Obstetrics and Gynecology Clinics of North America
EPIDEMIOLOGY AND NATURAL HISTORY OF PELVIC FLOOR DYSFUNCTION
Section snippets
Prevalence
Urinary incontinence is estimated to affect 30% to 40% of older American women.18, 25, 41, 113, 123 Contrary to popular belief that the prevalence of any urinary incontinence increases with age,92 the relatively few studies that have examined incontinence across an age spectrum including younger women have shown only minimal increases in prevalence with age115, 127 or a higher prevalence in younger age groups.48, 88 The severity and certain types of urinary incontinence may increase with aging.
CAUSES AND PREVENTION
Figure 5 represents a model for the development of pelvic floor dysfunction in women based mainly on expert opinion and supported by limited epidemiologic and clinical evidence. None of the factors have been studied in a longitudinal fashion in a representative study. The relative importance of predisposing, inciting, promoting, and decompensating factors remains to be established. Assignment of various factors to a given category is admittedly arbitrary and arguable. For example, a promoting
SUMMARY
Pelvic floor dysfunction, including urinary incontinence, anal incontinence, and pelvic organ prolapse, is extremely common, affecting at least one-third of adult women. A minority of patients sustaining these conditions volunteer their symptoms. Risk factor identification and the development of tactics for prevention are significant priorities for future research. Understanding both the specific predisposing factors that place an individual woman at risk and the precise events of the labor and
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Address reprint requests to Richard C. Bump, MD, Department of Obstetrics and Gynecology, Duke University Medical Center, 246 Baker House, Box 3609, Durham, NC 27710