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Ingrid Nygaard, MD, MS; Matthew D. Barber, MD, MHS; Kathryn L. Burgio, PhD; Kimberly Kenton, MD, MS; Susan Meikle, MD, MSPH; Joseph Schaffer, MD; Cathie Spino, DSc; William E. Whitehead, PhD; Jennifer Wu, MD, MPH; Debra J. Brody, MPH; for the Pelvic Floor Disorders Network

JAMA. 2008;300(11):1311-1316.

Context  Pelvic floor disorders (urinary incontinence, fecal incontinence, and pelvic organ prolapse) affect many women. No national prevalence estimates derived from the same population-based sample exists for multiple pelvic floor disorders in women in the United States.

Objective  To provide national prevalence estimates of symptomatic pelvic floor disorders in US women.

Design, Setting, and Participants  A cross-sectional analysis of 1961 nonpregnant women (20 years) who participated in the 2005-2006 National Health and Nutrition Examination Survey, a nationally representative survey of the US noninstitutionalized population. Women were interviewed in their homes and then underwent standardized physical examinations in a mobile examination center. Urinary incontinence (score of 3 on a validated incontinence severity index, constituting moderate to severe leakage), fecal incontinence (at least monthly leakage of solid, liquid, or mucous stool), and pelvic organ prolapse (seeing/feeling a bulge in or outside the vagina) symptoms were assessed.

Main Outcome Measures  Weighted prevalence estimates of urinary incontinence, fecal incontinence, and pelvic organ prolapse symptoms.

Results  The weighted prevalence of at least 1 pelvic floor disorder was 23.7% (95% confidence interval [CI], 21.2%-26.2%), with 15.7% of women (95% CI, 13.2%-18.2%) experiencing urinary incontinence, 9.0% of women (95% CI, 7.3%-10.7%) experiencing fecal incontinence, and 2.9% of women (95% CI, 2.1%-3.7%) experiencing pelvic organ prolapse. The proportion of women reporting at least 1 disorder increased incrementally with age, ranging from 9.7% (95% CI, 7.8%-11.7%) in women between ages 20 and 39 years to 49.7% (95% CI, 40.3%-59.1%) in those aged 80 years or older (P < .001), and parity (12.8% [95% CI, 9.0%-16.6%], 18.4% [95% CI, 12.9%-23.9%], 24.6% [95% CI, 19.5%-29.8%], and 32.4% [95% CI, 27.8%-37.1%] for 0, 1, 2, and 3 or more deliveries, respectively; P < .001). Overweight and obese women were more likely to report at least 1 pelvic floor disorder than normal weight women (26.3% [95% CI, 21.7%-30.9%], 30.4% [95% CI, 25.8%-35.0%], and 15.1% [95% CI, 11.6%-18.7%], respectively; P < .001). We detected no differences in prevalence by racial/ethnic group.

Conclusion  Pelvic floor disorders affect a substantial proportion of women and increase with age.

Author Affiliations: Department of Obstetrics and Gynecology, University of Utah School of Medicine, Salt Lake City (Dr Nygaard); Obstetrics, Gynecology, and Women's Health Institute and Cleveland Clinic, Cleveland, Ohio (Dr Barber); Department of Medicine, University of Alabama at Birmingham and Department of Veterans Affairs, Birmingham, Alabama (Dr Burgio); Departments of Obstetrics and Gynecology and Urology, Loyola University Chicago–Stritch School of Medicine, Maywood, Illinois (Dr Kenton); Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, Maryland (Dr Meikle); Department of Obstetrics and Gynecology, University of Texas Southwestern Medical Center, Dallas (Dr Schaffer); Department of Biostatistics and Biostatistics and Outcomes Research Core, University of Michigan School of Public Health, Ann Arbor (Dr Spino); Department of Internal Medicine, University of North Carolina School of Medicine, Chapel Hill (Dr Whitehead); Department of Obstetrics and Gynecology, Duke University School of Medicine, Durham, North Carolina (Dr Wu); and National Centers for Health Statistics, Hyattsville, Maryland (Ms Brody).

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