THE BLADDER MATTERS! Lindsey A Kerr MD Associate Professor of Urology Co-Director, Center for Pelvic Floor Disorders University of Utah

THE BLADDER MATTERS! Pelvic Floor Disorders are Common Bladder Dysfunction including Pain Disorders and Incontinence disproportionately impact Women These are Expensive, Debilitating but Treatable Entities

Bladder Matters and Urinary Incontinence Incontinence: The unexpected and unwanted leakage of urine Uromythology: Uncommon Natural part of aging Nuisance but not a health issue Not cost effective to treat

Senate Special Committee on Aging Alzheimer’s Loss of Vision Osteoporosis Urinary Incontinence Determined four health problems affecting quality of life for seniors:

Urinary Incontinence Affects as many as 30+ million Americans Three quarters are women Half of nursing home residents are incontinent Associated with other disease processes and the treatment of those diseases

Conservative Estimates AHCPR Urinary Incontinence Guidelines estimates 15% to 30% of community-dwelling adults 5% to 10% of all Americans are affected by periodic or chronic urinary incontinence More Common than Asthma and Heart Disease

Costs of UI to Older People Costs of UI to Older People (65+ in the United States) (T.W. Hu, 1997)

The Bladder Matters! Patients with incontinence also complain of Decreased sexual function Sleep disturbances Decrease in normal activities Fear of stigmatization Roe B et al. J Adv Nurs. 1999;30: Abrams P et al. Am J Manag Care. 2000;6(suppl):S Lenderking WR et al. Phamacoeconomics. 1996; 9:11-23.

The Bladder Matters! Patients with incontinence are at increased risk for falls and fractures More urinary tract infections and skin infections More likely to need treatment for depression Wagner TH et al. Am J Manag Care. 2002;8:S , Brown JS et al. Am J Manag Care. 2000;6:S Fonda D et al. Aust Clin Rev. 1988;8: , Stewart WF et al. Eur Urol. 2003;20:

Bladder Matters: Urinary Incontinence A valid predictor of heavy nursing home use Nursing home costs are between $39,000 and $43,000 per year Two-thirds paid by Medicare and Medicaid

Urinary Incontinence: Terminology Stress incontinence – Leakage that occurs with “stress maneuvers” coughing, running Urge incontinence – Leakage associated with the “urge” to void, cannot make it to the bathroom on time. Functional incontinence – inability to get to the bathroom Overflow incontinence – bladder is overly full, does not empty on its own

2001 ICS Terminology Urge incontinence now included in the definition of Overactive Bladder Overactive bladder is an empiric diagnosis Patients can be wet or dry Used as the basis for initial management Abrams P et al. Urology. 2003;61:37-49.

17% Take a Prescription Medication Multiple Types of Coping Behaviors Used in Attempt to Regain Control 45% 53% 28% 29% 32% 42% 44% Empty Bladder Frequently, Even Without Urge Learn in Advance Where Bathrooms Are Limit Intake of Fluids Use Panty Liners Use Incontinence Pads Use Pads/Sanitary Napkins Do Pelvic Floor Exercises Avoid Going Where I Don’t Know Location of Bathroom Limit Activities That Are Not Close to a Bathroom Voiding/Mapping Fluid Intake Pads/Undergarments Exercises Lifestyle Rx Therapy Source: Consumer Segmentation Study (2002).

Options for Incontinence Improved Understanding Better Pharmaceuticals New Devices Novel approaches

Options for Incontinence Improved Understanding – Research Requires commitment and funding UITN Network NIH funded PFDN Network HR 4979 support these, but no funding for these initiatives

Options for Incontinence Improved Understanding – Research TRU Act -Training and Research in Urology Act of 2003 Establishes a Division of Urology at NIDDK Stimulates intra- and interagency research in incontinence Establish O’Brien Research Centers with emphasis on women’s urologic issues – incontinence and IC

Better Pharmacologic Options for Incontinence Oxybutynin 2000 Tolterodine IR, Oxybutynin ER 1998 Tolterodine ER Oxybutynin TDS 2003 Duloxetine Solifenacin Darifenacin, Trospium

Abrams P, Wein AJ. The Overactive Bladder: A Widespread but Treatable Condition. Stockholm, Sweden: Erik Sparre Medical AB;1998. Muscarinic Receptor Distribution CNS Dizziness Somnolence Cognitive deficits Iris/ciliary bodyBlurred vision Dry eyes Lacrimal gland Stomach and esophagus Colon Bladder (detrusor muscle) Constipation Dyspepsia Heart Tachycardia Salivary glands Dry mouth

Incontinence: Better devices Novel approaches Implantable stimulators Botox for the bladder Radiofrequency modification of tissues Graphics complements of Pfizer

Incontinence: Biofeedback and Electrical Stimulation

Incontinence: Urethral Devices Uromed Rochester Medical

Incontinence: Better devices Improved Surgical Devices Better conservative management Cutting edge minimally invasive procedures Graphics complements of Pfizer

The Bladder Matters Incontinence is prevalent It is very treatable Better therapies are needed More investment in research and better diagnostic tools Support is needed at every level Ask your urologist

Key Global Messages A significant health issue The importance of adding life to years Reimbursement scrutiny Women’s health issue- Education of professionals and patients Public health directives Help is available New options

The Bladder Matters! National Association for Continence BLADDER