Introduction

By the most conservative estimates, urinary incontinence (the involuntary leakage of urine) affects at least 30 million Americans in community and institutional settings, 85-90% of whom are women. A recent study suggests that women have a 10% chance during their lifetime of having surgery to correct incontinence or pelvic support problems (prolapse, when the pelvic organs begin to sag out of place ). The economic cost of treating incontinence in the United States alone is staggering, conservatively estimated to be approximately 30 billion dollars per year. Incontinence is a significant health care problem and will only increase as the population of America continues to age. One example of its importance is the development of clinical practice guidelines for urinary incontinence by the Agency for Health Care Policy and Research, Public Health Service, US Department of Health and Human Services. This report, updated in 1996, noted that urinary incontinence is widely underdiagnosed and underreported, despite the fact that appropriate treatment can cure or significantly improve most patients. There is a serious shortage of specialists trained to treat these diseases, as evidenced this year by the 30 to 40 job opportunities available for about ten fellows finishing training.

Urinary incontinence is an embarrassing condition that most women do not discuss, even with close friends or a physician. While studies show that 25-40 percent of all women may suffer from some degree of incontinence, only one in ten will seek help for the problem. Instead, some women rely on absorbent pads. Others begin to go to the bathroom more frequently or avoid social and work situations which seem to aggravate the problem.

Myths regarding incontinence abound. Many patients and physicians mistakenly believe that incontinence is a normal part of childbirth, menopause, and aging. Others think that there is no effective treatment for incontinence. Fortunately, with proper diagnosis and treatment, urinary incontinence can be treated successfully in the vast majority of cases.

Urinary incontinence is a complex problem and may have many causes. Also, many women may leak urine for more than one reason. With a careful medical history, physical examination, and appropriate testing, an accurate diagnosis of all factors contributing to the leakage can be made, and individual treatment plans can be constructed.

Pelvic support problems (prolapse, when the pelvic organs begin to sag out of place) can also cause significant dysfunction and disruption in a woman's life. These support problems commonly are found with incontinence. Even in situations where a woman with prolapse has no urinary problems, treatment of the prolapse can often cause incontinence.

In fact, all of the organ systems of the pelvis are in extremely close proximity to one another, and a disorder affecting one system can affect its neighbors. Similarly, treatment of a disorder of one system can produce deleterious effects in the others, as noted in the above example. The pelvis is comprised of the lower urinary tract (bladder and urethra), genital tract (vulva, vagina, cervix, uterus, fallopian tubes, and ovaries), lower gastrointestinal tract (sigmoid colon, rectum, and anus), and pelvic floor (the levator ani muscle complex). Because of the intimate association between these organ systems, symptoms relating to the pelvis can be very difficult to treat. For many years, pelvic disorders have been inappropriately compartmentalized, diagnosed, and treated along partisan (urologic, gynecologic, and colorectal) lines without appreciation for the entire pelvis, resulting in inadequate and sometimes inappropriate treatment.

Recognizing this, the American Board of Obstetrics and Gynecology (ABOG) began formally accrediting fellowships in Urogynecology and Reconstructive Pelvic Surgery in 1996. In 2000, ABOG and the American Board of Urology agreed to jointly sponsor a new subspecialty in Female Pelvic Medicine and Reconstructive Surgery (FPMRS). Regardless of the name, fellowship-trained subspecialists have extensive training in gynecology, female urology, and lower gastrointestinal disorders, and can approach the patient in an integrated fashion, thus optimizing care for the patient. It is cost-effective, cutting down on the number of specialists a patient has to see and also on the amount of surgery performed. Many of our patients are optimally treated with non-surgical therapies.

Northeast Urogynecology, Pelvic Medicine, and Reconstructive Pelvic Surgery has been established to provide this integrated care, offering the most advanced diagnostic techniques, supportive services, and effective therapy to people with all degrees of urinary or fecal incontinence as well as to women with pelvic support disorders. Since its establishment in 2001, Northeast Urogynecology has been recognized locally and nationally as providing the highest quality health care and continence services in the region.