Panel urges end to incontinence stigma

LAURAN NEERGAARD
One in four U.S. adults will experience incontinence at some point, a surprisingly high toll, and the condition is so embarrassing that many suffer silently, a government panel said Wednesday.
Women are most prone to incontinence, which is the inability to control urination or bowel movements. But everyone's risk rises as they get older. Being overweight and a couch potato adds to the risk.
With the population rapidly graying and fattening, scientists convened by the National Institutes of Health issued an urgent call for research to find better ways to prevent incontinence and to remove the stigma so more people will seek help.
"We as a society need to get over our discomfort with this subject so that incontinence sufferers receive the compassion, acceptance and care they need, and our aging population can take steps to prevent incontinence in the future," said Dr. C. Seth Landefeld, geriatrics chief at the University of California, San Francisco, who led the panel.
Today, fewer than half of the people with incontinence volunteer their symptoms to a doctor, the panel found. That is the case despite a variety of effective treatments, from exercises to medications and surgery.
Prevention is better, but the panel found major gaps in the understanding of the biology of incontinence that hinder that effort. For now, the panel's best advice is for people to seek help.
And for those without the problem, exercise and dropping extra pounds are recommended as protection.
"All of us are walking around with a bag of water and a bag of stool in our pelvis," Landefeld said. "Anything that exerts increased pressure on those, tends to push them out, is potentially leading to incontinence."
Among other suggestions are:
_Women especially should try exercises of their pelvic floor muscles, popularly termed "Kegels," to keep them strong enough for good bladder control. But ask at a checkup if they are being done correctly. Too many women wind up squeezing the wrong muscles.
_Obestricians should end routine use of episiotomies, an incision that enlarges the vaginal opening for childbirth. Obstetric groups long have issued the same advice, saying episiotomies are useful only if the baby is in distress. But Wednesday's panel cited estimates that 1 million women a year still receive a routine one, leading to perhaps 1,000 of them suffering fecal incontinence directly after birth or later in life.
Urinary incontinence is the more common type; previous estimates have put the number of people with this condition at around 13 million. Actually, more than 20 million women and 6 million men have experienced urinary incontinence at some point, the NIH panel concluded.
The two most prevalent subtype are stress incontinence and urge incontinence.
Stress incontinence is leakage caused by physical pressure to the abdomen, such as coughing, sneezing, laughing, jogging or lifting a heavy object. Urge incontinence is a sudden, uncontrollable urge to urinate, sometimes called overactive bladder.
Fecal incontinence is harder to measure, even more stigmatized and thus hardly ever studied. The best estimates suggest it affects up to 5 percent of the general population and up to 39 percent of nursing home residents.
Pregnancy and childbirth can trigger incontinence that can be either temporary or lasting. So can menopause, when the loss of estrogen is thought to weaken some bladder-control muscles.
But other risk factors are myriad and poorly understood: radiation therapy, pelvic injury or surgery, urinary tract infections, neurological diseases, the panel found.
The severity of incontinence varies widely, from a few drops to a major impairment that requires wearing diapers and may strand people in their homes.
It is a huge trigger of nursing home admissions, particularly with dementia patients whose caregivers cannot handle the added stress and physical toll of diapering an uncooperative adult.
Disturbingly, much incontinence in nondemented nursing home patients is not due to biology but lack of staff to help the frail get to the bathroom in time, the panel noted.