Disorders of pelvic health affect a large majority of women with disabilities. Bladder, bowel, and reproductive health and sexual dysfunction are found in greater than 70 percent of women with neurologic abnormalities such as spinal cord injury, multiple sclerosis, spina bifida, stroke, and traumatic brain injury. New research studies are finding a high occurrence in other populations of women with physical disabilities such as joint and connective tissue diseases (JCTD) and cerebral palsy. Dysfunction of the pelvic organs and pelvic floor muscles and tissues relate to underlying neurological disease, immobility, medications, and a combination of all. Urinary incontinence, chronic constipation, fecal incontinence, urinary tract infections, pelvic pain, menstrual problems, and sexual dysfunction are a source of ongoing physical and psychosocial secondary conditions.
Female pelvic health depends upon the overall health of bladder and bowel transit, pelvic floor muscle function, visceral sensation - ability to feel changes in an organ such as fullness or pain-, the motivation to maintain bladder and bowel control, and the ability to access means of elimination. Muscles and organs of the pelvis share nerves with other abdominal organs and the upper leg. They also share limited real estate in the small female pelvis, resulting in overlapping disorders. When neurologic disorders affect the extrinsic neurologic control of the rectum, the bladder is likely to exhibit disorders of urinary control, and vice versa. Muscle spasticity in one muscle group can lead to a combination of constipation, urinary retention, and sexual pain in the same patient. Leakage of urine and/or stool puts patients at risk for urinary tract infections, dermatitides, and skin breakdown, not to mention embarrassment, depression, and avoidance of intimate and social interaction. Limitations of mobility, particular in women, further exacerbate these problems as the female urethra and vagina are particularly susceptible to infection in the immobile pelvis. For these reason, optimal care for disabled women complaining of dysfunction in one pelvic organ system necessitates screening for symptoms in the others.
Models for multidisciplinary care in female pelvic health exist in non-disabled women, and we are proposing one for women with disabilities. Screening tools for women with pelvic floor complaints are widely available, and are of paramount importance given limits in access to care in this population. With the complexity and multi-factorial nature of pelvic health conditions in women with disabilities, a multidisciplinary approach to diagnosis and treatment is essential. Furthermore, research initiatives should embrace an inter-disciplinary approach to identification and prevention of these disorders.
