Urinary incontinence is an undiagnosed epidemic among women in American households. It leaves millions depressed, isolated and sometimes even housebound. Yet, it is almost entirely curable.
Urinary incontinence is estimated to effect at least 14 million women in the United States, yet only about 10-15 percent of women ever seek medical advice for the complaint, largely because they are embarrassed, believe it is simply a function of aging or feel that nothing can help them, or that the help will not be a permanent solution for them.
Consumer research indicates that there is more money spent on controlling and dealing with incontinence – on purchases such as pads and protective under garments – than on all women’s cancer care. But because that money is spent at pharmacies and supermarkets, rather than at physician’s offices and healthcare facilities, the epidemic continues to go largely unnoticed.
Why should you care about incontinence? While this is a relatively minor problem from a physical point of view, quality of life assessments have shown that it has devastating psychological consequences. Our personal experience is that when women are helped with this problem, they have often returned and related that they feel like they have regained their life, their self esteem and a sense of joy they had not had for years since suffering from the problem. In addition to the fact that this mostly social, there are potential medical complications that can occur.
Perineal rashes and recurring urinary infections with their consequent debilitation and costs are a possible result of incontinence. Patients with incontinence consistently score low on quality of life assessments.
In fact, their scores compare to those with far more serious life style threatening health condition, such as diabetes and uncontrolled hypertension.
DIAGNOSING THE PROBLEM
The truth is that incontinence is such a widespread problem that almost any woman can experience it. A young woman drinking several bottles of water a day to help lose weight, a mother of three, a hard—charging executive whose intense workday leaves little time for bathroom breaks—are all likely candidates to develop the condition. The more obvious candidates include elderly women, those with diabetes, and those who have experienced multiple vaginal deliveries of their children. It is important to understand that there are differing types of urinary incontinence. The two major types seen are: urge urinary incontinence (UUI), which is treated medically with pharmaceuticals, exercise and lifestyle adjustments, such as timed voiding.
The second type of urinary incontinence is stress (SUI), which can be treated with exercises, but usually requires surgical correction.
Patients with UUI and the related condition called overactive bladder (OAB) exhibit symptoms of frequency, urgency, nighttime urinary voiding (nocturia) and incontinence. Patients with SUI experience a loss of bladder control when engaging in specific activities that put pressure on the lower abdominal wall, such as coughing, laughing, sneezing, sudden upward movements, lifting something heavy or other exercises. In many severe forms, even the act of standing up may cause involuntary urinary leakage. These patients may or may not feel urgency before leaking. Most women have a combination of both UUI and SUI, which is caused mixed urinary incontinence (MUI). In these cases, the patient should expect careful questioning to help determine which symptoms are dominant.
While prevalence increases with age, recent consumer research reveals that one in four women over the age of 18 years experience involuntary urinary leakage. However, many of these women have depression, diabetes, family histories of bladder problems, have given birth, or have gone through menopause and are not taking hormone replacement therapy.
Woman who have had pelvic radiation almost always have OAB. Comorbid conditions that contribute to the problem include frequent infections (self diagnosed or documented), constipation, diuretic use, sedatives, poorly controlled diabetes, and neurologic disease such as stroke or multi infarct dementia.
TREATMENT
Prior to treatment, a detailed history will be taken. The detailed history will include consideration of items such as the nature of the incontinence, the duration of the leakage, the amount of urine that is lost, the number of pads used, previous treatment that may have occurred and the impact that this is having on the patient’s lifestyle. It is important to distinguish whether the patient suffers from UUI, SUI or MUI. And, if the latter, which component is more dominant. Many times the question is simply “Do you have problems with bladder control?” Or, “Do you leak your urine?” If the answers are yes, then an appropriate discussion will ensue in an effort to discover the type of urinary incontinence that you have. Depending on the answers and depending on the severity of the leakage, a physical exam, which will include the urinary tract will usually be done. A urinalysis will be performed as well. Things that can be found on exam of the lower abdomen include the finding of a distended bladder which is a sign either of a physical blockage presenting the lady from emptying her bladder or one of many urologic conditions which may also prevent complete bladder emptying.
This is a sign of a more serious condition that will require different answers than those for stress or urge incontinence. Many times a voiding diary will be found useful. This can help just as an eating diary can modify behavior and help the patient lose weight.
Many times keeping a voiding diary unconsciously allows the patient to improve her condition. She is likely to pay more attention to her voiding and practice time voiding which may prevent much of her urinary loss. She is also likely to exercise a little more controlled using exercises that she will be taught that will help strengthen the pelvic floor muscles.
Pharmacologic treatment includes anticholinergic medications which have become the mainstay for treating UUI. There are currently five different medications that are available specifically for this utilization. This is in addition to many older medicines that have been used for years.
These medications sometimes require the application of a patch or taking tablets on a daily basis. All of these medications have side effects which can become problematic and cause physicians to look for other treatments that can rectify the cause of these symptoms. Other possible conservative forms of therapy include pelvic floor exercises, biofeedback and behavioral therapy, such as timed voiding and reduction of liquid intake, which in themselves can make a significant difference, especially when combined with medications. It is seldom that the behavioral methods will eliminate the problem entirely, but in many cases, they significantly reduce the frequency of leakage and the amount of incontinence endured, making further treatment unnecessary.
In addition to surgical correction, of which there are many, there is also neuromodulation which is an artificial device that is placed and attempts to control the nerves that serve the bladder, as well as bladder injections, most recently with botulinum toxin.
The botulinum toxin is a recent addition to the armormentarium of treating urge incontinence, but has the limitation of lasting only between six and 12 months. Secondary injections, however, last longer and work better. This is something that is currently a significant step forward in our treatment of this condition, should medications and their utilization become problematic.
If the inability to control urination is having a negative impact on your life, take this short quiz to gain insight into a potential disorder you may be experiencing.
#Does the sudden and often urge to urinate send you rushing to the nearest restroom?
#Do you visit the bathroom more than eight times in a 24-hour period?
#Does delaying going to the restroom ever result in wetting accidents?
#Are you walking a path between your bedroom and restroom several times a night?
#Does access to a restroom decide where and how you travel?
#Do you make other decisions as to what you will and will not do based on your concern that you may lose control of your urine?
If you answer yes to any of these questions, you are possibly experiencing urinary incontinence. Discuss these concerns with your physician and ask him for help. He will be able to initiate treatment or he may elect to send you to the Springer Clinic Department of Urology for further testing and discussion of alternative forms of therapy.
