Study: Most Overactive Bladder Is Treatable

Researchers believe bladder spasms, not shrinkage, cause the disorder

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HealthDay Reporter

WEDNESDAY, May 25, 2005 (HealthDay News) -- Urinary incontinence, which strikes one in every six adults and increases with age, is largely fixable, experts report.

For many years, health professionals have assumed the reason that incontinence predominantly affects older people is that their bladders shrink, but doctors at the University of Pittsburgh School of Medicine now contend that bladder spasms cause the problem.

In most cases those spasms can be controlled, often without resorting to either drugs or surgery, they say.

"Despite the common thinking, the bladder does not shrink with age," said study author Dr. Neil M. Resnick, chief of the division of geriatric medicine.

"We were surprised. We thought that it did decrease," he said.

Instead, he said, he and his colleagues found that people who suffered from incontinence had no changes in the sizes of their bladders, but that bladder spasms, by contracting the bladder, made it appear as if the bladder had shrunk. This means that it was the bladder spasms that was causing the incontinence.

Bladder spasms -- involuntary contractions of the detrusor muscle that controls bladder emptying -- create a sudden urge to urinate in individuals plagued by urinary incontinence, the researchers explained. These contractions can result from a variety of illnesses or injuries that that interfere with nerve circuits linking the bladder to the brain. Parkinson's disease, Alzheimer's disease and stroke are examples of illnesses known to have this effect, according to the Pittsburgh team.

The findings were to be presented Tuesday at American Urological Association annual meeting, in San Antonio.

For the study, doctors looked at 95 women with incontinence, and compared data on a number of variables, including bladder capacity, urethral closure pressure, voiding flow rate and detrusor contraction strength. They found that while bladder and urethral function deteriorate as people age, bladder capacity rarely changes.

"Everyone tends to blow off incontinence, with a 'What can you do,' attitude," he said. "Women think it's a consequence of having a baby, women going through menopause think it's menopause, older men think it's prostate."

But Resnick added the good news from this study is that bladder spasms -- which could be the main cause of incontinence -- can be controlled, often without drugs or surgery.

Lifestyle and behaviorial interventions could have a "dramatic effect" on two-thirds of individuals suffering from the disorder. By teaching them to anticipate when a spasm will occur and to tighten their pelvic floor muscles when they're having a spasm, sufferers can significantly control their problem, Resnick said.

The biofeedback approach, available at incontinence centers like the one at Pittsburgh, takes from several to eight weeks to show results, but can also significantly reduce the incidence of incontinence. People who've restricted their activities to avoid embarrassing incidents often resume a normal life after the therapy, he said.

Resnick said he and his colleagues at Pittsburgh have received a grant from the National Institutes of Health to further refine their biofeedback techniques.

Other remedies for incontinence include drugs that suppress bladder spasms. However, these medications can have side effects such as dry mouth, constipation or blurry vision. Finally, in rare cases surgery might be required.

Another expert was cautiously optimistic about the findings.

"This is a relatively small study -- of 95 females, only 12 were between the ages of 60 to 90-- and while the concept is good, you need to replicate it in much bigger studies to make sure the idea holds," said Dr. Angelo Gousse, director of the division of voiding dysfunction and female urology at the University of Miami Medical School. Older women, he noted, are the age group most prone to incontinence.

In other news at the meeting, The Urologic Diseases in America Project, a University of California, Los Angeles-based research effort, reported that expenditures for urinary incontinence among female Medicare beneficiaries aged 65 years and older nearly doubled from 1992 to 1998, from $128.1 million to $234.4 million.

Monies were primarily spent on an increase in visits to doctors' offices and for surgeries to treat urinary incontinence. The jump could be due to an increased awareness of the disorder as well as marketing of new drugs to treat the problem, the study authors suggested.

Another study by the same Los Angeles team found the overall prevalence of reported urinary incontinence within the previous year among women to be about 38 percent, with daily incontinence experienced by 12 percent of women aged 60 to 64 and nearly 21 percent of women 85 or older. The researchers sourced their data from the large, ongoing National Health and Nutrition Examination Survey.

Finally, a survey of nearly 21,600 American men found that they, like women, are more prone to urinary incontinence with age, and that there is a strong association between prostate conditions and loss of bladder control. Overall, just over 9 percent of adult men surveyed reported symptoms of incontinence occurring at least once over the past month, according to researchers at Beaumont Hospital, in Royal Oak, Mich.

More information

Learn more about urinary incontinence at the American Academy of Family Physicians.

SOURCES: Neil M. Resnick, M.D. professor and chief, division of geriatric medicine, University of Pittsburgh School of Medicine; Angelo Gousse, M.D., associate professor and director, division of voiding dysfunction and female urology, University of Miami Medical School; May 24, 2005, presentation, American Urological Association annual meeting, San Antonio

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