Let's Talk About Sex*
*Sex troubles, that is. And while we’re at it, let’s break the silence on mental illness and drug abuse. Incontinence? Now there’s another taboo topic women are only beginning to discuss with their doctors. Open up. Don’t be embarrassed. Honest, you’ll feel better if you’re frank with your physician—and with other women—about such verboten subjects.
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Taboo Topic No. 4
It’s been almost 20 years since Ann Landers first wrote about urinary incontinence (UI) in her syndicated newspaper advice column, thus breaking a long silence in the major media. That same year (1987), Time published an article about incontinence titled “The Last of the Closet Issues.”
Although it’s no longer an unmentionable topic (after all, “protective pads” have since been peddled on TV by none other than America’s former sweetheart, Debbie Reynolds), UI is still essentially ignored by the media—except perhaps as a joking reference to getting old.
As bioethicist Arthur L. Caplan has noted: “It is hard to imagine J. Lo or Jennifer Aniston leading a march on Washington to demand more research on urinary incontinence.”
Yet UI (officially defined as “the complaint of any involuntary leakage of urine”) is a very common—and often debilitating—condition among women, including young women. Just how common is a matter of debate. Estimates of the percentage of American women with UI range from 2 percent to 50 percent, depending on how UI is defined. A recent government report estimated that 75 percent of women have some urinary leakage, and as many as 10 percent may have a severe problem.
No one knows the precise numbers, partly because women don’t like to talk about incontinence, even with their doctors. “People feel very embarrassed about it,” explains Jean Wyman, PhD, clinic director of the Minnesota Continence Associates at the University of Minnesota’s School of Nursing. “There’s definitely a stigma attached to it.”
It’s not only embarrassment that keeps women from bringing up the topic with their physicians. Many women tend to think (mistakenly) that the only treatment for UI is surgery. Or they believe (again, wrongly) that incontinence is an inevitable part of growing older.
And so they suffer. Unnecessarily, says Wyman.
Incontinence can be so severe that a woman becomes reluctant to leave home, fearing that she will have an “accident,” or that, if she wears an adult “diaper,” she will smell of urine.
“Many women won’t even tell their husbands,” says Wyman. “They may avoid sex, because sex can trigger leakage.”
UI has many causes. Often, the cause is temporary, the result of taking a medication that interferes with bladder control, for example, or drinking too much caffeine (which acts as a diuretic).
Persistent UI, in contrast, usually involves an underlying physical condition—weakened pelvic muscles, nerve problems, or an obstruction in the urinary tract—and doesn’t have a quick fix.
Childbirth, particularly vaginal delivery, has long been considered a major risk factor for UI because of the damage it can do to the pelvic floor, the network of muscles, ligaments, nerves, and tissues that support the uterus, bladder, and rectum.
UI has also been blamed on the hormonal changes associated with menopause. But that idea was debunked last year when a major study found that postmenopausal hormone therapy (estrogen with or without progesterone) actually increases a woman’s risk of becoming incontinent.
Being overweight is a major risk factor for UI, and so, surprisingly, is being depressed—although whether the depression or the UI comes first is not quite clear.
Wyman recalls a woman who became extremely distressed when she became incontinent after the birth of her first child. “I’ll never forget her because of her anger,” she says. “She was furious with her doctors, furious that no one had told her that this could happen to her.”
That woman eventually had corrective surgery, but there are other treatment options, says Wyman, including behavior therapies, bladder training, pelvic floor muscle training, and a variety of new medications.
Karen Dunlap, RN, who works on the faculty of the University of Minnesota’s School of Nursing, was able to cure her incontinence without surgery. In 1998, at age 34, she had a hysterectomy to remove several precancerous tumors. Her recovery went well—until she returned to aerobics class. “That’s when I began leaking,” she says.
Dunlap was devastated. The hysterectomy had been traumatic enough. Now she was incontinent. “I felt my life was over,” she recalls. She returned to her surgeon, who referred her to a nurse practitioner who specialized in incontinence in women. The nurse taught Dunlap how to work on tightening muscles deep within her pelvis. “After just three or four visits over the course of four weeks, the problem was completely gone,” Dunlap says.
As Dunlap’s story shows, women shouldn’t be afraid to seek help. Often, the first step toward a remedy is a visit to a continence nurse specialist, a urogynecologist, or a urologist who specializes in the treatment of women.
“You don’t have to suffer,” Wyman says. “There is help out there.”
Susan Perry is a health and science writer whose latest book is Taking Charge of High Blood Pressure: Start-Today Strategies for Combatting the Silent Killer (Reader’s Digest).