More MS news articles for June 2001

Nature's cruel trick,,72-2001200031,00.html

As the political merry-go-round follows its predetermined track, the election of the new Parliament will be followed by the State opening of the new session. The wives of new MPs will be hoping that they will be fortunate in any ballot and have a place at their first State opening. As on all formal occasions, they will need to be in their seats long before the ceremonies begin.

Spare a thought for the 15 per cent of those women over the age of 30, rising to more than 35 per cent later in life, who are suffering from urinary incontinence and its associated symptoms of urgency and frequency. Urgency is the strong, sometimes overwhelming and sudden urge to urinate. Frequency is defined as having to pass water at three-hourly intervals or less.

The more fortunate, continent watchers of the ceremony will be able to remain relaxed as they while away the waiting period. Those with incontinence, once penned into their seats, will have no thoughts for idle pleasantries for they will be worried whether the ceremony will go on too long — for their bladders, that is — and whether they can hold out.

Incontinence is not only an embarrassment to those who suffer from it — it can also be a nuisance to others. Understanding smiles become a little forced after a performance has been interrupted for the second or third time, or a discussion at a meeting needs to be constantly paraphrased for the benefit of the member who has had to leave the room.

Stress incontinence is the leaking that occurs when lifting heavy weights, playing tennis, enjoying a rough-and-tumble with children or grandchildren, and sometimes even when laughing, coughing or making love. Stress incontinence is even more common than urge incontinence, and it is therefore a safe bet that some of the carefully dressed tennis players at Wimbledon later this month will be having to wear protective pads beneath their seductive shorts.

There are many types of incontinence; it is a mistake to think that it affects only women, or that when men are incontinent it is necessarily part of ageing and an enlarging prostate — the so called “bladder daddies”.

Incontinence is not an inevitable part of ageing — it often affects younger people too. The causes must always be sought, and since they are unlikely to disappear without treatment they always need attention.

The most common type of urinary incontinence is stress incontinence. In this type, physical exercise increases the pressure within the abdomen and the closure mechanism of the bladder and urethra is inadequate to hold back the urine. Men suffer from stress incontinence less often than women, but it can be associated with prostatic disease.

In the case of benign prostatic enlargement it may be of a mixed type of both stress and urge incontinence. After surgical treatment for an enlarged prostate — whether the enlargement was the result of benign or malignant change — there may occasionally be stress incontinence.

Detrusor instability is the second most common cause of incontinence. It is characterised by urgency — and frequency. In this case people just can’t wait; for them a queue in the washroom could spell disaster and their only course of action is to elbow past the queue in their dash to the loo. These are the same people who, when they accept an invitation for a weekend, plaintively ask if they may have a bedroom with a bathroom en suite.

Often patients suffer from both stress incontinence and detrusor instability. If the symptoms can be related to some definable neurological disease, such as multiple sclerosis or the late results of an old stroke, doctors nod wisely and describe this form of incontinence as detrusor hyper-reflexia.

Help is at hand for most patients with incontinence, but the tragedy is that shyness and taboos prevent sufferers from benefiting from it.

Some forms of stress incontinence — such as that which follows childbirth, and with it varying degrees of prolapse — can be helped surgically, but no surgeon can help patients with bladder instability. These patients are cursed with a mechanism which an earlier generation would have referred to “as having a weak bladder”. However, the good news is that many of these sufferers can be helped by taking medication.

Despite the popular description of this condition, the bladder wall isn’t really weak, but rather the nervous mechanism which triggers the bladder’s emptying is unusually sensitive. The bladder starts to contract involuntarily once it begins to fill and before it is fully stretched. The receptors in the bladder muscle, which initiate the contractions, signal that the time has come to rush quickly to the loo. These receptors are activated by the neurotransmitter acetylcholine.

Fortunately, antimuscarinic drugs are available to block the receptors, but unfortunately many of the antimuscarinic drugs also have a range of adverse side-effects such as a dry mouth, constipation, blurred vision and drowsiness.

Relief came to those people with over-sensitive “weak” bladders when Detrusitol was developed a few years ago by British research workers. Detrusitol retains the ability to inhibit the receptors in the bladder and thereby relieve urgency, frequency and urge incontinence, but doesn’t usually give a patient a hazy vision or, in the majority of cases, a too-dry mouth.

Detrusitol has revolutionised the lives of many people with urge incontinence and helped those with mixed urge and stress incontinence. It is to be hoped that the 15 per cent, or more, of people soon to be jammed into the galleries of the Houses of Parliament will have heard all about it and will be able to enjoy the State opening.

Dr Stuttaford answers your health questions in Talking Point next Wednesday at noon. E-mail your questions to
Copyright 2001 Times Newspapers Ltd.