Leading Physician Group Releases Guidance for Treatment of Urinary Incontinence
It’s a subject few people openly discuss—yet millions of senior American women are living with urinary incontinence (UI), a troublesome problem that if not managed, can lead to infection, isolation, falls, inactivity and an overall decline in health. Many of these women and their families fail to realize that UI can be treated, often without surgery.
The American College of Physicians (ACP) recently reported that each year, treatment for UI costs upwards of $19.5 billion. In September 2014, the organization released updated, evidence-based recommendations for non-surgical treatment options “to help doctors and patients understand the benefits, harms, and costs of tests and treatment options so they can pursue care together that improves health, avoids harms, and eliminates wasteful practices.”
Treatment recommendations depend on the type of incontinence a woman is experiencing:
Stress incontinence means that urine leaks from the bladder when a woman laughs, coughs, exercises or lifts something heavy. It is caused by physical changes in the muscles of the pelvic floor caused by factors such as childbirth, menopause and obesity. This type is most common in women. For this type, the ACP recommends a specific series of exercises of the pelvic floor called Kegel exercises.
Urgency incontinence, sometimes called “overactive bladder,” happens when the bladder begins to empty itself suddenly, perhaps when the patient thinks about going to the bathroom or hears running water. It can be caused by damage to the nerves or by irritation from infection or certain foods. For urgency incontinence, the ACP is recommending “bladder training, a form of behavioral therapy that involves urinating on a set schedule and gradually increasing the time between urination.” If bladder training is unsuccessful, the ACP recommends medication as recommended by the patient’s physician.
Mixed UI is a combination of stress and urgency incontinence. For this type, the ACP recommends Kegel exercises with bladder training. They also recommend weight loss and exercise for women who are obese.
ACP president Dr. David Fleming states that about half the women who experience this problem don’t even report it to their healthcare provider. He says to doctors, “Urinary incontinence is a common problem for women that is often underreported and underdiagnosed. Physicians should take an active approach and ask specific questions such as onset, symptoms and frequency of urinary incontinence.”
The information in this article is not meant to replace the advice of your doctor. If you are experiencing incontinence, seek the advice of your healthcare provider.
Source: AgeWise reporting on material from the American College of Physicians. You can read the entire “Nonsurgical Management of Urinary Incontinence in Women” set of guidelines in the Sept. 16, 2014 issue of the Annals of Internal Medicine.