For many patients, pelvic floor disorders remain unspoken struggles that significantly impact their daily lives and overall wellbeing.
These conditions are remarkably prevalent – one in three women experience at least one pelvic floor disorder during their lifetime. By age 80, the numbers are even more striking, with nearly 50% of women in the U.S. living with these conditions.
Despite their extraordinary prevalence, many women do not seek care, allowing these common yet deeply impactful health issues to remain unaddressed.
"It takes women several years to feel comfortable seeking care," says Isuzu Meyer, MD, urogynecologist and reconstructive pelvic surgeon. "Research shows that the majority of patients go straight to their primary care to address these issues. However, primary care providers may not feel comfortable addressing them or know where to send these patients."
We can help
The Nebraska Medicine urogynecology team can serve as your collaborative partner for these often-overlooked conditions, the most common of which include:
- Vaginal bulge or pelvic organ prolapse: Protrusion of pelvic organs into or through the vaginal canal due to weakening of the supportive musculature and connective tissue of the pelvic floor.
- Urinary incontinence: Including both stress incontinence and urge incontinence.
- Accidental bowel leakage: Dr. Meyer notes that research shows patients prefer the term “accidental bowel leakage” to “fecal incontinence” when discussing this condition.
“These conditions are very private, and patients are often embarrassed to talk about them,” Dr. Meyer says. “We try to be sensitive to how they feel so they’re comfortable discussing their symptoms. Using patient-preferred terminology like ‘accidental bowel leakage’ instead of clinical terms can make a significant difference in communication.”
Simple screening questions that make a difference
Dr. Meyer emphasizes that diagnosing common pelvic floor conditions doesn't require specialized training or time-consuming exams – just two simple screening questions:
- For pelvic organ prolapse: “Do you see or feel a bulge outside the vagina?”
"This question has been research-proven," Dr. Meyer says. "When the answer is yes, there's a 90% or higher chance that the patient has a prolapse beyond the vaginal opening. You don't even need to do a physical exam in your busy practice."
- For urinary issues: "Do you have bothersome urine leakage?"
"It doesn't matter what type of leakage," Dr. Meyer explains. "We talk about stress incontinence, overactive bladder, urgency urinary incontinence – we do them all. Primary care providers don't need to feel obligated to identify the specific type of diagnosis. Just ask about bothersome urine leakage and send them to us. We'll sort them out."
Debunking myths: Pelvic floor disorders are not "normal aging"
Many patients dismiss their symptoms as an inevitable part of getting older, sometimes because they've seen family members or peers suffer without treatment.
"Patients think it's a normal part of aging, which is not true," Dr. Meyer says. "There are treatments that exist, and these shouldn't be considered a normal part of aging. It's just that the prevalence increases as people get older."
The impact on quality of life goes beyond discomfort
These conditions profoundly affect patients' overall well-being and can lead to other health issues.
"Although these are not life-threatening conditions, they directly impact quality of life," Dr. Meyer says. "When patients can't exercise because they're always leaking urine or concerned about stool leakage, or when a bulge is very uncomfortable, they alter their lifestyles and often isolate themselves."
This isolation and reduced activity can lead to other health concerns. "Cardiovascular health, diabetes, cancer prevention – all these health issues require patients to maintain a healthy lifestyle. But when they have these conditions, patients may choose not to engage in healthy activities."
A lifespan issue, not a geriatric concern
While the average age for surgical intervention is in the 60s and 70s, Dr. Meyer says she treats patients across a wide spectrum. "The youngest age group I treat is in their twenties, and the oldest patient I operated on was 96. Age is just a number – it's a lifelong problem."
Dr. Meyer identifies childbirth as the primary risk factor for pelvic floor disorders. However, she notes that symptoms often develop gradually over time.
"Many people don't see problems until 20 to 30 years later. And then menopause hits, affecting tissue quality, as estrogen helps keep pelvic floor tissue healthy. So, menopause is another hit and then aging compounds these issues."
Partner with us for patient-centered care
Dr. Meyer stresses the importance of a collaborative approach: "I want primary care providers to know that they don't have to address these issues themselves. All they have to do is send patients to us, and we will coordinate care as part of their team. I'm not taking over – I'm joining their team."
Her message to primary care providers is clear: "I don't set minimums or maximums for referrals. I want providers to go as far as they feel comfortable with treatment, and when they don't feel comfortable, they can send patients to us."
If you have questions or would like to refer a patient, please call 402.559.4500.