Determining different types of the condition dictates treatment, study says
By Meryl Hyman Harris
HealthDay Reporter
WEDNESDAY, May 17 (HealthDay News) -- When diagnosing incontinence in women, doctors can ask three simple questions rather than subject their patients to lengthy, inconvenient, invasive and expensive tests, a new study suggests.
While loss of bladder control strikes both men and women, it's more common in women, with about 35 percent over the age of 40 affected. But proper treatment can depend on determining which kind of incontinence is to blame -- stress incontinence or urge incontinence, the researchers said.
Treatments range from medications for urge incontinence to muscle exercises or surgery for leakage due to physical stress, the study authors said.
According to the authors, in many cases doctors only need to have the answers to three questions to make a basic determination:
- Have you leaked urine in the past three months, even a small amount?
- During the last three months, did you leak urine when: performing a physical activity, including coughing, sneezing, lifting or exercising; when you had the urge but couldn't get to a toilet fast enough; or without physical activity or a sense of urgency?
- During the last three months, did you leak urine most often when: performing a physical activity, including coughing, sneezing, lifting or exercising; when you had the urge but couldn't get to a toilet fast enough; or about equally as often with physical activity as with a sense of urgency?
The answers can help doctors determine whether the patient has stress incontinence (urine leaks when a person strains, coughs or exercises), urge incontinence (a person feels a sudden need to urinate and can't hold it long enough to get to a bathroom), or some combination of the two, the authors said.
These questions "are only for women we studied -- straightforward, relative healthy women with incontinence (which is most women) and not complicated failed surgery patients," study author Dr. Jeanette S. Brown, a urogynecologist and director of the University of California, San Francisco Women's Continence Center, said. The study included 301 women over the age of 40 at five academic centers in the United States.
The findings appear in the May 15 issue of the Annals of Internal Medicine.
Too often doctors don't even raise the question of incontinence because current practice is complicated and impractical in many cases, Brown said, including a pelvic exam, a diary of when urination occurred, and tests for infection, urine volume and other factors.
The three questions "made sense from our common daily practice and I had always felt the [existing treatment] guidelines were not correct," Brown said. "If you ask most urologists and urogynecologists, from a patient's history you can make a clinical diagnosis and we use those three questions every day in our practice. However, to change practice you must do the proper study to show your 'test' is sufficient -- and we did."
Incontinence has many causes, including weakening of some muscles due to childbearing, said Dr. Jean Fourcroy, a member of the National Association for Continence's project advisory council, and a consultant on urology and endocrinology.
But about a third of women have both kinds of incontinence -- urge and stress, Fourcroy said, adding that they can often be helped by treating for "urge" incontinence.
For Fourcroy, the most important question is, "Are you wet and does it bother you?" she said. When incontinence forces you to change the way you live and the things you do, it's time for treatment, she said.
There's no reason to hide the condition from a health-care professional, or to be embarrassed, both doctors said.
Women "should learn about their incontinence, educate and empower themselves," Brown said.
SOURCES: Jeanette S. Brown, M.D., urogynecologist and director, the University of California, San Francisco Women's Continence Center; Jean Fourcroy, M.D., member, project advisory council, National Association for Continence, and consultant, urology and endocrinology, Bethesda, Md.; May 15, 2006, Annals of Internal Medicine
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