At least one-third of U.S. women will suffer pelvic health problems by age 60, sometimes including heavy menstrual bleeding or incontinence, but many of them dont seek medical help, a national study and health-care providers here say.


The onset of such conditions is highest among baby boomers, says the recent report, issued by the National Womens Health Resource Center.


Health-care providers here say that many women suffer the conditions in silence because theyre too embarrassed to tell their doctors about the symptoms, or they dont think treatments are available. Thats changing, though, they say, because physicians are paying more attention to such problems, advancements are being made in diagnosis and treatment, and aging baby boomers are refusing to let such conditions hinder their active lifestyles.


It used to be that people just quietly lived with these problems, says Dr. Debra Ravasia, a gynecologist at Womens Health Connection PS, of Spokane, who focuses particularly on urogynecology in her practice. People have been told that its normal and thats the way it is, but its really not, and once they hear theres a solution, they come forward.


The national report was released in June and was funded by the National Womens Health Resource Center, a Red Bank, N.J.-based nonprofit organization that collects and distributes womens health information. It focused on four pelvic health conditions: abnormally heavy menstrual periods, uterine fibroid tumors, stress urinary incontinence, and pelvic organ prolapse.


About one-third of baby boomer women, or 13.5 million people, suffer from heavy periods, the report says. Heavy periods and uterine fibroids were the primary cause behind 44 percent of hysterectomies done in the U.S. in 2005.


Ravasia says women ages 40 to 50 often have heavy menstrual bleeding as a result of the early stages of menopause. Before diving into treatment options for such women, she first runs tests on patients to rule out an anemia or a thyroid problem, a pre-cancerous condition, or chronic infection as possible causes.


Some patients elect to use a combination of hormone therapies to stop heavy periods, while others opt for one of two relatively new proceduresendometrial ablation and laparoscopic supracervical hysterectomy (LaSH), she says.


Endometrial ablation is a minimally-invasive procedure done in a doctors office that involves destroying part of the uterine lining that bleeds every month. LaSH is an outpatient partial hysterectomy that involves removing the top part of the uterus that bleeds every month and preserving the cervix, ovaries, and ligaments that support the cervix and vagina, she says.


It used to be that total hysterectomy was the only option, but now we have these procedures that dont have the longer recovery times and higher risk of injuries, Ravasia says.


Eighty percent of African-American women and 70 percent of Caucasian women develop uterine fibroids by age 50, the report says. While fibroids are fairly common and typically are benign, they can cause heavy bleeding or urinary frequency in some cases, Ravasia says. In such instances, patients can take medication, undergo total or partial hysterectomies to remove fibroids, or choose a procedure that removes the tumor only. A procedure called radiological embolization, which involves killing tumors by cutting off blood flow to them, also can be done, she says.IncontinenceAbout one-third of baby boomer women struggle with stress urinary incontinence, or SUI, and 50 percent to 75 percent of women who likely have SUI dont tell their doctors about their symptoms, the report says.


SUI occurs when the muscles and tissue that support the bladder weaken and cant prevent urine flow when activities such as laughing, coughing, sneezing, or exercise increase pressure on the abdomen. Causes of SUI include childbirth, smoking, obesity, and aging, among others, Ravasia says.


For patients suffering from SUI, Ravasia runs urodynamics tests to learn more about the bladder problem so she can treat it properly. Such tests measure activity in the bladder and pelvic-floor muscles to find out where, when, and how theyre malfunctioning.


She also runs electromyography tests and nerve function tests to determine the strength and endurance of pelvic-floor muscles and whether theres proper nerve conduction.


Depending on the results of those tests, Ravasia will prescribe certain exercises to strengthen the pelvic-floor muscles, and may use nerve stimulation techniques to help improve muscle function. For patients with more severe SUI cases, an outpatient surgical procedure that involves placing a sling around the urethra to lift it back into normal position also can be done, she says.


Providence Continence Centers, located at both Holy Family Hospital and Sacred Heart Medical Center here, also offers such diagnosis and treatment services.


Word is getting out that theres things to be done about incontinence problems, says Joyce Binford, a physical therapist at Holy Familys continence center. The baby boomers are the ones that have researched, are aware of what can be done, and arent willing to put up with the problem.


Therapists at the center focus on retraining and strengthening patients pelvic-floor muscles, oftentimes aided by the use of biofeedback machines, Binford says. Biofeedback therapy involves placing in the patient a vaginal probe that picks up electrical activity in pelvic-floor muscles and sends that information through an electronic lead to the machine, which displays the activity in graph form, similar to an echocardiogram. Thus, patients can see their muscle activity, which helps when theyre focusing on controlling specific muscles, she says.


Kootenai Rehabilitation Services, located at Kootenai Medical Center in Coeur dAlene, expects to buy a biofeedback machine next year as part of its plan to focus more on womens health issues, including urinary incontinence, says Roger Rung, its director. Rehab Services plans to target women in their 30s who experience SUI as a result of childbirth and need to get control of the problem before it worsens with age, Rung says.


Its one of those closet diseases, but younger women dont want to sit on Pampers and older women who have had it for 30 years are starting to come out now, he says. It also helps that physicians are better trained and are asking women if theyre having problems.


Although more people are learning about their treatment options and seeking help, theres a lingering stigma about incontinence, and sometimes such problems are misperceived to be normal and not something to be concerned about, Binford asserts.


A lot of women have urinary leakage when they cough or sneeze and laugh about it with their girlfriends, but thats not normal, she says. When youre looking for bathrooms all the time or have incontinence, you should address it, because it will just get worse.


For patients with severe cases of SUI who have to live with a catheter, nurses and specialists at the center teach them how to do self-catheterizations, says Marilyn Hatch, a registered nurse at the Holy Family center. Severe SUI can cause pain and lead to urinary-tract infections and a breakdown of skin in the pelvic region, she says.


Some women suffer whats called pelvic organ prolapse, or POP, a condition that involves the sagging of organs such as the bladder, uterus, vagina, small bowel, and rectum as a result of the weakening of muscles and tissue that hold those organs in place. Ravasia says rehab can be an effective treatment for POP.


Forty percent of women over 40 years old suffer from POP, according to the National Womens Health report.


If rehab doesnt work, a doctor can use whats called a pessary, which is a small, rubber medical device thats inserted into the vagina or rectum and held in place by the pelvic floor muscles, Ravasia says. The device can be used for treatment of both POP and stress urinary incontinence. For more severe POP cases, pelvic floor reconstruction surgery is an option, she says.


Contact Emily Proffitt at (509) 344-1265 or via e-mail at emilyp@spokanejournal.com.