Urinary incontinence affects millions of men and women. Unfortunately, this is not often openly discussed, leading to common misconceptions that stand in the way of people seeking and receiving treatment. We explore and hopefully dispel some of these common incontinence myths.
1. Urinary Incontinence only happens to older women.
Urinary incontinence certainly becomes more common in older populations, with over one-half of women aged over 65 reporting at least one episode of incontinence. But even younger women still experience urinary leakage at fairly significant rates. Nearly 1 in 5 women aged 20-25 also report urinary incontinence, proving this is not simply a disease of older women. In addition, younger women seek treatment for urine leakage at much lower rates than they report symptoms, suggesting that this myth may be creating barriers to younger women asking for help for their incontinence.
2. Urinary Incontinence is a normal part of getting older.
While incontinence is more likely to occur as men and women age, that does not make it a “normal” part of aging. We see many diseases (heart disease, diabetes, high blood pressure) that are more common as we get older but do not then conclude that it is something to just be accepted and accommodated. Not only does urine leakage have immense impact on the lives of men and women but there are so many treatments that can provide real benefits. This myth, unfortunately, seems to keep many people from talking to their health care provider about diagnosis and treatment of their urine leakage.
3. Men never experience Urinary Incontinence.
While men certainly experience incontinence less often than women, it is still fairly common in men. As many as 11% of men overall report incontinence, with much higher rates than this in older men. Men with urinary incontinence most often report urgency incontinence. Unlike women, men report stress incontinence much less frequently and this is often related to prior surgeries or treatments for the prostate (such as for prostate cancer).
4. Surgery is the only treatment for Urinary Incontinence.
Not only is surgery not the only treatment for urinary incontinence, it is not even the most common treatment for incontinence. Stress incontinence may be treated with surgery (such as a mid-urethral sling) in men and women who have failed to see improvement with more conservative therapy such as pelvic floor exercises (Kegel exercises). However, urgency incontinence, is treated first with behavioral changes (such as dietary modification and bladder training) and medications (such as oxybutynin, VESIcare or Toviaz). Only patients with moderate to severe symptoms of urgency who cannot take or do not see improvement with earlier treatments consider more invasive therapies (Interstim, Urgent PC or Botox).
5. Diagnosis of Urinary Incontinence requires expensive and invasive testing.
The vast majority of patients with overactive bladder (OAB) are evaluated very simply in the office with a thorough history and physical exam. At The OAB Clinic, we do find that questionnaires and a voiding diary help us in our evaluation, but even these are not necessarily required. More expensive or invasive tests are reserved for the few patients with difficulty such as failure to improve with prior therapy or complications such previous pelvic surgeries or blood in their urine. Similarly, most patients with stress incontinence are diagnosed with a history and physical exam and often a questionnaire and voiding diary.
By some estimates, only 1/3 of patients reporting symptoms of urinary incontinence may seek treatment. This may be due to relatively mild symptoms, but is likely also influenced by many of the myths that surround the evaluation and treatment of incontinence. By dispelling these myths, we hope to remove barriers to patients who desire treatment for bothersome incontinence.
-Colin M. Goudelocke, MD, FPMRS