Urinary incontinence (UI) is the involuntary loss of urine. The problem afflicts an estimated 13 million adults in the United States, 85% of them being women. Because of the embarrassment of UI, only a 1/3 to ½ of people that have UI seek treatment, yet UI can be improved in approximately 8 out of 10 cases. Often, women with UI are reported to be depressed and/or embarrassed about their appearance and odor. Consequently, social interaction with friends and sexual activity may be avoided. In a survey of American women from 2002, 26% reported experiencing UI over the last year, and 37% over the past thirty days. UI begins to be reported by women in their thirties, but even women active into their eighties experience it.
Some of the common causes of female UI include: childbirth, menopause/aging, pelvic surgery (hysterectomy), obesity, repetitive straining (chronic cough), and neurological diseases such as multiple sclerosis or Parkinson’s Disease. Other types of incontinence that can often be reversible include: delirium/dementia, urinary tract infection, vaginal atrophy, drug effects and side effects, depression, diabetes, restricted mobility and constipation.
There are two general categories of UI in women: stress urinary incontinence (SUI) and urge urinary incontinence (UUI), which a component of overactive bladder (OAB). SUI is the involuntary loss of urine in the absence of a bladder contraction during a rise in abdominal pressure, such as leaking provoked by coughing, sneezing, laughing, exercise, lifting, or bending over. UUI is the involuntary loss of urine during an episode of uncontrolled urgency. OAB is the constellation of “gotta go” symptoms such as urinary frequency, urgency and UUI in the absence of infection or other bladder disease. Often, nocturia, getting up at night to void, is included in this category but there are several non-bladder causes of nocturia. Mixed incontinence is when someone experiences both SUI and UUI.
The impact on a woman’s quality of life depends on the frequency and severity of the UI, the desire for physical and sexual activity and its influence on the person’s social functioning. Since women are living longer and healthier, UI impacts a greater number of people than ever before. Most of the common coping strategies women adopt are often done as second nature such as: using absorbant products, toilet mapping, voiding manipulation, diet and fluid restriction, and pelvic muscle exercises.
Review of a person’s medical history, surgical history, medication list, dietary and sleep habits, usually and often declare the type of UI that is present. Often there are multiple coincident factors that are present, and sometimes treating one medical condition will lead to improvement of UI to some degree.
However, treatment is limited by patient motivation, cognitive level, physical impairment and/or anatomic abnormalities of the urinary tract. For most, conservative management is the first line strategy and often quite successful in decreasing the severity of UI, or at least elucidating the variety of causal factors that can then be addressed.
What are some common and often successful non-surgical treatment options that exist? Behavior modification and bladder retraining are among the first strategies employed. Timed voiding and double voiding are habits that are easy to adopt and can help empty residual or retained urine. Often fluid management and timing of medication during the day, such as when to take a diuretic, can improve control. Drug therapy for OAB symptoms is used in conjunction with bladder retraining since together the combination will have an additive effect. Pelvic floor exercises, avoiding constipation and caffeine are frequently successful. Avoiding overuse of certain medications such as diuretics, antidepressants, antihistamines, and cough/cold preparations can make a significant impact. Those caring for others with cognitive impairments can prompt them to void on a schedule and maintain easy access to toilets to minimize UI.
The goal of treating UI is to restore a socially acceptable level of urinary continence while minimizing the risk of quality of life adjustments and minimizing the risk of side effects of potential treatments. What happens if conservative management is tried but UI persists or worsens? This will be discussed in the next Urology Health installment.
Matthew E. Karlovsky, M.D.
Center for Urological Services, P.C.
4545 E. Chandler Blvd, Suite 300
Phoenix (Ahwatukee), AZ 85048