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Women Deserve to Be Heard on Quality of Life Health Issues, Like Incontinence

Health care for women is rapidly changing. New treatments for women’s health problems are available, more research specific to women is being performed, and scientists are looking at how diseases affect men and women differently. Women can expect better health options than in decades past.

Doctors are aware that biological differences between men and women go beyond just the anatomy. Scientists are discovering that – even at the cellular level – there are differences in the ways men’s and women’s bodies develop symptoms and disease. These differences may affect how men and women respond to treatments. For example, heart attack symptoms can be very different in women as compared to men. This is why women’s heart disease was not always promptly diagnosed in past years. Another example of how men and women differ is in the recovery following stroke. Women are more likely to recover language ability after suffering a left-hemisphere (left brain) stroke. It is clear that a relapsing intermittent form of multiple sclerosis occurs mostly in women but has a more debilitating effect on males. These differences dramatically impact health care, and because of this, women’s health is receiving increased scientific attention.

As recently as 20 years ago, it was widely believed that women should not be used as clinical study participants because of hormonal instability. Scientists believed that if men were used as research subjects, the findings could be applied just as well to women. Now, the National Institutes of Health (NIH) policy statement recommends the inclusion of women in clinical trials, and the U.S. Food and Drug Administration (FDA) reserves the right to refuse a new drug application that doesn’t analyze safety and efficacy data by sex. In addition, federal funding for women’s health research has increased substantially since the formation of the NIH’s Office of Research on Women’s Health in 1990.

At the same time, many more practicing physicians and scientists are women. For the first time, in fall 2005, the Loyola University Chicago Stritch School of Medicine entering class included more women than men. The team of physicians I work with in the Women’s Pelvic Medicine Center at Loyola University Health System includes four fellowship trained urogynecologists, a colorectal surgeon and a general surgeon – who are all women.

The relatively new field of urogynecology (also called female pelvic medicine and reconstructive surgery) is another example of how health care is developing to more thoroughly understand the specific health needs of women. The field, which is a subspecialty within obstetrics and gynecology or urology, takes a unique approach to the evaluation and treatment of conditions affecting the female pelvic organs, like prolapse and bladder and bowel incontinence. The specialty also is advancing the science of women’s pelvic health by seeking ways to prevent problems or catch problems early, so that less invasive treatments can be used.

In the medical world, urogynecology is still fairly new. To put it in perspective, the cancer research network Southwest Oncology Group, known as SWOG, has been functioning since 1956. The NIH, funded by American taxpayers, has created research networks only within the past ten years to advance the treatment of female pelvic floor disorders and incontinence. Three clinical trial networks have been established to study pelvic floor disorders and urinary incontinence in women: the Pelvic Floor Disorder Network, the Urinary Incontinence Treatment Network, and the Interstitial Cystitis Clinical Research Network. Loyola’s Women’s Pelvic Medicine Center is the only center in the nation to be involved in all three of these research networks, and therefore, the only center able to offer participation in all major trials on female pelvic floor disorders.

Awareness of incontinence and pelvic medicine problems – uniquely women’s problems – is still growing. Much has improved, but we need to improve screening for these problems. A woman might be embarrassed to talk about incontinence if her physician does not bring up the topic, or she might think nothing can be done. Especially these days, with so many advances in women’s health, it is important to seek out physicians who will listen and take your concerns seriously.

In our practice, we can see that women’s attitudes and expectations are changing. Baby Boomers do not tolerate incontinence like their mothers did – and they should not. Our perspective is that leakage may be a common problem, but it is not normal to have to wear heavy wetness pads or diapers. Compared to their grandmothers, younger women want to remain active. They do not want to ignore nor have their physicians ignore an irritating problem like incontinence. Researchers at Loyola have done ground-breaking work on the practice of patient-reported goals for pelvic care. Our team is aware that our patients expect to have their quality-of-life pelvic issues taken seriously.

A note of caution – the growing need to treat female pelvic floor disorders has attracted big business, especially the surgical supply industry. Some of the treatments being offered are very good and others are not, and unlike medications, new surgeries do not require as rigorous an FDA approval process. Consumers should be proactive in selecting physicians whose practice is grounded in scientific evidence and who can discuss the advantages and disadvantages of different treatments, especially surgery.

Women who partner with their physicians often come to appointments with prepared questions – and once a mutually acceptable treatment plan is selected – follow instructions and communicate any concerns. After all, incontinence is not life threatening, it is a quality-of-life disorder. We have found there is a broad spectrum of what treatment is preferable to different women. Some women will not tolerate a single drop of leakage; others would rather put up with three diapers a day than undergo surgery. Therefore, we offer a full range of treatment options, including simple fitness classes, many nonsurgical options and innovative treatments that are not available elsewhere in the Chicago area.

Our goal is to create open lines of communication in which patients and physicians can agree on their goals for treatment. We want to understand how women experience symptoms and which symptoms are most bothersome and discuss what can realistically be achieved through surgery or other treatments. For example, I can do surgery to fix stress incontinence, but my patient might still have leakage from an overactive bladder and need to take a medication as well. A lot of symptoms run together, so discussions about treatment options take time. We are convinced, though, that active patient and physician collaboration will yield the best outcome. ‚

Kimberly Kenton, MD, MS, FACOG, FACS
Assistant Professor, Female Pelvic Medicine & Reconstructive Surgery
Obstetrics & Gynecology and Urology
Loyola University Chicago Stritch School of Medicine