Dr. William YoungQ: I'm having some problems with incontinence. Can my primary care doctor help me, or do I need to see a urologist?
A: Primary care physicians are well positioned to manage incontinence, a major health challenge that frequently remains untreated. Women are affected more than men, and the prevalence increases with age, with half of those in nursing homes living with the condition.
The basic evaluation includes a history and physical, post-void residual (PVR) urine test and urinalysis. When incontinence is not considered transient, these general categories can help guide treatment decisions:
» Stress incontinence, or the leakage of urine during times of increased abdominal pressure, can be treated with pelvic floor exercises, sympathomimetics, and topical estrogen. If these options fail, referral to a urologist is needed.
» Overflow, or the frequent dribbling of urine, can be addressed with alpha blockers, intermittent catheterization and necessitates a urologic referral.
» Urge incontinence in those with a PVR volume of less than 75 milliliters can be treated with anticholinergics. PVR levels over 100 milliliters should be referred to a urologist.
» Functional incontinence based on physical or mental limitations can be improved through assistive devices and behavioral therapy.
- William Young, M.D., CHI Memorial Chattanooga Urology Associates; member, Chattanooga-Hamilton County Medical Society