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Incontinence is a “hidden condition” for many women

Posted Jul 07 2008 7:13pm

We read with interest an article by Liz Szabo in US Today last month.

This supports the widely held believe thatIncontinenceis far more common than reported and can be treated at any age.

The article focuses on the range of treatments and also on the experiences of Lee Greenwood, a real estate agent, who wet herself while showing a home. This was to be the first of many accidents. “I had to do something about it,” says Greenwood, 59, from Pennsylvania. “I was not going to be a recluse.”

Though Greenwood’s problem is common — 20% to 30% of women have it — her attitude is not. Fewer than half of women withincontinenceseek treatment, says University of Pennsylvania nurse practitioner Diane Newman, who treated Greenwood. Some women are afraid to ask, she says, and others don’t realize treatments are available. “These patients are devastated,” Newman says. “It’s still such a hidden condition.”

Greenwood tried a variety of strategies for 1½ years — including pills to ease bladder spasms, a special diet and even antidepressants. Nothing worked.

While surgery is effective for up to 90% of women, Newman says, it can be painful and increases the risk of side effects, such as bleeding. Some patients who have surgery develop new bladder problems, such as the need to urinate frequently, Newman says.

The most promising non-surgical approach — physical therapy called pelvic floor exercises — can cure half of women with stress incontinence, in which urine leaks during activities such as sneezing or coughing, the report shows.

Through the training, also called Kegel exercises, patients strengthen muscles around the urethra that control urination, says Jean Wyman, report co-author and a nursing professor at the University of Minnesota. Unlike medication, the exercises have no harmful side effects and often can be taught by women’s primary care providers, she says.

But isolating tiny internal muscles isn’t easy for everyone, Wyman says. Only about half of women can do the exercises correctly on their own. The rest need additional help from physical therapists or nurses, Wyman says.

Pelvic exercises also can preventincontinence, says Robert Kane, a co-author of the March report and geriatrician and epidemiologist at the University of Minnesota School of Public Health.

The report considers also considers other ways to treatincontinence.

In a study called the Diabetes Prevention Program, overweight women who exercised and lost at least 7% of their weight reduced their risk of stress incontinence by 15% after a follow-up of three years, according to the NIH paper, published in Annals of Internal Medicine. Women who quit smoking are also less likely to leak, partly because they cough less, which reduces strain on their pelvic floor, Newman says.

And certain medications can also can help. But all medications aren’t alike. While estrogen patches and gels alleviate incontinence, the report notes that hormone pills make it worse. Kane says doctors aren’t sure why.

Greenwood finally solved her problem three months after Newman taught her to use electrical stimulation at home. Greenwood still uses the system, in which an internal sensor contracts the pelvic floor muscles for her, half an hour a day. Although the technique worked for her, the NIH report notes there’s no evidence that it benefits women in general.

Greenwood says she no longer lives in fear of accidents. She still uses a patch, which provides Detrol through the skin, and wears pads as insurance. She also does regular pelvic floor exercises.

Wyman says women shouldn’t be afraid to seek help — even if they’ve suffered for years.

“At any age”, Wyman says, “it’s never too late.”

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