The Bob Butler Tribute: Day 11 – Incontinence: The Silent Disability

Incontinence – The Silent Disability

Mike Magee

There’s an extraordinarily common medical condition out there that affects millions of Americans, mostly women. It brings them high levels of disability, discomfort and lost productivity, but very seldom will you hear them talk about it. They often suffer in silence, fearful of ridicule or embarrassment – sometimes to the point of not leaving their homes. It’s not breast cancer. It’s not heart disease. And it’s not depression. It’s incontinence – the loss of bladder control – and about 25 million Americans have experienced it. (1)

If only grandmothers come to mind, that’s not exactly accurate. Study results printed in the Archives of Internal Medicine in 2005 found that, yes, 55% of the women in the study who were in their 80s had urinary incontinence. But it might surprise you to learn that 28% of the women in their 30s experienced some loss of bladder control at least once a month. Put it all together and you’ll find that approximately 50% of American women have experienced incontinence, resulting in more than $26 billion a year in direct costs and lost productivity.(1,2,3)

It’s important to point out that incontinence is a symptom, not a disease, and it has a variety of causes, which I’ll explain in a moment. Also, there are several different types of incontinence with the most common being stress incontinence. This is urine leakage when any physical pressure is placed on the bladder, such as sneezing, coughing, or exercising. Many think incontinence is a life-altering condition, but the truth is, the majority of incontinence conditions can be improved or cured with treatment. (4) But in order to get treatment, you have to take that first step – talk openly and honestly with your health care professional.

Now, in order to understand why incontinence is so common in women, let’s first take a step back and talk about the bladder. As with the heart, the bladder is a hollow organ, constructed of muscles, designed to propel fluid outward. This fluid, urine, is brought from the kidneys to the bladder via two tubes, called ureters. The amount of urine carried is a function of fluid intake.

The bladder is a sophisticated organ. It’s expected, on the one hand, to be able to relax enough to serve as an adequate reservoir for urine collection. While, on the other hand, it also must be able to contract in order to efficiently empty when it’s supposed to. (5,6) If it does not relax completely, it can only hold small amounts of urine, and frequent urination is the result. If it does not contract completely, the bladder fails to release all the urine it holds. This is a problem because with less emptying there is less room for more urine that arrives from above and, once again, frequent urination is the result. To make matters worse, when the bladder does not empty completely, the stagnant urine is more likely to become infected. Infection makes the bladder wall irritable and less likely to relax and be able to hold an adequate amount of urine.

All of this relaxing and contracting must be synchronized with the voluntarily controlled sphincter muscle that surrounds the urethra, the tube that empties the bladder. The sphincter muscle must relax as the bladder muscles contract in order for urine to flow easily outward. When the sphincter muscle contracts, it squeezes the urethral tube and prevents urine outflow. (4)

Basically, women are more susceptible to incontinence because of their anatomy. A woman’s urethra is much shorter than a man’s, so it offers less resistance to outflow when the bladder muscle

contracts. Also in women, the urethra sits on the upper wall of the vagina, and it is relatively easy for bacteria in the vagina to find their way up the urethra and into the bladder to cause a urinary tract infection. (5)

The bladder, urethra, and sphincter muscle are all directly contiguous with the woman’s uterus, vagina, and pelvic musculature. Therefore, women who deliver babies vaginally have an increased risk of incontinence – around 17%, compared to non-childbearing women. (1) How does this happen? Vaginal delivery can stretch pelvic muscles, allowing abdominal organs and the bladder to push downward. This causes the already short urethra to telescope on itself and become shorter still, offering even less resistance to urine flow. In addition, in some births, the urinary sphincter muscle and urethra can be traumatized. (5)

Weight can have the same effect on the urinary system as childbirth. In the study I mentioned earlier, women with a body mass index (BMI) of greater than 30 were 139% more likely to be incontinent than those within a normal weight range. (1)

Due to the fact that the bladder and the sphincter muscle are nerve dependent, any metabolic conditions, like diabetes or depression, or neurological degenerative diseases, like multiple sclerosis, can injure the nerves of the bladder and urethra and increase the risk of incontinence. (1,6,7)

And finally, as you might expect, problems with incontinence increase linearly with age in women. (1) In the late years, it can become a serious enough management problem that it can trip a woman from independence to dependence. In fact, half of all nursing home patients are incontinent. (8) And dependency doesn’t come cheap. Adding a single month of independence and health to America’s senior population would save $5 billion. With a 10% decrease in hospitalization and institutionalization, $50 billion in savings per year would accrue. (9)

What to do? First, as a woman, understand that bladder care is essential. If you have pain, frequency, or leakage, don’t suffer in silence. Be evaluated thoroughly. Second, for caregivers, routine questioning and screening for incontinence in women is crucial – especially among those who havehad children or hysterectomies, are depressed or overweight, or are diabetic or have
neurological problems.

In her lifetime, a woman’s bladder will be asked to relax and contract with perfection 300,000 to 400,000 times. We can’t expect that type of performance unless we take better care of this
remarkable organ.

References:

1. Melville JL, Katon W, Delany K, Newton K. Urinary incontinence in U.S. women. Arch Intern
Med. 2005;165,537-542.
2. Fantl JA et al. Urinary Incontinence in Adults: Acute and Chronic Management, Rockville MD.
US Dept. of Health and Human Services. Agency for Health Care Policy and Research 1996.
Clinical Practice Guideline 2.
3. Wagner TH, Hu TW. Economic costs of urinary incontinence in 1995. Urology. 1998;51, 355-
361.
4. American Academy of Family Physicians. “Urinary Incontinence in Women: Evaluation and Treatment.”
5. Patrick DL, et al. Quality of life of women with urinary incontinence: Further development of the Incontinence Quality of Life Instrument. Urology. 1999;53:71-76.
6. National Association for Continence. “What is Incontinence?”
7. Grodstein F, et al. Association of age, race and obstetric history with urinary symptoms among women in the Nurses’ Health Study. Am J Obstet Gynecol. 2003;189:423-434.