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Treatment advances for millions with urinary problem
By Kathleen Nelson, Globe Correspondent, 12/2/2003

One out of every three women over 45 has an embarrassing problem when she sneezes, lifts a heavy bag or swings a golf club: She pees.

This loss of control, called stress urinary incontinence, leaves many of its 15 million victims -- most of whom are women -- feeling ashamed and frustrated. More than half the women questioned in a poll this fall were so uncomfortable about the leakages they hadn't even discussed them with their doctor.

And, until recently, women who did tell their doctors were told there was little medical science could do to help.

But now treatment ranging from simple exercises to surgery are showing that those who develop stress urinary incontinence aren't stuck with it forever.

"Incontinence is not a normal part of aging," said Dr. Stephen Young, chief of the division of urogynecology and reconstructive pelvic surgery at UMass Memorial Medical Center in Worcester.

The leakages, which are more common among women who have given birth, are caused by a weakening of the muscles and connective tissue that support the bladder and help close the urethral sphincter. Any physical activity that changes abdominal pressure can push the urethra down and open, causing a leak, Young said.

Strengthening the pelvic floor muscles through Kegel exercises is a good first step in treating stress incontinence, and sometimes the only one that's needed, said Dr. Patricia Goode of the Department of Veterans Affairs Medical Center in Birmingham, Ala.

Lifestyle modifications such as keeping fit, emptying the bladder regularly, and avoiding caffeine and foods or medicines with diuretic effects also may work for some people.

Seeking expert advice can also help. Urogynecologists like Young specialize in caring for women with pelvic floor problems. In a "urodynamics visit," the doctor may thread a very thin catheter with a microtip sensor through the urethra and record pressure in the bladder and sphincter. The process doesn't cause any pain, Young said, and helps tailor the treatment to the patient's diagnosis.

If noninvasive therapies fail, there are surgical options, too. Young's operation of choice for complicated forms of stress incontinence, the PuboVaginal Sling, holds up the urethra and bladder neck with a hammock and has a cure rate of 94 percent. A newer, minimally invasive operation called tension-free vaginal tape inserts a mesh under the urethra to hold it up, and 85 percent of those treated remain "cured" after five years, said Young, who has published several studies on incontinence surgery.

Other surgeries include stabilizing and elevating the urethra with permanent stitches or attaching it to the abdominal connective tissue (rectus fascia) via long needles. Collagen injections that bulk up the urethral sphincter can help women with very weak urethras, and for men who suffer from stress incontinence from prostate surgery, sometimes an artificial sphincter is created. These and other surgical treatments come with potential down sides of temporary urinary urgency, difficulty emptying the bladder, or erosion of the synthetic sling materials.

There are no pharmaceutical treatments yet for stress incontinence (the ones on the market help with urge incontinence, a different condition) but duloxetine has shown promise in preliminary studies. Duloxetine, a combined serotonin and norepinephrine reuptake inhibitor, may improve nerve impulses that squeeze the sphincter shut. Pharmaceutical companies Eli Lilly and Co. and Boehringer Ingleheim are manufacturing the drug and expect FDA approval next year.

A Chinese herbal formula called BetterWOMAN, developed by Dr. Peipei Wu Wishnow, founder of the Marblehead-based company, Interceuticals Inc., claims to improve incontinence and urinary frequency, with the abstract of a small clinical study published in the November-December issue of Menopause journal.

Diane Newman, an advanced nurse practitioner and the codirector of the Penn Center for Continence and Pelvic Health at the University of Pennsylvania, said many of her patients have waited years to seek treatment. That shouldn't be the case, she said. "My hope is that women learn the symptoms of stress urinary incontinence, feel comfortable talking about it, and bring it up with their doctor, because this problem is treatable."

© Copyright 2003 Globe Newspaper Company.

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so, how many of you ladies seriously have this problem? talk about pissing my pants!!!

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-LIFE IS ABSURD-

YourNeverThere

this is not remotly as funny as I thought it would be.

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The Above post is a direct quote from Shakespeare

wilbjammin

Yeah, but it reminds us of "Oops, I crapped my pants", and that's always funny.

Actually, it is surprising that this is something 1/3 of women over 45 have. I mean, that could be my mom! (<b>Don't think about that!!!</b>)

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Innominate.

Tiger69z

Heh...actually my mom has that.

That's why she always refused to jump when we played basketball 6 years ago..sux for her, maybe i can tell her about treatments

taliendo

Sorry everyone. . . (I didn't mean to be misleading)

I got a good chuckle out of the story, but maybe because my grandma has something like this and we like to tease her about it. Mean? yes, but its all in good fun.

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-LIFE IS ABSURD-

aurigus

Yeah that definately took the fun out of peeing in your pants.

"If peeing in your pants is cool, then I must be Miles Davis!"

sailor

Hahaha, great quote.

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"Good people do not need laws to tell them to act responsibly, while bad people will find a way around the laws."
--Plato

quadro2000

Wow. The one out of three statistic is really surprising to me. I had no idea.

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You have to laugh at yourself...because you'd cry your eyes out if you didn't. - Emily Saliers

water_boy1999

Instead of developing a Chinese herbal formula called BetterWOMAN, I think Dr. Peipei Wu Wishnow should have developed a formula called.....you ready for this?

PeePee YouNo WishNow.

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Doh!!!!


-Homer Simpson

YourNeverThere

HAHahahAHaha you're right!
oh goodness that is a great line to use out of context, like when your just sitting around or driving or something, just "Opps! I crapped my pants!" "really??" "no,"

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The Above post is a direct quote from Shakespeare