A smarter approach to pelvic floor care

At a time when musculoskeletal (MSK) costs are the top cost driver for 71% of organizations, pelvic floor health is a largely untapped opportunity for employers to improve outcomes and rein in avoidable spend.¹

The opportunity is sizeable. Nearly 1 in 3 U.S. women will experience at least one pelvic floor disorder in their lives.² Caused by problems with the muscles and tissues that support the bladder, bowel and reproductive organs, these disorders include urinary and fecal incontinence and pelvic organ prolapse.

Yet despite how common — and often treatable — they are, pelvic floor disorders rarely come up in benefit conversations. Nearly half of benefit professionals have either never heard of pelvic floor therapy or don’t know much about it.³

That lack of knowledge is worth addressing, especially because of the overlap between pelvic floor disorder and MSK care. While not all pelvic floor disorders are MSK in nature, many involve the muscles and connective tissues of the pelvic floor.

The goal is to provide a benefit that is accessible and valuable to women no matter what stage of life they’re in. Employers using this whole-person, life-stage approach to women’s health benefits have seen a 2.7:1 return on investment.⁴

Here’s how employers can help make pelvic floor care more accessible, improve outcomes and reduce health care spend.

Symptoms like urinary urgency and leakage impact women’s lives in persistent ways — frequent bathroom breaks, distracting discomfort and constant low-grade worry about unpredictable symptoms. And these conditions often peak just as many women are balancing the highest demands of their careers and caregiving. The impact is measurable:

• Mental health: Compared to the general population, women with pelvic floor disorders have higher rates of depression (26.9% vs. 17%) and anxiety (38.3% vs. 29%).⁵
• Medical spend: In a 2-year period, employers and payers saw $10,000 more in health care costs for employees with urinary incontinence versus those without.⁶
• Presenteeism and absenteeism: Pelvic floor disorders are connected to lower energy and self-confidence and higher rates of sick leave and short-term disability.⁷

And yet, nearly two-thirds of women with urinary incontinence wait at least a year to seek care.⁸ Half wait 3 years or more.⁸ Common reasons for the delays? Limited time, embarrassment, fear of needing surgery and the belief that their symptoms are just a normal part of aging or postpartum recovery.⁹

The good news: pelvic floor therapy has a strong track record as a first-line treatment, curing or improving symptoms for 67% of women with urinary incontinence.¹⁰

The health system, though, isn’t always ready for women when they do seek care. Primary care providers and gynecologists are usually the starting point for issues like stress incontinence, but access to specialists — such as urogynecologists and pelvic floor physical therapists — is more limited. 

That shortage makes benefits design especially important. Rather than leave employees to navigate a fragmented system on their own, employers and health plans can build pathways that make evidence-based care easier to find, start, and complete.

Here’s how employers and health plans can ensure pelvic health care is part of a successful benefits strategy.

1. Integrate pelvic floor care into MSK care 

It makes sense to start with the ties between pelvic floor disorders and MSK issues.

As an example, pelvic floor dysfunction and low back pain are closely connected. Many women getting help for back pain may unknowingly be dealing with pelvic floor issues at the same time.¹¹ Multimodal physical therapy — addressing the pelvic floor alongside the hips, lower back and core — can provide reliable relief for many pelvic floor disorders and MSK problems.¹²

When pelvic health is built into the MSK benefit, it reaches women who might not otherwise seek out “pelvic floor therapy” on their own. 

2. Expand reach through virtual and hybrid care models

Even when women are referred for in-person pelvic floor health therapy, fewer than half complete treatment. Distance to the appointment, scheduling conflicts and multistep referral processes are major barriers.¹³ 

Digital care removes those obstacles.¹⁴ A 2025 study found that a fully remote pelvic health program that combined biofeedback therapy, education and exercises resulted in a 77.6% completion rate and improvements in participants’ symptoms, mental health and work productivity.¹⁴

For employers, the right model is often hybrid: digital programs and virtual coaching for broad population reach, with clear escalation pathways to in-person or specialist-level care when clinical complexity warrants it.

3. Communicate clearly

Awareness is one of the biggest barriers to pelvic floor disorder care. Nearly half of women with urinary incontinence don’t think their condition is treatable.¹⁵ Many don’t recognize their symptoms as a medical issue at all. Benefits communication can change that. When communication is specific and timely, employees are far more likely to engage.

That can mean:

• Listing specific conditions — urinary incontinence, postpartum pelvic recovery — in benefits guides and open enrollment materials.
• Making sure HR teams and benefits navigators can speak to these issues if an employee brings them up.
• Timing outreach for the most relevant moments — during maternity leave, return-to-work or around perimenopause transitions.

4. Think in life stages, not just diagnoses

Pelvic floor problems often develop over time. Issues may start with a pregnancy, worsen after childbirth, shift again during perimenopause and increase with age. A benefits strategy that only responds reactively, after things have gotten serious, will always be playing catch-up.

Two periods in women’s lives are especially key for pelvic floor benefit outreach: 

Postpartum: Access to early pelvic floor therapy reduces the odds of urinary incontinence by 37% and pelvic organ prolapse by 56% when compared to no treatment.¹⁶ And while many women are advised to do Kegel exercises at this stage, it’s also important they receive individualized instruction, which greatly improves efficacy.¹⁷

Menopause: Nearly half of postmenopausal women will experience a pelvic floor disorder, yet few benefits address the connection between hormonal changes and pelvic health.¹⁸ That’s a missed opportunity to improve outcomes and reduce costs.

Optum Women's Health Solutions covers this full continuum of women’s health — from pregnancy and postpartum recovery through perimenopause and beyond. MSK care, behavioral health support and clinical guidance work together as a seamless part of care. 

Nearly a third of women may be living with a pelvic floor disorder — often silently. They manage their symptoms by limiting liquids, wearing protective garments or by turning down travel and other opportunities. These steps help women get by but often prevent them from doing things they want to do.

Importantly, these aren’t conditions women have to just live with. Employers can provide access to pelvic floor disorder care that can boost focus, reduce absenteeism and strengthen retention.¹⁹ 

It’s a workforce well-being investment with documented impact and a much-needed opportunity for women who have been dealing with disruptive symptoms for far too long.