Dr. Sandra Culbertson

Dr. Sandra Culbertson, urogynecologist with the University of Chicago’s Center for Pelvic Health., is a spokeswoman for the Pelvic Floor Disorder Alliance. (Handout)

The term "pelvic floor" was not part of polite conversation a generation ago, when women with pelvic floor disorders, or PFDs, often suffered in silence.

Fortunately for the millions of women who know this acronym all too well, times have changed.

"It's no longer taboo," said Dr. Sandra Culbertson, urogynecologist with the University of Chicago's Center for Pelvic Health. "Women are talking about it and getting help earlier. Younger women, especially, are not accepting the idea that the symptoms have to be a natural part of aging, and they don't."

Culbertson is a spokeswoman for the Pelvic Floor Disorder Alliance, which formed in 2011 to educate patients and primary-care physicians about treatment of PFDs. An offshoot of the American Urogynecologic Society, the alliance includes physicians, researchers and medical-product manufacturers.

The Tribune asked Culbertson about this enigmatic part of female anatomy.

Q: What is the pelvic floor?

A: A woman's pelvic floor is a muscular shelf that supports the organs that affect reproduction, urination and defecation.

Pelvic floor disorders include urinary or bowel control problems, prolapse of a pelvic organ (bladder, urethra, cervix or rectum) and chronic pain.

Q: How many women suffer from PFDs?

A: None of the major medical organizations keeps track, but we estimate one-third of women will have a PFD at some point in their lives.

You're more likely to suffer from a PFD when you're older, and our population is aging, so the numbers are up. A Duke University study said the number of women with at least one PFD will increase from 28.1 million in 2010 to 43.8 million in 2050.

But it's not just older women. Ten to 15 percent of pre-menopausal women will have some form of urinary incontinence, one of the more common PFDs.

Q: Now women are mad as hell and not going to take it anymore?

A: More women are, but I still hear some say, "I leak when I cough, but doesn't everyone?" A poll conducted by the Alliance said 40 percent of women plan to manage their symptoms with over-the-counter products until they're too uncomfortable.

Through our Break Free from PFDs campaign, we're educating women about solutions and empowering them to speak up. The symptoms are embarrassing, but you have to talk to your doctor about them to get help.

Q: How do you treat the urinary problems, which the Duke study said are the most common?

A: Urinary problems include urge incontinence (you can't make it to the bathroom or feel like you have to go all the time) and stress incontinence (you leak when you cough, sneeze, laugh or exercise).

The first-line treatment for both types is pelvic-floor strengthening exercises. If that doesn't work, urge incontinence can be treated with medications or Botox injections. For stress incontinence, the next step may be surgery.

What used to be a 11/2 surgery, though, is now outpatient and minimally invasive.

Q: What is new with the treatment of the bowel problems?