1. Crawford, Bruce MD


With regard to urinary incontinence, the Cochran Review states that there is support for the recommendation of pelvic floor muscle exercise as first-line conservative therapy for women with stress incontinence, urge incontinence, and mixed incontinence. Despite all of this, most patients with pelvic floor disorders are generally not offered, and consequently do not participate in, an organized program of pelvic floor rehabilitation before using medication and/or surgery to address these problem. As we confront mounting, and unsustainable, health care costs, we should make an effort to examine the possibility that some human conditions previously thought to be medical conditions may in fact, at least initially, be best addressed outside the medial arena. The data that support pelvic floor exercise as an effective preventive, and first-line therapeutic, strategy for pelvic floor disorders certainly suggest that there is a fitness issue at hand.