Ask the right questions to assess bladder problems

Women aren’t lying when they deny incontinence. The word itself shuts doors. Say incontinence, and it conjures images of frail old women in housecoats and diapers. The 33-year-old new mom and 48-year-old golf enthusiast in your waiting room simply don’t see themselves in that light. But when you ask questions about bladder control, you’ll get a different picture.

"I ask, ‘Do you wear protection?’" says Pam Gillaspie, RN, program director of the Maturity Center at the Women’s Clinic of Lincoln (NE). "If they say yes, they always wear protection, then it’s a problem."

In addition to those questions, the following should be routine for every woman who walks through your doors, according to Gillaspie and Lynda Christison, MPA, executive director of the Spartanburg, SC-based National Association for Continence:

• Do you have any urinary leakage? When?

• How many times a night do you go to the bathroom?

• Do you ever leak urine during or right after intercourse?

• Do you have trouble with leakage during a particular week of your menstrual cycle?

• How much urine do you pass when your bladder leaks?

• Do you lose control of your bladder when coughing, sneezing, or exercising?

• How long have you had these problems?

Christison urges you to teach Kegel exercises to all your patients, old and young.

"Women should start Kegels at age 12 and plan to do them their entire lives because the bladder is a muscle and it needs exercise to be strong," Christison says.

If women’s health providers can teach young and middle-aged women to take care of this problem, Christison continues, women might dramatically reduce the risk of going to nursing homes in later life — 50% of nursing home admissions are due to incontinence. ß