Dr. Liliana Bordeianou discusses the taboo associated with incontinence and recalls the causes, complications, and treatment options available. Dr. Bordeianou is a physician at the Massachusetts General Hospital.
The most frustrating thing about incontinence, both urinary and bowel, is that it is an epidemic, but it is a silent epidemic that no one is talking about. It is a taboo in our society and so, nobody will bring it up at the dinner table or when they come to see the doctor.
They also will not bring it up because many think that it’s a part of aging and that there is nothing to do about it, that one just needs to live with the condition, and it’s absolutely not true.
It is staggering to think that one out of three women in this country have either urinary or bowel incontinence and by the age of 50, one out of four have bowel incontinence.
Sometimes it’s neurological causes – diabetes, multiple myeloma, lymphoma; sometimes it’s a connective tissue disorders such as Ehlers-Danlos syndrome.
Sometimes it’s a tear, either from a traumatic accident or from a bad delivery, and sometimes it is prolapse, which is a drop over the pelvic organs. All of these are treatable once identified properly.
At Mass General we found that these conditions frequently co-exist. Patients with urinary incontinence will also have bowel incontinence, and sometimes they will have associated pelvic organ prolapse, which is a drop of their pelvic organs.
Treatment of one without addressing the other will lead to an earlier recurrence, or sometimes it will simply inadequate which is why we teamed up. Now we have bio feedback specialists who can provide physical therapy, which is sometimes all a patient might need. If that fails, we might initiate medical therapy and that’s why we have expert gastroenterologists on our team.
Once in a while, surgery is needed and when it is, we team up – both gynecologists and colorectal surgeons might be in the room with a patient that has combined urinary and bowel symptoms. This way we make sure that both conditions are addressed at the same time, during the same anesthesia, during the same hospitalizations, and we make sure that persistence of one problem does not cause to recurrence of the other.