FAMILY MEDICINE® COLUMN
By John C. Wolf, D.O.
Associate Professor of Family Medicine®
Ohio University College of Osteopathic Medicine

[SURGERY CAN OFTEN CURE INCONTINENCE]

Question: Whenever I cough, sneeze or run, I leak urine. It usually is a small amount, but it is enough that I wear a pad most of the time. Occasionally, I leak enough that it is embarrassing. My doctor didn't seem very concerned when I mentioned it to him. Is this a woman's condition that I must live with, or do I need to see another doctor?

Answer: The leaking of urine, a condition we doctors call urinary incontinence, affects about 10 million Americans. And to answer your question quickly, it is not a condition that you must live with. Most causes of incontinence are treatable and many are curable. Incontinence is most common in women, but it also occurs in men, so it is not just a woman's condition.

Urinary incontinence can have several causes, and identifying the specific cause and instituting treatment may require consultation with a urologist - a surgeon specializing in problems of the urinary tract. Your physician is apparently not trained in this area and has failed to give you accurate advice. This is not a condemnation of him. Instead, look at this as a reflection of the complexity of the human body and the diversity of treatment options we have available today.

The process of bladder control is quite complex, and as is typical of any complex system, tracking down the specific cause of a problem can be difficult. The symptoms associated with your incontinence help your doctor quickly reduce the list of possible causes down to a few. One of the simple things you can do to help your doctor help you is to keep a diary of when you urinate. Include the time of day, the amount of urine you pass - yes, you'll need to catch and measure it, and whether you've been incontinent since the last time you urinated. Additional comments about what brought about the incontinence, such as coughed, are also helpful.

When the urge to urinate immediately follows an episode of incontinence, it is called urge incontinence. This type of problem can have several causes, but all are a consequence of the muscles of urination - or nerves that control these muscles - failing to work properly. The treatment of urge incontinence often involves a certain type of medication that is not helpful for incontinence that's due to other causes. So be sure to tell your doctor if you have urge incontinence.

The most common type of incontinence is stress incontinence. You described the symptoms of this disorder quite well - the involuntary loss of urine with activities like laughing, coughing, and physical exertion, without a following urge to urinate. In women this condition is often due to excessive mobility of the lower portion of the bladder and tube that carries urine out of the body (urethra). Frequently it develops after vaginal delivery, particularly of a baby weighing 8 or more pounds. Fortunately, this condition is often curable by surgery designed to provide better support for the urethra and bladder.

Another type of incontinence that predominately affects men is overflow incontinence. In this condition the bladder becomes full but the individual can't empty it effectively, usually because of an enlarged prostate. Urine frequently dribbles, and it may or may not be associated with physical activities that bring on stress incontinence. The treatment for overflow incontinence is surgery designed to remove the blockage producing the underlying problem. There are conditions that can give women overflow incontinence, too. This usually occurs as a complication of previous surgery.

So, don't believe those ubiquitous advertisements for new pads and other bladder control products. Instead, you should see another physician - preferably a urologist - to identify the type, cause and treatment for your incontinence.

Family Medicine® is a weekly column. To submit questions, write to John C. Wolf, D.O., Ohio University College of Osteopathic Medicine, Grosvenor Hall, Athens, Ohio 45701.