MEDICAL SURFARI: URINARY PROBLEMS CAN BE TREATED

The kidneys are paired "kidney" bean-shaped organs, together weighing less than a pound, that lie deep in the back on either side of the spine where they are insulated in fat and protected by the lower-most ribs. They rest behind the organs of the abdomen, and the right one is slightly lower than the left due to the Herculean heft of the liver that sits on it. These organs of discrimination filter a fifth of the blood pumped by the heart each minute through more than 2 million arterial rivulets.

This produces an ultra-filtrate of water, waste and salts. Some 180 quarts a day are filtered across the downstream membranes ultimately producing 1 1/2 quarts of urine. Some 99.2 percent of the filtered water is reabsorbed by the kidneys' remarkably discriminating tubular system, and only a trifling amount of salt is excreted. This straw-colored, clear fluid trickles through the tubular ureters, one from each kidney, to the bladder. The muscular contractions of the ureters, combined with the fine hair-like cilia, usher the urine into the bladder where it may store as much as two quarts in extreme circumstances.

Once 1 1/2a pints accumulate, the bladder sends a signal to the brain, which in turn initiates a contraction of the muscles in the wall of the bladder. These muscles are oriented in three planes; consequently when they contract they close in on the space of the bladder, pushing down symmetrically toward the urethra. The urethra is guarded by a circular sphincter muscle that normally holds back momentarily until it suddenly opens, allowing a brisk stream of urine through the urethra to the outside.

This is a simplified version of what occurs every time you "pass your water," when everything works well.

However, for at least 10 million adult Americans (yes, you're not alone) the controlled storage and release of urine is impaired, resulting in urinary incontinence (UI) or uncontrolled leaking of urine. UI is a symptom rather than a disease, and it often is a temporary symptom that may be related to a medication or an acute illness like a urinary tract infection. Many times this condition is chronic, and it may last indefinitely unless it is properly diagnosed and treated. There is a persistent myth that UI is a normal consequence of aging -- it is not! There are age-related changes in the lower urinary tract that increase the risk for UI. The six main types of UI include: urge incontinence, which is an urgent need to urinate followed by urine leakage; stress incontinence, which is the leakage of urine when laughing, coughing, sneezing or lifting heavy objects; overflow incontinence, which occurs when small amounts of urine leak from a very full bladder; total incontinence, or constant dripping of urine day and night; psychological incontinence, which has an emotional rather than a physical cause; mixed incontinence, which is a mixture of causes.

Urinary incontinence can occur at virtually any age, and women are twice as likely as men to be affected.

There is a litany of causes and risks for UI, some of which include urinary tract infection, bladder stones, weakened bladder muscles, medications, constipation, bladder overactivity, changes resulting from childbirth or surgery, excessive caffeine or alcohol intake and enlargement of the prostate.

The condition is usually diagnosed on the pattern of symptoms by a thorough history of the problem. A physical examination is also necessary, and sometimes some urine and/or bladder tests are performed. Of course, it is not unusual for people who experience UI to have some social embarrassment, frustration or even depression.

The good news is there are treatments ,and the majority of UI is treatable. The treatment depends, in part, on the cause of the problem. Treatment often involves simple steps to regain bladder control, and these may include pelvic muscle exercises, biofeedback control, bladder training, medications and in some cases, devices that prevent uncontrolled loss of urine. There are a variety of surgical procedures that may be performed when nonsurgical measures are ineffective. You don't have to "just live with it." Consult your family physician or urologist for a proper evaluation.

World Wide Web Resources

National Kidney and Urologic Diseases Information Clearinghouse

www.niddk.nih.gov/health/kidney/nkudic.htm

This clearinghouse is designed to increase knowledge and understanding about kidney and urologic diseases and health and provides very comprehensive information about urinary incontinence.

National Association for Incontinence

www.nafc.org

Through this Web site you can access information on urinary incontinence for both consumers and healthcare professionals.