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<sup?) 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.4 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.ibx.com/providers/resources/connections/chmp.html
.