Incontinence

Urinary incontinence (UI), the involuntary leakage of urine from the bladder, affects some 25 million adults, 75-80% of them women. Estimates of the annual cost of managing and treating incontinence in the U.S range from $16 billion to $26 billion.

There are three principal types of incontinence:

• Stress urinary incontinence or SUI
• Overactive bladder (also called urge incontinence)
• Mixed incontinence

STRESS URINARY INCONTINENCE
Stress urinary incontinence or SUI is the most common type of incontinence, characterized by leakage of urine during coughing, sneezing or laughing. SUI is caused by weakening of the pelvic muscles that support the bladder and urethra. As a result, the urethra is not held in its correct position and/or loses its seal. Then, when a sudden movement of the diaphragm puts pressure on the bladder, the sphincter muscle on the urethra is not able to control the leakage of urine. SUI may be a symptom of pelvic organ prolapse, but it is also a health condition on its own. Unlike other forms of incontinence, SUI is not accompanied by an urge to urinate.

Prevalence
Studies suggest that SUI may affect more than 30 million American women. Although SUI can occur in women of all ages, it becomes more prevalent with age. One review of published studies estimates that severe symptoms of SUI are experienced by:

• 29% of women aged 25 to 44 years
• 33% of women aged 45 to 60 years
• 86% of women aged 60 or older

Risk factors
The single biggest risk factor is vaginal childbirth.  The risk of SUI increases proportionately with the number of vaginal deliveries a woman has had.  Previous gynecologic surgery, especially a hysterectomy, is another factor:  women who have had pelvic surgery have a 40% higher risk of developing SUI.  Other risk factors include high-impact physical activity, smoking, and chronic conditions such as obesity, respiratory ailments, coughing and constipation.

Under-diagnosis
SUI is not well known or understood by most women.  According to the National Association for Continence, most women with SUI suffer from the condition for 3 to10 years before talking to their doctor about it.  As many as two-thirds of women with SUI never talk about it with their doctors at all.  This is a serious concern, because SUI has a negative impact on a woman’s quality of life, self-esteem and activity level.  In one survey, nearly 60% of women with SUI said they changed their lifestyle to accommodate their condition instead of seeking medical help.

Treatment options
It is important for women to know that incontinence is not a normal consequence of aging. In addition to non-surgical approaches, minimally invasive surgical approaches are now available to treat SUI, so women do not have to accept a compromised lifestyle. These include retropubic suspension and sling procedures performed vaginally such asTVT.

OVERACTIVE BLADDER/URGE INCONTINENCE
Overactive bladder (OAB) and urge incontinence (UI) are overlapping conditions characterized by the sudden, uncontrollable urge to urinate about every two hours, including through the night. UI occurs when nerve passages along the pathway from the bladder to the brain are damaged, causing a sudden bladder contraction that cannot be consciously inhibited. Many factors can cause overactive bladder, including certain types of foods, beverages and medications. However, some cases of OAB have no known cause.

Prevalence
According to the National Association for Continence, about 17% of women and 16% men over 18 years old have overactive bladder and an estimated 12.2 million adults have urge incontinence. Like SUI, OAB and UI occur more frequently in women than in men and become more prevalent with age. Women with OAB are significantly more likely to suffer from other health disorders, such as hypertension, obesity and arthritis, than women without OAB.

OAB has a negative impact on a woman’s quality of life. In a national survey, sufferers of OAB reported they are two to three times more likely to regularly experience disturbed sleep, overeating and poor self-esteem, compared with non-OAB sufferers.

Treatment options
At least 80% of people with urinary incontinence can be cured or improved.Treatment of OAB/UI normally involves lifestyle changes and techniques for bladder retraining, strengthening of pelvic floor muscles, and frequently medications.

MIXED INCONTINENCE
Mixed Incontinence is the coexistence of both stress urinary incontinence and overactive bladder/urge incontinence. It affects approximately one-third of all women with SUI. Treatment options are likely to include approaches for both conditions and will depend on which symptoms are most troublesome to the patient.

References

1. Hampel C, et al. Definition of overactive bladder and epidemiology of urinary incontinence. Urology. 1997;50(6A Suppl):4-14
2. Hannestad YS, et al. A community-based epidemiological survey of female urinary incontinence: the Norwegian EPINCONT study. Epidemiology of Incontinence in the County of Nord-Trondelag. J Clin Epidemiol. 2000;53(11):1150-57.
3. Lewin Group, Inc. Prevalence and treatment patterns of pelvic health disorders among U.S. women. National Women’s Health Resource Center 2007. www.healthywomen.org.
4. Luber KM. The definition, prevalence, and risk factors for stress urinary incontinence. Rev Urol. 2004;6 Suppl 3:S3-69.
5. Melville JL, et al. Incontinence severity and major depression in incontinent women. Obstet Gynecol. 2005: 106(3):585-92.
6. Muller N. What Americans understand and how they are affected by bladder control problems: highlights of recent nationwide consumer research. Urologic Nursing. 2005:25(2):109-115.
7. National Association for Continence. www.nafc.org
8. National Institutes of Health. www//kidney.niddk.nih.gov/kudiseases/pubs/iuwomen/index.htm.
9. Stewart WF, et al. Prevalence and the burden of overactive bladder in the United States. World J Urol. 2003;20(6):327-36.
10. Stewart WR, et al. Prevalence and impact of OAB in the US: results from the NOBLE program. Neurological Urodynamics. 2001;20:406-08