Manuscript Type: Narrative Review / Cost-of-Illness Synthesis

Authors: Novasono Corporation (original multi-study synthesis by Isac Cabrera. Tatiana Pupo. Felix J. Martin)

Date: January 2026

Funding / Conflicts of Interest: None declared

ABSTRACT

Objective: Pelvic floor dysfunction (PFD) affects up to one in four US women and includes urinary incontinence (UI), pelvic organ prolapse (POP), fecal incontinence, and overlapping chronic pelvic pain. This synthesis examines the direct medical economic burden to payers, with emphasis on symptom-driven costs when underlying mechanisms remain unevaluated.

Methods: Narrative synthesis of key US claims-based and national survey studies published 2010–2025 (Datar et al. 2022 on stress/mixed UI; Sung et al. 2010 on ambulatory PFD costs; Hutton et al. 2023 and related analyses on chronic pelvic pain/PFD per-case burden; supporting budget-impact models).

Results: Women with diagnosed stress/mixed urinary incontinence incurred mean 2-year all-cause costs of $27,446 versus $17,036 in matched controls (61% higher; incremental ~$5,205/year), driven by outpatient visits and medications. National ambulatory PFD physician office costs reached an estimated $412 million annually (2005–2006, adjusted for deductibles/copayments). Broader PFD/chronic pelvic pain cases generate ~$29,951–$30,000 per individual in in-network services (diagnostics, treatments, surgeries), with untreated/undiagnosed phases contributing substantial downstream burden. Pelvic floor physical therapy utilization remains extremely low (<5%).

Conclusion: PFD imposes a substantial and modifiable payer burden through fragmented, symptom-driven care when dynamic mechanisms are not assessed. Earlier targeted evaluation and first-line conservative management represent high-value opportunities to reduce costs. Critical data gaps persist in broad prediagnosis claims analyses and indirect costs.

Keywords: Pelvic floor dysfunction; urinary incontinence; economic burden; healthcare costs; ambulatory care; pelvic organ prolapse

INTRODUCTION

Pelvic floor dysfunction (PFD) encompasses urinary incontinence (stress, urge, mixed), pelvic organ prolapse, fecal incontinence, and associated chronic pelvic pain/myofascial disorders. Prevalence reaches 23.7–32% among US women, rising with age, parity, obesity, and menopause. Symptoms (leakage, bulge/pressure, straining, pain) are frequently normalized, stigmatized, or misattributed, delaying care-seeking and leading to fragmented management.

When underlying mechanisms—urethral hypermobility/funneling, levator ani avulsion/hiatal ballooning, dyssynergic defecation, anal sphincter defects, cystocele subtypes, or impaired muscle coordination/contractility—are not dynamically evaluated, care defaults to repeated outpatient visits, polypharmacy, and eventual invasive interventions rather than guideline-recommended first-line pelvic floor physical therapy (PT). This narrative synthesis integrates available US data on direct medical costs to payers, critically analyzing inefficiencies in both diagnosed and undiagnosed phases.

METHODS

This is a narrative synthesis of peer-reviewed US studies published 2010–2025. Primary sources include:

-Datar et al. (2022): Retrospective matched cohort (IBM MarketScan Commercial/Medicare databases; n=68,636 women with stress/mixed UI vs. matched controls) examining 2-year post-index healthcare resource utilization (HRU) and direct costs.

-Sung et al. (2010): National Ambulatory Medical Care Survey (NAMCS) analysis estimating annual PFD-related physician office visit costs.

-Hutton et al. (2023) and related analyses: In-network costs for chronic pelvic pain (frequently overlapping with PFD) and per-case burden estimates for untreated PFD.

-Supporting recent budget-impact models and national estimates of PFD/UI economic burden.

Outcomes focused on direct medical costs (plan-paid amounts), HRU (outpatient, inpatient, physician visits, medication use), and identified gaps in prediagnosis/undiagnosed phases. Critical evaluation addressed consistency across sources, methodological limitations (e.g., UI-focused data, older ambulatory estimates), and opportunities for cost reduction via mechanism-specific care.

RESULTS

Post-Diagnosis Costs — Urinary Incontinence (Primary Documented PFD Component)

Datar et al. (2022) reported that women with diagnosed stress/mixed urinary incontinence (SUI/MUI) incurred mean 2-year all-cause costs of $27,446 compared with $17,036 in age- and comorbidity-matched controls (61% higher; p<0.0001). This equates to an incremental burden of approximately $5,205 per patient per year. Outpatient costs were the dominant driver ($7,032 vs. $3,349), followed by inpatient ($3,991 vs. $2,314) and physician office visits (30.43 vs. 18.42 total; primary care 7.33 vs. 5.53; urology/gynecology markedly higher). Prescription medication use (anticholinergics, antidepressants, anxiolytics) was significantly elevated in the SUI/MUI cohort. Notably, only 0.25% of patients had any physical therapy visits and 4.64% had pelvic floor muscle training visits during the 2-year period.

National Ambulatory Burden Across All PFDs

Sung et al. (2010) estimated annual ambulatory physician services costs related to female PFDs (UI, POP, fecal incontinence, and related conditions) at $298 million in 2005–2006 (95% CI $203–394 million), up from $190 million in 1996–1997. After adjusting for deductibles and copayments, the total reached $412 million. The majority of visits were established-patient level 3–4 encounters with generalists or specialists, reflecting the chronicity of PFD. Older women (>65 years) and the South region drove higher costs; UI and POP were the primary diagnosis contributors.

Broader PFD and Chronic Pelvic Pain Burden

Analyses of chronic pelvic pain (often intertwined with PFD myofascial dysfunction) report average in-network costs of ~$29,951 per patient (diagnostics + treatments + surgeries). Untreated or undiagnosed PFD cases generate a total per-individual burden approaching ~$30,000 yearly per patient (direct medical + productivity losses + downstream effects from delayed or misdirected care). Recent budget-impact models for UI treatment estimate 24-month per-patient costs around $11,000 in usual care, with targeted pelvic floor interventions demonstrating potential per-person savings of ~$3,000+ through reduced surgeries and medications.

Table 1. Selected US Direct Cost Estimates for Pelvic Floor Dysfunction.

Study                                                  Population / Focus                                            Key Finding                                 Time Frame

Datar et al. 2022                        SUI/MUI vs. matched controls                     $27,446 vs. $17,036 (all-cause)                  2 years post-index

Sung et al. 2010                       All female PFD ambulatory visits                   $412 million national (adjusted)                          Annual

Hutton et al. 2023 / related        Chronic pelvic pain / untreated PFD             ~$29,951–$30,000 per case                             Per patient

DISCUSSION — Critical Analysis

The economic burden of PFD is substantial, persistent, and likely underestimated. Claims data consistently show elevated all-cause utilization and costs versus controls once diagnosed (e.g., 61% higher in SUI/MUI), driven overwhelmingly by outpatient care and medications. National ambulatory estimates further illustrate the scale, while per-case analyses for broader PFD/chronic pelvic pain highlight ~$30,000 burdens in untreated scenarios.

Strengths of Evidence

Convergence across independent datasets (MarketScan claims and NAMCS national survey) strengthens the finding that PFD generates inefficient, high-volume ambulatory care. Low PT utilization (<5%) despite guideline recommendations underscores a clear gap between evidence and practice.

Limitations and Methodological Gaps

-UI-centric data: Most granular cost studies focus on urinary incontinence; broader PFD (POP, fecal incontinence, isolated myofascial dysfunction) data are more aggregate or older.

-Prediagnosis/undiagnosed burden: Unlike endometriosis (where delay-stratified claims analyses exist), true prediagnosis costs for PFD are scarce in claims literature—largely inferred from “untreated” or symptom-driven patterns, stigma/normalization barriers, and downstream surgical escalation.

-Temporal and indirect costs: Many estimates require inflation adjustment; indirect costs (productivity loss, presenteeism, caregiver burden) are substantial but inconsistently captured.

-Mechanism-assessment gap: When dynamic tools for urethral mobility, levator integrity, hiatal ballooning, dyssynergia, or sphincter function are not used, care remains empiric and costly—contributing to repeated visits and higher eventual procedural rates.

Opportunities for Cost Reduction

Early mechanism-specific evaluation with 3D dynamic transperineal pelvic floor ultrasound with tomographic ultrasound imaging shows promise for savings. Addressing stigma, improving access, and integrating dynamic assessment into routine care could compress the “diagnostic odyssey” and lower long-term payer burden. Value-based models incentivizing conservative management warrant investment, especially given the aging female population and projected demand growth.

CONCLUSION

Pelvic floor dysfunction imposes a substantial direct medical burden on US payers—exemplified by 2-year costs exceeding $27,000 per SUI/MUI patient, national ambulatory expenditures in the hundreds of millions annually, and per-case totals approaching $30,000 in untreated scenarios. When underlying mechanisms remain unevaluated, fragmented symptom-driven care drives inefficiency and downstream escalation. Greater emphasis on early, targeted pelvic floor assessment and first-line conservative therapy represents a high-value strategy to reduce costs, improve outcomes, and meet the needs of millions of women. Updated, broad PFD claims analyses and intervention cost-effectiveness studies are needed to guide policy.

REFERENCES (selected):

-Datar M, et al. Healthcare resource use and cost burden of urinary incontinence to United States payers. Neurourol Urodyn. 2022.

-Sung VW, et al. Costs of ambulatory care related to female pelvic floor disorders in the United States. Am J Obstet Gynecol. 2010.

-Hutton D, et al. The burden of Chronic Pelvic Pain: Costs and quality of life. J Pain Res. 2023.