Career-long women’s health provider (PT), educator & advocate with current roles as VP at a digital women’s health company, adjunct university faculty, & consultant in global/community women’s health.
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Like many persistent health conditions, female urinary incontinence (UI) is unlikely to resolve without treatment, and symptom management can be burdensome – socially, economically, and psychologically –for people living with the condition. Fortunately, this is a persistent health condition for which many effective treatments exist, and so there is benefit in communicating with women to determine (1) if they have UI, (2) if it bothers them, and (3) if they want to do something about it.
It was with this in mind that systematic health screening for UI was explored by the Women’s Preventive Services Initiative (WPSI), a federally-supported program led by The American College of Obstetricians and Gynecologists (ACOG). In light of rates of care-seeking among women with UI as low as 25%, the WPSI issued recommendations in 2017 that screening for UI be added as a core component of Well Woman care, such that adult women of all ages are asked annually about the presence or absence of UI, the degree to which any UI bothers them, and if they are interested in pursuing treatment. Several validated survey tools have been developed for this purpose, among them the 3-Incontinence Questions (3IQ) and the Michigan Incontinence Symptom Index (MISI).
Putting this recommendation into universal practice would be a challenge under “normal” circumstance but became markedly difficult when the COVID-19 pandemic shifted all semblance of normal work, home, and family life, along with access to health care, especially health care unrelated to COVID-19. Clinicians of all disciplines working in the field of female UI experienced unprecedented disruptions and shifts in their ability to provide care, including moratoriums on most gynecologic surgeries, clinic closures, and patients unable or unwilling to leave home in the pandemic. A recent survey by the National Association for Continence (NAFC) revealed that for individuals with UI, both the management of their leakage and the severity of their symptoms have become increasingly stressful in the pandemic. Individuals report that they are having more incontinence episodes and having greater difficulty securing the protective garments (i.e. pads, adult diapers) required to manage their UI. An impersonal interpretation of this may be to say that there is now a backlog of patients and pent-up demand for UI care to which the health care system will need to respond. Alternatively, a woman-first response is to recognize that the burden of UI for individual women has increased, that any UI experienced by a woman at the beginning of 2020 is unlikely to have resolved spontaneously and may have worsened without treatment, and that there remains an imperative for the women’s health community to prioritize UI screening and shared decision-making about treatment.
Guidance has been issued during the past year by WPSI and leaders in Female Pelvic Medicine and Reproductive Surgery (FPMRS) and Female Urology to encourage the use of telehealth for UI screening, early evaluation, and implementation of first line care (i.e. pelvic floor muscle training, behavioral modifications). It is likely this will remain a viable avenue beyond the pandemic and offers an opportunity to scale-up these services to meet the health needs of women with UI. It has been reported that over 50% of women with UI who did not discuss it with their healthcare provider (HCP) indicated it was because the HCP did not ask. So let me ask you….are you ready to be a part of changing this story?
#acog2021 #femtech #Kegels #womenshealth