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Cited by 1,869Pelvic floor disorders treatmentsUrinary Bladder and Prostate ResearchSexual function and dysfunction studies

Prevalence of symptomatic pelvic floor disorders in US women

Open access
Nygaard, Ingrid·2008·JAMA
DOI 10.1001/jama.300.11.1311PMC PMC2918416
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Abstract

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 (>or=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 >or=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.

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Registry

Crossref · 10.1001/jama.300.11.1311

Cites

46 of 46 references verified0 citation errors · 0 not checkable

Statistics

Nothing to recompute.

Claims the paper makes

0 of 39 cited sources checked · 0 supported · 0 flagged

  • Findingown data

    The weighted prevalence of fecal incontinence among US nonpregnant women aged 20 years or older in the 2005-2006 NHANES was 9.0% (95% CI, 7.3%-10.7%).

    “9.0% of women (95% CI, 7.3%–10.7%) experiencing fecal incontinence”
    • Also stated in: § RESULTS · plain
      “9.0% (95% CI, 7.3%–10.7%) experienced fecal incontinence”
    Quote in the paperNot a substantial claim
  • Findingown data

    The prevalence of at least one symptomatic pelvic floor disorder increased with parity, from 12.8% in nulliparous women to 32.4% in women with three or more deliveries (P<.001).

    “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)”
    • Also stated in: § RESULTS · plain
      “parity (12.8% [95% CI, 9.0%–16.6%] for nulliparous women vs 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 those women with 1, 2, and ≥3 deliveries, respectively; P<.001)”
    Quote in the paperNot a substantial claim
  • Findingown data

    In this study, Hispanic women were less likely than white or black women to report fecal incontinence.

    “Although Hispanic women were less likely than white or black women to report fecal incontinence in our study, other studies found no such difference in community-dwelling adults.”
    Quote in the paperNot a substantial claim
  • Findingown data

    Race/ethnicity was not significantly associated with having at least one symptomatic pelvic floor disorder (P=.26).

    “We detected no differences in prevalence by racial/ethnic group.”
    • Also stated in: § RESULTS · plain
      “Race/ethnicity and education were not significantly associated with having at least 1 pelvic floor disorder (P = .26 and P = .06, respectively).”
    Quote in the paperNot a substantial claim
  • Findingown data

    Overweight and obese women had a higher prevalence of at least one symptomatic pelvic floor disorder than normal weight women (26.3%, 30.4%, and 15.1%, 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)”
    • Also stated in: § RESULTS · plain
      “body mass index (15.1% [95% CI, 11.6%–18.7%] for underweight/normal weight, 26.3% [95% CI, 21.7%–30.9%] for overweight, and 30.4% [95% CI, 25.8%–35.0%] for obese women; P<.001)”
    Quote in the paperNot a substantial claim
  • The quote only partly states this claim. 2
  • Classified as probably not a substantial claim. 18
  • May combine two claims. 11

  • The quote only partly states this claim.

    Findingown data

    The weighted prevalence of urinary incontinence among US nonpregnant women aged 20 years or older in the 2005-2006 NHANES was 15.7% (95% CI, 13.2%-18.2%).

    “15.7% of women (95% CI, 13.2%–18.2%) experiencing urinary incontinence”
    • Also stated in: § RESULTS · plain
      “15.7% (95% CI, 13.2%–18.2%) experienced urinary incontinence”
    Quote in the paperSubstantial claim

  • The quote only partly states this claim.

    Findingown data

    Among US nonpregnant women aged 20 years or older in the 2005-2006 NHANES, the weighted prevalence of at least one symptomatic pelvic floor disorder was 23.7% (95% CI, 21.2%-26.2%).

    “The weighted prevalence of at least 1 pelvic floor disorder was 23.7% (95% confidence interval [CI], 21.2%–26.2%)”
    • Also stated in: § RESULTS · plain
      “Overall, 23.7% (95% CI, 21.2%–26.2%) of women had symptoms of at least 1 pelvic floor disorder.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Published estimates of the prevalence of fecal incontinence in the community range widely, from 2.2% to 24%.

    “published estimates of the prevalence of fecal incontinence in the community range widely, from 2.2%14 up to 24%.15–18”
    Quote in the paperNot a substantial claim0 of 5 sources checked
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  • May combine two claims.

    Interpretationreasoning

    Symptom-based prevalence estimates likely represent the best estimate of disease burden on the population because women typically seek care only when symptoms develop and physicians generally do not treat until symptoms are bothersome.

    “because women typically do not seek care for prolapse until symptoms develop and physicians generally do not offer surgical treatment until symptoms become bothersome, symptom-based prevalence estimates likely represent the best estimate of disease burden on the population.”
    Quote in the paperNot a substantial claim

  • Classified as probably not a substantial claim.

    Study design and conductown data

    After excluding 292 currently pregnant women, the final analytic data set comprised 1961 women.

    “After eliminating 292 women who were currently pregnant, our final analytic data set comprised 1961 women.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Study design and conductown data

    The sample sizes were adequate to describe prevalence rates by demographic characteristics but too small to provide meaningful estimates of adjusted risk factors, including the effect of delivery type.

    “although the sample sizes were adequate to describe prevalence rates by demographic characteristics, they were too small to provide meaningful estimates of adjusted risk factors, including the effect of delivery type on pelvic floor disorders.”
    Quote in the paperSubstantial claim

  • Classified as probably not a substantial claim.

    Study design and conductown data

    Weighted prevalence estimates and 95% confidence intervals were calculated incorporating the design effect, sample weights, stratification, and clustering of the complex NHANES sample design.

    “Weighted prevalence estimates and 95% confidence intervals (CIs) were calculated by using SAS version 9.1 (SAS Institute Inc, Cary, North Carolina), incorporating the design effect, appropriate sample weights, stratification, and clustering of the complex NHANES sample design.”
    Quote in the paperSubstantial claim

  • Classified as probably not a substantial claim.

    Study design and conductreasoning

    The 2005-2006 NHANES used a complex, stratified, multistage, probability cluster design to select a nationally representative sample of the civilian, noninstitutionalized US population.

    “Each NHANES provides national estimates of health status of adults in the United States at the time of the survey by selecting a nationally representative sample of the civilian, noninstitutionalized US population, by using a complex, stratified, multistage, probability cluster design.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Study design and conductnone given

    The National Centers for Health Statistics Ethics Review Board approved the protocol, and all participants provided written informed consent.

    “The National Centers for Health Statistics Ethics Review Board approved the protocol, and all participants provided written informed consent.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductnone given

    Estimates with relative standard errors greater than 30% were considered statistically unreliable.

    “Estimates with relative standard errors of more than 30% were considered statistically unreliable and are identified as such (Table).”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Premisecitation

    Vaginal bulge symptoms have high specificity (99%-100%) but low sensitivity (16%-35%) for predicting prolapse beyond the hymen in low-prevalence populations.

    “The specificity of vaginal bulge symptoms for predicting prolapse beyond the hymen is high in low-prevalence populations (99%–100%); however, the sensitivity is low (16%–35%), because some women with even advanced prolapse deny symptoms.”
    Quote in the paperSubstantial claim0 of 2 sources checked
    • cites [7]

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    • cites [25]

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  • Classified as probably not a substantial claim.

    Study design and conductcitation

    Fecal incontinence was defined as at least monthly leakage of solid, liquid, or mucous stool using the validated fecal incontinence severity index.

    “We defined fecal incontinence as at least monthly leakage of solid, liquid, or mucous stool, determined by responses on the validated fecal incontinence severity index, which applies a type × frequency matrix to obtain the patient’s perception of symptom severity.”
    Quote in the paperSubstantial claim0 of 2 sources checked
    • cites [4]

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  • Classified as probably not a substantial claim.

    Study design and conductcitation

    Symptomatic pelvic organ prolapse was defined as a positive response to a question derived from the Pelvic Floor Distress Inventory about seeing or feeling a vaginal bulge.

    “We defined symptomatic pelvic organ prolapse as a positive response to the question, “Do you experience bulging or something falling out you can see or feel in the vaginal area?”, which was derived from the Pelvic Floor Distress Inventory.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [6]

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  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Interpretationreasoning

    As the population of older women increases, the national burden of pelvic floor disorders in health care costs, lost productivity, and decreased quality of life will be substantial.

    “As the population of older women increases, the national burden related to pelvic floor disorders in terms of health care costs, lost productivity, and decreased quality of life will be substantial.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Interpretationreasoning

    The study's prevalence estimates are likely underestimates of the true prevalence of pelvic floor disorders because they exclude successfully treated women, use conservative definitions, and rely on symptom-based diagnosis that underestimates anatomic prolapse.

    “our prevalence estimates are likely underestimates for several reasons: (1) they do not reflect symptoms of women who have undergone successful treatment for pelvic floor disorders; (2) we used conservative definitions; and (3) symptom-based diagnosis underestimates the true prevalence of pelvic organ prolapse diagnosed by physical examination.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductnone given

    The 2005-2006 NHANES oversampled persons aged 60 years or older and black, Mexican American, and low-income white individuals to provide more reliable estimates for these groups.

    “The 2005–2006 NHANES oversampled persons aged 60 years or older, and black, Mexican American, and low-income white individuals to provide more reliable estimates for these groups.”
    Quote in the paperNot a substantial claim

  • Classified as probably not a substantial claim. May combine two claims.

    Study design and conductcitation

    Urinary incontinence was defined using the validated 2-item incontinence severity index, which correlates well with incontinence volume and frequency.

    “To define urinary incontinence, we used the validated 2-item incontinence severity index, which correlates well with incontinence volume based on pad weights and incontinence frequency obtained on bladder diaries.”
    Quote in the paperSubstantial claim0 of 2 sources checked
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  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Other studies, including earlier NHANES waves, concluded that between 25% and 75% of women have urinary incontinence, depending on how the condition is defined.

    “Other studies, including data from NHANES in earlier waves,9–13 concluded that between 25% and 75% of women have urinary incontinence, depending on how the condition is defined.”
    Quote in the paperNot a substantial claim0 of 5 sources checked
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  • May combine two claims.

    Premisecitation

    In a cross-sectional study of Norwegian women, the effect of two or more deliveries on urinary incontinence was greatest in younger women aged 20-34 (RR 2.8), decreased among women aged 35-64 (RR 2.0), and was not associated in women older than 65.

    “In a cross-sectional study of Norwegian women, compared with women with no deliveries,34 the effect of 2 or more deliveries on urinary incontinence was greatest in younger women aged 20 to 34 years (relative risk [RR], 2.8; 95% CI, 2.3–3.3), decreased among women aged 35 to 64 years (RR, 2.0; 95% CI, 1.6–2.3), and then, consistent with other literature, was not associated with urinary incontinence”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [34]

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  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    National hospital discharge statistics show that black women have lower rates of prolapse surgery than white women.

    “Although national hospital discharge statistics show that black women have lower rates of prolapse surgery than white women,41 this difference cannot be attributed to just race.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [41]

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  • Probably not a substantial claim: may not pass S2 (checkable), S3 (load-bearing), S4 (based).

    Interpretationreasoning

    Many factors, including access to care, contribute to the decision to undergo surgery and therefore to surgical prevalence rates.

    “Many factors, including access to care, contribute to the decision to undergo surgery, and therefore to surgical prevalence rates.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Premisereasoning

    Population-based epidemiological studies of pelvic organ prolapse are rare, despite prolapse being a common indication for gynecologic surgery in older women.

    “Population-based epidemiological studies of pelvic organ prolapse are rare, despite the fact that it is a common indication for gynecologic surgery in older women.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductown data

    Because the study has no information about treatment for pelvic floor disorders, it cannot comment on whether treatment varies by race/ethnicity in the sample.

    “Because we have no information about treatment for pelvic floor disorders, we cannot comment on whether treatment varies by race/ethnicity in our sample.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisecitation

    There is no clear consensus about what level of prolapse represents normal variation versus disease, but there is growing consensus that prolapse beyond the hymen is more likely clinically significant.

    “There is no clear consensus about what level of prolapse represents a variation of normal uterovaginal support and what represents disease, although there is growing consensus that prolapse beyond the hymen is more likely to be clinically significant.”
    Quote in the paperNot a substantial claim0 of 2 sources checked
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  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisecitation

    Up to 75% of women presenting for routine gynecological care demonstrate some prolapse, and 3% to 6% have descent beyond the hymen.

    “Up to 75% of women presenting for routine gynecological care demonstrate some prolapse, and 3% to 6% have descent beyond the hymen.”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites [26]

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  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisecitation

    A recent analysis using earlier NHANES data (2001-2004) found a higher prevalence of stress urinary incontinence in white and Mexican American women than black women, but no differences in other incontinence subtypes.

    “A recent analysis using earlier NHANES data (2001–2004) found a higher prevalence of stress urinary incontinence in white and Mexican American women than black women, but no differences in other incontinence subtypes.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [41]

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26 of 26

  • The paper relies on this without support.

    Before this study, no national prevalence estimates for multiple pelvic floor disorders in US women had been derived from a single population-based sample.

    “No national prevalence estimates derived from the same population-based sample exists for multiple pelvic floor disorders in women in the United States.”

  • The paper relies on this without support.

    The national burden of pelvic floor disorders in US women was unknown because no single national population-based survey had assessed the prevalence of the three major disorders.

    “because no single national population-based survey has assessed the prevalence of the 3 major pelvic floor disorders in US women, the national burden related to these diseases remains unknown.”
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Authors
Nygaard, I.
Affiliations
University of Utah (US)
Corresponding author
Nygaard, Ingrid
ORCID
Nygaard, Ingrid
Venue
JAMA
Publisher
American Medical Association (AMA)
Published
2008-09-17
Volume
300
Issue
11
Pages
1311
ISSN
  • 0002-9955 (ISSN-L)
  • 0098-7484
DOI
10.1001/jama.300.11.1311
PMC
PMC2918416
OpenAlex
W1981272273
Cited by
1,869
References
46
Citations by year
2026: 96 · 2025: 126 · 2024: 132 · 2023: 109 · 2022: 139 · 2021: 115 · 2020: 120 · 2019: 122 · 2018: 124 · 2017: 130 · 2016: 99 · 2015: 110 · 2014: 97 · 2013: 89 · 2012: 70
FWCI
42.81
Type
journal article
Language
en
Open access
Locations
  • JAMA (publishedVersion)
  • PubMed (publishedVersion)
  • PubMed Central (acceptedVersion)
Funders
  • National Institutes of Health (U10 HD41267, U10 HD54215, U10 HD41261, U10 HD54214)
  • National Institute of Diabetes and Digestive and Kidney Diseases
  • Office of Research on Women's Health (U10 HD41261, U10 HD41267, U10 HD54215, U10 HD54136, U10 HD41250, U01 HD41249, U10 HD54214)
  • Eunice Kennedy Shriver National Institute of Child Health and Human Development (U10 HD 54215, U10 HD41267, U10 HD41261, U10 HD41269, U10HD041268, U10 HD 41268, U10HD41248, U01-HD41249, U10 HD 54214, U10HD041261, U10HD054136, U10HD054214, U10 HD 41250, U01HD041249, U10HD054215, U10HD041263, U10 HD 54136, U10HD041267, U10HD041248, U10HD041269, U10HD041250, U10 HD 41263, UG1HD041267)
Topics
  • Health Sciences › Medicine › Rheumatology › Pelvic floor disorders treatments
  • Health Sciences › Medicine › Urology › Urinary Bladder and Prostate Research
  • Health Sciences › Medicine › Psychiatry and Mental health › Sexual function and dysfunction studies
Keywords
pelvic floor dysfunction, urinary incontinence, fecal incontinence, pelvic organ prolapse, prevalence, women's health, age differences, parity, NHANES, Incontinence Severity Index, vaginal bulge, American women, population survey, health disparities, health care utilization, health care costs, quality of life
MeSH terms
Adult, Aged, Aged, 80 and over, Fecal Incontinence, Female, Humans, Middle Aged, United States, Urinary Incontinence, Uterine Prolapse, Pelvic Floor, Rectocele

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