“When I get a sudden urge to urinate, if I am not in the bathroom within seconds, I have already gone on myself and am completely soaked. I know of every bathroom in my area. I live in the bathroom more than in my living room or for that matter anywhere else.
I have stopped having sex with my husband because I am so scared of urinating on him. In fact, I have even stopped sleeping in the same room as I have to put a rubber pad under the bed sheets in case I lose urine control in the middle of the night.
I have given up on travels as I am so worried that I may not find a bathroom. If at all I travel, my bag is filled more with pads than clothes. Wherever I go, I always carry a spare pair of pants and underwear. I dare not leave the house without wearing a pad. I wish I had bought shares in the pad companies. That is how much I am spending on them. The only coupons I look for are for pads.
When my daughter invites me to stay with her at her house, I always make excuses as I am so afraid to wet her bed or leave urine trails on the way to the bathroom.
The skin around is chapped from constant wetness. In fact when the urine comes in contact with the skin, it burns.
I am fed up, fed up, fed up. What did I do to deserve this? Is this any way to live?”
These are the stories of my patients with overactive bladder or urgency incontinence. This is no way to live! Enough is enough! Help is here!
What is overactive bladder?
This is the condition where there is sudden urgency to go the bathroom that cannot be delayed. If this is associated with loss of urine it is then referred to as urge urinary Incontinence.
How common is this problem?
More than 33 million Americans suffer from OAB. More women than men are affected by this condition.
Is it due to aging?
This could happen at any age and is not age specific. Though the prevalence data will show that older women get this more, it is more an issue of waiting too long.
Why then do women wait so long? is it due to embarrassment?
Intuitively this may seem to be the case. However, in reality it is not. No woman wants to leak urine or wear a pad for leakage. They understand that this is not normal. However, the major problem is that they do not know who to turn to for help.
Furthermore, since bladder problems are rarely life-threatening, they are sometimes taken lightly by the healthcare providers: “do Kegel exercises until the problem gets really bad”. The only other information that they may get is from the TV ads that glorify pads or ads touted by lawyers that show incontinence procedures to be harmful. Fearful of what she sees on TV or what she has heard about “bladder suspensions”, a woman continues to suffer in silence and resigns herself to wearing pads.
What is the social impact of urine leakage?
Just reading the story above makes one feel depressed. Can you imagine what the woman herself is going through? It is not surprising then that incontinence has also been associated with depression. Several quality of life parameters show negative impact of incontinence on a woman’s physical and mental health.
So, can anything be done about urge incontinence?
The good news is that ALMOST ALL women with incontinence will notice improvement if not cure. Treatment options have improved dramatically over the past few years. Gone are the days of bladder suspensions and long term catheter use. Urgency incontinence can be taken care of completely in an office based setting.
Are pads helpful in the management?
Pads weaken the pelvic floor and make the patient dependent upon them like a crutch. They may be used initially while the treatment is being instituted but eventually our goal is to completely eliminate the pads. It not only makes the muscles weak but also takes away a key reflex called the guarding reflex which is important for us to tighten our muscles so that we do not leak.
Why is it then that over 60% of women who have Overactive bladder do not go back to their specialist doctor after just one visit?
There could be several factors for this, but this statistics is mind boggling but true. One reason is that patients are started on a medication right away without any workup and it did not help her. She was already on a medication that her primary care doctor had given her which also did not work. Another reason could be that the side effects or the cost of the medications are too much for her to continue on with treatment.
How do you prevent this from happening in your practice? How do you ensure that your patients with OAB are taken care of and do not fall through the cracks?
We make sure that the patients undergo specific, comprehensive and targeted work up and we first and foremost confirm the diagnosis. Based upon the findings especially the urinary voiding diaries and the urodynamic testing, we then offer the patient the appropriate treatment choices. More importantly we show the patients the entire OAB road map so that they understand where they are and what is still left for them to try.
Most importantly we impress the patient about her role in this management. She has to watch her fluids and avoid caffeinated beverages if this management is to be successful. This is made very clear to her that there is no magic wand that we possess and without her co-operation the treatment is unlikely to work. Finally we put things in perspective. The goal is improvement and not cure. The condition if well managed, can be controlled to the patient’s satisfaction. This may mean that she has to be stringent when it comes to fluid intake and also may have to take a pill or go through an office procedure. If the protocol is strictly followed, ALL women will notice improvement in their symptoms.
In summary, with the medications and simple office based procedures available today, there is absolutely no reason why a woman should suffer in silence and for that matter suffer at all from this dreadful condition!