Common Pelvic Floor Disorders Research Articles

Establishment and initial implementation of the Australasian Pelvic Floor Procedure Registry.

Stress urinary incontinence (SUI) and pelvic organ prolapse (POP) are common pelvic floor disorders (PFDs). Owing to significant adverse events associated with mesh-related pelvic floor procedures (PFPs) in a proportion of the surgically treated population, and deficits in collection and reporting of these events, the Australian Government identified an urgent need for a tracking mechanism to improve safety and quality of care. The Australasian Pelvic Floor Procedure Registry (APFPR) was recently established following the 2018 Senate Committee Inquiry with the aim of tracking outcomes of PFP involving the use of devices and/or prostheses, with the objective of improving the health outcomes of women who undergo these procedures. This paper will describe the APFPR's aims, development, implementation and possible challenges on the way to its establishment. The APFPR has been developed and implemented in accordance with the national operating principles of clinical quality registries (CQRs). The minimum datasets (MDS) for the registry's database have been developed using a modified Delphi process, and data are primarily being collected from participating surgeons. Patient recruitment is based on an opt-out approach or a waiver of consent. Patient-reported outcome measures (PROMs) providing additional health and outcome information will be obtained from participating women to support safety monitoring of mesh-related adverse events. Currently in the Australasian Pelvic Floor Procedure Registry (APFPR) there are 32 sites from various jurisdictions across Australia, that have obtained relevant ethics and governance approvals to start patient recruitment and data collection as of January 2023. Additionally, there are two sites that are awaiting governance review and five sites that are having documentation compiled for submission. Seventeen sites have commenced patient registration and have entered data into the database. Thus far, we have 308 patients registered in the APFPR database. The registry also published its first status report and a consumer-friendly public report in 2022. The registry will act as a systematic tracking mechanism by collecting outcomes on PFP, especially those involving devices and/or prostheses to improve safety and quality of care.

Pelvic Organ Prolapse: Overview, Diagnosis and Management

Pelvic organ prolapse (POP) is a common pelvic floor disorder (PFD) that affects quality of life (QoL) in millions of women in the United States and around the world. The normal position of pelvic organs relies on both the pelvic floor muscles/levator ani muscle and the connective tissue support for the uterus and vagina. Known risk factors for POP include age, parity, family history, genetic predisposition, and chronic straining. The diagnosis of POP depends mainly on history and clinical examination. After diagnosis, progression is slow, and regression is more common than expected. Treatment starts with patient education about the disorder and available treatments. It is important to note that “doing nothing” is always an option. If patient has troublesome symptoms, there are nonsurgical and surgical options. Nonsurgical options include pelvic floor muscle training and pessary therapy. Surgery is an option for patients with POP who decline nonsurgical options or for whom those options fail. Management of women with POP and other PFDs requires a multidisciplinary team to evaluate and formulate individualized plans to address the specific health and QoL issues facing each patient. (J GYNECOL SURG 39:3)

Development of a Uterosacral Ligament Suspension Rat Model.

Pelvic organ prolapse (POP) is a common pelvic floor disorder (PFD) with the potential to significantly impact a woman's quality of life. Approximately 10%-20% of women undergo pelvic floor repair surgery to treat prolapse in the United States. PFD cases result in an overall $26.3 billion annual cost in the United States alone. This multifactorial condition has a negative impact on the quality of life and yet the treatment options have only dwindled in the recent past. One common surgical option is uterosacral ligament suspension (USLS), which is typically performed by affixing the vaginal vault to the uterosacral ligament in the pelvis. This repair has a lower incidence of complications compared to those with mesh augmentation, but is notable for a relatively high failure rate of up to 40%. Considering the lack of standard animal models to study pelvic floor dysfunction, there is an urgent clinical need for innovation in this field with a focus on developing cost-effective and accessible animal models. In this manuscript, we describe a rat model of USLS involving a complete hysterectomy followed by fixation of the remaining vaginal vault to the uterosacral ligament. The goal of this model is to mimic the procedure performed on women to be able to use the model to then investigate reparative strategies that improve the mechanical integrity of the ligament attachment. Importantly, we also describe the development of an in situ tensile testing procedure to characterize interface integrity at chosen time points following surgical intervention. Overall, this model will be a useful tool for future studies that investigate treatment options for POP repair via USLS.

Online prediction tool for female pelvic floor dysfunction: development and validation.

The aim was to develop and validate (internally and externally) a prediction model for the presence and diagnosis of pelvic floor dysfunction (PFD) in women, including pelvic organ prolapse, stress urinary incontinence and/or overactive bladder via a patient-completed online tool. Using a retrospective cohort of women aged >18 years, from multiple tertiary gynaecology units within Queensland, Australia (2014-2018), the prediction model was developed via penalized logistic regression with internal and external validation utilizing multiple clinical predictors (42 questions from the Australian Pelvic Floor Questionnaire and demographics: age, body mass index, parity and mode of delivery). The main outcome measures were the accuracy of the model in predicting a diagnosis of pelvic floor dysfunction and its specific conditions of prolapse and incontinence. A total of 3,501 women were utilized for model development and internal validation and 449 for external validation. On internal validation the model correctly identified those with PFD with 97% sensitivity, 74% specificity and a concordance index (C-index) of 0.96. Predictions of pelvic organ prolapse were also accurate, with 86% sensitivity, 83% specificity, C-index 0.83, as was stress urinary incontinence, 84% sensitivity, 87% specificity, C-index 0.87, and overactive bladder, 76% sensitivity, 77% specificity, C-index 0.77. External validation confirmed the model's accuracy with a similar C-index in all parameters. This model provides an accurate online tool to differentiate between those with and without PFD and diagnoses of common pelvic floor disorders. It serves as a valuable self-assessment for women and primary care providers.

The establishment of a 3D anatomical coordinate system for defining vaginal axis and spatial position

Background and ObjectivePelvic organ prolapse (POP), the herniation of the pelvic organs toward the vaginal opening, is a common pelvic floor disorder (PFD) whose etiology is poorly understood. Traditional methods for evaluating POP are often constrained to external vaginal examination, limited to 2D, or have poor reproducibility. We propose a reliable 3D anatomic coordinate system for standardized 3D assessment of pelvic anatomy using magnetic resonance imaging (MRI). MethodsThe novel 3D anatomic reference system is based on six bony landmarks of the pelvis manually identified in MRI: the ischial spines and the superior and inferior pubic points of the left and right pubic symphysis. The origin of this system is defined as the midpoint of the ischial spines. The reproducibility and applicability of the pelvic coordinate system were evaluated by (1) implementing it in a new method to quantify vaginal position and axis (angulation) in 3D space from MRI segmentations of the vagina and (2) computing the intraclass correlation (ICC) on coordinate system and vaginal measures. The MRI analysis was performed by four non-medically trained observers on five pelvic MRI datasets on approximately five separate occasions. ResultsOverall, all bony landmarks had excellent intra-observer reliability and inter-observer reliability (ICC>0.90); intra-observer reliability was moderate-to-good among the vaginal position parameters (0.5<ICC≤0.90) and moderate for the vaginal axis angles (0.50<ICC≤0.75); inter-observer reliability was moderate in the vaginal position coordinates and vaginal axis measures. On average, within-observer differences in the vaginal position and angle measures relative to the overall mean were <1 mm and <1°, respectively. ConclusionsThe proposed anatomic coordinate system and vaginal analysis approach allow quantitative assessment of pelvic anatomy that is robust to the experience level of the observer. The application of these methods in radiographic studies will give new insight into the underlying anatomic changes involved in the pathogenesis of POP and other PFDs and help better understand their etiology.

The Relationship Between Static Standing Posture and Common Pelvic Floor Disorders

The Relationship Between Static Standing Posture and Common Pelvic Floor Disorders

Urotherapist activities in caring for patients with pelvic floor disorders: a prospective single-center observational study

PurposePatients with pelvic floor disorders are growing in number. The aim of this study is to outline the main activities of a urotherapist, an advanced nurse practitioner, in the care of patients with pelvic floor disorders and to evaluate patient satisfaction with the service urotherapists provide.MethodsThe prospective single-center observational study was carried out from July 2016 to June 2018. Parameters used to assess the urotherapist activities included the number of consultations, type of counselling, time frame of consultations and therapy and patient satisfaction. In a subgroup of 38 patients, satisfaction with the urotherapy sessions was evaluated by a questionnaire.ResultsTotally, 1709 patients were examined by urogynecologists. Five hundred and fourteen (30%) with chronic pelvic floor disorders were subsequently referred to a urotherapist. Of these patients, 60% were at least 65 years old. The most common pelvic floor disorders (221 patients; 43%) were an overactive bladder, recurrent urinary tract infections, chronic cystitis and pelvic pain syndrome; the second most common pelvic floor disorder was pelvic organ prolapsed (151 patients; 29%). Of the study subgroup comprising 38 patients, 32 (84%) returned the patient satisfaction questionnaire. All 32 patients specified their level of agreement with the urotherapist’s professional competence, empathy, temporal availability and quality of advice as “agree to strongly agree.”ConclusionsManagement by a urotherapist was highly appreciated. The role of the urotherapist as a care coordinator, their level of autonomy and barriers to the implementation in primary care requires further exploration.

Women’s Pelvic Floor and Urinary Incontinence (UI) Health Literacy: A Mixed-Methods Study

Abstract Date Presented 03/28/20 UI is a common pelvic floor disorder (PFD) that affects up to 50% of women age 50 years and older and significantly diminishes quality of life. This mixed-methods project collects important information on women’s health literacy, which will contribute to the OT evidence base to inform future education-based health-promotion interventions. Primary Author and Speaker: Jessica Alden Additional Authors and Speakers: Lynda Hill Contributing Authors: Tatiana Sanses, Sharee Pearson, Alice Ukaegbu, Shannon Gopaul

Relationship Between Urinary (UI) Incontinence & Functional Mobility and Life Satisfaction in Older Adult Women

Abstract Date Presented 03/28/20 UI is a common pelvic-floor disorder that affects up to 50 percent of women age 50 years and older and significantly diminishes quality of life. This quantitative randomized controlled trial will assess whether a multimodal therapeutic exercise program combined with pelvic floor physical therapy is more effective than providing the standard of care. This research has the potential to expand OT scope of practice, improve QOL for women with UI, and contribute to evidence-based practice in women’s health. Primary Author and Speaker: Jessica Alden Contributing Authors: Tatiana Sanses, Sharee Pearson, Shannon Gopaul, Alice Ukaegbu

Vitamin D: another piece of the puzzle in pelvic floor protection.

Pelvic floor protection strategies have become are an important area of research. Our knowledge and understanding of such strategies continue to increase with the growing body of research in this area. Urinary incontinence is the most common pelvic floor disorder with prevalences up to 67% in parous women (Wesnes, S. L. et al.; Obstet Gynecol 2007;109;922-8). Risk factors for pelvic floor disorders such as age, body mass index and parity have been well established (Nygaard, I. et al.; JAMA 2008;300;1311-6). Urinary incontinence (UI) during pregnancy is associated with an increased risk of postpartum UI. However the relationship between pregnancy associated UI and postpartum UI is not always clear. In 2010 we performed a questionnaire-based study on the prevalence of UI during pregnancy and the postpartum period. This study determined that the group of women who experienced postpartum UI were not the same women who suffered from UI during pregnancy (Huebner, M. et al.; Int J Gynaecol Obstet 2010;110;249-51).

From anatomy to patient experience in pelvic floor surgery: Mindlines, evidence, responsibility, and transvaginal mesh.

Beginning in the late 1990s, surgeons around the world widely adopted the transvaginal placement of permanent synthetic mesh for the treatment of several common pelvic floor disorders in women. By 2012 it had become the subject of extensive litigation, including one of the biggest mass-tort cases in U.S. history, with litigants reporting debilitating and unexpected complications. Based on qualitative research that includes interviews with surgeons, observations of medical conferences, and analysis of archival materials, we argue the adoption of transvaginal mesh cannot be fully explained without recognizing the role of mindlines, or collective moral-epistemological ways of knowing and acting responsibly. The adoption of mesh was anchored in a mindline focused on repairing anatomy. The harms that resulted from transvaginal mesh necessitated a shift to a focus on patient experience. We analyze the role of evidence-based medicine (EBM) in the re-organization of these surgeons' mindlines, showing that mindlines are not reducible to evidence as defined by EBM and that evidence thus defined facilitated the adoption of transvaginal mesh.

Enhancing Pelvic Health: Optimizing the Services Provided by Primary Health Care Teams in Ontario by Integrating Physiotherapists.

Purpose: The purpose of this review was threefold: (1) to outline the current landscape of service provision for two common pelvic floor disorders, urinary incontinence (UI) and pelvic organ prolapse (POP); (2) to describe common pelvic floor dysfunctions (UI and POP) and the associated evidence-based, conservative care; and (3) to present the potential to integrate physiotherapists into inter-professional primary health care teams to optimize the provision of care for these disorders. Method: A literature review was undertaken and a case study was developed to describe evidence-informed conservative care for pelvic floor dysfunctions. Results: A variety of models exist to treat pelvic floor disorders. Physiotherapists and nurses are key care providers, and their scope and care provision overlaps. In Ontario specifically, both nurses and physiotherapists with additional postgraduate training in pelvic floor disorders are integrated into primary health care, but only to a very limited degree, and they are arguably well positioned to leverage their skills in their respective scopes of practice to optimize the provision of pelvic health care. Conclusions: Physiotherapists and nurses are shown to be key providers of effective, conservative care to promote pelvic health. There is an opportunity to integrate these types of provider into primary care organizations in Ontario; this collaborative care could translate into improved outcomes for patients and the health care system at large.

The mysteries of menopause and urogynecologic health: clinical and scientific gaps.

A significant body of knowledge implicates menopausal estrogen levels in the pathogenesis of the common pelvic floor disorders (PFDs). These health conditions substantially decrease quality of life, increase depression, social isolation, caregiver burden, and economic costs to the individuals and society. This review summarizes the epidemiology of the individual PFDs with particular attention to the understanding of the relationship between each PFD and menopausal estrogen levels, and the gaps in science and clinical care that affect menopausal women. In addition, we review the epidemiology of recurrent urinary tract infection (rUTI)-a condition experienced frequently and disproportionately by menopausal women and hypothesized to be potentiated by menopausal estrogen levels. The abundance of estrogen receptors in the urogenital tract explains why the natural reduction of endogenous estrogen, the hallmark of menopause, can cause or potentiate PFDs and rUTIs. A substantial body of epidemiological literature suggests an association between menopause, and PFDs and rUTIs; however, the ability to separate this association from age and other comorbid conditions makes it difficult to draw definitive conclusions on the role of menopause alone in the development and/or progression of PFDs. Similarly, the causative link between the decline in endogenous estrogen levels and the pathogenesis of PFDs and rUTIs has not been well-established. Innovative human studies, focused on the independent effects of menopausal estrogen levels, uncoupled from tissue and cellular senescence, are needed.

Translabial Ultrasound in Midurethral Sling (Mesh) Visualization and Erosion Detection in Women With Stress Urinary Incontinence: A Retrospective Pilot Study.

Sling erosion is a significant complication of midurethral sling (mesh) placement for stress urinary incontinence, a common pelvic floor disorder. The goal of this retrospective case-control pilot study was to evaluate the performance of translabial ultrasound (TLUS) and magnetic resonance imaging in diagnosing mesh erosion. Therefore, women who underwent surgery in the setting of prior failed midurethral sling for stress urinary incontinence were identified from the hospital database. The case subcohort comprised all women with intraoperatively documented erosion, and the control subcohort comprised an equal number of randomly selected patients without erosion. The data consisted of selected clinical parameters, the presence of erosion at surgery (reference standard) and at cystourethroscopy, and dual-reader preoperative TLUS consensus interpretation for mesh location (intraluminal, mural, and extramural) and erosion (defined as intraluminal or mural mesh location). Odds ratios were calculated for the selected clinical parameters. Of the 198 women identified, 15 (8%) had mesh erosion at surgery into the lower urinary tract. The sensitivity, specificity, and accuracy of TLUS and cystourethroscopy in detecting erosion in the combined group of cases and controls (30 women) were 93%, 88%, and 90%, as well as 67%, 100%, and 83%, respectively (TLUS Cohen κ = 0.85). Thus, TLUS may be a good diagnostic tool in diagnosing mesh erosion. Only 7 of 30 women had pelvic magnetic resonance examination, and mesh fragments were not visualized. Case-control comparison of the selected clinical parameters was not statistically significant.

One in five women suffer from pelvic floor disorders in Kersa district Eastern Ethiopia: a community-based study

BackgroundHundreds of millions of women suffer from pelvic floor disorders globally, often in silence. Women in developing countries do not disclose their problems due to associated social stigma or lack of access to services. Thus, the extent of the problem remains largely unknown. This study was conducted to assess the magnitude of pelvic floor disorders in Kersa district Eastern Ethiopia.MethodWe conducted a community-based cross-sectional study among ever married women who reside in Kersa district, Eastern Ethiopia. The study subjects were selected through stratified multistage probability sampling. The data were collected using a structured questionnaire through face-to-face interviews. The prevalence of various pelvic floor disorders are presented along with the 95% Confidence Intervals (CI).ResultsA total of 3432 women participated in the study, of which 704 (20.5%; 95% CI; 19.2, 21.8) reported at least one type of pelvic floor disorder and 349 (49.6%; 95% CI: 46.0, 53.0) reported two or more pelvic floor disorders. The most common pelvic floor disorders included an over active bladder (15.5%; 95% CI: 14.4, 16.8), pelvic organ prolapse (9.5%; 95% CI: 8.5,10.4), stress urinary incontinence (8.3%; 95% CI: 7.4, 9.2) and anal incontinence (1.9%; 95% CI: 1.5, 2.4). More than two-thirds of the women with pelvic floor disorders (68.0%; 95% CI:64.4, 71.3) reported having severe distress but had never sought health care.ConclusionsThe magnitude of the health problem and the low level of health seeking behavior indicates the silent suffering of many women in the study area. Extrapolating these figure to national statistics would indicate the staggering number of women suffering from pelvic floor disorders in the country. This calls for urgent action to improve prevention, diagnosis and treatment services to mitigate the suffering of women from pelvic floor disorders.

Prevalence and predictors of double incontinence 1year after first delivery.

Urinary (UI) and anal incontinence (AI) are common pelvic floor disorders (PFD), and postpartum women experiencing double incontinence (DI), the combination of UI and AI, tend to have more severe symptoms and a greater impact on quality of life. Our objective was to investigate the prevalence and predictors of postpartum DI and UI alone 1year after first delivery. In this prospective cohort study, 976 women reported the prevalence of DI and UI alone 1year after their first delivery in one of two hospitals in Norway using the St Marks score and the ICI-Q UI SF. DI was significantly reduced from 13% in late pregnancy to 8% 1year later, whereas 30% reported UI at both time points. Incontinence in late pregnancy predicted incontinence 1year after delivery. Higher age was associated with UI alone. Compared with caesarean delivery, normal vaginal or instrumental delivery increased the risk of UI alone more than three and four times respectively. Obstetric anal sphincter injuries showed a four-fold increase in the risk of DI. Nearly 50% reported incontinence symptoms 1year after first delivery. Continence status during pregnancy was one of the main predictors of postpartum continence status. Mode of delivery increased the risk of postpartum UI, whereas obstetric anal sphincter injuries increased the risk of postpartum DI.

Knowledge, Perceptions, and Attitudes Toward Pelvic Organ Prolapse and Urinary Incontinence in Spanish-Speaking Latinas.

The aim of the study was to explore individual views and perceptions of Spanish-speaking Latinas living on the US/Mexico border toward pelvic organ prolapse (POP) and urinary incontinence (UI), including awareness of conditions, implications of diagnoses, knowledge, and attitudes toward available treatment options. Spanish-speaking Latina women were recruited from clinics at Texas Tech University Health Sciences Center El Paso. Focus group discussions were conducted, addressing topics including female pelvic anatomy, perceived etiology and course of POP and UI, and attitudes toward treatment options. Discussions were transcribed and qualitative analysis performed to identify common themes and concepts. Twenty-four women participated in 5 focus groups as follows: 2 groups of women diagnosed with POP/UI, 2 groups of women with POP/UI symptoms, and 1 group of asymptomatic women. Mean age of participants was 52 years. Participants had a good basic understanding of pelvic organs and function. The following 3 common themes were derived from our analysis: culture, barriers, and misconceptions. Concepts identified from common themes included views of POP/UI as "abnormal" conditions; perceptions that providers may downplay or ignore symptoms of POP/UI; fear of doctor; views of cancer as a common POP complication; embarrassment; views of "massage" therapy as an effective treatment for POP; and willingness to consider all available treatment options for POP and UI, including pessary. Findings suggest need for patient reassurance about the prevalence and benign course of POP and UI upon initial assessment, with continued reinforcement of basic concepts after diagnosis, and need for increased awareness and information resources for healthcare providers and Spanish-speaking Latina women regarding these common pelvic floor disorders.

64: Pelvic floor disorders and psychiatric diagnoses: Are they related?

To identify the prevalence of psychiatric diagnoses in a Female Pelvic Medicine and Reconstructive Surgery (FPMRS) clinic population and to determine if associations exist between these diagnoses and pelvic floor disorders (PFDs). We retrospectively reviewed de-identified medical records for all new patients who presented to the FPMRS clinic from 2007-2013. Urogynecologic and psychiatric diagnoses were identified by ICD-9 codes. Statistical analysis of patients with various PFDs was performed comparing those patients with and without psychiatric diagnoses. Chi-square was used for categorical data and Student’s t-test or Mann-Whitney U test were utilized for continuous data. Backwards multivariate logistic regression was also performed to identify those variables related to PFDs significantly correlated with having a psychiatric diagnosis. A total of 6,461 women were seen in the FPMRS clinic during this time. Patients had a mean age of 60.8 ± 16.3 years and most were white (58%). Half (50%) carried at least one comorbid psychiatric diagnosis. The number of psychiatric diagnoses in those affected ranged from 1-11 with a median of 3. The majority (75%) of patients had more than one PFD diagnosed with a median of 3 (range = 1-14). High-tone pelvic floor/painful bladder syndrome (PBS), overactive bladder (OAB), fecal incontinence (FI), and neurogenic bladder were each associated with having a psychiatric diagnosis on multivariate logistic regression. Each PFD had a different constellation of associated comorbid psychiatric disorders, however, anxiety disorders were linked to every PFD correlated with having a psychiatric diagnosis (Table). PFDs that were not associated with psychiatric comorbidities were stress urinary incontinence, acute/recurrent urinary tract infection, nocturia, mesh complications, vulvovaginal atrophy, care for obstetric anal sphincter injury after delivery, and genitourinary or rectovaginal fistula. Patients were more likely to receive a referral to pelvic floor physical therapy for treatment of PFD if they were white and younger, had an anxiety disorder, psychosis, or sexual disorder. They were less likely to be referred if they were Black/African American, had post-traumatic stress disorder or dementia. White or Hispanic race were correlated with undergoing a urogynecologic surgery, while patients of Black/African American race were less likely to undergo surgery for their PFD. Patients with comorbid anxiety or dementia were also less likely to have surgery. Comorbid psychiatric diagnoses are found in half of the FPMRS patient population and often correlate with common PFDs. Anxiety disorders correlated highly with all PFDs associated with having a psychiatric disorder. As psychiatric diagnoses may have an effect on clinical practice patterns, clinicians should take this into account when counseling and treating patients with PFDs.

Imaging of Pelvic Floor Reconstruction

Stress urinary incontinence and pelvic organ prolapse are 2 common pelvic floor disorders that are important causes of pelvic pain and disability. Mesh and sling placement are some of the surgical treatment options available for treatment of these conditions. In addition to clinical assessment, imaging plays an important role in managing postoperative patients with complications such as recurrent organ prolapse and chronic pain. Role of high-resolution pelvic magnetic resonance imaging with additional advanced imaging techniques, such as magnetic resonance neurography that are invaluable in managing such patients, are discussed in this article.

Endocrine therapy and urogenital outcomes among women with a breast cancer diagnosis.

Endocrine therapy for breast cancer can exacerbate menopausal symptoms. The association between endocrine therapy and common pelvic floor disorders including urinary incontinence has rarely been evaluated. We examined urogenital and sexual side effects among women with a breast cancer diagnosis, comparing endocrine therapy users to nonusers. Urogenital and sexual symptoms were self-reported during the enrollment interview within the University of North Carolina Cancer Survivorship Cohort. Tumor characteristics and endocrine therapy use were collected from medical and prescription records. We calculated multivariable prevalence ratios (PR) and 95% confidence intervals (CI) for the association of endocrine therapy (versus no endocrine therapy) and urinary incontinence, overall and by therapy type (tamoxifen or aromatase inhibitors). PROMIS Sexual Function and Satisfaction domain scores were compared across endocrine therapy groups. Among the 548 women with a breast cancer diagnosis, 49% received endocrine therapy. Overall, 18% of women reported urinary incontinence symptoms. We observed no association between urinary incontinence and endocrine therapy use overall (PR=0.97; 95% CI 0.67, 1.43), tamoxifen (PR=1.20; 95% CI 0.74, 1.96), or aromatase inhibitors (PR=0.89; 95% CI 0.55, 1.42), compared to no use. Approximately 55% of women were sexually active. Sexual function scores did not vary according to endocrine therapy use, although urinary incontinence was associated with lower satisfaction scores (p=0.05). Our findings demonstrate a high prevalence of urinary incontinence after breast cancer diagnosis similar to the overall prevalence in older U.S. women, and this did not vary strongly according to use of endocrine therapy.