Dr. Corso's med blog: Dying of Embarrassment

Monday, March 19, 2007

Dying of Embarrassment

I was asked to write about some of the embarrassing medical conditions that women may conceal from their physicians, things like facial hair, body odors, etc. Having done this job for 20 year I’ve heard it all from bad breath to old tattoos.

But the one issue I definitely want to put forward, because it’s proven to be more than embarrassing, is the often-mortifying experience of urinary incontinence. Over 20 million American women (and several million men as well) silently suffer from this health issue! Many lay people are already aware of the problem of leakage after childbirth or surgical trauma to the pelvis. The woman with this problem (stress incontinence) must be careful every time she laughs, coughs or sneezes for fear of a bit of urine getting away. However, this only constitutes about one fifth of the problem. A different form (urge incontinence) affects over 15 million ladies and can cause the untimely emptying of the entire bladder!

The cause is neurological and progressive, beginning with a sense of urgency to find a bathroom and progressing to a complete inability to hold back the voiding reflex. Sleep can be terribly disrupted and depression is common. Many of these patients become withdrawn and isolated and the death rate soars from a variety of medical and social dysfunctions. And the terrible truth is this: urge incontinence is the easiest of all to treat. They say that nobody ever died of embarrassment, but they're wrong. Lonely, isolated women do so every day, it's just a long, slow process.

The problem is believed to be the loss of the inhibitory signal (part of the sympathetic autonomic nervous system) that descends automatically from the brain to the bladder, to keep it from emptying on its own. We all take this inhibition for granted even though it was something we had to develop during our potty-training years. Patients with spinal chord injuries rediscover that the bladder is happy to fill and empty on its own if it can no longer talk to the brain.

Treatment goes after both legs of the problem, the psychological/social and also the medical. Often these patients have developed neurotic habits around going to the bathroom, knowing the location of every place-to-pee in their world, or habitually going to the restroom every half hour or so to avoid getting to the point of feeling any urgency. Medication helps to restore the balance between the sympathetic and parasympathetic arms of the autonomic system and is remarkably effective in many cases. If you or someone you know is concealing a urinary incontinence problem, get to your doctor today. Surgery is seldom needed and relief may just be a simple medicine away.


Anonymous Anonymous said...

Previously working for this doctor, I can say that his insight and the excellent care that this doctor takes of his patient, this is someone to feel comfortable with, he is genuine and his bedside manner is appropriate, professional and something that we need more of in our community. I am proud of him for getting out there and sharing. If I ever get these three kids under control, I would eagerly look forward to working with him again.

11:03 PM  
Anonymous Anonymous said...

Working with John as a physician was excellent. If there were more like him, maybe women would feel more comfortable talking about this with their doctors. He is competent, genuine, personable and gets the job done.

Some day, when I get these three kids going to their lives, I would look forward to working with someone like Dr. Corso again.

11:08 PM  

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