It is an embarrassment that many women choose to ignore, but incontinence is a widespread disorder that may affect one in four women and perhaps as many as one-third of older women in their lifetime, according to a study published Tuesday in the Journal of the American Medical Association (JAMA). While there are several medical solutions to treat this common problem, the study's authors say that one of the simplest and most effective ways to ward it off is to maintain a healthy weight.
The new report found that about 24% of the nationally representative sample of 1,961 women studied had symptoms of at least one pelvic-floor disorder, conditions that occur when the pelvic muscles and tissues are weakened or injured, according to Dr. Ingrid Nygaard, a urogynecologist and pelvic reconstructive surgeon at the University of Utah School of Medicine in Salt Lake City. The disorders reported in the JAMA study included incontinence and pelvic-organ prolapse, the result of pelvic muscles so weakened that they can't hold organs, such as the uterus, correctly in place. Of the women who reported any symptom of a pelvic-floor disorder, 16% experienced urinary incontinence, 9% reported fecal incontinence and almost 3% had symptoms of pelvic-organ prolapse. Those numbers increased with age: At least one pelvic-floor disorder affected almost 10% of women aged 20 to 39, 27% of those 40 to 59, 37% of women aged 60 to 79 and almost half of all women over 80.
"It's really, really common in women, even teenagers, to leak once in a blue moon," says Nygaard, perhaps when they cough during an illness, bounce on a trampoline or laugh extremely hard. But the JAMA study reveals that moderate to severe incontinence is also a widespread condition. More than half of all women who suffer from it, however, never bring it up with their doctors, according to previous studies. "Partly it's embarrassment, or they don't think there is any treatment, or that the only treatment is surgical," says Nygaard.
Increasingly, however, advertisements for urinary incontinence drugs have made women aware of the prevalence of the condition and its treatments. Not so for fecal incontinence, says Nygaard, which she calls a "profoundly embarrassing" condition for most patients. It can be attributed to muscle damage during childbirth, but a more common cause is irritable bowel syndrome. Most patients are shocked when they discover just how common prolapse and leakage problems are — about one in 10 women will have surgery to address the disorders, Nygaard says.
Two factors that increased the risk of incontinence, the study found, were obesity and childbirth. Although the odds of suffering a pelvic-floor disorder were lower for thin women who had not been pregnant, there is no way to avoid the risk altogether, Nygaard says. But there are few simple things women can do to lower risk, including changing two common habits. For one thing, Nygaard says, she sees too many of her patients lugging around one-liter bottles of water. This trend makes it more likely that women will drink too much water, leading to what doctors call urge incontinence, a condition that may exacerbate incontinence due to other causes. "If you are on the verge of having leakage and you are drinking three or four times more water than you need, then you are going to urinate three or four more times than you need to," she says.
Another possible culprit: those addictive lattes. Caffeine is a diuretic that is believed to increase the urge to urinate. Though the association between caffeine and incontinence requires further study, Nygaard suggests that for women who know they already have incontinence, it doesn't hurt to "keep caffeine down to one or two cups a day."
It is also important for women to raise the issue with their family physician or gynecologist. Physicians have to depend on patients to detail symptoms like urinary and fecal incontinence that are not apparent in a routine physical exam. Pelvic-organ prolapse, in severe cases, may be obvious to a doctor, Nygaard said, but in some cases women don't necessarily feel discomfort, so patients need to explain their symptoms and ask for a physical exam.
The most important thing a woman can do, given the study's conclusion that a pelvic-floor disorder may be in her future, is to get better acquainted with the condition and its cures. Surgery is not the only treatment, Nygaard says. Rather, there is a wide range of other therapies, including drugs, lifestyle changes, biofeedback, pelvic muscle exercises and medical devices that relieve prolapse without surgery. Nygaard, a past president of the American Urogynecologic Society, suggests visiting the group's website for a guide to the disorder and helpful advice for women.