An estimated 25 million adult Americans experience temporary or chronic urinary incontinence.
Although urinary incontinence can occur in both women and men at any age, it is more common in women over age 50. According to Rise for Health, a national survey-based research study on bladder health, up to 40% of girls and women experience urinary problems and it may be as high as 50% or 60%.
“The main known predictors of urinary incontinence are age, obesity, diabetes, and pregnancy and childbirth,” said internist Joan M. Neuner MD, MPH, a professor of women’s health at Medical College of Wisconsin, Milwaukee.
courtesy Northwell Health
Dr. Sarah Friedman
Other causes are urinary tract infections, pelvic surgery, and in men, of course, prostate problems. Medications such as antihypertensives and antidepressants can promote urinary incontinence. Inexplicably, smokers seem to be at higher risk. Childbearing is a prime reason women are at greater risk. “While C-section can be protective against many pelvic floor issues, vaginal delivery, particularly forceps assisted, increases the risk for urinary incontinence,” said Sarah Friedman, MD, director of the Division of Urogynecology at Staten Island University Hospital, New York City.
Urinary incontinence is underrecognized and undertreated in primary care and may not get enough emphasis in medical schools. Dr. Neuner recently coauthored a small pilot study on developing a primary care pathway to manage urinary incontinence. It suggested that a streamlined paradigm from identification and patient self-care through basic medical care and specialty referral might assist primary care providers as first-line providers in urinary incontinence.
courtesy Medical College of Wisconsin
Dr. Joan M. Neuner
Urinary incontinence’s impact on quality of life should not be underestimated. “It depends on severity, but people may limit their physical activities and social activities, including work, going out with friends, and sexual activity, which can in turn increase loneliness and depression,” Dr. Neuner said in an interview. “Incontinence products like pads and adult diapers are costly and often not covered by insurance.”
In fact, urinary incontinence costs US men and women more than $20 billion per year, mostly for management supplies such as pads and laundry.
Primary Care
While primary care practitioners are well positioned to manage urinary incontinence, the majority of patients remain untreated.
courtesy Corewell Health
Dr. Khaled A. Imam
The current stepwise approach should start with a knowledge of basic micturition physiology to identify the incontinence type before selecting treatment, said Khaled A. Imam, MD, CMD, a geriatrician at Corewell Health William Beaumont University Hospital in Royal Oak, Michigan. “More important, this working knowledge can prevent the prescription of an inappropriate treatment or drug, thus preventing many adverse effects,”
According to Dr. Imam, urinary incontinence occurs “because the outlet is open when it should be closed, the outlet is closed when it should be open, the detrusor fails to contract, or the detrusor contracts when it should not.”
There are five main types of incontinence: transient, detrusor overactivity (urge), stress, overflow, and functional. The primary care evaluation of urinary incontinence should include history taking, physical examination, post-voiding residual volume measurement, urinalysis, and urine culture, according to Dr. Imam. “The physical examination should include a urine stress test, abdominal examination, pelvic examination in female patients, rectal examination, and neurologic evaluation.”