The Medical Condition Nobody Talks About

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by MARK POWELL

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It’s not the kind of thing that comes up in casual conversation – and with good reason. It’s something that can be painfully embarrassing to talk about.

That doesn’t mean we shouldn’t have the conversation, though. Because with proper medical attention, this condition is often treatable – and a great deal of personal anxiety and unpleasantness can be put behind us.

September is National Prostate Cancer Awareness Month, and in many cases that’s associated with a condition that all too often goes unspoken: urinary tract incontinence.  

“Broadly speaking, urinary incontinence is when people lose voluntary control of their bladder,” says Dr. Phillip Westbrook, Trauma and Reconstructive Urologist at Lexington Health. “Some of the primary symptoms could be leaking urine before they’re able to get to the bathroom, leaking urine at inappropriate times where they weren’t planning to use the restroom, or leaking urine when they sneeze, cough, laugh, or exercise. Those are some of the main symptoms that someone would have.”

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It’s understandable why those who are dealing with this condition are reluctant to bring it up. After all, it’s not the kind of thing you share with guests at parties – or even with friends or relatives. It’s a common condition, though, according to the National Institutes of Health (NIH). Last year, approximately 13 million Americans were “directly affected by urinary incontinence.”

So, who typically struggles with the condition? According to Dr. Westbrook, it involves both sexes – and a wide range of ages.

“You certainly see it in younger people who maybe have some neurologic conditions, and some spinal cord injury patients… (as) the spinal nerves play an important role in sensing when your bladder is full,” he said. “It’s very common to have incontinence. You can have situational incontinence, also, such as with a urinary tract infection.”

While the problem is typically associated with seniors, Dr. Westbrook says that is a misconception.

“While incontinence does become more common as we age, I tell people that it’s not a normal part of the aging process,” he said. “People tend to think, ‘oh, it’s normal. I’m getting older. This is kind of the expectation.’ And I counter that and say, ‘You know, incontinence in any form as you get older is not necessarily normal – and there are things we can offer you to help.’”

The condition also doesn’t discriminate between genders. Approximately 24% to 45% of women reported urinary incontinence, according to the NIH – and its prevalence among younger women might surprise you. Among women between the ages of 20 and 39, 7% to 37% experienced some degree of incontinence. In women older than 60, approximately 9% to 39% reported urinary incontinence on a daily basis.

“Incontinence is probably more common in women, but in men, the time when we see the most incontinence is after they’ve either had surgery for an enlarged prostate or surgery or radiation to treat prostate cancer or surgery or radiation to treat bladder cancer,” Dr. Westbrook said.

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While we use the umbrella phrase ‘urinary tract incontinence,’ it’s not a one-size-fits-all condition.

“There are four types of incontinence,” Dr. Westbrook explained. “There’s urgent incontinence, where you experience a sudden, intense urge to use the bathroom. And then on the way to the restroom, you may leak a little bit. We have overflow incontinence, which is usually when your body doesn’t sense when your bladder is full. Imagine a pitcher full of sweet tea and someone continues pouring tea into it; it just overflows. The bladder’s similar. It’s a flexible reservoir, but at some point it reaches capacity, and if you continue to add more fluid – it has nowhere to go but out. Overflow incontinence is usually due to some kind of issue, diabetes or stroke, or a nerve issue where your body’s not sensing the bladder is full. Stress incontinence is characterized by leakage during physical activity – coughing, laughing, sneezing, running, lifting objects, playing sports – and you experience leakage during that activity. And then there’s what we call mixed incontinence, which is a blend of one to two of those.”

What should individuals concerned about urinary tract incontinence be on the lookout for? And when should they seek treatment?

“Any time you notice leakage when you weren’t anticipating it – or you’re having to change your bathroom habits – or you catch yourself going to the bathroom more than you have in the past,” Dr. Westbrook said. “Anytime either one of those issues is starting to impact your quality of life – preventing you from doing the things that you normally do and preventing you from enjoying the things you used to enjoy – that’s the time you need not only to seek out help, but then consider doing something about it.”

When it comes to treatment, Dr. Westbrook says several options are available.

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“There are four treatment categories,” he said. “There are lifestyle changes, including dietary changes; some things that we teach you to avoid at certain times of the day, or some things that we can offer as an alternative. The second would be physical therapy, specifically pelvic floor physical therapy. It focuses on strengthening the pelvic floor muscles, which are crucial for helping to control the bladder. The third would be medications – if it’s more related to urgency or frequency, that could be related to some overactive bladder problems. So, we can offer some medications. And finally, then there are some surgical options, especially for stress incontinence.”

The important thing, Dr. Westbrook concluded, is to get help. There’s no need to continue suffering needlessly – or being ashamed of the condition – when treatment is available.

“In most cases, there is a treatment option we can offer to either improve it or cure it,” Dr. Westbrook said. “So, my job is to normalize these conversations, bring awareness to them and be open to talking about them.  Sometimes they’re not the most comfortable conversations – and you kind of have to ask the question and just be quiet for thirty seconds. Eventually, the patient will come around and give you an honest answer. Sometimes, it takes a little bit of an uncomfortable conversation to get the dialogue going.”

Comfortable or not, it’s a dialogue worth having – especially if it leads to solutions that improve our health and our quality of life.

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ABOUT THE AUTHOR…

J. Mark Powell is an award-winning former TV journalist, government communications veteran, and a political consultant. He is also an author and an avid Civil War enthusiast. Got a tip or a story idea for Mark? Email him at mark@fitsnews.com.

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