When researchers delve into the gender-specific issues of urology they discover that function definitely follows form.

Urology
Understanding urinary tract infections and incontinence

Physical Distinctions
Incontinence
Seeking Treatment
Urinary Tract Infections in Women

Physical Distinctions

The anatomy of the urogenital tract in women and men is significantly different: The female urethra (the tube that carries urine from the bladder) is five times shorter and notably wider and more pliable than men’s. Because of geography, it is also more likely to be cross-contaminated with bacteria from the intestines. These differences make women much more susceptible to infections and or damage to the urinary tract than men.

Women have a 10 to 20% chance of contracting a urinary tract infection during their life time and spend more than a billion dollars a year on treatment of acute cystitis—an inflammation of the urethra triggering pain on urination, burning and, sometimes, incontinence.

Fluctuations in female hormones also play a major role in the development of urinary tract disorders.

The urethra is lined with multiple layers of squamous epithelial cells, and the mucosa coats the folds running the length of the tube. With menopause, the mucosa becomes thinner and the urethra shortens. All this can make the system more vulnerable to infection, and can trigger bladder leakage even if there is no infection. The solution? Estrogen replacement using hormone replacement pills or estrogen cream applied topically to the area.

Legato, Gender-Specific Aspects of Human Biology for the Practicing Physician (GSAHB), Futura Publishing Co., 1997; p.117-122.

Back to top

Incontinence

The problem of incontinence is much more widespread than acknowledged generally: According to the Older Women’s League, 20 percent of college age women experience at least one episode of incontinence and older men are also affected. Throughout life, however, being female is the greatest risk factor for incontinence.

Among seven and eight year olds, bed-wetting is a problem for twice as many girls as boys--12% vs. 7% respectively. Girls are also more prone to episodes while awake than boys.

10 to 20% of women 15 to 64 years old and 2 to 5% of men 15 to 64 years old experience incontinence.

Over the age of 65, up to 40% of women and 20% of men experience the disorder. Fully half of all institutionalized elderly suffer from incontinence. In fact, incontinence is a common reason for nursing home admission.

Back to top

Seeking Treatment for Incontinence

Because of the social stigma against incontinence and a mistaken idea that it is a psychosocial not a physical problem, many men and women are reluctant to discuss it with their doctor or seek treatment. This is a shame, since much can be done today to control or cure the problem, even among the very old or infirm.

Many women will wait an average of 8 years before seeking medical care for their incontinence symptoms. These women cite embarrassment and an assumption that incontinence is a normal part of aging as the two primary reasons for the delay. They may also be somewhat comfortable using pads, as they have all their adult lives with their menstrual period, to control minor, if chronic, leakage of urine. Many women say their clinicians are dismissive and unhelpful. When they do receive treatment, a significant number of women remain unsatisfied with the results.

Although few quality-of-life studies focus on incontinent men, this population has been found to have an equally emotional response to the incontinence symptoms that frequently occur as the result of prostate cancer treatment. These men, who, unlike women, are unaccustomed to wearing pads of any sort, tend to react to pad usage with a greater degree of depression than females in the same situation and also remain dissatisfied with the results of their incontinence therapy.

Source: Urinary Tract Infections in Women (The Partnership for Women’s Health at Columbia, 1997); GSAHB, p.117-122.

Back to top