I 

108TH CONGRESS 

2D SESSION H. R. 4979 

To amend the Public Health Service Act to provide for educational activities 

and research with respect to women’s pelvic floor health through the 

Centers for Disease Control and Prevention and the National Institutes 

of Health. 

IN THE HOUSE OF REPRESENTATIVES 

JULY 22, 2004 

Mr. NETHERCUTT (for himself, Mrs. DAVIS of California, Mr. GERLACH, Mr. 

SESSIONS, and Mr. VITTER) introduced the following bill; which was referred to the Committee on Energy and Commerce 

A BILL 

To amend the Public Health Service Act to provide for 

educational activities and research with respect to women’s pelvic floor health through the Centers for Disease 

Control and Prevention and the National Institutes of 

Health. 

1 Be it enacted by the Senate and House of Representa2 tives of the United States of America in Congress assembled, 

3 SECTION 1. SHORT TITLE. 

4 This Act may be cited as the ‘‘Women’s Pelvic Floor 

5 Health Education and Awareness Act’’. 

6 SEC. 2. FINDINGS. 

7 The Congress finds as follows: 
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1 (1) Women’s pelvic floor disorders are a group 

2 of common conditions that cause considerable dis3 ability and pain. 

4 (2) Such disorders include bladder and bowel 

5 dysfunction, including incontinence. Another such 

6 disorder is pelvic organ prolapse, which involves a 

7 downward shift of uterine or vaginal structures from 

8 their normal positions. Often these conditions coex9 ist. 

10 (3) Women’s pelvic floor disorders are ex11 tremely common and are barriers to healthy living. 

12 (4) Women often suffer from a broad overlap of 

13 all pelvic floor disorders, usually experiencing several 

14 disorders simultaneously. 

15 (5) Thirty percent of American women will suf16 fer from a form of urinary incontinence. 

17 (6) Eleven percent of women in the United 

18 States have surgery for urinary incontinence or pel19 vic organ prolapse during their lifetime, and close to 

20 one third will have a second surgery. Many more 

21 women are treated with nonsurgical techniques or 

22 remain untreated. 

23 (7) Of the 3 million vaginal deliveries that 

24 occur each year in the United States, 900,000 

25 women will develop symptomatic urinary inconti-
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1 nence and a smaller number will develop pelvic 

2 organ prolapse and bowel incontinence. 

3 (8) An estimated $26.3 billion is spent annually 

4 to either treat or compensate for urinary inconti5 nence. 

6 (9) Many health care providers are not pre7 pared to evaluate urinary pelvic floor disorders, in8 cluding incontinence, and are unaware of treatment 

9 options. 

10 (10) To address the public health threat posed 

11 by women’s pelvic floor disorders, there is a need for 

12 the establishment of awareness and education pro13 grams directed at the public and primary-care pro14 viders, including the authorization of research fo15 cused on urinary incontinence and other pelvic floor 

16 disorders. Such programs will greatly help promote 

17 better care and treatment to those women afflicted 

18 with these disorders. 

19 SEC. 3. EDUCATION REGARDING WOMEN’S PELVIC FLOOR 

20 DISORDERS. 

21 (a) IN GENERAL.—Part P of title III of the Public 

22 Health Service Act (42 U.S.C. 280g et seq.) is amended 

23 by adding at the end the following section: 
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1 ‘‘SEC. 399O. EDUCATION REGARDING WOMEN’S PELVIC 

2 FLOOR DISORDERS. 

3 ‘‘(a) IN GENERAL.—The Secretary, acting through 

4 the Administrator of the Health Resources and Services 

5 Administration and the Director of the Centers for Dis6 ease Control and Prevention, shall carry out a program 

7 to provide education regarding bladder and bowel dysfunc8 tion (including incontinence), pelvic organ prolapse, and 

9 other pelvic floor disorders to health professionals and the 

10 general public. Activities under such program shall be car11 ried out directly by the Secretary and through awards of 

12 grants or contracts to States, political subdivisions of 

13 States, and other public or nonprofit private entities. 

14 ‘‘(b) CERTAIN INFORMATION.—The Secretary shall 

15 ensure that education under subsection (a) includes, at a 

16 minimum— 

17 ‘‘(1) information describing the prevalence of 

18 pelvic floor disorders in women; and 

19 ‘‘(2) information regarding treatment options 

20 for such disorders. 

21 ‘‘(c) USE OF INTERNET.—The Secretary shall ensure 

22 that the means through which education under subsection 

23 (a) is provided includes the posting of information on the 

24 Internet site of the Centers for Disease Control and Pre25 vention. The Secretary shall ensure that, in the case of 
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1 health professionals, such means includes means in addi2 tion to the posting of information on such site. 

3 ‘‘(d) AUTHORIZATION OF APPROPRIATIONS.—For the 

4 purpose of carrying out this section, there are authorized 

5 to be appropriated such sums as may be necessary for 

6 each of the fiscal years 2005 through 2009.’’. 

7 (b) SENSE OF CONGRESS.—It is the sense of the 

8 Congress that the Director of the Centers for Disease 

9 Control and Prevention should establish a national reg10 istry for surgical treatment of pelvic floor disorders, espe11 cially procedures using new technology. 

12 SEC. 4. RESEARCH THROUGH NATIONAL INSTITUTES OF 

13 HEALTH. 

14 (a) IN GENERAL.—Part B of title IV of the Public 

15 Health Service Act (42 U.S.C. 284 et seq.) is amended 

16 by adding at the end the following: 

17 ‘‘SEC. 409J. WOMEN’S PELVIC FLOOR DISORDERS. 

18 ‘‘(a) IN GENERAL.—The Directors of the National 

19 Institute of Diabetes and Digestive and Kidney Diseases 

20 and the National Institute of Child Health and Human 

21 Development shall expand and intensify the activities of 

22 such Institutes with respect to women’s pelvic floor dis23 orders, including proposals for research on such disorders 

24 that are developed independently of solicitations by the 

25 National Institutes of Health for research proposals. 
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1 ‘‘(b) NETWORKS.— 

2 ‘‘(1) URINARY INCONTINENCE TREATMENT

3 NETWORK.—The Director of the National Institute 

4 of Diabetes and Digestive and Kidney Diseases, in 

5 consultation with the Director of the National Insti6 tute of Child Health and Human Development, shall 

7 provide for the continuing operation of the Urinary 

8 Incontinence Treatment Network. The Network was 

9 established pursuant to financial awards from such 

10 Institutes, and includes multiple continence treat11 ment centers and a single biostatistical coordinating 

12 committee. The Director shall ensure that not fewer 

13 than eight such treatment centers are in operation 

14 and may provide for the establishment of additional 

15 treatment centers, subject to appropriations Acts. 

16 ‘‘(2) CLINICAL TRIALS NETWORK FOR FEMALE

17 PELVIC DISORDERS.—The Director of the National 

18 Institute of Child Health and Human Development, 

19 in consultation with the Director of the National In20 stitute of Diabetes and Digestive and Kidney Dis21 eases, shall provide for the continuing operation of 

22 the Clinical Trials Network for Female Pelvic Dis23 orders. The Network was established pursuant to fi24 nancial awards from such Institutes, and includes 

25 multiple clinical sites and a single data coordinating 
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1 committee. The Director shall ensure that not fewer 

2 than seven such clinical sites are in operation and 

3 may provide for the establishment of additional clin4 ical sites, subject to appropriations Acts. 

5 ‘‘(c) PEER REVIEW.—With respect to technical and 

6 scientific peer review under section 492, the Director of 

7 NIH shall ensure that groups that review research pro8 posals under this section include urogynecologists. ’’. 

9 (b) SENSE OF CONGRESS.— 

10 (1) IN GENERAL.—The Congress commends— 

11 (A) the National Institute of Diabetes and 

12 Digestive and Kidney Diseases for its financial 

13 support of the Urinary Incontinence Treatment 

14 Network; 

15 (B) the National Institute of Child Health 

16 and Human Development for its financial sup17 port of the Clinical Trials Network for Female 

18 Pelvic Disorders; 

19 (C) the successful collaboration of such In20 stitutes with respect to the Networks; and 

21 (D) each of such Networks for the re22 search it is conducting toward improving wom23 en’s pelvic health. 

24 (2) CERTAIN ACTIVITIES.—It is the sense of the 

25 Congress that the Directors of the National Institute 
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1 of Diabetes and Digestive and Kidney Diseases and 

2 the National Institute of Child Health and Human 

3 Development should— 

4 (A) increase the size, scope, number, and 

5 funding for multidisciplinary research through 

6 centers and clinical sites of the Networks re7 ferred to in paragraph (1); 

8 (B) encourage industry relationships in 

9 women’s pelvic floor health related research; 

10 (C) recruit established scientists from 

11 other relevant areas (such as cardiac or gastro12 intestinal physiology, cell signaling, biomechan13 ical engineering, genomics, and proteomics) to 

14 apply their work to the urinary tract and incon15 tinence by encouraging collaborative efforts be16 tween basic and clinical scientists; 

17 (D) increase research funding for studies 

18 that use cellular and molecular techniques to 

19 examine the basic mechanisms of bladder and 

20 urethral interactions that create urinary con21 tinence and incontinence; 

22 (E) support research to develop appro23 priate animal models of urinary incontinence; 

24 (F) develop novel techniques (both invasive 

25 and noninvasive) for measuring neural, mus-
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1 cular (striated and smooth), and vascular func2 tion relating to pelvic floor health; 

3 (G) identify risk factors for pelvic floor dis4 orders and urinary incontinence related to 

5 childbirth and aging so that prevention meas6 ures and improved disease-specific treatment 

7 can be developed; 

8 (H) initiate research to develop preventive 

9 and therapeutic approaches to urinary inconti10 nence that are sensitive to gender, race, and 

11 culture, and develop the means of measuring 

12 outcomes for treatments in these varied set13 tings; 

14 (I) develop a national data registry and tis15 sue bank of people suffering from incontinence 

16 to meet the needs of researchers for well-char17 acterized tissue samples; and 

18 (J) research the relationship between the 

19 anatomic changes of pelvic organ prolapse and 

20 the functional derangement’s commonly seen in 

21 association with them, including voiding dys22 function and incontinence. 
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1 SEC. 5. INCLUSION OF WOMEN’S PELVIC FLOOR HEALTH IN 

2 NATIONAL CHILDREN’S STUDY. 

3 The Director of the National Institute of Child 

4 Health and Human Development shall include women’s 

5 pelvic floor health as one of the matters studied in the 

6 prospective cohort study regarding child health and 

7 human development that is being conducted under section 

8 1004(b) of the Children’s Health Act of 2000 (Public Law 

9 106–310; 114 Stat. 1130) and is known as the National 

10 Children’s Study. 

11 SEC. 6. CONSULTATION. 

12 In carrying out this Act, the Secretary of Health and 

13 Human Services shall consult with the American 

14 Urogynecologic Society and such other qualified profes15 sional and patient organizations as the Secretary deter16 mines to be appropriate. 

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