Mitzi Perdue

Overactive Bladder and Urinary Incontinence

OVERACTIVE BLADDER AND INCONTINENCE ARE MAJOR PROBLEMS FOR WOMEN

Almost 31% of women between the ages of 42 and 50 and 38% of women over age 60 suffer from overactive bladder (OAB) and/or urinary incontinence (UI). These conditions afflict as many as 33 million Americans and 200 million worldwide. More than two-thirds of the persons with these conditions are women. The total annual cost of providing care for persons with urinary incontinence in the US is ~$28 billion. The inability to control urine is one of the most unpleasant and distressing problems from which a person can suffer. It often causing isolation, depression, and physiological problems including skin breakdown and UTIs. Incontinence is a major reason for putting aging parents in nursing homes.

THESE CONDITIONS ARE UNDER-REPORTED AND UNDERTREATED

One of the obstacles to effective management is the misperception that these conditions are inevitable and irreversible. This view unfortunately is almost as common among healthcare providers as patients. Therefore, most women do not report their UI problem to their health care providers. Embarrassment is another reason for not reporting the problem. Surveys note that less than half of people with UI or OAB symptoms report them to primary care providers. Instead of seeking treatment, many individuals start self-care practices. Limiting trips outside the home, discontinuing exercise that triggers urine leakage, among others. Underreported and undertreated OAB and UI leads to decreased quality of life in sufferers and financial burdens for both the patient and the healthcare industry.

ASK YOUR PATIENT IF SHE HAS PROBLEMS WITH FREQUENCY OR URGENCY

Ask before she brings it up because we know that a woman will typically wait years before asking for help. (Men, in contrast, typically ask for help after a couple of months with OAB.) The goal is to do something about the condition earlier, given that most patients with OAB or UI can be managed and effectively treated, especially if treatment starts in the initial stages. By the time a woman is 80, you probably can’t do much to cure her, although you can help with symptoms.

THINGS THAT MAY HELP

If a woman is overweight, losing weight is highly likely to improve her urinary symptoms.

Keeping a “voiding diary,” can also help her discover her triggers, such as caffeine, alcohol, or chocolate that might be causing symptoms. It can also help both of you track the progress of her treatments. There are a number of .pdf voiding diaries available on the Internet, or she can download a voiding diary app at the iTunes store.

Encourage her to do Kegel exercises. Many studies show that these are particularly helpful with stress urinary incontinence, (SUI) the kind that happens when, for example, she coughs or during exercise. Her muscles may be weak, and it may take 4 to 6 weeks for her to notice greater bladder control and less leakage. Further, it may take 3 to 4 months to get the full benefit.

TIMED VOIDING CAN MAKE A MAJOR DIFFERENCE FOR A WOMAN WITH MIXED SYMPTOMS

If a patient complains of voiding every 30 minutes, ask her to wait 45 minutes before voiding. When she’s gotten used to 45 minutes, ask her to increase it to an hour. Ideally, by the end of treatment, she’ll be able to wait two to four hours to void.

While she’s waiting to void, instruct her to find something distracting. This can include things such as doing a couple of quick pelvic floor muscle contractions, or focusing on deep breathing. She’s likely to find that she can override the nerve message telling her that she has to void right now. It’s the same principle as when a nurse wants to pee but suddenly learns that a patient has fallen out of bed. The nurse will delay voiding in order to take care of her patient, even if it takes an hour or two. The messages from her bladder are overridden by the emergency situation.

Although timed voiding can be very effective, let her know that this is a process that takes months, not days. If someone is used to voiding every hour, an additional problem is that her bladder has adjusted to the size that holds an hour’s urine. It can gradually enlarge over time when forced to, but it’s a gradual process.