In the News

New York Daily News- Mitchell Bernstein, MD "Incontinence doesn't have to pin you down"

- Feb 22, 2004

INCONTINENCE DOESN'T HAVE TO PIN YOU DOWN

DR. ROCK POSITANONew YorkDaily News. New York, N.Y.: Feb 22, 2004. pg. 26

Full Text (524 words)

Copyright Daily News, L.P. Feb 22, 2004

Few of us can remember what it was like wearing diapers as a child. But, if you ever had to wear one as an adult, you would never forget it.

Twenty-five million Americans are affected by the loss of bladder or bowel control, yet many go untreated because of a sense of shame about discussing the matter. And there are many misconceptions about the condition, contributing to a sense of hopelessness for those who don't realize there are innovative treatments available.

Incontinence, or the loss of bladder or bowel control, can result from any number of conditions, although it's commonly assumed to be a function of aging. But aging is only part of the story.

Incontinence also can result from a problem resulting from pregnancy and vaginal childbirth. Pelvic injuries and injuries to the nerves that control the anal sphincter - as well as accidents, infections and various medications - can sometimes lead to bladder and bowel control problems.

"Incontinence is a condition that affects both men and women of all ages and people of all social classes. While those over the age of 50 are more likely to suffer from urinary incontinence, fecal incontinence affects young men and women alike," said Dr. Mitchell Bernstein, director of the Total Continence Center at Mount Sinai St. Luke's- Roosevelt Hospital.

Incontinence is a problem that often interferes with a person's social and emotional well-being. The majority of people who are incontinent tend to have a poor quality of life, have to wear adult diapers and often will stay at home whenever possible.

Fortunately, new treatments are being developed, including dietary changes, biofeedback training, sphincter exercises and simple surgical procedures to tighten the muscles.

Dietary counseling usually involves adding more fiber to the diet, while behavioral counseling requires learning to retrain some muscles or to use new muscles after damage has been done to the pelvic floor. Medication and rehabilitation can also help patients overcome their problems. Treatment often will depend on the cause of incontinence, the severity of the symptoms and the extent to which the symptoms interfere with daily life.

Surgery may be required for patients who don't respond to noninvasive approaches, especially if there's a mechanical problem. Surgery can repair the anal sphincter or restore the support of the pelvic floor.

The development of an artificial bowel sphincter is one pioneering new treatment in the field of fecal incontinence. The device can return bowel control to a patient whose sphincter muscles are absent or severely damaged.

"The use of an artificial bowel sphincter can allow patients to resume a relatively normal lifestyle," Bernstein said. "Tragically, embarrassment and a lack of knowledge about available treatments can prevent those who need it from seeking help," he said.

There is no way of knowing how many cases of incontinence go unreported, but the number may actually be much larger than is generally thought. Diapers were a solution many had to face in the past, but with new treatment, they do not have to be the solution in the future.

Dr. Rock Positano, M.S., M.P.H., D.P.M., is on the faculty and staff of the Weill Medical College of Cornell University.