Women's Health Feature
Pelvic Floor Dysfunction
A special women's health feature written for ConfidenceClub by one of Australia's leading urologists
Table of contents
Pelvic Floor Dysfunction
Special Guest Author
Doctor David Ende, Urologist
St Vincents Clinic and Blacktown Hospital
For more about Dr David Ende see endeurology.com.au (contact details)
What is Pelvic Floor Dysfunction?
Pelvic floor dysfunction and its consequences probably effects most Australian families.
As women age, the pelvic floor muscles and ligaments become weak which causes the normal continence mechanisms to fail. It may start with urine leakage with exercise or exertion, or even with coughing or sneezing. Urine can even leak if you pick up bags of groceries or grandchildren. A weakened pelvic floor can also be associated with having to pass urine frequently during the day and night. In more severe cases, the frequency can be associated with urgency and many women are unable to hold on until they can find a toilet.
Many women know where all the toilets are in their local shopping precinct so as not to get caught out. Leakage with urgency also occurs when you arrive home and put the key in the lock. Even though you know the toilet is less than a minute away, it can be impossible to hold on.
Common Causes
Many women have multiple factors all acting to cause pelvic floor problems.
Ageing:
When patients are elderly, it can be difficult to move quickly and even though their symptoms may not be severe, limited mobility, and possibly the dependence on carers, mean that leakage is more likely.
Decreased Estrogen:
Age alone, with decreased estrogen levels, is also enough to weaken the ligaments.
Surgery:
Women who have had pelvic floor surgery, such as hysterectomy, may be at increased risk of pelvic floor abnormalities as the pelvic ligaments will be damaged during surgery.
Childbirth:
Childbirth via the vaginal canal also stretches and damages the ligaments, again causing weakness and pelvic floor dysfunction.
The Impact
Women with these issues are often forced to wear pads or liners in their underwear to avoid the embarrassment and inconvenience of wet clothes. Many women are able to take care of their own needs, but carers and family members are often needed to help elderly or frail women when incontinence occurs. This may include not only changing into dry underwear or other clothes, but also often changing bed linen. Not to mention the laundry bills. This can be multiplied when bowel and faecal incontinence are also an issue.
Even more significant is the potential for physical harm or injury associated with pelvic floor dysfunction. Elderly and frail women who wake multiple times at night to void are at risk of falls and hip fractures which is unfortunately a common event. This therefore leads to hospital admissions for surgery and the associated surgical risks. It also places a massive burden on the health care budget.
Image copyright Victorian Continence Resource Centre from their booklet "Reclaim Your Core - Exercises To Help Get You Started" available for purchase here >
You're Not Alone
pelvic floor dysfunction clearly impacts millions of women and their families every day in Australia.
- Dr. David Ende -
According to a report by Deloitte Access Economics, ‘21% of the community population have urinary or faecal incontinence, or both. The prevalence rate is much higher in the Residential Aged Care (RAC) population where 70.9% or almost 129,000 residents have urinary or faecal incontinence (or both)’. This costs the community billions of dollars in care, medical fees, lost days work and other expenses.
So pelvic floor dysfunction clearly impacts millions of women and their families every day in Australia. Education about potential surgical and non-surgical therapy is critical, as is the imperative for women to have access to continence aids and other services.