Urinary Incontinence in Women: The Latest Recommendations
Urinary Incontinence in Women: The Latest Recommendations
It might be surprising to learn that 51% of women, overall, live with urinary incontinence. And though the numbers increase with age (a recent study determined it occurred at “13% in young, nulligravid women to 25% in reproductive-age, 47% in middle-age, 55% in postmenopausal, and 75% in older women“), it was around double the rate experienced by men.
Though there are multiple kinds of urinary incontinence, the most common ways that women experience an involuntary loss of urine is through stress incontinence, urge incontinence, or a combination of both.
Because such a marked percentage of women experience this life-changing symptom, and because it can be caused by such a long list of issues, the findings in the study mentioned above were as follows: “WPSI recommends screening women for urinary incontinence annually. Screening ideally should assess whether women experience urinary incontinence and whether it affects their activities and quality of life. The WPSI recommends referring women for further evaluation and treatment if indicated.”
The Women's Preventive Services Initiative is a U.S. coalition of women’s health care professional organizations aligned with patient reps, and the recommendations from the study are intended to shape and guide the Health Resources and Services Administration, among others. As the study explained, “The target audience for this recommendation includes all clinicians providing preventive health care for women, particularly in primary care settings. This recommendation applies to women of all ages, as well as adolescents.”
Why adolescents instead of the elderly in those higher brackets? As noted, urinary incontinence is not the condition, typically, but a symptom of something.
What is Urinary Incontinence?
Experts agree that urinary incontinence is simply an involuntary release of urine from the bladder. It may be accompanied by any number of other symptoms, such as the intense urge to urinate briefly before release, difficulty urinating, blood in the urine or dark urine, and so on. Any of these symptoms indicate different potential causes of the loss of urinary control.
For example, urinary incontinence in women could be due to:
- Pregnancy or childbirth
- Hysterectomy or similar surgeries
- Menopause and declining estrogen levels leading to muscle weakening
- Neurological issues, including stroke, Parkinson’s, and MS
- Constipation may cause overflow incontinence
- Bladder tumor
- Urinary stones or crystals
- Anatomical defect
- Problem from surgery for incontinence
- Excessive consumption of alcohol or caffeine
- UTI (urinary tract infection)
- Certain medications
Clearly, this represents an immense range of potential causes, and many of these issues are capable of being experienced by adolescents as easily as the elderly and all women in between those extremes.
And, more importantly, screening becomes significant because, as the report noted at the beginning of this article indicates, “Despite its high rates and adverse effects on health, well-being, and function, urinary incontinence is under reported by women and therefore infrequently recognized by clinicians.”
A survey revealed that more than half of women suffering from urinary incontinence failed to report the symptom “to their health care providers because of embarrassment, stigma, or acceptance as normal.”
This is troubling for many reasons. The first is that “symptoms may be treated by behavioral, nonpharmacologic, pharmacologic, and surgical interventions, depending on the type and severity of incontinence and patient preferences. Early intervention may reduce symptom progression, improve immediate and long-term quality of life, and limit the need for more complex and costly treatment.”
How Will Screening Be Done?
The report evaluated more than a dozen screening methods against the clinical diagnosis of incontinence or diagnostic test results. Their sample methods included:
- Brief clinician- or self-administered questionnaires describing symptoms
- Clinical diagnosis based on physical examinations
- Urodynamic testing
They discovered that two screening methods that yielded good outcomes. They described them in their report recommendation, saying that “Screening should include the use of validated assessment instruments that include questions about whether a woman has symptoms of urinary incontinence; the type and degree of incontinence; and how symptoms affect her health, function, and quality of life. Several brief clinician- or self-administered questionnaires for primary care settings identify women with stress, urge, or mixed incontinence and may be used to guide diagnostic evaluations and management.”
Though screenings are not mandatory, and few physicians use incontinence screenings with female (or male) patients during routine physical exams, you can ask your physician about them now. In fact, you must if you or a loved one has been experiencing such an issue.
As you can see from all of this, however, is that the severity of urinary incontinence as a symptom has made it clear that it must be evaluated on an annual basis for females in their adolescence and upward. While many experts felt that under-reporting might still occur, the screening methods recommended did yield good diagnoses and treatment plans.
What it tells the non-medical people of the world is that they must be honest about any level of urinary leakage, and particularly if it is a new symptom or issue. Urinary incontinence is clearly going to affect the health, but it also has an impact on the quality of life and even the day to day function a person experiences. Somehow, it remains under treated and often undiagnosed.
This may easily allow it to worsen into something that might have otherwise been treated or alleviated. Making a standardized screening part of any annual clinical exam or even gynecological exams can go a long way to bringing those numbers under control.
After all, urinary incontinence can often be due to something as treatable as an infection, a urinary stone, or muscle weakening. These can be remedied through medication and special exercises. Surgical interventions may also help to remedy the symptoms and improve quality of life.
When treatment does not erase the incontinence, though, there are many remarkable incontinence products just for women that exist to allow buyers to discreetly wear disposable or washable underwear that traps moisture, odor and allow a normal life. There are adult diapers, furniture and bed pads, deodorizers and skin care products, and any number of undergarments that can enable someone with incontinence of any level or type to enjoy a normal, active and social life without anyone knowing they are dealing with this often embarrassing issue.
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