Medical Experts Call Bladder Disorders ‘Last of the Closet Health Issues’

Medical experts who gathered last spring for the International Conference on Bladder Disorders called it “the last of the closet health issues.”

According to conservative estimates, the problem affects about 15% of the over-65 population. It so disrupts people’s ability to function normally that many withdraw into a paralyzing isolation, assailed by feelings of shame, fear, depression and anger.

Becoming virtual prisoners in their own homes, patients give up sports, dancing, jogging and long walks. Terrified of having their ailment exposed in public, they choose a severely restricted social life to avoid potentially embarrassing confrontations.

The problem is urinary incontinence, the involuntary release of urine at inappropriate times.

“Incontinence is a symptom of many conditions or diseases, but is not a disorder in itself,” said Dr. Neil Resnick, a medical instructor at Harvard Medical School and one of the conference’s keynote speakers. “With advances in treatment, we can cure or greatly improve the vast majority of cases.”

Aging doesn’t cause incontinence, he said, but it is associated with an increasing likelihood of urinary discharge. The strength and length of the urethra, which carries urine from the bladder, decreases with age in women, while enlargement of the prostate gland in men interferes with normal functioning.

Resnick outlined the four principal forms the condition takes in seniors:

Stress incontinence--leakage of small amounts of urine caused by exercising, sneezing, coughing or even laughing. Women, who have shorter urethras and weaker supporting muscles than men, frequently develop this form of incontinence.

Urge incontinence--a compelling desire to urinate, coupled with an inability to delay voiding.

Overflow incontinence--leakage of small amounts of urine without the urge to void or the ability to urinate normal volumes.

Total incontinence--complete absence of control, causing either continuous leakage or periodic uncontrolled discharges.

Stress incontinence, Resnick said, is caused by a weakening of the tissues surrounding the urethra, allowing it and the bladder to sag slightly. Increased pressure on the abdomen, initiated by a cough or sneeze, then can push urine out of the bladder more easily.

The bladder also may be subject to involuntary contractions, caused by diseases of the nervous system, such as Alzheimer’s disease, Parkinson’s disease or stroke. In some cases, the sphincter--the muscle at the bladder outlet--may not contract readily, allowing the involuntary expulsion of fluid.

Once the urologist has determined the cause of a patient’s incontinence, he can choose from a wide variety of behavioral, drug or surgical treatment modes.

“Unfortunately, only one in four incontinent people shares his symptoms with a physician,” said Anaias Diokno, chief of the urology department at William Beaumont Hospital in Royal Oak, Mich. “People with this problem must overcome the ‘taboo mentality’ that pervades our society and realize that help is available.”

Patients who seek medical help may benefit from four kinds of treatment, Diokno said.

In the behavioral approach, patients learn to coordinate levels of fluid intake with the frequency and time of urination. They may practice pelvic-floor muscle exercises (called Kegels), which strengthen the muscles that support the urethra and bladder, or use biofeedback therapy to monitor and eventually decrease incidents of leakage.

In the pharmaceutical approach, patients use drugs to prevent and control incontinence. Some medications, for example, tighten the sphincter, thus reducing the possibility of leakage, while others relax bladder muscles, reducing urinary frequency. Some women use estrogen preparations to thicken--and hence strengthen--sphincter muscles.

Patients who elect surgical correction may have their bladder muscles repositioned and held in place through a “bladder suspension” operation. Others may choose to have their sphincters “augmented” through the use of artificial devices.

Those who use supportive therapy can choose from an array of products, including absorbent pads and briefs, and external devices that collect and absorb urine, allowing people to participate in normal daily activities. People whose bladders are too weak to expel urine normally can insert a catheter--a tube through the urethra into the bladder--several times a day to drain urine.

Incontinent people will seek treatment with less mortification when society views the problem as a correctable medical condition, not a source of personal shame, according to Cheryl Gartley, founder of the Simon Foundation, an international self-help group.

The organization urges incontinent people to give up denial as a coping strategy and to become self-reliant through medical and psychological help. In this way, sufferers can end their self-imposed exile from everyday life and rebuild their damaged self-esteem.