by John Howser
Urinary incontinence is not the most pleasant of topics—in fact that’s
part of the problem. It can be a significant barrier to quality of life for
women of all ages. According to the National Association for Continence, urinary
incontinence (UI) may affect as many as thirty percent of U.S. women at some
point in their lives.
At Vanderbilt University Medical Center, Dr. Roger Dmochowski, assistant professor
of Urologic Surgery, sees many women in his clinic who have finally found
the courage to seek help.
The sufferers of UI typically fall into three groups:
• Stress urinary incontinence—usually caused by some form of physical
exertion like sneezing, coughing or athletic activity.
• Urgency urinary incontinence—where the sufferer suddenly and unpredictably
experiences the urge to urinate.
• Mixed, which is the most common type, is a combination of the two other
types.
Dmochowski says the problem can affect adolescent girls to women in their
90s, and affects as many as 18 to 20 million U.S. women. The incidence of
UI increases with each passing decade. Sixty to eighty percent of women over
age 80 suffer from UI. Dmochowski thinks the problem will increase dramatically
in the coming decades as baby boomers age.
“There are a variety of women who have incontinence. There are two classic
groups we see in clinic. One is the younger mother age 30 to 50 who may, or
may not, have a job where the incontinence is adversely impacting her work
activities or parenting activities, or both, to the point she has changed
her behavior and it’s impacting her ability to participate in the things
she enjoys, or had to change her work behavior to the point she can’t
perform her job effectively,” said Dmochowski.
“Then there are post-menopausal women, usually the age range of late-50s
on, who have had a slow and insidious onset of urinary incontinence over the
years. They’ve dealt with it many years for a variety of reasons, usually
because they’ve been told this is an inevitable part of aging and nothing
can be done about it. Usually for these women their problem has become so
significant that they are withdrawing from life and essentially becoming shut-ins.”
Quality of life issue
Urinary incontinence is not a life-threatening disease, but rather a quality
of life disease. “The destruction of quality of life can be dramatic,”
he said. “That’s what usually ends up bringing the patient in.”
The causes of UI can be many. Doctors believe that childbirth plays a role
in UI; however there are cases that occur in women who have never given birth,
or who have delivered by cesarean section. Hysterectomy can also be a contributing
factor.
“We think there are two predominant factors that cause urinary incontinence.
One is the hormonal change that starts around menopause, which becomes progressive.
We know the lower urinary tract is very sensitive to natural hormones and
a woman’s loss of those hormones,” he said.
“The other predominant factor relating to urinary loss is the natural
aging process of the bladder and pelvic floor in a woman. As women age, we
see a generalized weakening of the bladder and pelvic floor.”
Patients find it difficult to discuss their problems. “We try our best
to dispel the embarrassment and make it easy for the patient either through
humor, or a kindler gentler approach to let the information flow,” he
said. “Often because the embarrassment is so great women have waited
not months, but years, before seeking help. Virtually all women have some
emotional overlay associated with urinary incontinence.”
Misconceptions
Misconceptions women often have about UI are that it’s a natural part
of the aging process, there is nothing that can be done to help, that attempts
to help almost always meet with failure, or that over time the problem won’t
get worse.
Dmochowski thinks there is still much work for physicians to do with UI. “Because
incontinence is a quality of life disruption it tends to be further down the
list of disease processes we manage,” he said. “But to the incontinence
sufferer the consequences are more significant than some of the other silent
disease processes like diabetes or hypertension.”
There are now several treatments for UI. “Women want options for diseases
that are symptomatic. We can try things to see if less invasive therapies
may work before progressing to more invasive treatments,” he said.
Physical therapy to strengthen the muscles of the pelvic floor, drug therapies,
minimally invasive techniques such as injection therapy that can increase
resistance to urine channel to loss, and minimally invasive outpatient surgeries
that allow women to be treated rapidly are all available options. Dmochowski
says for women with more advanced and involved problems there is better understanding
of more definitive treatments that heretofore doctors have been able to offer.
“If women have this problem they should discuss it with their healthcare
provider, and discuss their specific symptoms,” he said. “In some
cases a trial of physical therapy or medication will be indicated. In other
instances a specialty referral may be warranted to deal with pelvic floor
dysfunction, including urinary incontinence. I strongly encourage women to
discuss the matter with whoever it is they see for healthcare on a regular
basis to seek attention for their symptoms.”