Prevalence of Urinary Incontinence: Females

September 21, 2016 (Ft. Lauderdale, Florida)

Severe UI (and/or FI) in females can happen for a number of reasons, including as a result of other primary diseases and conditions (including; Parkinson’s, Multiple Sclerosis, Muscular Dystrophy, dementia and Alzheimer’s and just age related degeneration exacerbated by smoking, obesity and/or lung disease), but overwhelmingly happens as result of either or both the anatomical changes that occur during childbirth and/or the reduction of a female’s estrogen levels over time (as estrogens play an important role in maintaining the suppleness of the urethral sphincter muscle system) affecting over 7 million females in the U.S. and over 18 million females in the industrialized nations of the world. The technology invented and developed by PMD is expected to optimally treat most such UI cases with the simple (15-20 minute) implant of our Bluetooth remote-controlled and adjustable urethral valve Flow Control device with the follow-on version of the technology expected to do the same for the FI cases, as well.

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Womens Health: Incontinence haunts many women

Dr. Janet Matthews

Guest Columnist

Summer has arrived in earnest, and we should all keep in mind that it’s important to drink plenty of water while we’re out getting that important half hour of exercise daily. Some women, though, try to limit their fluid intake because they suffer from a problem which is too often kept secret: urinary incontinence. It’s a rare day in my clinic when I don’t see at least one patient with the problem of leaking urine, and when I question these patients they seem to fall pretty evenly into two different camps. When I ask about symptoms some women readily admit to problems with leaking, but they assume that all women have the same problem. “Isn’t that something that just comes with age?” they ask. They’ve resigned themselves to living with pads or constant uncertainty because they think that incontinence is par for the course. Other women, often my younger patients, seem surprised and relieved when I ask about urine leakage. They seem to think that they are the only ones who have a problem, and often they’ve put up with incontinence for years because they’re embarrassed or ashamed. They, too, think that it’s something they’ll just have to live with. The true prevalence of urinary incontinence is somewhere in the middle: not all women have it, but it’s common enough that all women should at least be asked about symptoms. Of course, the only reason to screen for any medical condition is if there’s some action that can be taken if the condition is uncovered. If I or other physicians can’t help women with urinary incontinence, then why ask? Treatments for urine leakage vary depending on the type of incontinence, on what is actually causing the leakage. There are several main types of incontinence, and many women with leakage have some combination of causes. The type I see most commonly is called stress incontinence: when you cough, sneeze, laugh, or lift something heavy the added pressure causes urine to escape. Stress incontinence is often associated with a history of multiple vaginal deliveries, though women who’ve had C-sections or who’ve never even been pregnant can also be affected. Mild stress incontinence can sometimes be treated by strengthening the pelvic floor muscles (the muscles which help hold back urine) with Kegel exercises. To learn to do a Kegel exercise you need to pay close attention to feelings which muscles you use to voluntarily stop a stream of urine, then consciously exercise those muscles by tightening them multiple times throughout the day. Sometimes, though, Kegel exercises aren’t enough to correct more severe incontinence. In those cases, minor surgical procedures can often help. Another common type of incontinence is called urge incontinence. Women with this problem tell me “When I’ve got to go, I’ve really got to go.” They have strong and sudden urges to urinate, and sometimes just don’t make it to a restroom on time. This type of incontinence can many times be treated with oral medication which calms down the over-activity of the bladder. The process of diagnosing a specific type of urinary incontinence involves asking specific questions and doing a thorough exam, and sometimes also involves special tests called urodynamic studies. The main take-home point for today, though, is for those of you who live with frequent leaking. You are definitely not the only woman around with the problem, and you don’t necessarily just have to live the rest of your life relying on pads or Depends. If your doctor doesn’t ask you about incontinence, then bring up the subject yourself. You have too many things to accomplish in life to have to worry about wetting yourself.

Dr. Janet Matthews is the OBGYN physician at The Women’s Center, a service of Muskogee Regional Medical Center. Send suggestions for columns to janet.matt.hews@capellahealth.com

Incontinent InsightThis web article is again illustrative of how common urinary incontinence (UI) is in

This web article is again illustrative of how common urinary incontinence (UI) is in women, yet how infrequently they actually attempt to seek treatment. Based on the statistics, UI is one of the most prevalent of any medical condition in existence, and in a substantial portion of the cases, causes a loss of the Quality-of- life (QoL) of the affected patients (and/or their caretakers) sufficient to have devastating consequences. Although many patients only suffer from the milder forms of the conditions and could be adequately helped by a number of the less invasive treatment alternatives, there are still a substantial number of people who suffer the far more devastating and intrusive, severe forms of the condition (perhaps as many as one-fourth of all patients).

The severe UI market is so vast as a result of the many common conditions and medical illnesses that cause UI, including, but not limited to; pregnancy and childbirth, lower estrogen levels, spinal cord injuries, birth defects (such as Spina Bifida), dementia and Alzheimer’s Disease, Multiple Sclerosis (and other muscle-wasting diseases), and post-prostate surgery complications, to name a few, and is further complicated by obesity, smoking and Diabetes, as well.

It is in the severe UI market that the Precision Medical Devices (PMD) Flow Control Device (FCD), a remote-telemetry- controlled bionic urethra valve implant, is expected to become the new “gold standard” treatment, mostly as a result of its remote adjustability feature.

The fact that the FCD product will set new standards in the ease of implant, the ease of use, having a more modest adverse events profile and lower risk profile as compared to all of the other currently-approved severe UI products and procedures (especially the more invasive products and/or procedures) will just add to the benefits derived from using it. The product is expected to last a lifetime, with little or no deterioration in its efficacy.

 

Incontinence Not Just a Problem for Older Women

By Judith Groch, Contributing Writer, MedPage Today

Published: September 16, 2008

Reviewed by Zalman S. Agus, MD; Emeritus Professor

University of Pennsylvania School of Medicine

SALT LAKE CITY, Sept. 16 Nearly one-quarter of U.S. women and 10% of those under 40 reported

Nearly one-quarter of U.S. women and 10% of those under 40 reported having at least one pelvic floor disorder, according to a large national study.

Action Points:

 Explain to interested patients that this national study found that pelvic floor disorders, mainly urinary incontinence, are common in women, especially those who are older, overweight, or who have given birth to one or more children. Of almost 2,000 women, 23.7% reported symptoms of urinary incontinence, fecal incontinence, or pelvic organ prolapse, with urinary incontinence affecting more than 65%, Ingrid Nygaard, M.D., of the University of Utah here, and colleagues reported in the Sept. 17 issue of the Journal of the American Medical Association. Among women 20 to 39, 10% had at least one such disorder, nearly 7% of them reporting urinary incontinence. Because there's no national population-based estimate of the prevalence of these disorders — or the burden imposed by them — the researchers undertook a cross-sectional analysis of 1,961 non-pregnant women, 20 and older, who participated in the 2005-2006 National Health and Nutrition Examination Survey (NHANES). Women were interviewed in their homes and then underwent standardized physical examinations in a mobile examination center. Symptoms assessed included urinary incontinence (score of ≥3 on a validated incontinence severity index, constituting moderate to severe leakage; both stress and urge), fecal incontinence (at least monthly leakage of solid, liquid, or mucous stool), and pelvic organ prolapse (seeing or feeling a bulge in or outside the vagina).

The weighted prevalence of having at least one pelvic floor disorder was 23.7% (95% confidence interval 21.2% to 26.2%). Of these, 15.7% of the women (95% CI 13.2% to 18.2%) experienced urinary incontinence, 9% (95% CI 7.3% to 10.7%) experienced fecal incontinence, and 2.9% (95% CI 2.1% to 3.7%) had pelvic organ prolapse. The proportion of women reporting at least one disorder increased incrementally with age, ranging from 9.7% in women ages 20 to 39; 26.5% for those ages 40 to 59; 36.8% for those ages 60 to 79; to 49.7% for those 80 or older (P<0.001). For urinary incontinence, these percentages ranged from 6.9% (ages 20 to 39) to 31.7% (80 or older). Also, the more children a woman had given birth to, the greater her likelihood of having at least one pelvic-floor disorder. The percentages were 12.8%, 18.4%, 24.6% and 32.4% for zero, one, two, and three or more deliveries, respectively (P<0.001). Weight also played a part. Overweight and obese women were more likely to report at least one of the disorders than normal-weight women. The prevalence was 26.3% for overweight women and 30.4% for obese women versus only 15.1% for underweight or normal-weight women (P< 0.001). Race, ethnicity, and education were not significantly associated with pelvic-floor disorders. By 2030, more than a fifth of women in the U.S. will be 65 or older, the investigators wrote. As that population increases, the national burden related to pelvic floor disorders in terms of healthcare costs, lost productivity, and decreased quality of life will be substantial, they said. In one health maintenance organization, the researchers noted, older women generated 10 times the number of consults per 1,000 women-years for treatment of pelvic floor disorders. “Given the burden these disorders place on U.S. women and the healthcare system, research is needed to further understand their pathophysiology, prevention, and treatment,” they concluded. The researchers noted that their prevalence estimates are likely to be under- estimations because they do not reflect symptoms of women who have had successful treatment, definitions were conservative, and symptom-based diagnosis underestimates the true prevalence of these disorders. For example, higher rates of urinary incontinence may be defined as occasional leakage, whereas lower rates are more likely to represent a disease. This study limited definitions to moderate-to-severe leakage to better reflect the women more likely to seek treatment, the researchers said.

Another limitation of this and many studies, the researchers said, was the need to assess prolapse by symptoms (seeing or feeling a vaginal bulge) rather than by physical examination. There is no clear consensus about what level of prolapse is abnormal. Probably symptom-based prolapse in this study underestimated the true prevalence of anatomic disease, the researchers said. The study was supported by grants from the Eunice Kennedy Shriver NICHD and funding from the National Institute of Diabetes and Digestive and Kidney Diseases and the National Institutes of Health Office of Research on Women’s Health. Dr. Nygaard had no financial disclosures to report Incontinent Insight. The cited article makes it clear that, especially for women, urinary incontinence (UI) is not just a problem for older women, but also a significant problem for even younger women in the 20-39 age group. As reported in the article, at least 7% of women in the 20-39 age group reported some level of UI. If it can be roughly extrapolated that there are approximately 46.5 million females in this age group, then approximately 3.25 million women between the ages of 20 to 39 suffer from some level of UI.

If it can be further extrapolated that the number of severe UI cases is approximately 25% of the total, then over 800,000 of these women suffer from UI levels that are severe enough to grossly interfere with their lives (and perhaps even more, as even more moderate cases could be quite disastrous to younger women in their prime socially-active lifestyles).

Unfortunately, these women have nothing to look forward to but the reality of an ever worsening condition. Also unfortunately, and even though there have been several treatments (mostly invasive surgical procedures) available over the last 30-plus years to treat severe UI, most of these treatments have been found to lack consistent significant long-term cure-rates, with up to 50% (or more) of the women treated by these procedures eventually ending-up incontinent for the longer term.

Women who end-up with severe UI, facing a future wherein their UI overwhelms their diapers and pads, may soon have a dramatic new treatment designed to reduce severe UI to the absolute minimum.

What would it be like for a day without worry?

It is in the severe UI market that the Precision Medical Devices (PMD) Flow Control Device (FCD), a remote-telemetry- controlled bionic urethra valve implant, is expected to become the new “gold standard” treatment, mostly as a result of its remote adjustability feature.

The fact that the FCD product will set new standards in the ease of implant, the ease of use, having a more modest adverse events profile and lower risk profile as compared to all of the other currently-approved severe UI products and procedures (especially the more invasive products and/or procedures) will just add to the benefits derived from using it. The product is expected to last a lifetime, with little or no deterioration in its efficacy.