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Submission For The Record of Ms. Susan Scanlan, Women's Research and Education Institute, President

On behalf of the Women’s Research and Education Institute (WREI), I appreciate the opportunity to submit this written testimony to the Committee.  I am Susan Scanlan, President of the Women’s Research & Education Institute.  For thirty years, WREI has provided timely information and expert issue analysis about women and their families to policymakers and the public. 

For nearly that long, WREI has been one of the few, if not the only progressive organization with a nonpartisan focus on the rights and responsibilities of women in uniform.  The Women in the Military project was established in 1983, and is now headed by Captain Lory Manning, a veteran of 26 years of service in the U.S. Navy.  This project provides research and analysis of issues of importance to military women and female veterans to legislators, the media, scholars, and the general public.  WREI publishes Women in the Military: Where they Stand, now in its 5th edition, and we also hold a Women in the Military Conference every other spring. 

Women veterans are the second fastest growing segment of the veteran population.  By 2040, it is estimated that women will exceed 11% of the veteran population.  Women veterans today are younger, more ethnically diverse, and have fewer socioeconomic resources than previous generations of military women.  In addition, the changing nature of war and its porous battlefields means servicewomen—and men--are faced with new health risks.   

I want to bring to the Committee’s attention a health condition that affects up to 30% of military women – namely, stress urinary incontinence (SUI).  At our May 2007 Women in the Military Conference, Lieutenant Colonel Irene Rosen, M.D., Assistant Chief of Family Medicine at Madigan Army Medical Center in Fort Lewis, Washington, reported that genitourinary problems are the fifth most common disease and non-battle injury (DNBI), and accounted for 5% of hospital admissions during Desert Shield/Storm.  The VA Health Services Workgroup also identified urinary incontinence among women veterans as a high-priority issue for research.   

Stress urinary incontinence is the involuntary leakage of urine associated with laughing, coughing, sneezing, sexual, and recreational activities.  The condition is caused by a variety of factors, most commonly childbirth, and often restricts the social, professional, and personal lives of an estimated 15 million women in the U.S. alone.  Physical fitness requirements and the demands of military life put both men and women, but particularly women, at risk for SUI during and after their military service.  Environmental barriers in the field often limit access to hygienic measures and can lead to urinary tract infections that can lead to incontinence.     

According to Dr. Rosen’s research, 30% of female soldiers reported urinary incontinence in the field.  Similarly, Dr. Roger Dmochowski, a professor of urology and researcher at Vanderbilt University, cited studies that found that 30% of female parachutists reported experiencing urinary incontinence when they hit the ground.  An April 2001 article entitled “Urinary Incontinence in Vulnerable Populations: Female Soldiers” published in Urologic Nursing (attached) reported the following additional statistics:

  • Nearly one-third of 450 female soldiers in field-oriented environments at Fort Lewis had significant problems with exercise-induced urinary incontinence. 
  • ·At Fort Benning, 100% of active duty women airborne trainees (n=10) who had no incontinence before airborne training demonstrated SUI after training.
  • In a study involving 563 female soldiers from several units at Fort Lewis, Fort Benning, and Fitzsimons Army Medical Center, 33% reported UT during physical training. 
  • 24% reported urine loss during recreational activities such as exercise and walking and 30% reported urine loss during the annual two-mile physical fitness run. 
  • Field exercises, which involve long road marches with heavy field backpacks, precipitated urinary incontinence.
  • Alarmingly, 30% of active duty military women with SUI reported restricting fluid intake in order to control symptoms. 
  • Women veterans of the Persian Gulf War have a higher proportion of genitourinary problems than other populations.

Given that approximately 20% of the total U.S. military active duty force in the future will be women, it is important for the military – both the Department of Defense and the Veterans Health Administration – to address this growing problem.

As Dr. Rosen’s research found, lack of awareness or embarrassment or reluctance concerning SUI may preclude optimal prevention and treatment of this common problem.  This research reinforces the results of a June 2007 Lewin Group report, Prevalence and Treatment Patterns of Pelvic Health Disorders Among U.S. Women, which found that approximately 50 to 75 percent of women who likely have SUI fail to tell their health care providers about their symptoms and, therefore, are never properly diagnosed and treated.

Non-treatment of SUI can put women at increased risk for numerous physical, social, and psychological conditions.  Avoidance of exercise and an active life, depression, loss of self-esteem, loss of a sense of control over one’s life, social withdrawal, and sexual dysfunction related to embarrassment, are just a few of the potential physical, psychological, and social impacts associated with non-treatment of SUI.  Withdrawal from physical and social activities can lead to a reduction in physical well being, which may in turn lead to obesity, diabetes, heart disease, and other medical complications.

In order to properly diagnose and treat SUI, Dr. Rosen recommends educating and screening military women and veterans for the condition, and providing appropriate treatment.  Walter Reed Army Medical Center’s Internet fact sheet on stress incontinence (which was last updated in September 2004) recommends the following treatments: 

    • Practicing good hygiene
    • Learning and practicing Kegel pelvic floor muscle exercises
    • Weight loss, smoking cessation, and cough suppression 
    • Biofeedback, electrical stimulation, or special weights to strengthen pelvic muscles 
    • Wearing absorbent underpants or incontinence pads 
    • A pessary (support device) made of rubber or other materials to fit inside the vagina for support
    • Surgery

With regard to medications, alpha-adrenergic drugs or estrogen therapy may be prescribed.   

Walter Reed’s list of treatments fails to include Renessa, an FDA-cleared non-surgical treatment for SUI that would be particularly beneficial in the military and VA healthcare settings.  This procedure is a non-surgical approach that can be performed in the convenience of a physician's office or other outpatient setting.  It takes less than thirty minutes and involves the use of radiofrequency energy to treat tissue targets within the lower urinary tract.  Most importantly, the procedure allows women to return to their duties quickly.  Most patients return to normal activities within 24 hours, and heavy lifting within days, not weeks.

It is my understanding that this procedure has already been performed at several military facilities, including Dr. Rosen’s institution -- Madigan Army Medical Center, Evans U.S. Army Community Hospital (Fort Carson, CO), and Travis Air Force Base in California.  A non-surgical option for the treatment of SUI would also be an attractive option for female dependents of military men.

As Members of Congress know, FDA approval does not automatically lead to the adoption of new medical technologies.  The Veterans Health Administration and the Department of Defense should do more to ensure that women veterans and active duty women are educated about stress urinary incontinence, screened, and provided with access to the full range of FDA-approved treatments – including non-surgical procedures – to address this debilitating condition. 

Thank you for the opportunity to submit this testimony and bring this important women’s health issue to the attention of the Veterans’ Affairs Committee.