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1992.03.23 :  AHCPR Study -- Urinary Incontinence

Contact: Bob Isquith (301) 227-8370
March 23, 1992

     A government-sponsored panel of private-sector medical
specialists said today that 80 percent of cases of urinary
incontinence can be significantly improved or cured -- yet half
of those affected never seek medical help.  The group, which 
announced a new guideline for detecting and treating urinary
incontinence, said that sufferers often ignore symptoms or rely
on absorbent materials.
     "Urinary incontinence is not inevitable in most cases -- nor
is it a shameful condition to be suffered in silence," HHS
Secretary Louis W. Sullivan, M.D., said.  "If more doctors ask --
and patients discuss their problems frankly -- fewer will have
their conditions deteriorate until they must rely on adult
diapers."
     The panel's guideline for medical practice, published by the
Public Health Service's new Agency for Health Care Policy and
Research, says both patients and doctors need to know more about
treatments that can work for the majority of patients:
     -- bladder training (learning to urinate on schedule),
       -- pelvic muscle exercises, and
     -- several types of drugs for infections and other
underlying conditions.
     Surgery can be helpful in specific cases, following
evaluation by a specialist, the panel said.
     But the first steps, the panel agreed, are for physicians
and nurses to ask patients routinely and aggressively, "Are you
having any bladder problems?" and then to test adequately to
determine what is causing the problem.  Incontinence can be
caused by the side-effects of drugs or other conditions,
including urinary tract infection or stool impaction.
     The disorder affects more than 10 million adults--most of
them older women--but is widely under-reported and under-
diagnosed.  Although most sufferers live in the community,
urinary incontinence is a significant factor in decisions to move
an older family member into a nursing home.  Half the nation's
1.5 million nursing home patients suffer from the condition.

     Urinary incontinence is a major factor in the development of
pressure ulcers, a leading health problem among nursing home
patients and other persons confined to beds or chairs.  Urine's
wetness and acidity can kill skin tissue, leaving the patient
susceptible to infection and ulceration.  Urinary incontinence
can also lead to psychological problems, such as depression.

       The guideline was developed by the AHCPR-sponsored panel
over a 15-month period.  The document was then tested in selected
hospitals and clinics.

     It was released today by James Mason, M.D., assistant
secretary for health and head of the Public Health Service, who
said, "This is 
the second in a series of guidelines--the first one was on pain--
that are going to produce a peaceful revolution in the effectiveness
of American medicine."

     Dr. Mason said, "Urinary incontinence erodes the quality of
life of older Americans, reducing their dignity and mobility.
Medical practitioners can change this situation."

      Ananias Diokno, M.D., chief of urology at the William Beaumont
Hospital in Royal Oak, Mich., and chair of the 15-member panel, said
the purpose of the guideline is to "improve reporting and diagnosis;
reduce the dramatic variations in the way the disorder is treated;
better educate clinicians and consumers; and encourage further
biomedical, medical effectiveness and cost research on urinary
incontinence."

       The document, which covers various types of urinary
incontinence, provides a framework for selecting appropriate
behavioral, pharmacologic, and surgical treatments, and evaluates
the use of supportive devices.
     
       The guideline recommends thorough medical history-taking and
testing and urges clinicians to identify and treat transient causes
of incontinence immediately.  The guideline also provides
indications for referring patients to specialists for further
evaluation.

      The panel consisted of experts in urinary incontinence
including urologists, gerontologists, obstetrician-gynecologists, 
family practitioners, nurses, a psychologist, an occupational
therapist and a consumer representative.  Kathleen McCormick, Ph.D.,
R.N., was the co-chair of the panel while serving as nursing
research director at the National Institute on Aging.  Dr. McCormick
is currently director of AHCPR's Forum for Quality and Effectiveness
in Health Care.

       The group examined current needs, therapeutic practices and 
principles, and emerging diagnostic and treatment technologies by 
reviewing over 7,000 studies and holding a public meeting before
drafting the guideline.  The document was then peer-reviewed and
tested in physicians' offices, home health agencies and other
settings.

     According to AHCPR Administrator J. Jarrett Clinton, M.D., the
agency will distribute the new guideline to physicians, nurses, and
others through state and national professional organizations and to
medical and nursing schools and consumer groups.

     Urinary Incontinence in Adults, a quick reference guide that
summarizes the guideline, and a patient's guide are available free
of charge from the AHCPR Publications Clearinghouse, P.O. Box 8547,
Silver Spring, Md. 20907; tel: 1-800-358-9295.


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