Incontinence was one of those secret, hidden, embarrassing problems, the kind we were more likely to talk around than talk about.
But when 10 million adult Americans are suffering -- many of them afraid to leave their homes lest they lose control of their bladders in public -- the story needed to be told.
That happened with a little book titled "Staying Dry: A Practical Guide to Bladder Control," published by the Johns Hopkins University Press last November and recommended recently by Ann Landers in her column.
One women in two has some degree of bladder leakage after childbirth, one woman in three has it after menopause, and one man in five has it in the older years, according to Dr. Angelo Lucco, one of the co-authors (with Kathryn Burgio and K. Lynette Pearce).
About half the people in nursing homes are incontinent. In fact, Dr. Lucco says, bladder incontinence is often cited as "the straw that broke the camel's back," when families talk about why they opted for a nursing home.
Actually, the problem has been peeking out of the closet for years, as those ubiquitous commercials for adult diapers have saturated the airwaves with this once-hidden topic. According to some experts, however, if you assume life in a diaper is the inevitable outcome of incontinence you may be short-changing yourself.
"It's a shame, because that [the ads] is usually the only information most people get," says Dr. Lucco, who is medical director of the specialty hospital at the Levindale Hebrew Geriatric Center in Baltimore.
"The information people should be getting is that this isn't normal for anyone, just as losing your eyesight isn't normal. It's a legitimate problem, and people should be diagnosed and treated for it. Diapers are good in that they make life more bearable if all else fails; but they're the last line of treatment, not the first."
The first line of treatment, according to the book, is to describe the problem precisely. To do that, the authors say, you should keep a diary, listing the times you urinate deliberately or accidentally.
With your doctor's help, you can then figure out what kind of incontinence you have: In "stress" incontinence, urine leaks when you laugh, sneeze, cough or exercise; in "urge" incontinence, your bladder contracts and urine passes before you get to the bathroom; in "overflow" incontinence, neurological impairment might have left you unable to recognize when the bladder is full.
The diary can also help your physician arrive at a treatment plan based on the nature of the underlying problem and the part of your urinary tract affected.
The proper functioning of this system involves the filtering activity of the kidneys, which send waste-containing water through the ureters to the bladder. As the bladder fills, it begins to send signals to the spinal cord, which eventually tells the bladder to contract and empty through the urethra.
When children are toilet-trained, they learn to recognize the signal from the bladder, and to override it by tightening the pelvic floor muscles, among which is the round sphincter that closes the urethra to prevent passage of urine.
Some of that control, however, can be reduced by infection or irritation in the genito-urinary tract; internal pressure caused by a blockage in the colon; the increased volume of water lost along with sugar in uncontrolled diabetes; overgrowth of the prostate, as begins to occur in most men in middle age; or weakening of the pelvic muscles after childbirth or with advancing age.
Neurologic impairments, caused by long-term diabetes, stroke or spinal cord damage can also interfere with proper signaling and control.
Most of these problems can be reversed or reduced, the authors say, by clearing up the infection, removing the obstruction, replacing estrogen in post-menopausal women, treating the underlying disease, or repairing the internal damage with surgery.
Whatever the problem or treatment, you might also benefit from exercises in which you strengthen the muscles that support the urinary bladder and close the urethra. You learn to do this by stopping the stream every few seconds as you urinate.
Or you might be helped by behavioral training, in which you learn your limits and use the bathroom on the schedule that works for you. There are also drugs that reduce the urge and increase the strength of the urinary sphincter. There are operations that repair damage in the urinary system as well.
order the book, send your order, with a check for $12.95, to The Johns Hopkins University Press, 701 W. 40th St., Suite 275, Baltimore 21211.