FAMILY MEDICINE® COLUMN

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

AUTHOR NOTE: After more than ten years of writing the "Family Medicine" column, ill health has forced me to pass the responsibility for it to my capable colleague William F. Duerfeldt, D.O. I'm sure that you will find his efforts both enlightening and entertaining. Since Dr. Duerfeldt will not be able to start writing columns for several months, the "Family Medicine" staff will be distributing a series of columns they're calling the "best of Dr. Wolf" during this transition time period. - JCW

DON'T LIVE WITH INCONTINENCE -- HELP IS AVAILABLE

Question: I've had problems with leaking urine for several years when I cough or strain. It has gotten quite a bit worse lately. I talked with my doctor about this several years ago. He didn't offer much hope for improvement of my condition. Is that true? Isn't there much that can be done for those who leak urine? Should I see another doctor?

Answer: Like most body functions, the process of urination is given little concern until it no longer works properly. Leaking urine, the situation we doctors call urinary incontinence, causes a risk of skin irritation and infection and creates a major social problem. Incontinence troubles many individuals, with the elderly population being most commonly afflicted by it. Fifteen to 30 percent of elderly individuals living at home have incontinence as do nearly half of those in nursing homes. Women are troubled more frequently than men regardless of age, but after age 70 the number of men with incontinence increases dramatically so that their numbers approach those for women. 

The process of urination is actually quite complicated, and an abnormality in any of several body systems can cause leaking urine. Let me explain a bit about the process to help you understand where problems that lead to incontinence can develop. 

The urinary bladder can be thought of as a stretchable container with walls made up of muscle tissue. It is connected to the kidneys, the source of urine, by two tubes called ureters and drained to the outside of the body by a single tube called the urethra. 

Under normal circumstances, the bladder slowly fills with urine. This stretches the bladder and slowly increases the pressure inside it. The nerves' endings in the bladder send information about this pressure to the spinal cord, where the information is processed. Once the bladder holds about 1 1/2 cups of urine, the nerves of the spinal cord send a signal to the brain that we recognize as "I've got to go." 

The automatic signal to urinate originates at the spinal cord, but the need to urinate can also be strongly influenced by the conscious portion of the brain. That is how each of us can normally wait until a convenient time before urinating. Emptying the bladder leaves only two or three tablespoons of residual urine, and this decreased volume relieves the bladder pressure and, therefore, removes the urge to urinate. 

Damage to the bladder or urethra often leads to incontinence. This can be a consequence of childbirth or surgery. Pressure from an enlarged prostate gland or from a malignant tumor can nearly block the urethra and bring on incontinence. Damage to the nerves of the bladder or spinal cord can cause incontinence. This damage may be due to diseases of the nervous system or pressure on the nerves of the spine caused by a ruptured disk or spinal tumor. Finally, damage to the brain -- from such ailments as stroke or dementia -- can also bring about incontinence. 

As the number of possibilities I've just mentioned would indicate, the process of identifying the cause of incontinence is often complicated. If your doctor doesn't have sufficient training to help you with this problem, and this isn't an insult to him or her because no physician can be an expert in all areas, then you should see another doctor. Choosing a urologist, a surgeon specializing in urinary problems, is likely to get you the help you need. The important message, however, is that almost everyone with incontinence can be helped, and many can be cured. So, don't live with incontinence -- get help! 

"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.

Past columns are available online at http://www.FamilyMedicineNews.org.