Beyond the Usual Suspects

By Paul J. Watkins

These days, more and more women are learning about the causes of bladder leakage and the available solutions. They are talking with their friends and their doctors. Bladder leakage has become a more frequent topic on television, in magazines, and on the Internet, and the subject is more out in the open than ever before. Still, not all women have benefited from this new openness. Women living in rural areas may find themselves isolated by the myths and lack of appropriate information and care that have long surrounded the topic of bladder leakage.

There are several reasons why rural women might be less informed about bladder leakage. A main one is the fact that specialists, such as urologists are not as readily available in rural areas as they are in the big cities. In this case, individuals essentially would be looking to their general practitioners for information on bladder health. Their general practitioner may consider bladder leakage a quality-of-life issue and give more attention to conditions such as heart disease, high blood pressure, diabetes, and obesity.

In this situation, some women may also feel uncomfortable discussing their condition, if their general practitioners don’t encourage an open dialogue. “A study done less than ten years ago looked at the time interval between onset of bladder leakage and the time the woman sought medical help," says Nicholas Franco, M.D., a board-certified and fellowship-trained urologist with Specialists in Urology in Bonita Springs, Florida. "It was an average of about seven years." This further shows that women are waiting a considerable amount of time before consulting their doctor.

Franco adds that myths about bladder leakage are another barrier that keeps women from seeking help. "They often think that bladder leakage is something that everyone gets as they grow older. They remember their mothers having it; they remember their grandmothers having it, so they believe it's to be expected, and they don't seek medical attention. Also, they may not have the financial means to seek medical attention."

Rural communities often lack outreach programs and seminars, adding to a lack of current, factual information reaching women in those areas. "In the larger cities, I think there are a lot more women that meet to talk about these issues, and more physicians go out and give talks to the public," says Franco. "I don't think those events are as common in rural areas."

Fortunately, awareness of the needs of rural women is growing. A study funded by the National Institute of Nursing Research (NINR), part of the National Institutes of Health, found that rural older women living with bladder leakage were able to reduce the severity of their bladder leakage by 61% through the use of behavior modification. The study involved 178 women ages 55 or older, and it was the first such study of its size.

Under the guidance of visiting nurses, the women set goals for their continence and worked toward them using three types of behavior modification. Most women started with bladder training, emptying their bladders at ever-increasing intervals until they were able to hold their urine for two or more hours. Some woman began with self-monitoring, keeping track of the fluid they consumed and the amount of time that passed between trips to the bathroom. Once the results were in, these women were advised to cut their caffeine intake and modify the amount of fluid they drank–and when they drank it–so the time between bathroom breaks could be increased or decreased as needed. Most women reached their goals using two behavior modifications.

Study investigators from the University of North Carolina School of Nursing, Chapel Hill and the NINR concluded that intervention is an ideal solution for community-based nurses to provide, and that it's especially helpful to women living in rural areas. Bladder control problems are a large reason why rural move to nursing homes, so helping them to maintain good bladder health can help them remain in their own homes for longer. Essentially, just a little bit of education can go a long way.

For more information about help with bladder leakage, talk to your physician and visit the National Association for Continence at www.nafc.org or the National Institute on Aging at www.nia.nih.gov.