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to both local and national websites of interest to women in NH & n. MA.
applaud local women. The core of the magazine is our inspirational women's articles, most of which feature local women but occasionally we are
able to interview national women who we feel provide a unique inspiration for our readers. Our other articles cover topics of interest such as food
recipes, home, garden, beauty, health, fashion, dating, parenting, seniors, finance, business, hair care, skin care, advice, real estate, insurance,
weddings etc. Each issue has a feature section as well. Many of our articles are written by local business people who provide information
relevant to their business expertise. The Applaud Women website is also a resource center for local women including the most comprehensive
listings of Restaurants, Weddings, Female doctors and Hotels. It also includes a number of informational pages with links, articles and RSS feeds
to both local and national websites of interest to women in NH & n. MA.
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| No More Suffering in Silence - There is Help for Incontinence By Dr. Veronica Triaca |
Pelvic floor disorders (PFD) include urinary incontinence, pelvic organ prolapse (POP), fecal incontinence and other sensory and emptying
abnormalities of the lower urinary and gastrointestinal tracts. One of every nine women undergoes surgery for urinary incontinence or pelvic
organ prolapse or both in her lifetime and often these will require re-operation for POP repair. The estimated demand for consultations for pelvic
floor disorders is anticipated to increase by 30% by the year 2030. Despite being among the top ten reasons for expenditure of health care
dollars, pelvic floor disorders are not typically addressed by primary care physicians. Barriers to diagnosis and treatment include: a
misunderstanding of the conditions, and a commonly held belief that effective treatments are surgical or that an extensive evaluation is required
before initiating treatment. Urinary incontinence is a hidden epidemic that consumes approximately $19.5 billion in health care expenditures
annually.
Defined as the involuntary leakage of urine, incontinence is more common among women than men. Unfortunately, fewer than 50% of women
affected by incontinence seek treatment. Possibly due to misconceptions related to the disorder. Many patients feel that urinary incontinence is a
normal part of aging and are embarrassed to discuss this problem with their health care provider. Not all women with bladder problems are
incontinent; overactive bladder is urinary urgency usually with frequency, with or without incontinence, and may severely affect many women.
There are several different types of urinary incontinence, stress, urge or mixed, as well as overflow incontinence. Stress incontinence (SUI) is
urinary leakage that occurs with coughing, sneezing or engaging in any activity. Urge incontinence (UI) is urinary leakage that occurs with a
sudden uncontrollable urge to urinate. Both types of urinary incontinence can coexist. Overflow incontinence typically occurs with the inability to
completely empty ones bladder which results in continues filling and subsequent leakage.
Pelvic floor disorders carry with them significant social burden beyond their financial cost. Urinary incontinence is associated with poor patient self-
rated health, impairment in quality of life, social isolation as well as often depressive symptoms.
Treatment options for urinary incontinence vary depending on the diagnosis. In both stress incontinence and urge incontinence several
behavioral and physical therapy interventions are available to ameliorate these symptoms. Treatment options for both disorders include
behavioral modifications (timed voiding, diet), pelvic floor strengthening and rehabilitation, weight loss, and hormone replacement therapy. For
overactive bladder medications exist that are designed to control those sudden frequent urges. Other treatment options for stress incontinence
include pessary use and surgery.
Management of fluid intake may play some role in controlling stress urinary incontinence. It is one of the main coping strategies for up to 38% of
women with bothersome urinary incontinence. Reducing fluid intake, although not an ideal or recommended solution, can result in a significant
reduction in incontinence episodes. Weight reduction also may play a role in the management of SUI, especially in obese women. Women who
experience weight loss report a marked improvement in SUI symptoms. Smokers have a higher rate of over active bladder symptoms and worse
treatment outcomes. Botox® is a novel treatment for refractory over active bladder and severe urge incontinence that has not responded to
medication. Interstim® is a form of “bladder pacemaker” known as neuromodulation also used for refractory overactive bladder and urge
incontinence.
Pelvic organ prolapse is also common. The International Continence Society defines pelvic organ prolapse as any stage of prolapse greater than
zero. If this definition is used, 27% to 98% of women have pelvic organ prolapsed. Not all prolapse is symptomatic, however. Prolapse above or to
the vaginal opening is not always symptomatic and does not necessarily require treatment particularly if it is not bothersome to patients. The
number of women who have prolapse beyond the vaginal opening is 3% to 6% of women who present for gynecologic care. Approximately
200,000 surgeries a year are performed for pelvic prolapse, costing more than $1 billion dollars annually. However, POP and incontinence and
bladder dysfunction often coexist and should often be treated simultaneously for optimal results.
In summary, I encourage women to seek help for pelvic floor disorders. Despite the delicate subject matter and the often embarrassing
associated symptoms, treatment is available and constantly evolving for this very common and widespread affliction.
Olsen A.L. et al: Obstet Gynecol 89. 501-506.1997
Luber et al: Am J Obstet Gynecol 184. (7): 1496-1501.2001
Nygaard et al, JAMA 300.(11):1311-1316. 2008
abnormalities of the lower urinary and gastrointestinal tracts. One of every nine women undergoes surgery for urinary incontinence or pelvic
organ prolapse or both in her lifetime and often these will require re-operation for POP repair. The estimated demand for consultations for pelvic
floor disorders is anticipated to increase by 30% by the year 2030. Despite being among the top ten reasons for expenditure of health care
dollars, pelvic floor disorders are not typically addressed by primary care physicians. Barriers to diagnosis and treatment include: a
misunderstanding of the conditions, and a commonly held belief that effective treatments are surgical or that an extensive evaluation is required
before initiating treatment. Urinary incontinence is a hidden epidemic that consumes approximately $19.5 billion in health care expenditures
annually.
Defined as the involuntary leakage of urine, incontinence is more common among women than men. Unfortunately, fewer than 50% of women
affected by incontinence seek treatment. Possibly due to misconceptions related to the disorder. Many patients feel that urinary incontinence is a
normal part of aging and are embarrassed to discuss this problem with their health care provider. Not all women with bladder problems are
incontinent; overactive bladder is urinary urgency usually with frequency, with or without incontinence, and may severely affect many women.
There are several different types of urinary incontinence, stress, urge or mixed, as well as overflow incontinence. Stress incontinence (SUI) is
urinary leakage that occurs with coughing, sneezing or engaging in any activity. Urge incontinence (UI) is urinary leakage that occurs with a
sudden uncontrollable urge to urinate. Both types of urinary incontinence can coexist. Overflow incontinence typically occurs with the inability to
completely empty ones bladder which results in continues filling and subsequent leakage.
Pelvic floor disorders carry with them significant social burden beyond their financial cost. Urinary incontinence is associated with poor patient self-
rated health, impairment in quality of life, social isolation as well as often depressive symptoms.
Treatment options for urinary incontinence vary depending on the diagnosis. In both stress incontinence and urge incontinence several
behavioral and physical therapy interventions are available to ameliorate these symptoms. Treatment options for both disorders include
behavioral modifications (timed voiding, diet), pelvic floor strengthening and rehabilitation, weight loss, and hormone replacement therapy. For
overactive bladder medications exist that are designed to control those sudden frequent urges. Other treatment options for stress incontinence
include pessary use and surgery.
Management of fluid intake may play some role in controlling stress urinary incontinence. It is one of the main coping strategies for up to 38% of
women with bothersome urinary incontinence. Reducing fluid intake, although not an ideal or recommended solution, can result in a significant
reduction in incontinence episodes. Weight reduction also may play a role in the management of SUI, especially in obese women. Women who
experience weight loss report a marked improvement in SUI symptoms. Smokers have a higher rate of over active bladder symptoms and worse
treatment outcomes. Botox® is a novel treatment for refractory over active bladder and severe urge incontinence that has not responded to
medication. Interstim® is a form of “bladder pacemaker” known as neuromodulation also used for refractory overactive bladder and urge
incontinence.
Pelvic organ prolapse is also common. The International Continence Society defines pelvic organ prolapse as any stage of prolapse greater than
zero. If this definition is used, 27% to 98% of women have pelvic organ prolapsed. Not all prolapse is symptomatic, however. Prolapse above or to
the vaginal opening is not always symptomatic and does not necessarily require treatment particularly if it is not bothersome to patients. The
number of women who have prolapse beyond the vaginal opening is 3% to 6% of women who present for gynecologic care. Approximately
200,000 surgeries a year are performed for pelvic prolapse, costing more than $1 billion dollars annually. However, POP and incontinence and
bladder dysfunction often coexist and should often be treated simultaneously for optimal results.
In summary, I encourage women to seek help for pelvic floor disorders. Despite the delicate subject matter and the often embarrassing
associated symptoms, treatment is available and constantly evolving for this very common and widespread affliction.
Olsen A.L. et al: Obstet Gynecol 89. 501-506.1997
Luber et al: Am J Obstet Gynecol 184. (7): 1496-1501.2001
Nygaard et al, JAMA 300.(11):1311-1316. 2008