Female Health Taboo

Urinary incontinence affects millions of women -- 38% of women over the age of 60 -- yet only 45% ever seek help for it. Men suffer from the problem too but at about half the rate. Only 22% of men seek help.

Why is this a taboo subject? One reason is that it's an embarrassing -- even infantilizing -- problem. But patients' shame is, well, a shame. Because urinary incontinence -- the involuntary leakage of urine -- can often be treated quite successfully. The first step is to make a proper diagnosis. One common type is "urge incontinence" -- the bladder contracting when a person isn't ready to urinate and can't get to the toilet fast enough. Another common type, especially after childbirth or in athletes, is "stress incontinence." It happens when there is a weakness in the pelvic muscles supporting the bladder and urethra (the structure through which urine exits the bladder), causing the urethra to lose its seal and allowing urine to escape when there is increased pressure on the bladder (e.g. coughing, sneezing, laughing, lifting, or exercise). As women get older, it's more likely they will develop urge rather than stress incontinence. A very simple three question test has been created to help with the diagnosis.

It's important to get a complete, head to toe medical evaluation because urinary incontinence may be a symptom of an underlying condition (e.g., neurological problem, diabetes, urinary tract infection, chronic bladder inflammation, or even a tumor) or may be a result of medication. Talk to your primary health provider and/or gynecologist. If needed, a specialist (e.g., urologist or urogynecologist) can be consulted.

Treatments for urge incontinence include bladder retraining and pelvic muscle exercises, medications to relax the bladder, and decreasing fluid intake. Approaches to stress incontinence include weight loss if obesity is present, a vaginal pessary, and surgery.

In today's segment of CBS Doc Dot Com, Dr. Lori Warren and Dr. Jody Blanco, gynecologists with expertise in urinary incontinence, discuss the problem. You'll meet a woman who overcame her embarrassment, sought help from Dr. Blanco, and is now symptom free after surgery.

There are several online resources on the subject, listed at the end of an excellent discussion in the online medical database, UpToDate.com.