It's Not Just Aussie Fitness Trainers Thinking About The Pelvic Floor - New England Journal of Medicine
Jennifer M. Wu, M.D., M.PHD,. UNC DEPARTMENT OF OBSTETRICS & GYNECOLOGY, published “Stress Incontinence in Women” in NEJM - Jun 24, 2021 . The article follows the Journal’s case story format. a case vignette, evidence supporting various strategies , a review of any formal guidelines and ends with the author’s clinical recommendations. Reading as a lay person, I found the basic statistics and the medical and alternative therapy recommendations useful. I’m making note of the questions doctors should ask patients about stress incontinence. In other words, what women should tell their doctors even if nobody asks. And pelvic floor work is effective.
It’s absurd that incontinence needs a case study be acknowledged and dignified. With more women rising in medicine, women’s health issues will not be “cases.” Thanks Dr. Wu. You go girl!
Dr. Wu's Key Points on Recognizing and Treating Stress Incontinence
· Stress incontinence is common among women, yet less than 40% of affected women seek care.
· Screening can be easily achieved by asking women if they have urinary leakage with coughing, laughing, sneezing, or exercise.
· Exercises that strengthen the pelvic-floor muscles are effective in controlling stress incontinence, and weight loss is recommended in overweight or obese women.
· Referral to a specialist for an incontinence pessary or surgery should be considered if behavioral therapy options have failed and the patient continues to have bothersome symptoms.
· Surgery is the most effective option; shared decision making should entail a detailed discussion of the risks and benefits of different surgical procedures.
· The most commonly performed surgery is placement of a midurethral mesh sling, a minimally invasive, outpatient, 30-minute procedure with high efficacy and a relatively low rate of complications.
Dr. Jennifer Wu, UNC Department of Obstetrics and Gynecology
Dr. Wu asks these questions. Your MD should too:
Does stress incontinence occurs with actions such as coughing, sneezing, or jumping.?
What is the severity of incontinence, including frequency of leakage (e.g., daily, weekly, or monthly), amount of leakage (e.g., small, moderate, or large), and the use of pads and pad type.
What degree of bother does stress incontinence cause? What range of treatment options should be considered?
Is the patient experiencing coexisting pelvic-floor disorders, including urgency incontinence, incomplete bladder emptying, pelvic organ prolapse, and fecal incontinence?
Are there coexisting medical complications and previous surgical procedures which might affect treatment decisions?
What she looks for in a pelvic exam:
Evidence of vulvovaginal atrophy, skin changes due to incontinence or pad use, and pelvic organ prolapse),
Pelvic-floor muscle strength
Anatomical factors (e.g., urethral diverticulum or fistula) that may be associated with urinary leakage.
A urinalysis to rule out urinary tract infection
“Pelvic-floor muscle training has been shown to reduce the number of leakage episodes and the quantity of leakage.
74% of women who underwent pelvic-floor muscle training for 3 to 6 months reported cure or improvement, as compared with 11% of women who received either no treatment or an inactive control treatment (risk ratio, 6.33; 95% confidence interval [CI], 3.88 to 10.33; moderate-quality evidence from three randomized trials involving 242 women).
Although there is no consensus regarding the ideal training program, a regimen in which at least 8 contractions are performed three times a day is recommended. In addition, programs that incorporate weekly supervision by a health care professional have been associated with greater improvement than unsupervised programs.
However, long-term outcome data beyond 1 year are limited.”
Learn more about your pelvic floor today - your future self thanks you.