Incontinence treatable, if reported

Washington -- Patients, primarily women, are often too embarrassed to tell their physicians that urinary incontinence is disrupting their lives.

Instead, they pass up job opportunities, withdraw from social activities and dress in ways that help them avoid the embarrassment that results from an involuntary loss of urine when they sneeze, laugh, cough or exercise.

The problem is often stress urinary incontinence, and it is the most common form of urinary incontinence -- affecting an estimated 15 million women in the United States.

Its widespread nature and the fact that there are effective treatments is behind an advocacy group push to reach out to women and their physicians and encourage them to overcome the silence that keeps the condition unreported and untreated.

The limited time physicians have with patients might make them hesitate to ask about incontinence, said Victor Nitti, MD, director of New York University School of Medicine's Dept. of Urology. "But when you realize the impact on quality of life a condition like SUI can have on a patient, you realize how important it is to ask about incontinence in general and SUI in particular."

"Even if a particular health professional doesn't believe they can treat the condition, they can refer the patient to someone who can. It's important to be a source of information," Dr. Nitti said.

Dr. Nitti, representing the American Foundation for Urologic Diseases, joined representatives from national continence organizations June 7 to launch the first Urinary Incontinence Awareness Week.

They were joined by Bonnie Blair, speed skating gold medal winner, who related her experience with SUI after the birth of her child.

Although SUI occurs in women of all ages, young women incorrectly believe it's a condition of older women, older women believe it's a natural part of aging, and neither group will take steps to address it.

Women should know that there are effective treatments for SUI, Dr. Nitti said. Treatments include restricting fluids, especially caffeine and alcohol; performing special pelvic floor exercises to strengthen the muscles near the urethra; using urethral inserts and seals; and undergoing corrective surgery.

Recent research has found that a small area of the spinal cord sends a message to the sphincter muscles that open and close the urethra to increase their tone, a finding that could lead to medications for the condition, he predicted. The weakened sphincter muscles of SUI can occur as a result of childbirth, surgery, radiation, aging or a neurological condition.

Thirty percent of women who deliver children vaginally will have the condition, but women who have never had children can also have SUI. Smoking, a chronic cough or obesity also can contribute.

Talking to a physician about urinary incontinence can seem an insurmountable obstacle to many women, said Jasmine Schmidt, director of support services at the Simon Foundation for Continence in Chicago.

And while shortened office visits and increased specialization are among the obstacles, the stigma of urinary incontinence is a major reason. "We need to elevate the status of the bladder and respect it as we do other organs like the lungs and heart," she said.

The Simon Foundation has designed a yellow, balloon-shaped "bladdermobile" that will undoubtedly raise the profile of bladder-related conditions as it travels to health fairs, medical conferences and shopping malls. The bladdermobile will carry information to community groups on a variety of conditions, including bladder cancer, overactive bladder, interstitial cystitis, enuresis, urinary tract infections and incontinence.

The very fact that a bladdermobile exists is a sign that the previously hidden disorders are moving into the public eye.

"I'm not sure that 10 years ago I would have believed we would be at the press club talking about SUI," said Vivian Pinn, MD, director of the Office of Research on Women's Health at the National Institutes of Health. "But we are, and that represents the kind of progress we are making in women's health."

As women realize that the condition affects 15 million others, they will decide, "I shouldn't be embarrassed. It's a common condition and it's treatable," Dr. Nitti said.