Nocturnal Enuresis And Overactive Bladder In The Female Veteran Population
- Female Pelvic Medicine & Reconstructive Surgery
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What does that mean?
Incontinence And Mental Health
So, back to the chicken and egg question. Both anxiety and depression have been found in many patients with incontinence. But was the incontinence caused by the mental health problems or did the mental health problems cause the incontinence?
It turns out its a two way street when it comes to anxiety and urinary incontinence. Anxiety and incontinence interact and exacerbate each other. And, anxiety is a risk factor for developing incontinence.
The same appears to be true with other mental health issues, like depression, which is also a risk factor for developing incontinence. Several studies have linked depression to urinary incontinence in women especially. And, people with pelvic floor disorders are three times more likely to experience depression than the general population.
Anxiety even rears its head when you start talking about overactive bladder. According to one study, 48% of patients with overactive bladder exhibit anxiety symptoms. Plus, according to the same study, about 24% of OAB patients have moderate to severe anxiety.
While anxiety and incontinence dont have to go together, its easy to see how incontinence can cause anxiety maybe even more anxiety than you started with.
Gerd Secondary To Ptsd
GERD Secondary to PTSD
Medical research supports a connection between GERD and PTSD.
Both veteran and non-veteran studies have reported high rates of comorbidity between PTSD, Depression, and Gastrointestinal symptoms.
A 2013 study of veterans who deployed to Iraq and Afghanistan found that nearly 45% of patients screened positive for PTSD and 23% screened positive for depression symptoms.
While only 11% of patients reported GI symptoms, 73.4% of these patients had a positive screen for PTSD, indicative of a significant relationship.
Many veterans with GERD or acid reflux, especially those who were diagnosed long after leaving the military are eligible under the law for GERD secondary to PTSD.
For example, if veterans are taking SSRIs to help manage their PTSD symptoms, perhaps youre suffering from side effects of those SSRI medications, which can lead to digestive system issues.
Thus, veterans can connect GERD as a secondary condition to PTSD.
Service connection on a secondary basis requires a showing of causation.
A showing of causation requires that the secondary disability be shown to be proximately due to or proximately aggravated by another service-connected disability.
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How To Establish Service Connection Secondary To Ptsd
In accordance with 38 CFR § 3.310 disabilities that are proximately due to, or aggravated by, service-connected disease or injury, a current disability condition, which is proximately due to or the result of a service-connected disease or injury shall be service connected.
Service connection on a secondary basis requires a showing of causation.
A showing of causation requires that the secondary disability claim be shown to be proximately due to or aggravated by another service-connected disability.
There are three evidentiary elements that must be satisfied for secondary conditions to PTSD to prove service connection under the law:
- A medical diagnosis of the secondary disability condition youre attempting to link to PTSD AND
- A current service-connected primary disability AND
- Medical nexus evidence establishing a connection between the service-connected PTSD and the current disability youre trying to connect
The first part can be satisfied with any existing medical evidence in service treatment records, VA medical records, or any private medical records.
The second part can be satisfied with a veterans existing service-connected disability rated at 0 percent or higher, which in this case, is PTSD.
The third part, and often the missing link needed to establish secondary service connection, can be satisfied with a credible Medical Nexus Letter from a qualified medical provider.
Truth bomb here veterans
How Aeroflow Urology Can Help You
Whether you or your loved one needs bladder control pads, underpads , or protective underwear, Aeroflow Urology can assist with receiving incontinence products through your insurance.
This can help relieve some of the incontinence’s financial stress, make accidents easier to manage, and bring back a better quality of life.
Once you find the right incontinence products for your needs, returning to your routine can be more achievable. This can also alleviate stress and give confidence to the individual in knowing that they are protected and covered if an accident occurs.
To see if you or a loved one can qualify for free incontinence products, simply fill out our form.
Once approved, one of our Continence Care Specialists will reach out to you to answer questions, fill out the necessary paperwork, and send you free product samples.
After youve chosen your supplies, theyll be sent directly to your home in discreet packaging every month.
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Influence Of Childhood Traumatic History Anxiety And Depression On Perceived Stress Levels
Stress levels may be influenced by psychosocial factors such as childhood traumatic events, anxiety and depression. These factors were assessed using the childhood traumatic event scale and the hospital anxiety and depression scale , respectively . OAB patients with a childhood history of sexual trauma or physical trauma reported higher stress levels on the PSS compared to OAB patients without such a history . OAB patients with higher anxiety scores had higher stress levels than those with lower anxiety scores , PSS of 23.1±1.3 versus 11.9±1.1, p< 0.0001. OAB patients with higher depression scores had higher stress levels than those with lower depression scores , PSS of 22.9±1.2 versus 15.1±1.4, p=0.014.
When Should I Contact My Healthcare Provider About Neurogenic Bladder
If you have any type of nervous system disorder, chances are that your healthcare provider will already know to address the issue of neurogenic bladder. Still, its important to be honest with your provider about the issues you face. Make sure you speak to your provider if you have new or worsening concerns, including things that might indicate infection like pain or fever.
A note from Cleveland Clinic
Neurogenic bladder can be managed, even though it cant be treated. Methods for dealing with neurogenic bladder dysfunction are being refined. You can help by following the suggestions that you get from your healthcare provider about lifestyle changes and nutritional choices. Maintaining a healthy weight can help with urinary incontinence.
Last reviewed by a Cleveland Clinic medical professional on 02/15/2022.
References
Cleveland Clinic is a non-profit academic medical center. Advertising on our site helps support our mission. We do not endorse non-Cleveland Clinic products or services.Policy
Cleveland Clinic is a non-profit academic medical center. Advertising on our site helps support our mission. We do not endorse non-Cleveland Clinic products or services.Policy
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What You Can Do
Its easy for someone on the outside to say just dont worry, right? However, this is definitely one of those things thats easier said than done. If you have significant anxiety or depression, please give your doctor a call. For the more common daily stressors in all of our lives, there are things you can do to help you worry less and hopefully decrease leaks too.
One option is to use absorbent products, so that the only person that knows you leaked is you. NAFC recently conducted a study that found that those who felt positively about wearing absorbent products said it was because it made them feel more protected and in control. And who doesnt want to feel more in control? Plus, Lily Bird can help take the stress out of going to the store by delivering pads and disposable underwear straight to your door.
Dont forget about trying pilates to doing Kegels or making dietary changes to see if that helps with incontinence or stress, too. Whether your stress is a symptom or a cause, getting it under control can help no matter what situation youre in.
~Written by Lily Bird, a proud Trusted Partner of NAFC
What Is Urinary Incontinence
Urinary incontinence is the failure to control ones bladder. You might experience urine leakage triggered by a physical action like coughing or sneezing. You might also leak a little while waiting to use the bathroom or driving over bumps in the road. These are all symptoms of urinary incontinence.
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Urinary Incontinence Secondary Claim
Hello everyone,
Ive had an issue urinating since 2013, when I urinate I zip up and walk away and by the time I get to wash my hands I have leaked down my leg. It doesnt matter how long I stand at the toilet it happens every time. I had to start wearing absorbent pads and I change these out 4-5 times a day. The thing I have always noticed with this is being driven by anxiety when my anxiety is really bad the amount of leakage is way worse. I also have anxiety issues starting to urinate if Im in a public restroom I cant go if Im standing next to some one. I have been complaining about this to the va for years and nothing, well I got a new primary care doctor and she has set me up with a urologist outside the va I live in a small town.
The big question is trying to get this service connected, do I try to link this to my PTSD or TBI I have read it could be caused by either. If the urologist is willing to diagnose me with urinary incontinence, can he also link this to ptsd or Tbi?
Department Of Veterans Affairs
St. Petersburg Regional Office Rating Decision: 05/22/15INTRODUCTION
The records reflect that you are a veteran of the Vietnam Era. You served in the Army from April 4, 1968 to March 30, 1970. The Board of Veterans Appeals made their decision on your appeal on May 14, 2015. We have implemented their decision based on the evidence listed below.
1.Service connection for residuals of cerebral vascular accident to include bowel incontinence is granted with an evaluation of 100 percent effective March 10, 2012.2.Service connection for loss of use of both legs is granted with an evaluation of 100 percent effective March 10, 2012.3.Service connection for loss of use of the left upper extremity is granted with an evaluation of 70 percent effective March 10, 2012.4.Service connection for urinary incontinence is granted with an evaluation of 60 percent effective March 10, 2012.5.Entitlement to special monthly compensation based on the need for aid and attendance at a higher level is granted from March 10, 2012.6.Entitlement to automobile or other conveyance and adaptive equipment is established.7.Entitlement to specially adapted housing is established.
EVIDENCE2. Service connection for loss of use of both legs.3. Service connection for loss of use of the left upper extremity as secondary to the service connected disability of residuals of cerebral vasculatr accident. 5. Entitlement to special monthly compensation based on the need for aid and attendance at a higher level
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Is Stress Contributing To Your Incontinence
As you may already know, incontinence is really common. Approximately 15 million American women deal with urinary incontinence. And about 24% of women over 40 have experienced fecal incontinence at least once in the past year, too.
But, just because incontinence is common doesnt take away the embarrassment. The sheer thought of an unexpected leak is stressful. Plus, research shows that stress and incontinence are closely intertwined. But do stress, anxiety, and other mental health issues cause incontinence? Or does incontinence negatively impact our mental health? With 1 in 5 American adults, or 43.8 million people, experiencing mental health issues every year, you just might want to stick around to find out.
Va Disability Benefits For Urinary Stress Incontinence
What Is Urinary Stress Incontinence?
Urinary stress incontinence is the unintentional loss of urine. Stress incontinence occurs when physical movement or activity puts pressure on the bladder, causing it to leak urine. Stress incontinence is not related to psychological stress.
Some of the most common symptoms associated with urinary stress incontinence involve leaking urine when you:
- Cough or sneeze
- Have intercourse
- Lift something heavy
Individuals with urinary stress incontinence may not leak urine every time they engage in one of these activities, but any activity that increases the pressure placed on the bladder can make them more likely to have unintentional urine loss. Due to the stigma and embarrassment surrounding conditions that cause urinary incontinence, those with urinary stress incontinence may feel the need to isolate themselves and avoid social gatherings, work, and other physical or leisure activities. However, with treatment some individuals who suffer from urinary stress incontinence are able to manage their symptoms and improve their overall quality of life.
Getting Service Connection For Urinary Stress Incontinence
How The VA Rates Urinary Stress Incontinence
Under 38 CFR § 4.115a, the VA rates dysfunctions of the genitourinary system. Among these rating criteria includes a rating schedule for voiding dysfunction, which the VA uses to evaluate conditions like urinary stress incontinence.
Help With Your Urinary Stress Incontinence Claim
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How Common Is Neurogenic Bladder
Neurogenic bladder dysfunction is very common among people with spinal cord injuries, affecting more than 90% of them. About 95% of people with spina bifida have neurogenic bladder dysfunction. The condition also affects 50% to 80% of people who have multiple sclerosis. Neurogenic bladder affects people with stroke and Parkinsons disease and many other types of nervous system conditions. Conditions that damage nerves like advanced diabetes can also cause neurogenic bladder.
Center For Research On Women With Disabilities
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There are three main types of urinary incontinence:
- Stress incontinence: A bladder control problem that causes a leaking of urine during activities that stress the bladder
- Urge Incontinence: Another bladder control problem that is a loss of urine after a sudden, strong urge to urinate. You may hear this called overactive bladder on medication commercials.
- Mixed Incontinence: symptoms of both urge and stress incontinence.
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Ptsd Increases Risk For Sexual And Urinary Problems
Post-traumatic stress disorder is categorized as a mental health problem, but it can also produce a range of physical symptoms. UCSF urologist Benjamin Breyer, MD, and his research team have found that in Iraq and Afghanistan war veterans, these physical effects can include sexual dysfunction and, to a lesser extent, urinary tract symptoms.
Sexual and urinary problems remain stigmatized issues in our society, so they havent been well studied, said Breyer. Addressing these issues can significantly improve a patients quality of life.
PTSD and sexual dysfunction
Prior investigations by other researchers had found an association with trauma-related mental illness, including PTSD, and sexual difficulties, but Breyers is the largest study of this kind to date. Breyer and his research team, which included PTSD experts Karen Seal, MD, Raymond Rosen, PhD, and Thomas Neylan, MD, conducted a retrospective record review of 406,275 male Iraq and Afghanistan veterans who received health care through the Department of Veterans Affairs from 2001 to 2009. Over half of the vets from these deployments who have enrolled for VA healthcare have received mental health diagnoses, with PTSD being the most common.
When we looked at the data and factored out other conditions that could contribute to sexual difficulties, such as medical and substance abuse problems, we found that PTSD resulted in a three-fold increase in a veterans risk for sexual problems, said Breyer.
How Va Rates Urinary Incontinence
All urinary conditions, including urinary incontinence, that cannot be rated as urinary frequency or obstructed voiding, are rated according to the voiding dysfunction urinary rating system. VA rates urinary incontinence as follows:
- 60% requires the use of a catheter or other urinary assistive appliance to remove urine from the bladder, or the use of absorbent materials that must be changed more than 4 times per day
- 40% requires the use of absorbent materials that must be changed 2-4 times per day
- 20% requires the use of absorbent materials that must be changed only once a day
These disability ratings are significant considering they are likely being combined with disability ratings related to the veterans primary condition .
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Do Pelvic Floor Exercises
If youre managing incontinence, pelvic floor therapy or pelvic floor exercises will help you gain strength in your pelvic floor muscles, which can improve incontinence symptoms.
You can do these exercises in the comfort of your own home or with a group or therapist. Exercise can also help by lessening anxiety and stress and increasing the hormones that make you happy.
Female Veterans And Urinary Incontinence
Just of the Journal of Obstetrics and Gynecology, evidence points to post-traumatic stress disorder among female military veterans as a cause of urinary incontinence. 968 women ages 20-52 completed surveys addressing gynecologic, medical, and mental health. 19.7% of the women reported urgency/mixed urinary incontinence , and 18.9% reported symptoms of stress UI. PTSD was associated with urinary urgency or mixed UI, but not with stress incontinence. Symptoms of depression did not correlate with stress or urgency/mixed incontinence. The authors concluded that for a female veteran having symptoms of urge or mixed UI, there is an increased likelihood that she also suffers from PTSD and an associated poorer mental health/quality of life. The authors also state that increased research is needed to better understand the neurobiology of continence.
A report in the Journal of Psychiatric Research suggests that women who have served in the military need to be screened for PTSD and prior trauma or stress events, as regular duty and reservist personnel serving in Canada were found to commonly deal with symptoms of PTSD. Other issues found to be clinically significant for female veterans include depression, sleep difficulties, and chronic pain. In 135 patients studied by Kelly et al. and reported in the journal Research in Nursing and Health, military sexual trauma is reported by 20-40% of female veterans.
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