Urinary incontinence is no barrier to active life


December 14, 1993|By Dr. Genevieve Matanoski | Dr. Genevieve Matanoski,Contributing Writer

Urinary incontinence is a common problem among older women but need not keep them from having an active life.

Many women restrict their activities because of fear of embarrassment, or simply don't seek help because they don't realize that something can be done to help them.

First, women need to realize that they are not struggling alone with this problem. One in four older women has problems significant enough to require wearing a pad at least some of the time.

Because this is a common complaint, I asked Dr. Jacek Mostwin, associate professor at the Johns Hopkins School of Medicine, to explain why it occurs and how to deal with it.

Q: What causes urinary incontinence?

A: Urinary incontinence can be caused by several things. Usually it is a result of weakening in the vaginal muscles that support the bladder.

It is more common in women than in men because of the anatomy of the female urethra, the passage from the bladder through which urine is excreted. In women, the duct that leads from the bladder is much shorter than in men.

Women need the support of their full muscle structure for the bladder and urethra to be fully functional, but those supporting muscles can be damaged by childbirth or weakened by age.

Incontinence also can be caused by thinning and weakening of the bladder muscles, by a bladder storage problem, by damage to the sphincter muscle, or by a combination of any of these.

Q: What are the early symptoms?

A: Women may notice several changes in their normal urinary habits.

Some women feel the need to urinate frequently or find that they wake up more often in the night to urinate.

Others experience involuntary bladder contractions.

Sometimes women find that they leak when they cough, sneeze, lift or do strenuous exercise.

Also, symptoms may disappear and reappear, as the incontinence itself may be transient.

Q: What should a woman do?

A: Women must recognize that there are people out there who can help.

Because urinary incontinence may be a symptom of many problems of the lower urinary tract, it is important to see a qualified urologist.

Women should look for a doctor who has studied urinary incontinence and made it an area of specialization.

The questions to ask are: What are the doctor's specialty areas? And is he or she a member of one or more of three specialty groups -- the Urodynamics Society, the International Continence Society or the Urogynecology Society?

Since the cause of incontinence is not always easy to pinpoint, a woman who is experiencing symptoms should try to be patient.

The right treatment depends on an accurate evaluation of the problem.

She will probably need to go to the urologist at least twice to complete the evaluation and decide on a treatment plan.

Treatment may include pelvic-floor exercises, biofeedback training, medication or changes in bladder habits.

Surgery is usually necessary only in severe cases.

Women should remember that there are many levels of incontinence and a number of treatments that can help.

For instance, women can learn to monitor their fluid intake; and exercises to strengthen the muscles of the vaginal walls can be done at any age.

The majority of women can be helped by one or more of these treatments.

If a woman does have to use urinary pads, she should keep in mind that there are good products on the market that work well and can give added protection.

Q: What about collagen?

A: I would caution any woman to approach the use of collagen injections in the urethra with the same wariness she would use with any collagen treatment.

Although the FDA has approved a new treatment of collagen injections to act as a bulking compound, only a few medical centers have been approved to use this treatment.

It has not been thoroughly evaluated and the consensus about collagen is that it is still in its earliest experimental stages. This may not be a long-term answer.

Q: Where should one turn for help and information?

A: HIP -- Help for Incontinent People -- can be contacted at 1-800-252-3337.

The Simon Foundation also has information and can be reached at 1-800-237-4666. "Staying Dry" by Dr. Katherine Burgio has been published by the Johns Hopkins Press and is a good book to explain how to resist and overcome the strong urge to void.

The book was written for older women who often have trouble sensing bladder fullness.

A paperback copy of the book costs $12.95 and can be ordered from the Johns Hopkins Press at 1-800-537-5487.

Dr. Genevieve Matanoski is a physician and epidemiologist at the Johns Hopkins School of Hygiene and Public Health. She is a founding director of the school's Institute for Women's Health Research and Policy.

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