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Urinary Incontinence: How Your Doctor Can Help

Posted Aug 24 2008 1:49pm
MABEL JONG: Hello, everyone. Welcome to our webcast. I'm Mabel Jong. When people start having the symptoms of urinary incontinence, they're often too embarrassed to talk about it, even with their doctors. But incontinence isn't something you have to live with. And a simple doctor's visit can make a big difference.

Joining me to discuss the importance of diagnosing incontinence and how it's done are Dr. David Chaikin, Clinical Assistant Professor of Urology at Weill Cornell Medical College and Dr. Jonathan Vapnek, Clinical Assistant Professor of Urology and Director of Neurourology at Mt. Sinai School of Medicine. Gentlemen, thanks for being on the program.



MABEL JONG: First of all, having bladder problems can be a very embarrassing topic to talk about, but what is your recommendation, Dr. Vapnek, on getting these patients to come out with some of the details of the condition.

JONATHAN VAPNEK, MD: I think the patients need to realize that it is not a normal part of aging and that despite the fact that some of their family members or even a family physician may have told them that it's okay, that it's really not okay and that they do need to seek help.

MABEL JONG: Can you describe some of the more common symptoms?

JONATHAN VAPNEK, MD: Well, one of the problems patients may have is the overactive bladder symptom complex which is urgency, frequency and perhaps getting up at night. Another type of incontinence would be stress incontinence when patients leak urine when they cough or sneeze. And either one or both of those can lead someone to come into the doctor's office.

MABEL JONG: Dr. Chaikin, what specifically should a patient do in advance of the visit to talk with you about this condition?

DAVID CHAIKIN, MD: I think it's really important for a patient to realize what their symptoms are. In other words, to think about what's bothering them the most so that when they see the doctor that they can be able to articulate it as well as they can. So for instance, if a patient is complaining of urinary urgency -- in other words, they just get this sudden urge to go, whether or not they can make it to the toilet or not, that that's a serious -- that's a significant symptom and can be treated.

Another thing that's very successful the patient and helpful is to complete a voiding diary. That's simply just a 24-hour chart of how often they go to bathroom, perhaps even to write down how much volume they void or urinate at that time, and what types of symptoms they are experiencing. In other words, if they got an urge to go at the same time, or whether or not they got up in the middle of the night in order to urinate.

MABEL JONG: Do you see that some patients adjust their behavior because they have this condition?

DAVID CHAIKIN, MD: There is no question about that. In fact, there are some patients who can map where toilets are so that they can find where a toilet is on their way to work. I've had some patients who know 20 toilets on their way to work and they stop at each one of them to use them before they get to work. Now obviously that's an extreme case, but there is no question that patients have figured out ways to cope with these behaviors.

Other ways that they've been able to figure out is to decrease the amount they drink at night. To stop exercising. And what I think is one of the worse things is simply just to use pads or diapers or absorbant products to just hide the problem. And it's a problem that can be treated easily in a lot of circumstances.

MABEL JONG: Now gentlemen, the two of you are specialists in this field, but what about a primary care physician, what does a patient need to convey to that doctor to alert him that this overactive bladder. Dr. Vapnek?

JONATHAN VAPNEK, MD: I think if a patient tells any physician that he or she is urinating too often, there is a sense urgency or that he or she is urinating more than eight times a day, a primary care physician or any other type of physician should identify that as being possibly an overactive bladder.

DAVID CHAIKIN, MD: I think also on the same terms, it would be important for the doctor to investigate some of the patient's complaints. And that is, if there is a loss of sleep at night, that might lead to the next question -- why are you getting up all night? And that might uncover the fact that they're getting up at night in order to urinate.

The same thing might happen during the day, and that is I'm not productive at work. And anything such as that might alert the doctor -- or should alert the doctor -- to ask the next question. And that would be why? And it would not be unreasonable for the overactive bladder to cause all of those things to occur.

MABEL JONG: So once you've heard what you need to know to diagnose the condition, what sort of treatments might you recommend?

JONATHAN VAPNEK, MD: Well, after taking a good history, obviously the physical exam would be the next step. And a physical exam may be a complete physical or it may be a directed physical depending on what type of physician. One the history and physical exam are done, usually we'll check a urinalysis to make sure there is no blood in the urine, to try and rule out diabetes, or urinary tract infection. At which point, then we can make a diagnosis or at least a tentative diagnosis and suggest some potential treatments.

MABEL JONG: Dr. Chaikin, what are some of the other tests you might employ?

DAVID CHAIKIN, MD: Well, sometimes depending on who the patient sees, if they come to see a urologist which is common when someone has overactive bladder, they might undergo a test called a cystoscopy which simply looking inside the bladder. It's not an uncomfortable test and it's very similar to having a pelvic exam for a woman.

Another test that a patient might undergo is a test called urodynamics. That's simply a test where we fill the bladder with fluid and try to reproduce the same symptoms that a patient has so we can try and understand them and then treat it -- depending on what's causing those particular symptoms.

MABEL JONG: If the tests are very involved, how long might a patient need to stay at the doctor's office to receive the test?

JONATHAN VAPNEK, MD: Well, it's certainly possible that a patient could be there for a couple of hours assuming that they haven't been waiting a couple of hours to begin with. But in general, I think most patients on their first visit should really undergo just the history, physical exam, and I think those other types of tests would generally wait until after the first visit. But each of those tests literally will only take between 20 minutes and 45 minutes plus turnover time.

MABEL JONG: After a diagnosis is made, what is the next step?

DAVID CHAIKIN, MD: Well, once diagnosis is made, I think that it would be important to discuss treatment options. I think it's important for a patient to understand that there is a myriad of treatment options available to them. The first step usually that one would think about would be medical therapy. There are once a day formulations such as Detrol which can oftentimes be a simple and effective way of treating overactive bladder symptoms.

Sometimes we might add in addition to medical therapy a behavioral training program where we can simply teach the bladder to stop being overactive. Finally, there are some surgical options and, of course, those are things that we try to leave as last resorts, when simple therapy such as medical therapy and other conservative treatments such as behavioral treatments aren't effective and the symptoms are still very bothersome.

MABEL JONG: Dr. Vapnek, Dr. Chaikin, thank you very much for the useful information. And thank you for watching our webcast. I'm Mabel Jong.

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