November is Bladder Health Awareness 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 Ob/Gyn, in the Division of Urogynecology, a world-class multidisciplinary team includes urogynecologists, nurse practitioners and physical therapists who can provide the full range of treatments for women with UI and other pelvic floor disorders. The Department also has dedicated research programs underway, with the goal of preventing and providing better treatments for these conditions. Some examples of the research being conducted/notable publications by the group include:
Cindy Amundsen, MD, and Fellow Whitney Hendrickson-Cahill, MD, were invited authors for the "Annual Update on Pelvic Floor Dysfunction" in the publication OBG Management, providing recommendations for treatment of fecal incontinence. "Take home points” from several well-designed trials that enrolled women with frequent nonneurogenic fecal incontinence were included. Read more.
Dr. Amundsen has been awarded a 5-year $760,000 grant supported by the NIH Eunice Kennedy Shriver National Institute of Child Health & Human Development of the National Institutes of Health (NICHD), for the AUGS/DUKE Urogynecology Clinical Research Educational Scientist Training (UrogynCREST) program.
Two Pelvic Floor Disorders Network (PFDN) studies conducted at Duke University (a national PFDN research site) were published in the September issue of the Journal of the American Medical Association. Alison Weidner, MD, MMCI, and Anthony Visco, MD, co-authored the two studies, Effects of Surgical Treatment Enhanced with Exercise for Mixed Urinary Incontinence (ESTEEM), and SUPeR: Study of Uterine Prolapse Procedures- Randomized Trial, respectively. Both studies researched patient outcomes in Urogynecology and Reconstructive Pelvic Surgery.
The American Urogynecologic Society (AUGS) named Urogynecology Fellow Rebecca Meekins, MD, a recipient of the prestigious Pelvic Floor Disorders Foundation Fellow Research Award in the amount of $25,000. The 2019 PFD Research Foundation Grant will fund Dr. Meekins' project on the OASIS Prediction Model titled “A Prediction Model and Electronic Calculator for Risk of Obstetric Anal Sphincter Injuries.” In addition to funding from AUGS, Dr. Meekins’ research received funding from the PDC Outcomes Research Team (PORT). The PORT initiative seeks to provide Duke clinicians with reporting tools to enhance their productivity in data collection and analysis.
Studies underway at Duke are evaluating the effects of aging on the female urinary microbiome, leading to a deeper understanding of recurrent urinary tract infections (UTI) and other pelvic floor disorders, and introducing possibilities for new treatments and protocols. Nazema Siddiqui, MD, MHS, is the principal investigator of a new study on aging and recurrent UTI. Read more.
Results of the Controlling Anal incontinence by Performing Anal Exercises with Biofeedback or Loperamide (CAPABLe) randomized clinical trial by Erik Jelovsek, MD, MMEd, and colleagues were published in The Lancet Gastroenterology & Hepatology (September 2019). The objectives of this study were to compare different combinations of anorectal manometry-assisted biofeedback, loperamide, education, and oral placebo. The study was funded by the Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD) and the National Institutes of Health Office of Research on Women's Health. Read more.