Urinary incontinence: finding a voice to talk about “it”

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Excerpt

October is breast cancer awareness month with pink ribbon seen everywhere. November is bladder health awareness month, but there are no ribbons to be seen. It is estimated that nearly 50% of women have symptoms of urinary incontinence (UI)1; however, most women suffer in silence. Daily UI has been reported in 12% of women aged 60 to 65 years and in 21% of women older than 85 years.2 UI has an impact on a woman's quality of life, affecting both social and work interactions, and compromising sexual and emotional health.3 Despite these effects on a woman's quality of life, studies have shown that only 25% to 61% of symptomatic women pursue care for their UI.1,4-6
Why do women choose not to talk about or seek care for UI? Is it because of the perceived notion that UI is a normal part of aging? It is true that the prevalence and severity of UI increases with age.7 Nevertheless, UI is not a normal part of aging, and women should not suffer in silence and blame their symptoms on the aging process. Women should be well-informed about the treatment options available, some of which are simply lifestyle modifications which will lead to an improvement in their quality of life. We also know there is more to the story than just aging, as UI has a rather intricate physiology. The ability to store urine requires a complex coordinated interaction between neural pathways in the brain, spinal cord, bladder, urethra, and also appropriate connective tissue and muscle support. UI is a multifactorial problem that can be divided into stress UI and urgency UI. Stress UI is the loss of urine that is associated with an increase in intra-abdominal pressure such as with laughing, coughing, or sneezing. Urgency UI is the involuntary loss of urine associated with a sudden, compelling sensation to void that cannot be deferred. Treatment options depend on the type and severity of the UI.
Perhaps, another reason why women do not seek care for UI is lack of understanding the condition. Studies have shown that women have limited knowledge about pelvic floor disorders, including UI, fecal incontinence, and pelvic organ prolapse. Mandimika et al8 found that 71% of community dwelling women lack proficient knowledge about UI, and when broken down by age the lowest proficiently was among women aged 19 to 39 years and it increased with age.
Another possibility is that UI can be attributed to pregnancy and childbirth. Pregnant women also lack knowledge about pelvic floor disorders. A study by Geynisman-Tan et al9 showed that only 39% of pregnant patients had proficient knowledge about UI. Women often believe that UI is a normal consequence of childbirth, and given this, do not discuss their symptoms with their clinicians. Postpartum women are hesitant to seek treatment for incontinence because they believe these symptoms are normal or that they are “wasting the doctor's time.”10 The antepartum period is an ideal setting to educate women about pelvic floor disorders and prevent existing myths from becoming further perpetuated.
The study by Waetjen et al,11 in the current issue of Menopause, further supports the need to break down the barriers to care and address UI at both the clinical and public health level. The authors analyzed questionnaire data from a large cross-sectional survey (Study of Women's Health Across the Nation) of community-dwelling women aged 40 to 55 years. In this study, over half of mid-life women did not seek care for their UI because they felt that “UI is a normal part of aging” and “healthcare provider never asked.

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