Adolescence and Young Womenhood (13-20 Years)

Young women are not immune to pelvic health problems. Even if you are not sexually active yet, aren’t old enough to need a pap smear or pelvic exam yet, and are light years away from considering having
a baby, you use your pelvis and pelvic floor muscles. Most young women ignore their pelvis and pelvic muscles until there is a problem “down there.” Even when a problem occurs, many will suffer in silence in hopes that it will just go away because they don’t know who to talk to about it. After all, “that part of the body” is generally ignored by doctors until they are “old enough to see a gynecologist.” Why do these habits or traditions get started? I am not sure, but by adolescence young women “are old enough” to have knowledge of their pelvis and how to protect its health. You may be surprised to learn:

•Between the ages of 18 and 44, approximately 24% of women experience urinary leakage.

•Leakage during exercise does occur in some young healthy women. Higher impact exercises are associated with higher likelihood of leakage than low impact exercise.

•Young women can get bladder infections at any time, but infections can become a common problem when they first become sexually active.

•Bothersome urinary frequency and urgency are often mistaken for persistent urinary tract infection and treated with unnecessary antibiotics, and could be better treated by other means.

•Pelvic illnesses, trauma or surgery can lead to pelvic pain in some cases even in the young woman. If that pain persists without attention, it may become a chronic pelvic health problem.

•Don’t smoke! In addition to all the reasons that you have been given about lung cancer and bladder cancer, smoking has an association with urinary leakage. Smokers seen for urinary leakage are also significantly younger than non-smokers.

Childbearing Years (20-40 years)

Pregnancy and childbirth causes dramatic changes in a woman’s body that are both visible and invisible.  We have typically blamed all those bothersome pelvic health problems like incontinence and prolapse on pregnancy and childbirth.  How often have you heard or used the excuse for your symptoms that “but my babies were close to 10 pounds.” The truth is that although pregnancy and childbirth do alter our pelvis, many factors that predispose our pelvis to problems after childbirth were present before we ever got pregnant. Additionally, some women who never have children or sex have pelvic health problems too. Did you know?

•Approximately 17% of women who have never been pregnant have urinary incontinence.

•Pregnancy and vaginal delivery can lead to pelvic floor problems by direct muscle trauma, disruption of the support of pelvic organs and nerve injury. The greatest risk of damage is the first vaginal delivery.

•Pelvic health and related problems that may occur after pregnancy and childbirth include: backache, hemorrhoids, vaginal and perineal pain, pain with intercourse, urinary leakage, fecal leakage, and pelvic organ prolapse. Despite the variety and frequency of pelvic problems after childbirth, women often do not seek treatment.

•Women in this age group may not be aware that Female Pelvic Medicine and Reconstructive Surgery is a medical specialty that specifically addresses these bothersome pelvic conditions.

Menopause: Pre, Peri, and Post (40-65 years)

The average age at menopause is now generally accepted to be 50 years, but women may begin to experience symptoms of menopause years before that and those symptoms may persist  long after.  Postmenopausal women make up a significant part of the female population in the US, and that number will increase as our population ages. The hormonal changes that occur at the time of menopause have an impact on all estrogen sensitive tissues including the urogenital tract (bladder, urethra, & vagina).  The effect of low estrogen levels in the urogenital tissues can cause a spectrum of urinary symptoms including frequency, urgency, nocturia, incontinence, and frequent urinary tract infections. Low estrogen in the vagina may promote vaginal dryness, itching, burning, and painful intercourse.

Estrogen replacement in topical form and applied in the vagina can be helpful for the prevention of urinary tract infections, and treatment of vaginal irritation due to dry vaginal tissues. However, estrogen is not a treatment for urinary incontinence.

With age, a woman’s body may lose muscle strength and tone. Pelvic surgery, particularly hysterectomy, which many women undergo after childbearing years can predispose to weakened pelvic tissues and muscles. During pelvic procedures, important supportive muscles and ligaments may be removed or damaged. If that happens, they may not be able to provide the support to the bladder, urethra, and other pelvic organs needed to prevent urinary leakage and pelvic organ prolapse.

•Most women in this age group have never been given any health information about their pelvic floor, and may not be familiar with their pelvic anatomy at all.

•It is not uncommon for women to think that they have tried pelvic floor exercises (Kegel’s) without success; however, pelvic exam often reveals that they are unfamiliar with how to isolate and contract the proper muscles. These women could benefit from having the correct information and instruction about pelvic floor muscle exercise.

•Women are often unaware that there are options available for urinary incontinence, pelvic organ prolapse, and other pelvic floor disorders. Treatment can be tailored to the needs, desires and expectations of the individual woman.

•Women in this age group may not be aware that Female Pelvic Medicine and Reconstructive Surgery is a medical specialty that specifically addresses these bothersome pelvic conditions.

Senior Ladies: 65 years and beyond

It is a commonly held belief among women that urinary incontinence and other urinary symptoms are a normal part of aging, but this is not true. Aging women have higher rates of illnesses related to urinary symptoms such as diabetes, congestive heart failure, and kidney disease. They may have other medical conditions that result in loss of muscle tone, muscle control, or which place greater strain on the pelvic floor muscles—like chronic cough, thyroid problems, Parkinson’s, Alzheimer’s disease, multiple sclerosis, stroke, bladder cancer or stones, interstitial cystitis, urinary obstruction, or spinal cord injury— all of which can lead to urinary incontinence.

•Medications used to treat chronic medical conditions may also incite urinary symptoms like diuretics and other blood pressure medications.

•Chronic constipation worsens urinary symptoms and can contribute to urinary tract infections.

•Nocturia is frequent urination at night. It affects older men and women more commonly than younger because of changes in the way the body manages fluid as we age.

•As age increases, there is an increase in urinary urgency incontinence and mixed urinary incontinence. Although it is not age itself that causes incontinence, the factors that predispose to it are more commonin older men and women.

•For women over age 60, approximately 23% deal with incontinence, and the problem is more commonin women than men.

•Approximately half of nursing home residents have urinary incontinence, and it is second only to dementia as the leading cause for nursing home admission.

•Urinary incontinence is associated with skin irritation, falls and fractures in the elderly, particularly those with a difficult time getting around and caring for themselves.

•Urinary incontinence has a heavy impact on a person’s emotional well-being. Incontinent women often limit their social activities, personal relationships, physical intimacy, and other routines to avoid the possibility of an “accident” and the discovery of their incontinence by others.

Copyright © 2014 Harriette Scarpero and PrattWebSolutions