There is help for urinary incontinence in women

Ask Dr. Keith Roach M.D

There is help for urinary incontinence in women

DEAR DR. ROACH: I read your column faithfully, but I can't recall you ever addressing urinary incontinence in women. As it's a subject that's not normally addressed socially, I wonder if you can tell us what can be done about it. — O.P.

ANSWER: Urinary incontinence is a big and important topic. Twenty-five to 60 percent of all women (and 11 to 34 percent of older men) seek care for urinary incontinence, and many more do not report it due to embarrassment or worry about treatment. This can lead to social isolation, poor quality of life, sexual problems, infection and increased burden on caregivers.

The two major types of incontinence in women are stress incontinence (for example, losing urine with a cough or a sneeze) and urge incontinence (the sensation of needing to go to the bathroom RIGHT AWAY for fear of an accident, or associated with accidental loss of urine). Other types include overflow (continuous dribbling from the bladder, associated with a weak stream). It's possible to have a mixture of several types.

Treatment depends on the type of incontinence, but most women benefit from pelvic floor exercises and bladder training (especially for urge incontinence). My experience has been that many providers, especially male ones, don't know how to recommend these properly, and a referral to a pelvic-floor physical therapist can be extremely helpful, as can biofeedback (which is covered by Medicare in the United States in women who don't have good results after a four-week trial without it). Since excess weight is a major risk factor for incontinence, weight loss can be helpful in many women.

The other condition I see frequently overlooked is vaginal atrophy. Many older women have thinning of the lining of the vagina and urethra, which can predispose a person to both stress and urge incontinence. A physical exam is all that is necessary to diagnose this condition, and estrogen cream can improve incontinence, though it may take several months.

If none of these is effective, medication can be used, but my experience has been, and the literature supports, that teaching women techniques to prevent incontinence is more effective and has fewer side effects than medication.

DEAR DR. ROACH: My daughter is in a college where there is an outbreak of mumps. She was vaccinated as a small child. The school is offering a free booster. Is it necessary to get this? — D.L.G.

ANSWER: Outbreaks of mumps happen periodically, even in highly vaccinated populations. The vaccine is thought to be about 95 percent effective. In a 2009-2010 outbreak, the attack rate was 4.9 percent among students. The students were offered a booster vaccine, which 80 percent received. Following vaccination, the attack rate was 0.13 percent, suggesting that the booster vaccine was effective.

Mumps can have serious side effects. In males, the virus can cause inflammation of the testicles, rarely causing sterility. It also rarely causes inflammation of the brain, leading to death or permanent disability in a few. Although most people have only fever and swollen salivary glands, it requires staying home for two to four weeks in addition to the risk of complications. Since the risk of a booster MMR vaccine (there is not a mumpsonly vaccine available) is negligible, I would recommend getting the booster vaccine during an outbreak in an environment where people live close together, such as a college. However, the vaccine should not be given to pregnant women, immunosuppressed people or those with active cancer. *** Dr. Roach regrets that he is unable to answer individual letters, but will incorporate them in the column whenever possible. Readers may email questions to ToYourGoodHealth@med.cornell. edu or request an order form of available health newsletters at 628 Virginia Dr., Orlando, FL 32803. Health newsletters may be ordered from www.rbmamall. com.