Urinary incontinence may sound like something that only affects middle-aged men and the elderly, but this is not the case. According to a recent recommendation from the Women’s Preventive Services Initiative (WPSI), people shouldn’t wait until they develop incontinence symptoms to see a doctor; they should be proactive and take preventative measures when they are young. These new guidelines published in the Annals of Internal Medicine in September of 2018, state that women and girls should start being screened for incontinence as early as adolescence.
The guidelines are based on the theory that early intervention is key in preventing or curing the condition. However, this new theory is not backed up by direct evidence or long-term studies. So, the question remains, are early incontinence screenings necessary?
What is Incontinence?
Urinary Incontinence is classified as the involuntary or unintentional leaking of urine. It can vary from losing a few drops, to the bladder emptying completely. Urinary incontinence tends to be an embarrassing issue for most and can also lead to a lesser quality of life. Those with urinary incontinence often feel isolated from their peers because they are too worried about the possibility of an accident to participate in everyday activities. Many will be afraid to spend extended periods of time in places where a restroom is not easily accessible, like a car or the outdoors. It can also result in poor sleep during the night, which can affect one’s mood and cognitive abilities. Due to the personal nature of the issue, many people suffering from incontinence can feel embarrassed to ask questions about their condition or seek treatment.
While urinary incontinence affects men and women, it occurs more often in women. This is because life events such as childbirth, pregnancy and menopause can cause the bladder muscles to weaken, which can result in different degrees of urinary incontinence. In fact, according to the American College of Physicians, 51 percent of women will struggle with urinary incontinence in their lifetimes, and without treatment, it can lead to a decline in physical, mental and social well-being.
New Incontinence Screening Guidelines
The new guidelines suggest that every woman should begin testing for urinary incontinence on the annual basis beginning in adolescence. These screenings would be non-invasive, and in most cases would consist of a simple survey that would help doctors recognize early signs of urinary incontinence. The survey would ideally “assess whether women experience urinary incontinence and whether it affects their activities and quality of life,” says the WPSI. If the survey indicates a positive response for incontinence from a participant, the guidelines recommend further evaluation and treatment for that patient.
Despite the limited evidence the guidelines provide, According to HealthDay, these questionnaires are “fairly accurate” in identifying incontinence early on. Having an annual survey could help many previously silent women discuss their incontinence symptoms with their doctors. Early identification and treatment of incontinence could prevent the worsening of the condition and prevent the need for costly and complex treatments later on.
Criticism for New Guidelines
Annual urinary incontinence screenings are being greatly encouraged by the WPSI; however, the new guidelines are experiencing some push back from other facets of the medical community. This criticism is primarily because there is little direct evidence of this in practice. After a systematic review of the 17 studies that have been conducted in reference to these new guidelines, none have focused on how effective or potentially harmful the annual screenings are. Instead, all of the tests have only evaluated how accurate the questionnaire is in detecting early symptoms of urinary incontinence.
On this issue, Monash University’s Robin Bell and Susan Davis state, “Using an existing tool in a low-prevalence setting might result in many false-positives. As a consequence, many women without urinary incontinence might needlessly undergo a diagnostic work-up involving invasive testing.” This means that while the annual test could do a lot of good, it could also cause a lot of unnecessary harm. Due to the lack of certainty in the survey, many women without incontinence could be wrongfully diagnosed or have to go through further, more invasive testing to finally arrive at that conclusion. These tests could be uncomfortable and costly to the women who did not need them in the first place.
Additionally, many cases of incontinence are temporary and can be resolved without help from a doctor, so the intervention and further testing resulting from a positive incontinence survey may be premature and unnecessary. Bell and Davis offer a different solution to the annual screenings, which entails, “advocating a randomized trial to directly assess the benefits and harms of urinary incontinence screening in women. This trial should be designed to assess the benefit-harm balance for screening at different life stages (from adolescence to old age) and to identify high-risk groups, such as women with comorbid pelvic floor conditions, for whom the benefits of screening might outweigh the risks.”
Do the Benefits Outweigh the Potential Risks?
So, are annual screenings for urinary incontinence a good idea? Despite the potential risk of a false-diagnosis, and the lack of direct evidence involved, there is no harm in taking an annual survey. What steps are taken after the survey should be left up to the patient. Additionally, women should not feel hesitant to start a conversation with their doctors about their incontinence symptoms. The new screening guidelines were created to help patients come forward and speak openly about their condition. It is the WPSI’s hope that these annual screenings will help prevent the escalation of symptoms in some and prevent the condition altogether in others. In the end, early intervention can make a great difference in the treatment options and overall quality of life in a person suffering from urinary incontinence.