Almost all global societies governing women’s health recommended Incontinence screening in adult women. This rarely happens. The reasons are inherent in the structure of our health care system, including long lists of recommended screenings, long wait times for short appointments, and sometimes limited access to health care.
However, with 62% of adult women Living with leaky bladder and/or bowel in the United States makes it imperative to improve screening for this treatable disorder. Untreated incontinence is associated with profoundly negative health consequences that impact women’s social, financial, physical, and emotional well-being. Shame keeps most of them silent. We believe that small changes by government, professional societies and insurers can make it easier for clinicians to screen and treat more women.
Leaks are not an inevitable consequence of aging. A treatment exists. Women don’t need to live a life that fuels $15.2 billion global adult diaper market and could lead them to a nursing home. The menopause movement activates women who demand change. However, medicine has a discouraging history of sidelining women’s health issues. And huge advertising budgets normalize incontinence, obscuring an important clinical fact: incontinence is a progressive disease. Without treatment, the situation can get worse.
Lots of data to show the uncertainty and unpredictability of living with incontinence can affect women’s lives mental health, quality of lifeand relationships. Women may limit their social engagements, experience feelings of isolation and distress, and/or have problems privacy. Incontinence is also associated with increased economic burden and a decrease in physical activity. Research watch that women with urinary incontinence (UI) may reduce their physical activity or stop exercising altogether to manage their symptoms. Compared to women on the continent, data shows that women with incontinence experience more rapid physical decline, including reduced muscle mass and lower scores on physical performance tests.
Among older women, unemployment insurance is a major risk factor for falls, hospitalizations, disabilities and dependency on a caregiver. THE quality of life of caregivers is also affected. The physical demands can be intense. Psychological, relational and social problems can also arise. More recently, a September The study found an association between overactive bladder, a syndrome that includes urge urinary incontinence, frequency and urge incontinence, and suicidal ideation. A October closely followed paper showing that unemployment insurance itself is an independent risk factor for death.
For many women, it is possible to stop this terrible cascade. Effective treatments exist, including a conservative (read: inexpensive) first-line treatment, pelvic floor muscle training (PFMT). So why is there no systematic screening? Short answer: it’s complicated. However, we believe that small changes from government, payers, medical societies, clinicians and women could make a real difference.
Research confirms that institutions that guide quality measurement, including organizations like the Centers for Medicare and Medicaid ServicesTHE Joint Commissionand the Agency for Healthcare Research and Quality have the ability to influence delivery of care, improve patient safety and improve outcomes. Earlier this year, the Core Quality Measures Collaborative (CQMC) examined OB-GYN core measures. For prevention and wellness, current baseline measures include screening for chlamydia, HIV, contraceptives, and depression – all valuable screenings. We do not advocate their removal. However, incontinence affects more women than all other measures except contraception, and yet urinary incontinence (postpartum or for the general population of women) is not even mentioned as a measure for the future. consideration. Furthermore, it is not mentioned or taken into account for primary carealthough the CQMC will review this issue in February 2025. Adding incontinence screening as a core measure is necessary and would help motivate clinicians and leading healthcare institutions to prioritize screening in their practices.
As specialists, we are very familiar with the tests needed to diagnose incontinence, which provide access to treatment. However, the current diagnostic pathway – typically pelvic exam, urinalysis, and post-void residue – can be burdensome for primary care, which can lead to unnecessary referrals. Primary care providers (PCPs) should be the first step in treatment for most women. Medical and professional societies could help by simplifying the diagnostic journey so that primary care becomes more accessible immediately after diagnosis by a PCP.
The average duration of a primary care visit is 18 minuteswhich can limit our attention to the most pressing health issues. Although a longer appointment would be ideal to engage patients in other concerns, we need to be realistic. In the absence of more time with patients, it might be helpful to immediately plan what to say about incontinence. As clinicians, we often have common talking points to discuss a variety of different conditions. This preparation, refined over years of practice, is part of what can make a brief meeting effective and incisive. For incontinence, clinicians could prepare to ask questions about leaking and, based on the answer, plan discussion points that would allow them to effectively refer women for treatment. It would take a bit of initial work (most of these conversation habits are initially formed during training) but it would be incredibly worth it.
Prevention is also essential.
Like many conditions people are more comfortable talking about, incontinence has obvious risk factors: childbirth is No. 1. However, payers view postpartum leakage as a lifestyle problem. Indeed, serious consequences appear later, generally during menopause, and probably after several insurance changes. We encourage all payers to take a long-term view, just as they do for other conditions associated with long-term health problems, such as diabetes, cardiovascular disease and obesity. Pelvic floor health should be a priority immediately after childbirth, and insurers should pay for this care.
This happens in the UK and France, where a single payer is responsible for a woman’s life: pelvic floor rehabilitation begins directly after childbirth. The National Institute for Clinical Excellence, which sets treatment guidelines for the UK, estimated that it could avoid 50% of surgical procedures for stress urinary incontinence if women performed PFMT first. Since 1985, the The French government funded 10 pelvic floor physiotherapy sessions after childbirth.
Some American insurers have taken a long-term view and are funding new modalities that help women access PFMT, including data to show can be difficult (an important fact that contributes to historically low adherence to screening). Access to in-person PFMT may be limited by long wait times, a limited number of providers to supervise PFMT, financial constraints, and difficulty taking time off work or obtaining child care. ‘children. Paying for new technologies creates an opportunity for forward-thinking payers to help promote screening by providing clinicians with an effective way to help women access PFMT without requiring significant outlay.
Women are used to facing the challenges of incontinence. Shame and embarrassment also silence people. Few things violate a person’s dignity like an accidental leak of urine or stool. Menopause has recently become a A $15.4 billion industry. We hope its tailwinds will give more women the confidence to advocate for their health needs.
The American healthcare system must think differently about a woman’s pelvic floor. Anyone suffering from a rotator cuff injury immediately comes to the attention of an orthopedic surgeon and is eligible for rehabilitation services, whether or not they have had surgery. Yet a woman who gives birth vaginally and experiences pelvic floor trauma – leading to weakness, dysfunction and ultimately urinary incontinence or other pelvic floor disorders – is given a stool softener and “congratulations.” With a few adjustments, we can and must do better.
Milena M. Weinstein, MD, is an associate professor of obstetrics and gynecology at Harvard Medical School. She is Chief of the Department of Urogynecology and Reconstructive Pelvic Surgery, Co-Chair of the Center for Pelvic Floor Disorders and Director of Research, Urogynecology and Reconstructive Pelvic Surgery Fellowship, at Massachusetts General Hospital. Samantha J. Pulliam, MD, is an assistant professor in the Division of Urogynecology and Pelvic Reconstructive Surgery in the Department of Obstetrics and Gynecology at Tufts University School of Medicine and chief medical officer of Axena Health Inc. at Auburndale, Massachusetts.