that patients are given the opportunity to address them,” said Dr. Rodriguez.

Weill Cornell also established a multidisciplinary center for female pelvic medicine to treat patients more holistically. It brings together urogynecologists, intestinal surgeons and physiotherapists trained in urology and/or gynecology. This new, innovative model brings together the professionals necessary to provide comprehensive care, as all of these aspects are interconnected and can coexist for most patients.

Research is progressing

Research is examining what can be done at the time of vaginal delivery to better identify those people who may be susceptible to developing these conditions and to suggest preventive measures before they experience problems.

“We also look at lifestyle stress as well as socioeconomic stressors that result from financial strain and discrimination, which can lead to poorer outcomes,” said Dr. Rodriguez. “Unfortunately, we don’t know much about the underlying biology and we haven’t put a lot of resources into this area as a health system.”

As a doctor and scientist, Dr. Rodríguez is also using preclinical models to find out how stress affects the brain-bladder connection and potentially triggers urinary symptoms such as frequency, bladder pain and urgency. Their research suggests that exercise may have positive effects on improving stress, which then leads to relief in urinary frequency and other symptoms. Further research could lead to ways to translate these findings to patients.

Ultimately, to further advance pelvic floor health, more research is needed that considers underlying biology, culture, stress, patient involvement, and physician involvement to achieve a new gold standard of care.

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