I was hiking in the woods recently with a group of women friends when something caught my attention. It wasn’t an interesting bird or plant, but the surprising number of “pit stops” my friends needed to make.
Their frequent detours into the bushes struck me because I had just finished working on Better Bladder and Bowel Control, the latest Special Health Report from Harvard Medical School. According to the report, incontinence is the unintended loss of urine or feces that is significant enough to make it difficult to do ordinary activities without frequent trips to the restroom. In the United States, about 32 million men and women have some degree of incontinence. For women, incontinence is a common but rarely discussed result of childbirth and aging—that could explain the pit stops of my hiking friends, who were all mid-life mothers. For men, incontinence is most often a side effect of treatment for prostate disorders.
Many things can go wrong with the complex system that allows us to control urination. Read more »
Millions of Americans—most of them women—suffer from a bladder condition known as interstitial cystitis. According to a new study of this disorder, fewer than 10% of women with symptoms of interstitial cystitis are actually diagnosed with the disorder, even though it severely affects their lives. Without a proper diagnosis, women with interstitial cystitis are missing out on treatments that might bring them some relief.
As I describe in an article in the August 2011 issue of the Harvard Women’s Health Watch, interstitial cystitis is a chronic bladder condition that causes recurring bouts of pain and pressure in the bladder and pelvic area. Individuals with the condition usually have an urgent and frequent need to urinate—sometimes as often as 60 times a day. The pain and discomfort can be so excruciating that only about half of people with interstitial cystitis work full-time.
Researchers with the federally funded RAND Interstitial Cystitis Epidemiology (RICE) study surveyed nearly 150,000 households in the United States between 2007 and 2009. Based on data gathered during follow-up interviews, the RICE researchers estimated Read more »
April is “Embarrassing Subject Month” for my podcast. I am covering the following problems:
Digestive problems (constipation/diarrhea)
It should be fun, and it will be promoted on iTunes, so it should drum up more subscribers and downloads.
But it begs the question: Why are certain conditions embarrassing to people? Why can people open up to me about so many personal things, yet be embarrassed to discuss hemorrhoids? Why is it easier to talk about your marriage falling apart than your urinary “accidents?” Why is diarrhea more embarrassing than vomiting? Read more »
Urinary incontinence affects millions of women – 38% of women over the age of 60 – yet only 45% ever seek help for it. Men suffer from the problem too but at about half the rate. Only 22% of men seek help.
Why is this a taboo subject? One reason is that it’s an embarrassing – even infantilizing – problem. But patients’ shame is, well, a shame. Because urinary incontinence – the involuntary leakage of urine – can often be treated quite successfully. The first step is to make a proper diagnosis. One common type is “urge incontinence” – the bladder contracting when a person isn’t ready to urinate and can’t get to the toilet fast enough. Another common type, especially after childbirth or in athletes, is “stress incontinence.” It happens when there is a weakness in the pelvic muscles supporting the bladder and urethra (the structure through which urine exits the bladder), causing the urethra to lose its seal and allowing urine to escape when there is increased pressure on the bladder (e.g. coughing, sneezing, laughing, lifting, or exercise). As women get older, it’s more likely they will develop urge rather than stress incontinence. A very simple three question test has been created to help with the diagnosis.
It’s important to get a complete, head to toe medical evaluation because urinary incontinence may be a symptom of an underlying condition (e.g., neurological problem, diabetes, urinary tract infection, chronic bladder inflammation, or even a tumor) or may be a result of medication. Talk to your primary health provider and/or gynecologist. If needed, a specialist (e.g., urologist or urogynecologist) can be consulted.
Treatments for urge incontinence include bladder retraining and pelvic muscle exercises, medications to relax the bladder, and decreasing fluid intake. Approaches to stress incontinence include weight loss if obesity is present, a vaginal pessary, and surgery.
In today’s segment of CBS Doc Dot Com, Dr. Lori Warren and Dr. Jody Blanco, gynecologists with expertise in urinary incontinence, discuss the problem. You’ll meet a woman who overcame her embarrassment, sought help from Dr. Blanco, and is now symptom free after surgery.
There are several online resources on the subject, listed at the end of an excellent discussion in the online medical database, UpToDate.com.
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