Until recently, loss of bladder control has been a "closet problem" borne mostly by women too embarrassed to tell their physicians about it.
Today, the problem is a much talked-about issue - both by actress June Allyson on TV commercials and by specialists at medical conferences.What the specialists agree is that much can be done to remedy the problem before resorting to diapers for adults. Most cases of urinary incontinence can be cured or treated.
This is welcome news for the 10 million Americans, including one-half of all nursing home residents, who are affected by urinary incontinence. The National Institutes of Health estimate the cost of managing the disorder is $10.3 billion a year.
"Urinary incontinence affects twice as many women as men, and, although it is not a consequence of normal aging, it is more common among the elderly. But patients, even some of those in nursing homes, often can be helped significantly," said Dr. James R. Scott, professor and chairman of the Department of Obstetrics and Gynecology at the University of Utah School of Medicine.
Scott, who recently participated in an NIH conference on the topic, said pelvic muscle exercises, behavioral changes, drug therapies and a variety of surgical approaches are common treatments.
The U.'s obstetrics and gynecology department provides bladder studies for patients of referring physicians in the six-state Mountain West area. Testing is done on an outpatient basis, and patients are sent back to their physicians after evaluation. Specific therapy is recommended.
The U. physicians encourage people to be evaluated immediately upon the onset of the problem.
Causes of incontinence include systemic illness such as congestive heart failure; central nervous system diseases, including multiple sclerosis, Alzheimer's and Parkinson's diseases; diabetes; drugs; and infections. Prolonged bed rest and immobilization, as well as some kinds of surgery, also may cause the problem.
Four categories of incontinence have been identified: stress, urge, overflow and a mixed form in which patients show signs of more than one type of the problem.
Stress incontinence, common in women, is involuntary urination precipitated by laughter, coughing, lifting heavy objects or bending. Stress exerted on the pelvic floor during childbirth is thought to be largely responsible for the problem.
If the situation has existed for some time, surgery may be necessary. However, such methods as the use of vaginal cones to exercise pelvic floor muscles may prevent the problem.
Urge incontinence, most common in older people, is the sudden urge to void, accompanied by the loss of large volumes of urine without warning. Drug therapy is sometimes used for this problem but can cause complications in elderly patients who are taking several other medications.
Dr. Peggy Norton, who coordinates the U.'s bladder program, said retraining may be the prescription of choice for these patients.
Urge-incontinence patients often have a history of running to the bathroom the minute their bladders tell them to do so. The bladder, rather than the brain, is in the driver's seat, the physician said.
"Retraining requires much habit-changing, since some women feel the urge to void whenever the bladder has as little as two ounces of urine in it. In general, a normal bladder can comfortably hold 12 ounces of fluid," Norton said.
Overflow incontinence occurs when the bladder cannot empty normally and becomes overdistended, causing frequent, sometimes nearly constant, urine loss. Tumors, benign strictures and medications, as well as neurologic abnormalities, may cause this problem.
These patients previously required long-term catheterization, but now these conditions can be successfully treated at home with intermittent self-catheterizations.