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Pregnancy Timeline by SemestersFetal liver is producing blood cellsHead may position into pelvisBrain convolutions beginFull TermWhite fat begins to be madeWhite fat begins to be madeHead may position into pelvisImmune system beginningImmune system beginningPeriod of rapid brain growthBrain convolutions beginLungs begin to produce surfactantSensory brain waves begin to activateSensory brain waves begin to activateInner Ear Bones HardenBone marrow starts making blood cellsBone marrow starts making blood cellsBrown fat surrounds lymphatic systemFetal sexual organs visibleFinger and toe prints appearFinger and toe prints appearHeartbeat can be detectedHeartbeat can be detectedBasic Brain Structure in PlaceThe Appearance of SomitesFirst Detectable Brain WavesA Four Chambered HeartBeginning Cerebral HemispheresFemale Reproductive SystemEnd of Embryonic PeriodEnd of Embryonic PeriodFirst Thin Layer of Skin AppearsThird TrimesterSecond TrimesterFirst TrimesterFertilizationDevelopmental Timeline
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Home | Pregnancy Timeline | News Alerts |News Archive Oct 31, 2013


Recent studies project that the number of women with pelvic flor disorders will increase significantly over the next 40 years. Currently, the United States spends over $12 billion annually for the management and treatment of urinary incontinence alone.

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Women of color less informed about incontinence and pelvic organ prolapse

Knowing what symptoms to look for may help women with pelvic floor disorders improve their chances of successful treatment. But knowledge of these disorders is lacking among most women, and especially among women of color, according to a new study by researchers at Yale School of Medicine.

The study appears in the October issue of the American Journal of Obstetrics and Gynecology.

Insufficient knowledge and misconceptions about pelvic floor disorders, which include urinary incontinence, fecal incontinence, and pelvic organ prolapse, are thought to be one of the biggest barriers to seeking care.

"If we can improve knowledge about pelvic floor disorders, we may be able to improve outcomes for all women,"

Marsha K. Guess, M.D., corresponding author

Pelvic floor disorders are a major public health concern, Guess said, noting that about 25% of women 20 years or older in the United States suffer from at least one of the three most prevalent pelvic floor disorders: urinary incontinence, fecal incontinence, and pelvic organ prolapse.

Recent epidemiologic studies project that the number of women with these disorders will increase significantly over the next 40 years. The United States spends over $12 billion annually for the management and treatment of urinary incontinence alone, and this number is also expected to rise in the coming years.

Guess and her colleagues conducted a cross-sectional study of 431 women of all ages, races, and socioeconomic levels.

They found that over 71% of these women lacked knowledge about urinary incontinence, and 48% lacked knowledge about pelvic organ prolapse.

After adjusting for age, race, household income, and education, the researchers determined that African-American women and the combined group of Hispanic, Asian and other non-white women were significantly less knowledgeable about these conditions than their white counterparts.

According to Charisse Mandimika, a Yale School of Medicine student who was the study's first author:"Improving knowledge about health problems has proven effective in promoting behavioral change, reducing levels of disease symptoms, and improving compliance with treatment for other chronic diseases. This study shows that African-American women and non-white groups in general are not benefiting from this knowledge."

The study also found that women with a history of pelvic organ prolapse demonstrated greater knowledge than women who had not had this problem, but women with a history of urinary incontinence did not have more knowledge of the disorder than their unaffected counterparts.

"Another very concerning finding is that the majority of women who experienced urinary incontinence had not received treatment," said Guess. "Culturally sensitive educational interventions are urgently needed to raise awareness, and address these disparities in knowledge head on."

Abstract - Objective
To investigate baseline knowledge and demographic factors associated with a lack of knowledge about urinary incontinence (UI) and pelvic organ prolapse (POP).

Study Design
Community-based, cross-sectional survey of 431 racially and socioeconomically diverse women aged 19-98 years. The Prolapse and Incontinence Knowledge Questionnaire was used to assess participants’ knowledge. Primary endpoints were the total number of correct responses on the UI and POP scales respectively. Percentages of individuals answering each item or group of items correctly were explored as secondary outcomes.

All women lacked knowledge proficiency about UI and POP, although knowledge about UI was slightly greater than knowledge about POP. Overall, 71.2% of subjects lacked UI proficiency (<80% correct), while 48.1% lacked proficiency in POP knowledge (<50% correct). Black women demonstrated significantly less knowledge about UI and POP than White women, both before and after adjustment for age, education, and household income. When combined into one group, Asian, Hispanic and Other women also showed significantly less UI and POP knowledge than White women. Most women who reported symptoms of UI had not received treatment for their problems.

There is a global lack of knowledge about UI and POP among community-dwelling women, with more pronounced knowledge gaps among non-White women. UI and POP are chronic medical conditions that should be included in routine screening questions for well-woman care. Further studies are needed to explore how best to educate and improve women’s awareness of these prevalent pelvic floor disorders.

Other authors on the study included William Murk, Alexandra McPencow, AeuMuro Lake, Terri Wedderburn, Charlene Collier, and Kathleen Anne Connell.

The study was funded by the Robert Wood Johnson Harold Amos Faculty Development Award, The National Institutes of Health, and a Yale University School of Medicine Medical Student Research Fellowship. Guess is a former CTSA recipient.

Citation: American Journal Obstetrics & Gynecology (Oct. 23, 2013)

Original press release:http://med.stanford.edu/ism/2013/october/liver.html