In “Managing urinary incontinence: an expanding role for Ob/Gyns” [December], Alan Garely, MD, tells us of the millions and millions of women who suffer from incontinence. I am 69 years old and have been in practice in the same place for 36 years. Most of my patients are more than 40 years old. I have asked every patient in my care for the past 20+ years whether she is incontinent. The majority say no.
After I read the article, I decided to keep a list of the patients I saw. Of 32 women, 25 had no complaints of incontinence, and the remaining 7 had insignificant incontinence. Granted, this may not be an entirely valid sample, but is the estimate of “more than 20 million American women who suffer from some form of urinary incontinence” reproducible using strict scientific methods? Furthermore, nothing positive comes from denigrating ourselves for not curing incontinence that is either minor or misdiagnosed.
James Honig, MD
DR. Garely responds:
Dr. Honig makes some good points. He questions the estimate of 20 million urinary incontinence sufferers in the U.S. I, too, find myself questioning this number and am not really sure if it encompasses women who have had only 1 episode or who are always incontinent.
However, according to the census bureau, there are approximately 41 million women over 50. In Dr. Honig’s small sample size, 22% suffered from some form of incontinence. Apply this percentage to all women over 50, and there would be roughly 10 million women with complaints of incontinence. If we include women of all ages, this number could easily reach 15 million. No, I don’t think “strict scientific methods” were used, but somebody out there is buying close to $2 billion worth of overactive bladder drugs and spending countless billions on adult diapers.
The bottom line: Urinary leakage is embarrassing. Experience has shown us if you don’t ask, patients may not tell. My goal was simply to help gynecologists develop a strategy that would be easy to apply to their practices.