Looking Out For Number One

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Nearly half of adult women may experience urinary incontinence, or the involuntary leakage of urine. This condition increases with age, affecting 10 to 20 percent of all women and nearly 80 percent of elderly women residing in nursing homes. The most recent data available indicates that incontinence affects 17 percent of women over 20 and 38 percent of women over 60. Despite the fact that incontinence in women is common, it remains underdiagnosed and undertreated. Only 25 percent of affected women seek care and, of those, less than half receive treatment. Untreated incontinence is associated with falls and fractures, sleep disturbances, depression, and urinary tract infections. Many women do not volunteer incontinence symptoms to their primary care provider due to embarrassment and/or lack of knowledge or misconception about treatment.

In all women reporting incontinence, the clinician should identify and treat possible causes such as urinary tract infection, excessive fluid intake (> 2 liters per day), use of medications that may worsen incontinence (i.e. diuretics), and comorbid conditions contributing to incontinence (obesity, constipation, sleep apnea, tobacco use, dementia, and depression). It is important to differentiate between the two subtypes of incontinence, urgency and stress. Stress incontinence is characterized by loss of urine with increases in abdominal pressure such as exercising and coughing. The main reason for this is a poorly functioning urethral closure mechanism and is associated with loss of anatomic support or trauma from childbirth, obesity, and situations that cause repetitive increases in abdominal pressure like chronic constipation, heavy lifting, and high-impact exercise. Urgency incontinence is characterized by a sudden compelling desire to pass urine that is difficult to defer.

Once incontinence has been diagnosed, treatment should start with noninvasive measures because they are low risk and inexpensive. For starters, smoking cessation should be advised for all types of incontinence. If constipation is present it should be addressed. Avoidance of excessive fluid intake is advised with reduction in consumption of caffeine, carbonated beverages, diet beverages, and alcohol. Fluid intake should be limited to small amounts at intervals (i.e. 4-5 oz per hour) and less than two liters daily. Voiding at regular intervals can reduce urge incontinence. There is also strong evidence that weight loss improves incontinence. There are no medications for stress incontinence but there are for urge incontinence. OB/GYN providers often advise pelvic floor muscle exercises. Always a last result, there are surgical procedures for both types of incontinence for those who do not improve with noninvasive measures.

Any woman who has incontinence issues and who wants to seek treatment should start with a visit to her primary care provider. From there it may be necessary to see a gynecologist and/or a urologist but sometimes the simple measures do help and surgery, if necessary, is usually a last resort.

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