Incontinence Affects Young Childless Women, Too

HealthDay – 2 hrs 2 mins ago TUESDAY, July 17 (HealthDay News) -- Urinary incontinence is often thought of as a problem that occurs after childbirth or in old age, but a new study finds that many young women who have never given birth have the bothersome condition, too.

Researchers in Australia surveyed more than 1,000 women aged 16 to 30 who had never been pregnant and found that one in eight, or nearly 13 percent, reported having urinary incontinence.

Urinary incontinence means leaking urine during certain activities such as running or sneezing, or being unable to hold urine with a full bladder.

Previous research has found the rates are higher among women who've had children. But this study shows that urinary incontinence can affect women of all ages, regardless of pregnancy history, and that the condition may be underdiagnosed and undertreated in younger women, experts said.

"Although incontinence is more prevalent as women age and with an increasing number of pregnancies, incontinence can affect women of all ages," said Dr. Jill Rabin, professor of obstetrics and gynecology at Hofstra North Shore-LIJ School of Medicine, who was not involved with the study.

The study, by Tessa O'Halloran and colleagues at Monash University, in Melbourne, is published in the July 17 issue of Annals of Internal Medicine.

The women who answered the survey came from eight medical clinics and three university campuses in Australia. They were asked to complete a questionnaire about an important issue in women's health, but were not told it was about urinary incontinence prior to filling it out. About 63 percent of those who took surveys returned them.

Commenting on the study, Dr. Elizabeth Kavaler, a urology specialist at Lenox Hill Hospital in New York City, pointed out that because people who have a problem may be more likely to answer a survey about it, that may mean the study overestimates the number of young women with incontinence.

On the other hand, Rabin noted, the women in the study were mostly normal weight, healthy and active, which may make the incontinence rate a conservative estimate.

There are two types of incontinence -- stress and urge incontinence, which have different causes, experts explained. In the study, about 6 percent of women reported stress incontinence, 4.5 percent reported urge incontinence, and about 2 percent reported both.

Stress incontinence is often caused by a weakening of the pelvic floor muscles that hold the bladder in place. Pregnancy and vaginal deliveries can weaken or damage pelvic floor muscles. But other factors, such as obesity or being overweight, are also associated with stress incontinence, although this study did not find an association between weight and incontinence.

Urge incontinence, or feeling the urge to go but not making it to the bathroom, usually has a neurological cause, in that the brain doesn't have sufficient control over the bladder. Neurological conditions such as multiple sclerosis, dementia or simply advancing age can contribute to urge incontinence, Kavaler noted.

It's well known that some younger women can experience what is essentially premature aging of that bladder control, and can experience urge incontinence earlier in life.

To alleviate stress incontinence, Kegel exercises, which strengthen the pelvic floor muscles, may help. Women should squeeze their pelvic muscles as if they are stopping the flow of urine for five seconds, then release for five seconds. Repeat that about five times, Rabin advised. Take a break, and then increase your Kegel set up to 10 times in a day.

"Over time, it thickens the muscle that supports the bladder, vagina and rectum and stabilizes it," Rabin said.

If Kegel exercises aren't helping, see your doctor. "There are young women who have urinary control issues, there are treatments, and they should seek help and talk to their doctor about it," Kavaler said.

Rabin pointed out that some women will resort to restricting fluid intake to alleviate incontinence, but that's a bad idea, she said. Dehydration can contribute to urinary tract infections and constipation, which can also stress the pelvic floor muscles during bowel movements.

The study did not receive university or outside funding.

More information

The U.S. National Kidney and Urologic Diseases Information Clearinghouse has more on urinary incontinence.

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Women Can Waive Test Before Incontinence Surgery: Study

HealthDay – 3 hrs ago WEDNESDAY, May 2 (HealthDay News) -- Many women are sent for pricey bladder-function tests before surgery for urinary incontinence. However, a new study suggests that in many cases these tests are not needed.

The tests are designed for patients with stress urinary incontinence -- a leakage of urine caused by muscle weakness in the pelvis and sphincter. But a team from the Urinary Incontinence Treatment Network found that women who had an office visit alone before their operation experienced results that were similar to women who also had these costly and invasive tests.

Bladder function tests assess how well the bladder, sphincter muscles and urethra store and release urine. The tests, however, averaging about $500 and uncomfortable for patients since many involve the insertion of a catheter or filling the bladder with fluid.

In conducting the study, researchers followed 630 women undergoing surgery for stress urinary incontinence. Half of the women had bladder testing and a checkup before their surgery. The others just had a pre-operative visit to their doctor.

The researchers report that the rate of treatment success -- about 77 percent -- was similar for the women regardless of whether or not they got the pre-op test. There was also no significant difference in the women's quality of life, satisfaction, or ability to empty their bladder completely.

The study, funded by the U.S. National Institutes of Health (NIH), was published online May 2 in the New England Journal of Medicine.

"The findings of our study argue against routine pre-operative testing in cases of uncomplicated stress urinary incontinence, as the tests provide no added benefit for surgical treatment success but are expensive, uncomfortable, and may result in complications such as urinary tract infections," the study's lead author, Dr. Charles Nager, director of urogynecology and reconstructive pelvic surgery at the University of California, San Diego, said in an NIH news release.

However, one expert believes the tests do have real value.

"Leaking of urine or urinary incontinence is a very common problem, affecting about 50 percent of women," said Dr. Peter Finamore, a urogynecologist at Winthrop University Hospital in Mineola, NY. "There are different reasons why women leak urine. The reason why we differentiate the types of urinary incontinence is because of how we treat this problem. Some leaking can be treated with physical therapy, some with medication and some with surgery."

These urodynamic screening methods are "a test on the nerve and muscle function of the bladder," Finamore explained. "It is an important test for patients with urinary incontinence that provides a great deal of valuable information that is essential to determine the appropriate treatment options. The test does have a financial cost, but for those of us who treat urinary incontinence that cost is worth it in order to make the appropriate diagnosis and treat patients properly."

Finamore added that, "the risk of complications such as urinary tract infection following urodynamics is very rare and we often give preventative antibiotics at the time of administering this test."

More information

The U.S. National Institute of Diabetes and Digestive and Kidney Diseases provides more information on urinary incontinence in women.

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Drugs help some women with incontinence

Reuters – 59 mins ago NEW YORK (Reuters Health) - Some women with a leaky bladder can get better using approved medications, but a new research review finds that inadequate relief and side effects may prevent many others from benefiting.

The study, published online in the Annals of Internal Medicine, reexamined 94 clinical trials testing drugs for women's urge incontinence -- when urine leaks after a sudden, strong urge to urinate.

It's less common than so-called stress incontinence, when urine leaks because of pressure on the bladder from things like exercise, coughing or heavy lifting.

In the U.S., there are several drugs approved to treat urge-type incontinence: fesoterodine (Toviaz), oxybutynin (Ditropan), solifenacin (Vesicare), tolterodine (Detrol) and trospium (Sanctura).

They work by relaxing the bladder and easing the urge to urinate. But that clears up incontinence episodes in only a minority of women, the new review shows.

Researchers found that for every 1,000 women treated with the drugs, anywhere from 85 to 130 saw their incontinence go away.

Fesoterodine was the most effective drug, and tolterodine the least.

But overall, the benefit of medication was modest, since most women in the studies did not become continent, said lead researcher Dr. Tatyana Shamliyan, of the University of Minnesota School of Public Health in Minneapolis.

And that modest effectiveness needs to be balanced against the risk of side effects, Shamliyan said.

She and her colleagues found that for every 1,000 women treated, between 13 and 63 stopped taking their incontinence medication because of side effects. The highest rate was among women on oxybutynin.

Dry mouth and constipation are the most common side effects of incontinence medications. Others include blurred vision and dizziness.

Shamliyan said women should try lifestyle changes and non-drug treatments first. "If you still can't find relief, then talk with your healthcare provider," Shamliyan told Reuters Health.

Medication, she said, "should be seen as a treatment option. But they are not magic pills."

Urinary incontinence is very common among women -- in large part because vaginal childbirth is a major risk factor.

One recent study of U.S. adults found that about 53 percent of women older than 20 said they'd had problems with urine leakage in the past year. That was up from less than half of women surveyed several years earlier. (See Reuters Health story of July 1, 2011.)

Researchers on that study said the increase was partly explained by rising rates of obesity and diabetes; diabetes is thought to contribute for a few reasons -- by causing nerve damage that affects the bladder, and by boosting the body's urine production, for example.

Shamliyan said the relatively small benefits of drug treatment make preventing urinary incontinence even more important.

Women can cut their risk, she said, by eating well and exercising to maintain a healthy weight, and by not smoking -- another risk factor for bladder-control problems.

There are also conservative treatments, Shamliyan pointed out.

One is "bladder training" -- tactics like going to the bathroom at fixed times, even if you don't feel like you need to go. It often includes Kegel exercises to strengthen the pelvic muscles that control urination.

Changing your lifestyle habits can also help. That often means cutting down on caffeine and alcohol, and limiting your beverages at night.

Shamliyan said there are still questions about drugs for incontinence. One is, how do women on the medications fare in the long term? The trials in this review typically lasted two to three months.

Women may also want to consider the drugs' cost, which ranges from around $100 to more than $200 a month. There is, though, a generic version of oxybutynin that is only about $10 a month.

SOURCE: Annals of Internal Medicine, online April 9, 2012.

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