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Urogynecologists tackle the stigma of incontinence

As a urogynecologist, my clinic is full of women with bothersome bladder issues. And while this likely does not appeal to you, curing incontinence is my favorite clinical endeavor.

Urinary incontinence seems like a minor medical problem. After all, it isn’t heart disease or cancer. However, urinary incontinence has a dramatic and negative impact on the quality of life. On any given day, I talk to women who have stopped exercising because of their leaking, women who are afraid of leaking during intimacy, women who are afraid to travel because of their leaking, and women who have let their leaking interfere with social activities. I talk to teens and octogenarians, as well as athletes and sedentary women. Bladder leaking spares few of us. Aging gracefully hinges on strong social relationships and physical activity. Correcting incontinence, therefore, facilitates aging gracefully by removing embarrassing barriers to physical activity and social interactions.

What could be better than getting a grandmother back to the power-lifting routine she started to make sure she could keep up with her grandkids? Or helping a young mom care for her infant without the fear of leaking? Or treating the bladder frequency to enable that bucket-list whale-watching excursion?

Treating urinary incontinence gives me immense clinical satisfaction. But why should my primary care colleagues care about bladder leaking, which seems more annoying than medically relevant?

Even though we don’t talk about it, urinary incontinence is common. A commonly quoted epidemiologic study from Norway found a 25 percent prevalence of any urinary incontinence and a 16 percent prevalence of moderate to severe incontinence in women. Incontinence was prevalent in all age groups, including 20-year-olds, although severity and prevalence increased with increasing age. And while these numbers may seem high, they likely underrepresent the prevalence in the U.S. as we are a more obese nation. So, while you may not be discussing it with your female patients, a good one in four has some bladder leaking.

Urinary incontinence is associated with decreased quality of life. There is a robust dataset substantiating this statement. Leaking has been shown to hurt social, physical, and sexual well-being. Women who leak have a negative body image and lower self-esteem. There is an increasing risk of sexual dysfunction in women with incontinence. And importantly, even small amounts of leaking have been shown to impact the quality of life. It is hard to feel like a vibrant and vital part of society when your bladder is leaky and making you worry. This is true at age 35 and at 80.

Urinary incontinence has been shown to increase the risk of hospitalization, falls, and fractures. And most notably, urinary incontinence has a profound effect on mental health and is strongly associated with increased depression. Life is hard enough without your bladder adding to your mental health concerns.

Urinary incontinence is expensive. A study from 2022 found that 25 billion dollars are spent annually on incontinence. Insurances pay some of this expense, but a hefty amount is from out-of-pocket expenditures. This is a considerable amount of cash to spend on a treatable medical condition.

Incontinence is embarrassing, and women are often reluctant to discuss their issues even when they want help. This can make an awkward conversation even more difficult. The associated shame can lead women to tentatively broach the topic as you are wrapping up their visit. But my one ask of all my primary care and gynecology colleagues is to take a moment, pause, and validate all symptoms of incontinence. Women need to know this is an important medical and personal concern. They need to know it is common. They need to know how it can impact their health over time. And they need to know that there is a full spectrum of treatment options. It does not matter if you begin the evaluation and treatment or quickly refer the patient on. Your local urogynecologist will surely be happy to help at any point. But please, don’t minimize bladder leaking and the impact it has on a woman’s personal life and ability to age gracefully. My goal for 2024 is to not allow the bladder to be ignored anymore. Help me with this lofty objective. Your patients will thank you.

Sarah Boyles is a urogynecologist.

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