The Medical Problem That People Don't Talk About - Andrew McGown, MD

Friday, June 24, 2005

Half of the people with this medical problem never report it to their physicians. If they did, most people would find that effective treatment is available.

What is this problem? Urinary incontinence, or the unintentional loss of urine. It’s a physical problem faced by millions of Americans. Yet many people with this disorder don’t discuss it with anyone—including their physicians, who most likely can help them. People find the problem embarrassing or accept it as a normal part of growing older. (While incontinence is more common as people age, it can affect adults at any age.) They decide to just live with the problem, rather than try to fix it.

If you or someone you know is living with incontinence, it’s important to know that, in many cases, it can be treated.

Normally, most people urinate three to four times a day, and perhaps once during the night. If you awake more than twice at night to urinate, have pain during urination, see blood in your urine, or have urinary incontinence, see your doctor.

Symptoms of incontinence may range from leakage or “dribbling” of urine to a complete loss of bladder control. Most of the time, a primary care physician—internist or family practitioner—can find an underlying cause for incontinence. In some cases, your doctor may refer you to a urologist for further evaluation.

People who are incontinent may have one or more disorders:

  • The bladder contracts when it shouldn’t.
  • The bladder doesn’t contract when it should.
  • The sphincter muscles, which help to control the retention and release of urine from the bladder, are not functioning properly.
  • The urethra, the tube leading from the bladder to discharge urine outside the body, is obstructed.

Risk Factors
A variety of risk factors may contribute to incontinence. These include increasing age (15 to 30 percent of people age 65 and older, and at least 50 percent of adults in long-term care facilities are incontinent), childhood bedwetting, obesity (in women), high-impact physical activity, congestive heart failure, lung problems/smoking/chronic cough, stroke, and diabetes. Other factors include surgery or radiation to the genitourinary tract, certain medications, nerve damage, and certain cancers.

Women are more likely than men to develop incontinence. Risk factors include pregnancy and childbirth, which weaken pelvic muscles, and hormonal changes (estrogen depletion) due to menopause. Urinary incontinence also can occur in men who have had surgery or radiation to treat prostate cancer.

Urinary incontinence may be a chronic, daily problem, or it may occur for a short time due to an infection, pregnancy, certain medications, or other temporary cause.

Types of Incontinence

  • Stress incontinence occurs when urine leaks out due to an increase in abdominal pressure, such as during a sneeze, cough, or even an intense laugh. This can happen to women of all ages and is the most common form of incontinence in younger women.

  • Urge incontinence can occur if the bladder contracts when it shouldn’t. There’s a sudden, powerful urge to urinate. A person often can’t reach the bathroom soon enough, and incontinence occurs.

  • Overflow incontinence can occur if the bladder outflow tract is obstructed or if the bladder cannot contract properly. The urinary stream may be weak and patients may have a difficult time initiating urination. The bladder becomes distended and eventually urine “overflows,” usually when the patient is not expecting it.

  • Sometimes more than one type of incontinence can exist in a person; this is called mixed incontinence.

Urinary incontinence can be treated successfully in many people. Treatment may include behavioral therapy, exercises, medications, or surgery.

In behavioral therapy, people can learn techniques to control the urge to urinate and to keep the volume of urine at a low level. Kegel exercises, which strengthen the pelvic muscles, can be helpful for women with stress incontinence.

Medications are available which can help to decrease the urge to urinate. There also are medications which can improve urinary outflow if there is an obstruction due to an enlarged prostate. In certain cases, surgery may be needed to help correct the cause of incontinence.

Dr. Andrew McGown is a board certified internist on staff at Columbia St. Mary’s. For more information, call 414-961-8008.


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