Many women suffer in silence from treatable pelvic floor conditions

Many women assume pelvic floor health issues are simply their fate - part of having vaginal deliveries, getting older, gaining weight or entering menopause. Perhaps they have watched their mothers and grandmothers live with symptoms, such as urinary incontinence and pain. Though pelvic floor disorders happen when the muscles and tissues that support the bladder, bowel and uterus weaken or don't work properly, they are not a normal part of aging.

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

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

Part of the issue is making sure women know that treatments exist: pelvic floor physical therapy, behavioral strategies, medications, devices, procedures and vaginal estrogen, which can reduce urinary tract infections and improve urgency symptoms. In the absence of a well-known spokesperson who can raise awareness about pelvic floor disorders and inspire fundraising for research, Dr. Rodríguez spends time educating women and empowering them to talk to their doctors and seek treatment.

"I try to have a role nationally and in New York City to encourage public policy discussions and highlight the importance of this issue," she said. "We give talks in libraries and other public venues, but we need to elevate this to a national agenda." Through research and advocacy, Dr. Rodríguez is working to change perceptions of this disorder, which affects one-in-three women in her lifetime.  

Cultural impact

Recently, Dr. Rodríguez published a paper that showed one message may not resonate with all women. Cultural differences impact how women view pelvic floor issues. Her study showed that many Latina women in Los Angeles experience symptoms of pelvic floor disorders like leaking urine, vaginal prolapse, or bowel issues, but most don't realize these symptoms indicate a medical condition that can be treated.

Though 63% had at least one symptom, only 15% recognized they might 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 lower feelings of independence made women less likely to identify their symptoms as a medical problem.

We have a population that has higher rates of this disorder, comes into the doctor later, presents with more advanced disease, has a lower rate of surgical repairs or treatments and has poor outcomes." 

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

The barriers that the researchers observed were related to cultural factors, such as the role of Latina women as caregivers, which may lead them to minimize symptoms and postpone treatment.

These insights suggest that culturally sensitive education and community outreach are essential to help Latina women recognize symptoms earlier and seek timely care. Beyond increasing knowledge, Dr. Rodríguez and her colleagues aim to identify the factors that help women recognize when a symptom is a medical problem that warrants a physician's evaluation.

Risk factors call for comprehensive care

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

Many European countries include pelvic floor physical therapy as part of pregnancy care, and it is covered by 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 educate physicians who have access to this younger population, so they provide strategies to prevent some of these disorders later in life," Dr. Rodríguez said.

During routine physicals, physicians are not asking about pelvic floor health partly because they are busy asking about other chronic conditions, including mental health, cardiovascular issues and metabolic disorders. "Since doctors may not be asking about these issues during primary care visits, it is critical that patients get empowered to bring them up," Dr. Rodríguez said.

Weill Cornell has also launched a Multidisciplinary Center for Female Pelvic Medicine to treat patients more holistically. It brings together urogynecologists trained in urology and/or gynecology, colorectal surgeons and physical therapists. This new, innovative model brings together the range of specialists necessary for comprehensive care, since all these aspects are interrelated, and may coexist in most patients.

Research moving forward

Research is looking at what can be done at the time of vaginal deliveries to better identify those people who might be vulnerable to developing these conditions and suggest preventive measures before they develop issues.

"We are also looking at lifestyle stress, as well as socio-economic stressors resulting from financial burdens and discrimination that may lead to worse outcomes," Dr. Rodríguez said. "Unfortunately, we don't know very much about the underlying biology, and we haven't put a lot of resources in that area as a health care system."

As a physician-scientist, Dr. Rodríguez is also working with preclinical models to identify how stress affects the brain-bladder connection, potentially triggering urinary tract symptoms of frequency, bladder pain and urgency. Her research suggests that exercise can have positive outcomes in improving stress, which then relieves urinary frequency and other symptoms. Further research may lead to ways of translating these findings to patients.

Ultimately, advancing pelvic floor health will require more research involving the underlying biology, culture, stress, patient empowerment and physician involvement for a new gold standard of care.