Advertisement

Current Geriatrics Reports

, Volume 6, Issue 3, pp 149–157 | Cite as

Updates in the Evaluation of Older Women with Pelvic Floor Disorders

  • Candace Parker-AutryEmail author
  • Jubilee Tan
Geriatric Urology (H Richter, Section Editor)
Part of the following topical collections:
  1. Topical Collection on Geriatric Urology

Abstract

Purpose of Review

Pelvic floor disorders (PFDs) are common among older women, and pose a unique challenge to the healthcare provider. The onset of PFDs in older women is gradual resulting from an inter-related process of anatomic, hormonal, and functional changes that occur over time and often impacted by concomitant medical co-morbid conditions. In this evidenced-based review, we provide an update on the epidemiology and provide an evidence-based approach to the evaluation of women with PFDs with a specific focus on the impact of aging.

Recent Findings

Physical function impairment is prevalent among older women with pelvic floor symptoms. The decline in physical function is likely the consequence of global changes in skeletal muscle health with aging, but may uniquely impact the pelvic floor muscle physiology and function.

Summary

Providers caring for older women with PFDs must account for the impact of the aging process on symptom presentation and evaluation.

Keywords

Urinary incontinence Evaluation Aging Older women 

Notes

Compliance with Ethical Standards

Conflict of Interest

Candace Parker-Autry and Jubilee Tan declare no conflict of interest.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.

References

  1. 1.
    Dieter AA, Wilkins MF, Wu JM. Epidemiological trends and future care needs for pelvic floor disorders. Curr Opin Obstet Gynecol. 2015;27(5):380–4.CrossRefGoogle Scholar
  2. 2.
    Nygaard I, Barber MD, Burgio KL, Kenton K, Meikle S, Schaffer J, et al. Prevalence of symptomatic pelvic floor disorders in US women. JAMA. 2008;300(11):1311–6.CrossRefGoogle Scholar
  3. 3.
    Wu JM, Vaughan CP, Goode PS, Redden DT, Burgio KL, Richter HE, et al. Prevalence and trends of symptomatic pelvic floor disorders in U.S. women. Obstet Gynecol. 2014;123(1):141–8.CrossRefGoogle Scholar
  4. 4.
    English E, Rogo-Gupta L. Impact of distance to treatment center on care seeking for pelvic floor disorders. Female pelvic medicine & reconstructive surgery. 2017;Google Scholar
  5. 5.
    Abrams P, Andersson KE, Birder L, Brubaker L, Cardozo L, Chapple C, et al. Fourth International Consultation on Incontinence Recommendations of the International Scientific Committee: evaluation and treatment of urinary incontinence, pelvic organ prolapse, and fecal incontinence. Neurourol Urodyn. 2010;29(1):213–40.CrossRefGoogle Scholar
  6. 6.
    Sultan AH, Monga A, Lee J, Emmanuel A, Norton C, Santoro G, et al. An International Urogynecological Association (IUGA)/International Continence Society (ICS) joint report on the terminology for female anorectal dysfunction. Neurourol Urodyn. 2017;36(1):10–34.CrossRefGoogle Scholar
  7. 7.
    Whitehead WE, Borrud L, Goode PS, Meikle S, Mueller ER, Tuteja A, et al. Fecal incontinence in US adults: epidemiology and risk factors. Gastroenterology. 2009;137(2):512–7. 7 e1-2CrossRefGoogle Scholar
  8. 8.
    Matthews CA, Whitehead WE, Townsend MK, Grodstein F. Risk factors for urinary, fecal, or dual incontinence in the Nurses’ Health Study. Obstet Gynecol. 2013;122(3):539–45.CrossRefGoogle Scholar
  9. 9.
    Wu JM, Matthews CA, Vaughan CP, Markland AD. Urinary, fecal, and dual incontinence in older U.S. adults. J Am Geriatr Soc. 2015;63(5):947–53.CrossRefGoogle Scholar
  10. 10.
    Markland AD, Goode PS, Burgio KL, Redden DT, Richter HE, Sawyer P, et al. Correlates of urinary, fecal, and dual incontinence in older African-American and white men and women. J Am Geriatr Soc. 2008;56(2):285–90.CrossRefGoogle Scholar
  11. 11.
    Haylen BT, Maher CF, Barber MD, Camargo S, Dandolu V, Digesu A, et al. An international Urogynecological Association (IUGA)/International Continence Society (ICS) joint report on the terminology for female pelvic organ prolapse (POP). Int Urogynecol J. 2016;27(4):655–84.CrossRefGoogle Scholar
  12. 12.
    Hendrix SL, Clark A, Nygaard I, Aragaki A, Barnabei V, McTiernan A. Pelvic organ prolapse in the Women’s Health Initiative: gravity and gravidity. Am J Obstet Gynecol. 2002;186(6):1160–6.CrossRefGoogle Scholar
  13. 13.
    Swift S, Woodman P, O'Boyle A, Kahn M, Valley M, Bland D, et al. Pelvic Organ Support Study (POSST): the distribution, clinical definition, and epidemiologic condition of pelvic organ support defects. Am J Obstet Gynecol. 2005;192(3):795–806.CrossRefGoogle Scholar
  14. 14.
    Dua A, Radley S, Jones G, Farkas A. The personal impact of pelvic floor symptoms and their relationship to age. Int Urogynecol J. 2014;25(1):117–21. A prospective study evaluating pelvic floor symptoms among young and older community-dwelling women utilizing validated questionnaires to determine bother and impact of quality of life CrossRefGoogle Scholar
  15. 15.
    Wieslander CK. Clinical approach and office evaluation of the patient with pelvic floor dysfunction. Obstet Gynecol Clin N Am. 2009;36(3):445–62.CrossRefGoogle Scholar
  16. 16.
    Dugan E, Cohen SJ, Bland DR, Preisser JS, Davis CC, Suggs PK, et al. The association of depressive symptoms and urinary incontinence among older adults. J Am Geriatr Soc. 2000;48(4):413–6.CrossRefGoogle Scholar
  17. 17.
    Erekson EA, Ciarleglio MM, Hanissian PD, Strohbehn K, Bynum JP, Fried TR. Functional disability among older women with fecal incontinence. Am J Obstet Gynecol. 2015;212(3):327–e1-7.CrossRefGoogle Scholar
  18. 18.
    Pizarro-Berdichevsky J, Clifton MM, Goldman HB. Evaluation and management of pelvic organ prolapse in elderly women. Clin Geriatr Med. 2015;31(4):507–21. A comprehensive review of pelvic organ prolapse staging of severity, symptom profile, physical examination diagnosis, and management options CrossRefGoogle Scholar
  19. 19.
    Yip SO, Dick MA, AM MP, Martin DK, Ciarleglio MM, Erekson EA. The association between urinary and fecal incontinence and social isolation in older women. Am J Obstet Gynecol. 2013;208(2):146–e1-7.CrossRefGoogle Scholar
  20. 20.
    Thiagamoorthy G, Cardozo L, Srikrishna S, Toozs-Hobson P, Robinson D. Management of prolapse in older women. Post Reprod Health. 2014;20(1):30–5.CrossRefGoogle Scholar
  21. 21.
    Wagg A, Chen L, Kirschner-Hermanns R, et al. Incontinence in the frail elderly In: Abrams P, Cardozo L, Khoury S, Wein A, editors. Incontinence ICUD-EAU 2013. p. 1001–100.Google Scholar
  22. 22.
    Johnson TM 2nd, Kincade JE, Bernard SL, Busby-Whitehead J, Hertz-Picciotto I, DeFriese GH. The association of urinary incontinence with poor self-rated health. J Am Geriatr Soc. 1998;46(6):693–9.CrossRefGoogle Scholar
  23. 23.
    Jelovsek JE, Barber MD. Women seeking treatment for advanced pelvic organ prolapse have decreased body image and quality of life. Am J Obstet Gynecol. 2006;194(5):1455–61.CrossRefGoogle Scholar
  24. 24.
    Doumouchtsis SK, Chrysanthopoulou EL. Urogenital consequences in ageing women. Best Pract Res Clin Obstet Gynaecol. 2013;27(5):699–714.CrossRefGoogle Scholar
  25. 25.
    Morrison A, Levy R. Fraction of nursing home admissions attributable to urinary incontinence. Value Health. 2006;9(4):272–4.CrossRefGoogle Scholar
  26. 26.
    Grover M, Busby-Whitehead J, Palmer MH, Heymen S, Palsson OS, Goode PS, et al. Survey of geriatricians on the effect of fecal incontinence on nursing home referral. J Am Geriatr Soc. 2010;58(6):1058–62.CrossRefGoogle Scholar
  27. 27.
    Wu JM, Hundley AF, Fulton RG, Myers ER. Forecasting the prevalence of pelvic floor disorders in U.S. women: 2010 to 2050. Obstet Gynecol. 2009;114(6):1278–83.CrossRefGoogle Scholar
  28. 28.
    Landefeld CS, Bowers BJ, Feld AD, Hartmann KE, Hoffman E, Ingber MJ, et al. National Institutes of Health state-of-the-science conference statement: prevention of fecal and urinary incontinence in adults. Ann Intern Med. 2008;148(6):449–58.CrossRefGoogle Scholar
  29. 29.
    Gebhart JB, Rickard DJ, Barrett TJ, Lesnick TG, Webb MJ, Podratz KC, et al. Expression of estrogen receptor isoforms alpha and beta messenger RNA in vaginal tissue of premenopausal and postmenopausal women. Am J Obstet Gynecol. 2001;185(6):1325–30. discussion 30-1CrossRefGoogle Scholar
  30. 30.
    Xie Z, Shi H, Zhou C, Dong M, Hong L, Jin H. Alterations of estrogen receptor-alpha and -beta in the anterior vaginal wall of women with urinary incontinence. Eur J Obstet Gynecol Reprod Biol. 2007;134(2):254–8.CrossRefGoogle Scholar
  31. 31.
    Robinson D, Cardozo LD. The role of estrogens in female lower urinary tract dysfunction. Urology. 2003;62(4 Suppl 1):45–51.CrossRefGoogle Scholar
  32. 32.
    Aikawa K, Sugino T, Matsumoto S, Chichester P, Whitbeck C, Levin RM. The effect of ovariectomy and estradiol on rabbit bladder smooth muscle contraction and morphology. J Urol. 2003;170(2 Pt 1):634–7.CrossRefGoogle Scholar
  33. 33.
    Stenberg A, Heimer G, Ulmsten U. The prevalence of urogenital symptoms in postmenopausal women. Maturitas. 1995;22(Suppl):S17–20.CrossRefGoogle Scholar
  34. 34.
    Zoubina EV, Mize AL, Alper RH, Smith PG. Acute and chronic estrogen supplementation decreases uterine sympathetic innervation in ovariectomized adult virgin rats. Histol Histopathol. 2001;16(4):989–96.PubMedGoogle Scholar
  35. 35.
    Alperin M, Cook M, Tuttle LJ, Esparza MC, Lieber RL. Impact of vaginal parity and aging on the architectural design of pelvic floor muscles. Am J Obstet Gynecol. 2016;215(3):312. e1-9CrossRefGoogle Scholar
  36. 36.
    Word RA, Pathi S, Schaffer JI. Pathophysiology of pelvic organ prolapse. Obstet Gynecol Clin N Am. 2009;36(3):521–39.CrossRefGoogle Scholar
  37. 37.
    Cook MS, Bou-Malham L, Esparza MC, Alperin M. Age-related alterations in female obturator internus muscle. Int Urogynecol J. 2017;28(5):729–34.CrossRefGoogle Scholar
  38. 38.
    Fox JC, Fletcher JG, Zinsmeister AR, Seide B, Riederer SJ, Bharucha AE. Effect of aging on anorectal and pelvic floor functions in females. Dis Colon Rectum. 2006;49(11):1726–35.CrossRefGoogle Scholar
  39. 39.
    Madersbacher S, Pycha A, Schatzl G, Mian C, Klingler CH, Marberger M. The aging lower urinary tract: a comparative urodynamic study of men and women. Urology. 1998;51(2):206–12.CrossRefGoogle Scholar
  40. 40.
    Pfisterer MH, Griffiths DJ, Schaefer W, Resnick NM. The effect of age on lower urinary tract function: a study in women. J Am Geriatr Soc. 2006;54(3):405–12.CrossRefGoogle Scholar
  41. 41.
    Resnick NM, Yalla SV. Detrusor hyperactivity with impaired contractile function. An unrecognized but common cause of incontinence in elderly patients. JAMA. 1987;257(22):3076–81.CrossRefGoogle Scholar
  42. 42.
    Smith PP. Aging and the underactive detrusor: a failure of activity or activation? Neurourol Urodyn. 2010;29(3):408–12.PubMedGoogle Scholar
  43. 43.
    Miller M. Nocturnal polyuria in older people: pathophysiology and clinical implications. J Am Geriatr Soc. 2000;48(10):1321–9.CrossRefGoogle Scholar
  44. 44.
    Shah BJ, Chokhavatia S, Rose S. Fecal incontinence in the elderly: FAQ. Am J Gastroenterol. 2012;107(11):1635–46. An evidenced-based review of the epidemiology, pathophysiology, evaluation, and management of fecal incontinence in the geriatric population CrossRefGoogle Scholar
  45. 45.
    Thekkinkattil DK, Lim M, Finan PJ, Sagar PM, Burke D. Awareness of investigations and treatment of faecal incontinence among the general practitioners: a postal questionnaire survey. Color Dis. 2008;10(3):263–7.CrossRefGoogle Scholar
  46. 46.
    Bliss DZ, AM, Whitehead WE, et al. Assessment and conservative management of faecal incontinence and quality of life in adults In: Abrams P, Cardozo L, Khoury S, Wein A, editors. Incontinence ICUD-EAU 2013. p. 1443–86.Google Scholar
  47. 47.
    Nicholas JA, Hall WJ. Screening and preventive services for older adults. Mt Sinai J Med. 2011;78(4):498–508.CrossRefGoogle Scholar
  48. 48.
    Norton C, Whitehead WE, Bliss DZ, Harari D, Lang J. Conservative Management of Fecal Incontinence in Adults Committee of the International Consultation on Incontinence. Management of fecal incontinence in adults. Neurourol Urodyn. 2010;29(1):199–206.CrossRefGoogle Scholar
  49. 49.
    Talley NJ, Fleming KC, Evans JM, O'Keefe EA, Weaver AL, Zinsmeister AR, et al. Constipation in an elderly community: a study of prevalence and potential risk factors. Am J Gastroenterol. 1996;91(1):19–25.PubMedGoogle Scholar
  50. 50.
    Lucas MG, Bosch RJ, Burkhard FC, Cruz F, Madden TB, Nambiar AK, et al. EAU guidelines on assessment and nonsurgical management of urinary incontinence. Eur Urol. 2012;62(6):1130–42.CrossRefGoogle Scholar
  51. 51.
    Rao SS, Go JT. Update on the management of constipation in the elderly: new treatment options. Clin Interv Aging. 2010;5:163–71.CrossRefGoogle Scholar
  52. 52.
    Wagg A, Gibson W, Ostaszkiewicz J, Johnson T 3rd, Markland A, Palmer MH, et al. Urinary incontinence in frail elderly persons: report from the 5th International Consultation on Incontinence. Neurourol Urodyn. 2015;34(5):398–406. Evidence-based guidelines for the management of frail older persons with urinary incontinence CrossRefGoogle Scholar
  53. 53.
    Sanses TV, Schiltz NK, Couri BM, Mahajan ST, Richter HE, Warner DF, et al. Functional status in older women diagnosed with pelvic organ prolapse. Am J Obstet Gynecol. 2016;214(5):613. e1-7 CrossRefGoogle Scholar
  54. 54.
    Podsiadlo D, Richardson S. The timed “Up & Go”: a test of basic functional mobility for frail elderly persons. J Am Geriatr Soc. 1991;39(2):142–8.CrossRefGoogle Scholar
  55. 55.
    Tinetti ME. Performance-oriented assessment of mobility problems in elderly patients. J Am Geriatr Soc. 1986;34(2):119–26.CrossRefGoogle Scholar
  56. 56.
    Kunkle CM, Abernethy MG, Van Tongeren LR, Fashokun TB, Wright EJ, Chen CC. Prevalence of cognitive impairment in older women with pelvic floor disorders. Int Urogynecol J. 2017.Google Scholar
  57. 57.
    Bo K, Frawley HC, Haylen BT, Abramov Y, Almeida FG, Berghmans B, et al. An International Urogynecological Association (IUGA)/International Continence Society (ICS) joint report on the terminology for the conservative and nonpharmacological management of female pelvic floor dysfunction. Neurourol Urodyn. 2017;36(2):221–44.CrossRefGoogle Scholar
  58. 58.
    Landi F, Cesari M, Russo A, Onder G, Lattanzio F, Bernabei R, et al. Potentially reversible risk factors and urinary incontinence in frail older people living in community. Age Ageing. 2003;32(2):194–9.CrossRefGoogle Scholar
  59. 59.
    Dumoulin C, Hunter KF, Moore K, Bradley CS, Burgio KL, Hagen S, et al. Conservative management for female urinary incontinence and pelvic organ prolapse review 2013: summary of the 5th International Consultation on Incontinence. Neurourol Urodyn. 2016;35(1):15–20.CrossRefGoogle Scholar
  60. 60.
    Bharucha AE, Fletcher JG, Melton LJ 3rd, Zinsmeister AR. Obstetric trauma, pelvic floor injury and fecal incontinence: a population-based case-control study. Am J Gastroenterol. 2012;107(6):902–11.CrossRefGoogle Scholar
  61. 61.
    Giri A, Hartmann KE, Hellwege JN, Velez Edwards DR, Edwards TL. Obesity and pelvic organ prolapse: a systematic review and meta-analysis of observational studies. Am J Obstet Gynecol. 2017;Google Scholar
  62. 62.
    Blaivas JG, Zayed AA, Labib KB. The bulbocavernosus reflex in urology: a prospective study of 299 patients. J Urol. 1981;126(2):197–9.CrossRefGoogle Scholar
  63. 63.
    Holroyd-Leduc JM, Tannenbaum C, Thorpe KE, Straus SE. What type of urinary incontinence does this woman have? JAMA. 2008;299(12):1446–56.CrossRefGoogle Scholar
  64. 64.
    Goode PS, Burgio KL, Richter HE, Markland AD. Incontinence in older women. JAMA. 2010;303(21):2172–81.CrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2017

Authors and Affiliations

  1. 1.Department of OB/GYN, UrologyWake Forest School of MedicineWinston-SalemUSA
  2. 2.Department of UrologyUniversity of Alabama at BirminghamBirminghamUSA

Personalised recommendations