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

READER'S INCONTINENCE MAY BE HELPED BY NEW DRUG

Question: For the last couple of months, since I was diagnosed with incontinence, I haven't felt comfortable being intimate with my husband because I occasionally have trouble with bladder leakage. Some times I have to run to the bathroom in the middle of everything. I heard about a new drug called Ditropan XL. Could it help my problem?

The leaking of urine, a condition we doctors call urinary incontinence, affects about 10 million Americans. It is most common in women, but it also occurs in men. Most causes of incontinence are treatable and many are curable.

Urinary incontinence can have several causes, and identifying the specific one is necessary before instituting treatment. Your family physician may be able to help you with this. However, because of the complexity of the human body and the diversity of treatment options we have available today, it often requires the expertise of a urologist -- a physician specializing in problems of the urinary tract.

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 first step is to report your symptoms to your doctor. This can help him or her to quickly reduce the list of possible causes down to a few that require further investigation. Another thing that you can do that will help your doctor arrive at the correct diagnosis is to keep a diary of when you urinate. Include the time of day, the amount of urine you pass, and whether you've been incontinent since the last time you went to the bathroom. Additional comments about what brought about the incontinence, such as "coughed," are also helpful.

The most common type of incontinence is stress incontinence. The usual symptoms of this disorder include 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 urethra -- the tube that carries urine out of the body. Frequently it develops after vaginal delivery, particularly of a baby weighing 8 or more pounds. Fortunately, stress incontinence is often curable by surgery designed to provide better support for the urethra and bladder.

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. Interrupting a moment of intimacy to make an emergency trip to the bathroom certainly sounds like urge incontinence to me. The treatment of this disorder often involves a medicine such as the Ditropan XL you have heard about. 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. The treatment for overflow incontinence is surgery designed to remove the blockage producing the underlying problem.

I'm sure that you've noticed the new practice of drug companies directing their advertising for prescription products to the general public. The publicity for Ditropan XL is a good example of this. While in your case these ads may have been helpful, health-related ads can sometimes be very deceptive. For instance, the advertisements for adult diapers and similar products carry an unspoken message that you must live with this problem. Don't be fooled by this insinuation -- most causes of incontinence can be dramatically improved or cured. I recommend that you see your 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.