Babies aren't the only ones - 30 million American adults wear diapers. But it's no laughing matter.
Incontinence affects one out of three Americans over the age of 60 and costs $17 billion every year to treat.
Researchers in the University Medical Center's Urology Department are working to understand the probable causes and treatments of the disorder.
Properly defined, urinary incontinence is the uncontrollable urine loss of a sufficient magnitude to comprise a hygienic problem for the sufferer.
Dr. William Steers, chairman of the Urology Department, co-authored the results of a new study published this summer, which says that low levels of serotonin, a brain chemical, may be the reason behind this often embarrassing and restricting problem.
Urinary incontinence exists in three forms, categorized by their causes: stress incontinence, which is attributed to obesity and physical exertion; urge incontinence, which is characterized by an overactive bladder; and mixed stress/urge, which has symptoms of both types. Steer's team's research focused on the urge variety, revealing that 60 percent of those patients had a history of depression.
It already was known that low serotonin levels were connected to depression. In his initial study, Steers examined the urinary habits of animals that were depressed as a result of low serotonin. He concluded that the depressed animals tended to have a higher frequency and lower quantity of urination. As a result, he suspected there would be an increased prevalence of depression in incontinent patients, based on the observations of these lab animals.
So it was no surprise when Steers saw the number of incontinent patients with depression "going off the charts." The research team of Steers, Dr. Mikel Gray and Dr. Howard Montgomery, at the University Urology Department and Burkhart Zorns at the Walter Reed Army Medical Center looked further into this link between depression and incontinence.
Gray tested patients for incontinence by performing urodynamics tests. Patients would attempt to fill their bladders until they were caused to urinate. He said, "Those with urinary incontinence would contract their bladders prematurely," and thus urinate sooner than continent patients.
Zorns, director of Urodynamics and Reconstruction at the Walter Reed Army Medical Center compiled the research done by Steers and Gray. From the human study, he noted that the presence of depression was associated with chemical changes in the brain. Zorns concluded, "The bottom line is that those patients who had a history of depression had a higher incidence of urinary abnormalities."
Although depression and urinary incontinence are linked through low serotonin, the researchers emphasized they did not find evidence to prove that depression caused incontinence.
"We're doing research to answer the question, 'Is serotonin the culprit?'" Steers said. "We're not saying that depression causes this. That is the key."
It was a long-thought myth that depression caused urinary incontinence. Gray said if that were a fact, his tests would have shown patients evenly spread out over the three types of incontinence. The researchers instead found that depressed individuals suffered from urge incontinence. This led them to conclude that depression might cause only a certain type of incontinence.
Incontinence also was believed to be a side effect that would subside when the depression did; taking antidepressants would curb depression and thus incontinence. The team's research, though, had proof to support that both disorders were independent of each other. The team believes patients with incontinence could take antidepressants just to control it.
"The hope is that we can link it to serotonin," Steers said. "Someday we can give patients a blood test, say that serotonin is the culprit and say, 'Oh, here's a drug for serotonin that can help them with their incontinence.'"
In the future, the team hopes to find a drug or treatment that will combat incontinence, since current treatments are ineffective. Steers said patients wait an average of eight years before seeking medical attention for incontinence.
"They don't go out because they're embarrassed," he said "They go through eight diapers a day. It's a social problem."
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