Best and Brightest: Solutions for Female Incontinence

At The Christ Hospital’s Institute for Pelvic Floor Disorders, Mickey Karram helps patients realize that the path to aging gracefully depends on good plumbing.


Pelvic floor disorders are extremely prevalent in women, almost to a point that every woman some time in her life will suffer from one. There’s a variety of different causes: The pelvic floor can be damaged by childbirth, heavy lifting, chronic disease, previous pelvic surgeries, and other causes that are not clearly understood.

There’s a tremendous overlap in symptoms related to things a gynecologist would see in a woman and things a urologist would see. You’ll have a patient who has a bladder control problem; maybe they’re having pain with intercourse, maybe a bowel problem. Historically they’ve been passed around—you need to see a gynecologist for this, a urologist for that, a colorectal specialist for that. It’s difficult for a patient to figure out, so you need this all-inclusive mechanism to guide the patient through the system.

The center’s been around less than a year [but] it’s been very well-received. It’s getting bombarded. It’s got state-of-the-art testing equipment; we can evaluate the most complex problems right there. Eleven percent of women who have a bladder control problem have a bowel control problem. Probably up to 40 percent of women who have a bladder control problem have a problem with pelvic organ support. Almost always, non-surgical treatment options such as medication, behavioral therapy, and pelvic floor rehabilitation are initially recommended. When surgery is necessary, it can often be done minimally invasively, on an outpatient basis. We get referrals from all over. We recently had a patient who came from Athens, Greece. 

The good news is, for 95 percent of patients, it’s a quality-of-life issue—nobody ever dies of losing urine. But it’s a _significant quality-of-life problem. For example, most people aren’t aware of the fact that in the adult protective wear industry, the amount of money spent on pads to control a leaky bladder is about $4 billion a year. It’s a huge, huge problem that, unfortunately, women are still in the closet about. They buy their pads and they do their thing but they don’t talk about it. Christ Hospital has done a great job in promoting the center and getting the word out. There’s almost hardly ever a situation where we can’t help you and make your quality-of-life better.

Originally published in the January 2012 issue.

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