Alicia A. Nixon PT, DPT, BCB-PMD
Urinary incontinence is defined as involuntary loss of urine by an individual and is a significant health problem that has considerable social as well as financial implications (Nitti, 2001) . Incontinence is NOT a normal part of the aging process and is treatable with a wide variety of treatments, both invasive and non-invasive. Surgery is not the only treatment option.
There are several types of incontinence and the treatments for each are different. The three main types of incontinence are stress incontinence, urge incontinence and mixed incontinence.
Stress incontinence is when a person leaks with activities such as laughing, coughing, sneezing or when moving from sitting to standing. This type of incontinence is fairly predictable.
Urge incontinence is when someone experiences the sudden urge to void and is unable to stop the urine from leaking. Urge incontinence is totally unpredictable.
Mixed incontinence is a combination of both urge and stress incontinence.
The current prevalence of urinary incontinence in the United States has been estimated in the general population at 20-30% in the young adult age group, 30-40% in the middle age group and 30-50% in the elderly population (Nitti, 2001). The prevalence of incontinence rises from low to a peak in middle age concurrent with menopause in women and then steadily increases with increasing age (Nitti, 2001) . This does not mean however that it is a normal part of aging, there are underlying reasons for the incontinence and they are treatable. Incontinence is more prevalent in women especially in the elderly population, with severe incontinence in men only half of that of women (Nitti, 2001).
We know that less than half of community dwelling adult women in the US that experience incontinence have ever discussed their symptoms with a physician. This single fact makes successful treatment difficult because effective identification is not occurring. There are many reasons that individuals are not being identified such as: embarrassment about seeking treatment, impact on the individuals quality of life and attitudes about healthcare use (Kinchen, Burgio, Diokno, Fultz, Bump, & Obenchain, 2003). The most harmful reason to not seek treatment is the belief that there is nothing to be done and thisa normal aging process.
The costs of incontinence are extremely high with estimates in 2000 at $19.5 billion with $14.2 billion spent by residents that were residing in the community, not elders residing in nursing facilities. This is a significant financial burden to the individual and to society (Gorina, Schappert, Bercovitz, Elgaddal, & Kramarow, 2014). These costs are unnecessary given the treatable nature of the condition.
There are many underlying causes for urinary incontinence but two that have not been explored fully have been the contribution that obesity and diabetes in the United States is making to the prevalence of this condition. Obesity is a potentially modifiable risk factor for the onset of developing urinary incontinence and the risk factor increases with subsequent increase in weight. There are now many studies that are showing that obesity is a very strong risk factor for developing urinary incontinence. Let’s look at this a little more in depth.
More than 50% of all Americans are overweight which is defined in terms of the body mass index ( BMI)
Over weight is 25-29.9 kg/m2
Obesity is defined as a BMI of >30 kg/m2.
With every 5 unit increase in an individual’s BMI there was an associated increase of daily incontinence of 60% (Whitcomb & Subak, 2011). This gives medical practioners another very effective treatment option for individuals suffering from incontinence as well as substantial overall health benefits from weight reduction.
Other causes of urinary incontinence may be the result of bladder dysfunction, sphincter dysfunction or a combination of both. Specific causes for men can be related to prostate surgery, trauma, neurological injury/disorder, obstruction, prostate cancer/enlargement, constipation or urinary tract infections
So what do I do about my condition?:
The most well-known treatments for urinary incontinence are surgical interventions and although not our first choice the success rates for surgery are 90%.
Non surgical options:
Physical Therapy for instruction in Pelvic floor strengthening and coordination exercises. Physical Therapy is effective with the treatment of all types of incontinence with different techniques for each type. The most well-known component of a physical therapy treatment plan is Kegel exercises that both strengthen and coordinate the pelvic floor. Physical Therapists can utilize biofeedback which gives the individual immediate feedback if they are doing the pelvic floor contractions correctly. There are other techniques that are utilized such as behavioral modification, urge suppression, and bladder retraining that are utilized for specific symptoms. Physical Therapist’s that are trained to treat the pelvic floor can utilize manual techniques, ultrasound and electrical stimulation to assist with reduction in spasms for painful conditions.
Medication ; medications have been commonly available for the treatment of urge related incontinence and currently in development are agents to assist with stress related incontinence.
Injections or bulking agents : these agents are injected near the neck of the bladder and urethra increasing the thickness of the tissue and allowing closing of the urethral opening decreasing leakage.
Vaginal pessary: to assist with supporting the women’s pelvic organs and improve prolapse( slipping down) and bladder control.
Penile clamps: are external clamps that are applied to the urethra/penis that stop leakage by applying pressure.
Sacral never stimulators: are devices that deliver mild electrical pulses to the nerves in the low back( sacral nerves) that assist with improving control over the bladder, the pelvic floor muscles and the sphincter.
There are many options available for treating urinary incontinence, “The greatest obstacle to progress is the belief that no progress is possible “ (Resnick, 1987). More than half the battle is overcoming the belief that there is no cure for incontinence and that it is just a part of getting older.
Gorina, Y., Schappert, S., Bercovitz, A., Elgaddal, N., & Kramarow, E. (2014). Prevalence of incontinence among older Americans. Vital and Health Statistics, Series 3, Analytical and Epidemiological Studies, 36, pp. 1-33.
Kinchen, K. S., Burgio, K., Diokno, A. C., Fultz, N. H., Bump, R., & Obenchain, R. (2003). Factors associated with women's decisions to seek treatment for urinary incontinence. Journal of Women's Health, 12(7), pp. 687-696.
Markland, A. D., Richter, H. E., Fwu, C. W., Eggers, P., & Kusek, J. W. (2011, August). Prevalence and trends of urinary incontinence in adults in the United States, 2001 to 2008. Journal of Urology, 186(2), pp. 589-93.
Nitti, V. W. (2001). The Prevalence of Urinary Incontinence. Rev Urology, 3(Suppl1), pp. S2-S6.
Resnick, N. M. (1987, July-Aug). Urinary Incontinence. Public Health Reports, 102(4 Suppl), pp. 67-70.
Whitcomb, E. L., & Subak, L. L. (2011, August). Effect of weight loss on urinary incontinence in women. Open Access Journal of Urology, 3, pp. 123-132.