November is Bladder Health Month. Bladder control problems, like urinary incontinence (UI) and overactive bladder, affect 30-50% of women. These conditions can affect all age groups, not just older women, and many women find that these symptoms significantly impact their physical or social activities, and negatively affect their quality of life. Unfortunately, studies suggest that two-thirds of women with symptoms don’t report them to their healthcare provider, usually because of embarrassment or lack of knowledge that safe and effective treatments exist. Because they are unlikely to volunteer their symptoms, ACOG’s Women’s Preventative Services Initiative now recommends screening women for urinary incontinence annually.
Beyond bladder control problems, there are other bladder conditions that predominantly affect women. Over 50% of women will get at least one urinary tract infection (UTI) in their lives, and women are 30 times more likely than men to get a UTI.
Bladder health tips for patients include:
- Manage Fluids – This includes managing daily fluid intake and avoiding bladder irritants like coffee, tea and carbonated drinks.
- Get Moving – Regular exercise is important for maintaining bowel and bladder function.
- Maintain a Healthy Weight – Overweight women have a greater risk for developing incontinence. Studies show that overweight women who lose as little as 5% of their body weight with diet and exercise can have substantial improvement and sometimes resolution of their incontinence.
- Do Kegel Exercises – Kegel exercise, also called pelvic floor exercises, are an effective treatment and prevention strategy for many types of urinary incontinence. How many are beneficial? 10-15 contractions 3 times per day.
- Don’t Smoke – Smoking increases the risk of UI.
It’s also important to remind patients that bladder control problems are not a normal part of aging and that there are safe and effective treatments that range from behavioral treatments, medications, office procedures and surgery.
At Duke, in our Division of Urogynecology, we are fortunate to have a world-class multidisciplinary team including urogynecologists, nurse practitioners and physical therapists, who can provide the full range of treatments for women with UI and other pelvic floor disorders. We also have dedicated research programs underway, with the goal of preventing and providing better treatments for these conditions. Some examples of the research being conducted by our group include:
Dr. Cindy Amundsen, along with colleagues from the NICHD Pelvic Floor Disorders Network, reported on 2-year outcomes of a randomized trial comparing sacral neuromodulation and botulinum toxin A (BotoxTM) for refractory urge urinary incontinence (ROSETTA trial).
Drs. Eric Jelovsek and Matthew Barber, along with an international group of collaborators from New Zealand, the United Kingdom and Sweden, developed a group of clinical prediction models that can accurately predict the risk of developing UI and other pelvic floor disorders 12 and 20 years after childbirth. Click here for info.
Drs. Nazema Siddiqui and Cindy Amundsen, along with investigators from the NIDDK Lower Urinary Tract Dysfunction Research Network (LURN), just published a study examining how mental health measures, sleep and physical function are associated with the presence, type and severity of urinary incontinence. Click here for info.
Dr. Siddiqui is working with a multidisciplinary team, including bio-informaticists from Oregon Health Sciences Center and statisticians from Duke Forge and Duke’s Biostatistics Department, to investigate how the urinary microbiome changes with aging. This work is funded by the National Institute of Aging. Dr. Monique Vaughan, 3rd year fellow, is partnering with this team to study which patterns of microbes play an important role in women with postmenopausal recurrent UTIs.
Emily Romanoff, Duke 3rd year medical student, is leading a pilot study to see if bladder instillations of lactobacilli can alter the urinary microbiome in a favorable manner. If this holds true, it will open new avenues for research and treatment for women with recurrent UTIs. This work is funded by the Duke Pepper Center.