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Urinary Incontinence:
Taking Back Control

First Published on: April 9, 2002
By: David C. Chaikin, MD
By: Robert Salant, MD

Urinary incontinence is embarrassing, frustrating, and more common than you might think. It has been estimated that as many as 14 million people in the United States suffer from urinary incontinence, and not all of those affected are senior citizens. There are a variety of causes that can affect younger adults as well, and oftentimes, urinary incontinence is actually a sign of a more serious problem.

Below, urologists Dr. David Chaikin and Dr. Robert Salant give us an introduction to the condition, and discuss basic treatments.

What causes urinary incontinence?

ROBERT SALANT, MD: There are many causes, some of which are correctable and curable. One of the most common causes is urinary infection, which is usually easily treatable. There are other causes of urinary incontinence, which may be temporary, such as pregnancy. In addition, bladder muscle problems can cause incontinence, such as an unstable bladder or an overactive bladder.

Urinary incontinence can also be the sign of more serious problems. For instance, in men, prostate enlargement may lead to incontinence and neurologic conditions such as multiple sclerosis and stroke can also lead to incontinence.

Additionally, diabetes can affect the bladder in many ways. It can affect the amount of urine that is being made, increasing the volume of urine, and it can affect the bladder muscle itself and the nerves in the muscle.

Are there different types of incontinence?

DAVID CHAIKIN, MD: There are several. One is called "stress" incontinence, and that's basically the involuntary leakage of urine with exertion. There is another type of incontinence called "urge" incontinence. That's typically related to an overactive bladder, and involuntary leakage of urine when someone can't get to the bathroom in time.

Another type of incontinence is called "overflow" incontinence. That's where the bladder loses its ability to contract and it simply just keeps on filling and the incontinence occurs because the bladder overflows.

The last type of incontinence is called "unaware" incontinence. And that's simply leakage that occurs because the person is unaware of the need to go to the bathroom because of disability or so forth.

How would you characterize overactive bladder?

ROBERT SALANT, MD: Overactive bladder is a constellation of symptoms that include things like urinary frequency, which is the feeling that you have to go to the bathroom quite often; urinary urge, which is that feeling that you always have to go to the bathroom; a feeling of incomplete bladder emptying, where you've urinated yet you feel like you have to go right back to the bathroom within one, two or five minutes.

Is overactive bladder a very common condition?

ROBERT SALANT, MD: It's very common, and the symptoms become more common as we age. However, overactive bladder is not a natural part of aging. People have been taught that it is. So very often the symptoms of overactive bladder are accepted as normal and the problem is not diagnosed.

How does this condition affect people's lifestyles?

ROBERT SALANT, MD: Patients either consciously or subconsciously modify their behavior. They will avoid drinking fluids. They will dehydrate themselves in an attempt to make less urine.

Overactive bladder can cause nocturia, which is getting up often at night to urinate, and so they don't sleep well. This of course leads to fatigue and subsequent difficulty with daily routines.

And perhaps most disturbing, patients who experience overactive bladder will often not want to go out because they're afraid that they're going to be caught out in public and not have a bathroom available.

DAVID CHAIKIN, MD: I've seen patients modify their behaviors to the point where they are "toilet mapping," which is mapping out where they could find a toilet everywhere they go...on their way to work or to the movies or even for a trip for dinner. And simple therapies can help people with this.

What can people do about this condition?

DAVID CHAIKIN, MD: There are a lot of solutions. First, it's most important to consult with your doctor and rule out medical conditions that may be causing the problem, such as diabetes or a urinary tract infection or the other more serious potential causes we discussed. Then you can find an effective medical therapy. There are lots of different types of medical therapies now and some that can just be given as a once-a-day formulation.

Behavioral therapies can be used in combination with medical therapy. You can actually teach your bladder to stop being overactive. And finally, there are some surgical solutions, but certainly those would be a last resort.

What are some of the more commonly used medical treatments?

DAVID CHAIKIN, MD: Detrol is a once-a-day treatment that was formulated specifically for the overactive bladder. Ditropan is another once-a-day formulation that is a time-honored treatment for overactive bladder symptoms as well.

Do you often recommend these kinds of treatments to your patients?

ROBERT SALANT, MD: I use the once-a-day formulations of both Detrol and Ditropan, as first-line therapy. They are very effective medications. However, the patient must continue to take the medications on a regular basis for them to be effective.

What happens if they don't?

ROBERT SALANT, MD: If the patient stops the medication, within a week or two weeks, the symptoms of overactive bladder return.

What I have found is that the new once-a-day formulations aid in compliance and there is a much higher rate of patients continuing with therapy and experiencing the benefits.

Do you find that people are talking about this condition more and more?

ROBERT SALANT, MD: There is no question that it's becoming much more common to see urinary incontinence discussed in the media. So people are less afraid to talk about it. They understand better that it it's something that can be treated, and often quite simply.

© Copyright 2002, Healthology