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 Connections^SM 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 .

References:

¹ National Quality Measures Clearinghouse. Management of urinary incontinence in older adults: percentage of Medicare members 65 years of age and older who reported having a urine leakage problem in the past six months and who received treatment for their current urine leakage problem. www.qualitymeasures.ahrq.gov/content.aspx?id=14984

² Medical Week. Bladder Control Problems Far More Common Than Generally Realized. Senior Health Report: Bladder Control. 2004. http://seniorhealthweek.org/NewsStories/bladder-story-n1.htm

³ Health Dialog. Bladder Control Problems. Growing Older, Staying Well. 2009.

⁴ Goode, P. et al. Behavioral Therapy With or Without Biofeedback and Pelvic Floor Electrical Stimulation for Persistent Postprostatectomy Incontinence. Journal of the American Medical Association. 2011; 305:151-159. http://jama.ama-assn.org/content/305/2/151.full.pdf+html

⁵ FDA U.S. Food and Drug Administration. Medical Devices: URYX? Urethral Bulking Agent - P030030. Last updated. 07/08/2009. www.fda.gov/MedicalDevices/ProductsandMedicalProcedures/DeviceApprovalsandCleara nces/Recently-ApprovedDevices/ucm079334.htm

⁶ National Quality Measures Clearinghouse. Guideline Synthesis: Assessment and Management of Urinary Incontinence in Women. Revised 2010. www.guideline.gov/syntheses/synthesis.aspx?id=16411

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