STORY BY

Deborah Mann Lake

Bayport area resident Kathleen Graf was resigned to putting up with umpteen trips to the restroom.

“My bladder would start coming down, and it’s hard to be ladylike when you have to go to the bathroom and push it back up,” the 74-year-old says. “I kept saying I could live with this. My doctor finally told me, ‘But you don’t have to.’”

Urologists and uro-gynecologists have an array of treatments, including a new type of surgical “sling” and new medications, to help women who are suffering from urinary incontinence.

“Urinary incontinence can cause social isolation and depression, and no woman needs to suffer through it because we have great options both surgically and medically to offer to patients,” says Gazala Siddiqui, a uro-gynecologist at The University of Texas Medical School at Houston.

Urinary incontinence, or loss of bladder control, results in urine leakage — from a few drops to a deluge. It is twice as common in women as it is in men, affecting up to 33 percent of all women. Severe leakage affects one in 10 women, according to the American College of Obstetricians and Gynecologists.

One of the most common causes of leakage is stress urinary incontinence from prolapsed pelvic organs due to weakened pelvic muscles because of childbirth or age. Prolapsed organs, including the bladder, urethra, small intestine, rectum, uterus and vagina, can usually be surgically corrected.

‘TOT’ procedure

For decades, the standard surgical approach involved opening up the abdomen and sewing the bladder neck and urethra to the pelvic bone. Recovery took three to four days. By 1999, open surgery was being replaced by a “sling” procedure, a less-invasive, vaginal surgery in which a sling, made from a mesh material, is attached under the urethra and bladder neck.

The newest form of sling surgery, introduced in 2004, is the mid-urethral trans-obturator-tape (TOT) procedure, which uses a narrow strip of synthetic material to cradle the urethra and allow it to close more tightly. Two tiny skin incisions are made near the inner thigh and the hammock is inserted through the vagina. It is usually performed in an outpatient procedure under local, regional or general anesthesia and takes about an hour.

“TOT has no risk of bowel injury and a very small risk of bladder perforation. Urinary retention and new onset bladder spasms that can happen with other slings are also minimal,” says Siddiqui, assistant professor in the Department of Obstetrics, Gynecology and Reproductive Sciences. “It also has fewer complications than open abdominal surgery, including less time in the hospital and less pain.”

In Graf’s case, the TOT procedure was just one of five that Siddiqui performed vaginally. She also removed Graf’s uterus and ovaries, repaired a bulging rectum and bladder and repaired a prolapsed vagina.

“I just breezed through it,” Graf says about her surgery. “I’m certainly pleased with the outcome. I say ‘hallelujah’ to it. It’s taken that worry out of my life.”

Overactive bladder disorder

While surgery is used to correct stress incontinence, medications are generally used to treat another common cause of urinary incontinence, urge incontinence, which is also known as overactive bladder disorder.

“The bladder spasms for reasons we don’t totally understand,” Siddiqui says. “The bladder begins to react to stimulus such as the sound of water.” (It’s also known as “latchkey syndrome” because of the sudden, urgent need to go just as you’ve pulled your keys out to open your door.)

In mild cases, avoiding caffeine, drinking less water and cutting down on liquids three hours before bedtime can help. Medications such as diuretics taken for hypertension can make urge incontinence worse, so patients could explore switching to a different medication. Doctors sometimes prescribe kegel exercises to strengthen the pelvic muscles, giving the patient enough time to make it to the restroom. (Kegel exercises also are recommended for women after childbirth to help reduce the risk of prolapsed organs). Kegel exercises are performed by squeezing the internal support muscles—the same ones used to interrupt the flow of urine.

When simple changes aren’t enough

When those lifestyle adjustments aren’t enough to keep urinary incontinence from affecting a woman’s life, medications can be prescribed, ranging from long-time standards such as Detrol and Ditropan to newer medicines such as Vesicare, Enablex and Sanctura.

Women who do not respond well to medications may be candidates for Interstim, a pacemaker placed in the backbone to stimulate the pelvic nerves and give better bladder control.

“If a woman realizes that her incontinence is affecting her lifestyle, that’s the time to seek help. I’ve had patients who were fired from their jobs, including a security guard because she had to leave her station every 20 minutes. Another was terminated because she smelled bad,” Siddiqui says. “They just don’t need to suffer like that.”

UPDATED: 7-26-2006

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