Toward Optimal Health: Approaching the Issue of Incontinence with Patients and Actively Managing the Condition

Abstract

U rinary incontinence (UI) is typically viewed as a nuisance of aging, but its effects on women's lives can be profound. Usually a physiological dysfunction, it can cause women to restrict their activities of daily living, including physical activity, increases the risk of falls (when rushing to the bathroom), and often leads to withdrawal from social contact. The medical fallout from these lifestyle limits can have a significant adverse effect on overall health. There is also the possibility that complaints of incontinence may be a precursor for diabetes or multiple sclerosis. Why then does this female-specific medical condition get so little attention from women and you, their healthcare providers?For too long, the foremost source of information about bladder control has been television commercials for undergarment protection (adult diapers), which may help to contain urinary leakage but does nothing to engender a positive dialogue or to correct a treatable condition. Fortunately, there is a choice of products available that promise treatment for busy, often working, women who want to remain active and who need not live with the limitations UI imposes.Clinical recognition of urinary and fecal incontinence is hindered by a variety of factors, including embarrassment, social stigma, discomfort in disclosing symptoms, lack of awareness about intervention, patient's use of nonspecific language to describe concerns to practitioners, competing demands and limited time during care visits, poor continuity of care, and inadequate directness from practitioners when assessing continence status. 1 The need to bridge the gap in care will only increase as aging women remain active well into and beyond their 80s.UI affects nearly two thirds of women, yet its prevalence is underestimated in the clinical setting. Only 1 in 4 symptomatic women voluntarily mention concerns about urinary leakage to their physician, despite the significant impact it may have on their quality of life and the potential for complications that may arise, such as urinary retention, chronic lower urinary tract infection (UTI), and vesicoureteral reflux. 2 With behavioral, medical, and surgical interventions available, identifying women who have incontinence is important. Why should any of us willingly suffer through such symptoms as wet underwear after every sneeze or deep knee bend, a condition that persists or worsens over 40 years or more? Maybe, with gold medalist Bonnie Blair, the world's fastest speed skater, speaking out publicly about her struggle with UI and the availability of effective therapies, we will see women begin to acknowledge that they have bladder control issues and seek treatment. Although treatment options confer relief from urinary leakage in to up to 80% of patients, a thoughtful evaluation that provides a supportable diagnosis is essential before appropriate therapy can be initiated.Holly E. Richter, M.D., Ph.D., shares her recommendations for improving diagnosis in women who have incontinence and offers consideration of the bes...