Vitality - Healthy Aging NewsletterSummer 2011

Leaky Pipes? Talk With Your Doctor

Some conditions that many of us share are embarrassing to talk about, even when we know that asking for help may lead to successful treatment. One of these is loss of bladder control, or urinary incontinence.

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Some conditions that many of us share are embarrassing to talk about, even when we know that asking for help may lead to successful treatment. One of these is loss of bladder control, or urinary incontinence.

Vitality asked Fred Heidrich, MD, Capitol Hill Family Health Center in Seattle, how Group Health doctors are addressing this issue, and how we can prepare for this type of conversation and muster the nerve to speak up.

Do you talk about urinary incontinence as part of a senior wellness visit?
Yes. The senior wellness questionnaire, which is often distributed to patients before the visit, includes a question about urinary incontinence. Some doctors use a patient's online Health Profile, which also asks about incontinence in people over 65. If your doctor forgets to discuss this with you, be sure to mention it.

When is it important to see a doctor?
Any leakage is worth discussing, whether it's minor or so severe that you're afraid to leave the house. Contact your doctor or nurse right away if the incontinence has just started, you sense that you can't empty your bladder completely, or you have a fever or burning sensation when you urinate.

Why do many seniors fail to discuss this problem with their doctor?
I suspect that it's due to embarrassment and a fear of potentially humiliating or uncomfortable examinations. It may also be difficult for some women to discuss this topic with a male doctor.

How is this condition treated?
It depends on the form of incontinence. Stress incontinence occurs when you laugh or strain. Urge incontinence is related to uncontrolled contractions of your bladder. These two forms are often initially treated with exercises and habit changes. If you have overflow incontinence, or problems emptying your bladder, tests may include measuring bladder volume.

Do men and women experience urinary incontinence differently?
Yes. Men suffer more from urinary blockage, and sometimes their incontinence is from overflow around that blockage. Overall, women have more incontinence problems than men up until their mid-80s. Then it starts to even out.

Do you recommend self-treatment?
Yes. Lose weight, stop smoking, and do pelvic floor strengthening exercises (Kegels) for stress and urge incontinence. Use panty liners or adult diapers, empty your bladder frequently, time your fluid intake so you will be near a bathroom, and, for urge incontinence, recognize what triggers the bladder contraction. For example, if you often experience an urge when you drive up to your house, it's possible to train your bladder not to respond by doing relaxation exercises, and mentally prepare yourself to wait until you reach the bathroom.

What other treatments are available?
Medications can help, but side-effects limit their use. A few cases require surgery. The most common are for bladder outlet obstructions in men with an enlarged prostate, and procedures to change the angle between the urethra and the bladder for women with stress incontinence.

How can I better prepare for this discussion with my doctor?
Fill out the senior wellness questionnaire well ahead of your visit. Include all unusual or uncomfortable symptoms, such as body odor or pelvic area irritation. You can also keep a journal to track when urinary leakage occurs, so we can get an idea of the pattern and frequency.


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