Incontinence a hidden medical problem, study finds
CMAJ 1997;157:1501
© 1997 Janice Hamilton
About 45% of people who experience urinary incontinence have never consulted a health care professional about the problem, a recent survey conducted by the Canadian Continence Foundation indicates. The foundation says the problem affects more than a million Canadians of all ages.
"Patients are shy and doctors are shy," says Dr. Sender Herschorn, chief of urology at Toronto's Sunnybrook Health Science Centre. "Awareness is the first step because, most of the time, something can be done to improve the quality of life."
Herschorn says incontinence is often overlooked because it is not a high-profile, life-or-death health matter. As a result, many physicians simply aren't aware of the quality-of-life issues raised by the problem.
It holds particularly cruel implications for elderly patients. Incontinence creates too much work for home caregivers to cope with, so patients who lose bladder control are often sent to nursing homes, at huge expense.
Obesity, stroke, Parkinson's disease, diabetes, multiple sclerosis, arthritis, benign prostatic hypertrophy, the loss of estrogen after menopause and radical or vaginal hysterectomy can contribute to urinary incontinence. Stress incontinence, which is largely related to labour and delivery, affects 10% to 30% of women. It is not as prevalent in men, although it is becoming more common in younger males who have had radical prostatectomies.
Herschorn suggests that questions about bladder function should be part of routine physical examinations. "It is easy and inoffensive to say: 'Do you have any problem with your bladder? Do you ever leak? Do you have to wear pads? Do you always make it to the bathroom in time?' "
Once the problem has been recognized, patients can often be educated to help themselves through dietary management. The advice can be as simple as encouraging them to forgo beverages with caffeine. "These noninvasive measures can be applied to a large number of patients at no cost," says Herschorn.
When the simple measures don't work, urodynamic tests can help diagnose the problem; pharmaceutical treatment is available for different types of problems, although surgery remains the most effective treatment for female stress incontinence. -- © Janice Hamilton
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