Source: DGNews  |  Posted 8 years ago

By Peggy Peck

NEW ORLEANS, LA -- October 12, 2003 -- Although women with urinary incontinence will visit their family doctors on a regular basis, few of those family physicians will ever diagnose this "silent scream disease," said Mary Elizabeth Roth, MD, vice president for medical affairs, Sacred Heart Hospital, Allentown, Pennsylvania.

The problem, said Dr. Roth, is that while urinary incontinence is a common condition in women of all ages, it fails to make the diagnostic radar screens of most family physicians. She drove that point home during a Doctors' Lounge seminar on incontinence here October 4th at the 55th Scientific Assembly of the American Academy of Family Physicians.

Dr. Roth said she has been preaching the incontinence message since "my niece, who was just 26 [years old], became incontinent after her first pregnancy. When she asked her obstetrician about it she was told 'Oh, that's just routine after you have a baby'. So she suffered with it for 2 years before it went away. No one should be told that it is just routine. Whether the patient is 26 or 86 the loss of quality of life is what concerns me."

Moreover, Dr. Roth said that diagnosing urinary incontinence is not time consuming and does not require expensive diagnostic tests. She said that "there is every bit of evidence that 80% of incontinence can be diagnosed in the time it takes to take a history." In fact, she said that one simple question can provide much of the needed information.

"Ask every woman if she has times when she loses urine when coughing or sneezing or when she can't get to the bathroom fast enough," Dr. Roth said. These conditions happen so frequently and are so common, she said, that "there should be absolutely no embarrassment in talking about them."

In addition to history-taking, Dr. Roth said incontinence evaluation should include a "look at the urine, just a dip stick to make sure the patient isn't spilling protein or sugar" and a check of post-void residual. "When the woman thinks her bladder is empty, put in a catheter and check the residual urine to make sure she doesn't have an infection," she said.

Also evaluate the patient in a few different positions. During the physical exam, women may leak when in the lithotomy position while men are likely to leak when standing, she said.

DIAPPERS is a useful pneumonic for those factors that should be considered when evaluating a patient for urinary incontinence, Dr. Roth said. It works this way: