That sinking feeling

Maria Stubbs, a 44-year-old mother from Carson, wasn't surprised when she leaked a little urine after the birth of her third daughter 10 years ago; she had experienced a bit of leakage during and immediately after all three of her pregnancies. But when a full year had passed and she was still crossing her legs to stave off leakage every time she coughed, she knew she had a problem.

Her low point occurred when she was washing dishes and suddenly urinated on the kitchen floor. "After I cried, I told my husband I had to do something," she said.

Stubbs' experience is surprisingly common, but researchers are only now beginning to realize just how widespread it is. Problems such as incontinence and dropped pelvic organs -- together called pelvic floor disorders -- affect 1 in 3 women, according to a 4,000-person Kaiser Permanente study funded by the National Institutes of Health (NIH). Other research shows that at least 11% of women end up having surgery for a pelvic floor disorder.

The pelvic floor is a group of muscles, ligaments and nerves that form a sling across the opening of a women's pelvis. A strong pelvic floor holds the bladder, uterus, bowel and rectum in place and allows them to function properly.

Muscles in the pelvic floor tend to weaken as women grow older, with pregnancy and obesity adding extra pressure. Childbirth may also stretch or damage the muscles, especially if forceps are used or severe tearing occurs. The result can be incontinence, which refers to leakage of urine or stool, or pelvic organ prolapse, in which pelvic organs sag into the vagina. In severe cases, the uterus may even herniate between the legs.

Many women avoid seeking treatment because they're embarrassed to talk about their condition or don't think anything can be done. Fortunately, a variety of therapies are available -- many of them introduced just a few years ago.

"Things have improved a lot in the past 10 years," said Dr. Mary McLennan, director of urogynecology at St. Louis University in Missouri.

Open procedures are being replaced by minimally invasive ones, new medications are now available, and researchers are gaining a better understanding of what causes pelvic floor problems -- and how to treat them.

Urinary incontinence

The mainstays of treatment for urinary incontinence are pelvic floor exercises and bladder training. "Surgery should be at the very end of the list," said Dr. Jeanette Brown, a uro- gynecologist who directs the Women's Continence Center at UC San Francisco.