A government-sponsored panel of privatesector medical specialists said that 80% of cases of urinary incontinence can be significantly improved or cured, yet half of those affected never seek medical help. The group, which announced a new guideline for detecting and treating urinary incontinence, said that sufferers often ignore symptoms or rely on absorbent materials.
"Urinary incontinence is not inevitable in most cases, nor is it a shameful condition to be suffered in silence," Health and Human Services Secretary Louis W. Sullivan, MD, said. "If more doctors ask and patients discuss their problems frankly, fewer will have their conditions deteriorate until they must rely on adult diapers."
The panel's guideline for medical practice, published by the Public Health Service's Agency for Health Care Policy and Research, says both patients and doctors need to know more about treatments that can work for the majority of patients: bladder training (learning to urinate on schedule); pelvic muscle exercises; and several types of drugs for infections and other underlying conditions. Surgery can be helpful in specific cases, following evaluation by a specialist, the panel said.
But the first steps, the panel agreed, are for physicians and nurses to ask patients routinely and aggressively, "Are you having any bladder problems?" and then to test adequately to determine what is causing the problem. Incontinence can be caused by the sideeffects of drugs or other conditions, including urinary tract infection or stool impaction.
The disorder affects more than 10 million adults, most of them older women, but is widely underreported and underdiagnosed. Although most sufferers live in the community, urinary incontinence is a significant factor in decisions to move an older family member into a nursing home. Half the nation's 1.5 million nursing home patients suffer from the condition.
Urinary incontinence is a major factor in the development of pressure ulcers, a leading health problem among nursing home patients and other persons confined to beds or chairs. Urine's wetness and acidity can kill skin tissue, leaving the patient susceptible to infection and ulceration. Urinary incontinence can also lead to psychological problems, such as depression.
The document, which covers various types of urinary incontinence, provides a framework for selecting appropriate behavioral, pharmacologic, and surgical treatments, and evaluates the use of supportive devices.
The guideline recommends thorough medical history-taking and testing and urges clinicians to identify and treat transient causes of incontinence immediately. The guideline also provides indications for referring patients to specialists for further evaluation.
The report. Urinary Incontinence in Adults, a quick reference guide summarizing the guideline, and a patient's guide are available free from AHCPR Publications Clearinghouse, PO Box 8547, Silver Spring, MD 20907; 800-358-9295.