Approximately 13 million
Americans are plagued by urinary incontinence. Although bladder control
problems are not a normal part of aging, the problem is most common in older
adults; in fact, one in three people age 65 and older suffers from some degree
of urine leakage. Unchecked, loss of bladder control can lead to complications
such as pressure ulcers and urinary tract infections. Psychological
ramifications such as depression and social isolation are also common in older
adults suffering from urinary incontinence. And, according to the National
Quality Measures Clearinghouse, the price tag associated with the direct cost
of caring for urinary incontinence is estimated to top $15 billion
yearly.1
Loss of bladder control is often easily treatable
— if the physician is aware of the problem. A survey conducted by the
National Association for Continence (NAFC) revealed that patients endured
urinary leakage an average of 6 years before bringing the issue to the
attention of a health care professional. Women in particular are reluctant to
mention the subject.2 This reluctance makes it extremely important
for you to bring up this topic with your older adult patients during regular
office visits.
Of the treatments available for bladder control
problems — pelvic floor exercises (Kegels), medication, surgery, or a
combination of the three — the choice of therapy should be based on the
form of urinary incontinence a person has (stress, urge, or mixed), whether the
patient is male or female, and the patient's preferences and
abilities.3
Kegel exercises are effective for stress
incontinence in both sexes. A recent trial published in the January 2011 issue
of the Journal of the American Medical Association (JAMA) showed that
men with stress incontinence following prostatectomy saw significant
improvement in urinary leakage after eight weeks of combined behavioral therapy
and pelvic floor exercises.4 Medications such as oxybutynin
(Ditropan?) and tolterodine (Detrol?) that calm strong urinary urges can be used to
treat overactive bladder symptoms in both men and women. However, if a man is
suffering from urinary leakage due to an enlarged prostate gland, drugs such as
tamsulosin (Flomax?) and dutasteride
(Avodart?) may be appropriate for this
condition. Similarly, surgery to remove part of the prostate may ease urinary
problems in men. Stress incontinence in women can often be alleviated with
surgery (such as the "Burch" and "sling" procedures) to repair the pelvic
support muscles.3 Another option for women with stress incontinence
who are not good candidates for surgery is the injection of a bulking agent
into the wall of the urethra at the bladder outlet.5 The bulking
material expands the tissue around the bladder neck thus narrowing the opening
and preventing urine loss. This is not a permanent solution, however, and may
need to be repeated.6
Each patient is different with unique preferences,
concerns, and needs. There is not one right treatment option for everyone;
therefore, it is important to discuss urinary incontinence treatments with your
older adult patients. When patients need to discuss these options further, they
may seek information and support from a Health Coach. Health Coaches —
health care professionals such as registered nurses — from the
ConnectionsSM Program are available to speak with your patients
about the many options available to treat urinary incontinence. To learn more
about the health coaching services available to your practice, call
1-866-866-4694. You can refer a member to the Connections Program by
filling out a fax referral form available at www.amerihealth.com/providers/resources/connections/chmp.h
tml.