Women have bladder control options

By Anita Srikameswaran
Pittsburgh Post-Gazette
With gold medals from several Olympics to her credit, former speed skater Bonnie Blair knows better than most what her body is capable of doing.

So she was startled when she went for a run a couple of months after her first child was born, in 1998, and, within blocks of her house, lost bladder control, soaking her shorts.

Did I drink too much this morning? Blair thought. Didn’t I go to the bathroom before I left?

Figuring it was a fluke, she decided to run the next day, after being careful to drink minimally and empty her bladder well.

“The exact same thing happened again,” Blair recalled. “I’m frustrated, disheartened, (and) thinking, ‘Is this what happens when you have a kid? Why did nobody tell me?’ ”

At the time, she was 34 years old. Now 43, she has learned a lot about stress urinary incontinence. She is the spokeswoman for a national public education campaign – sponsored by ETHICON Women’s Health & Urology, the maker of a mesh used in incontinence surgery – called “What’s Happening Down There? Breaking the Ice about SUI.”

It took a while before Blair of Milwaukee said anything about her difficulties to her husband, to her sister, who is a health care professional who lived nearby, or to her doctor.

She worked out her inner thigh muscles, unaware that they were not the weak link causing her incontinence.

Actually, it was her pelvic floor muscles that needed strengthening. Stress incontinence occurs because those muscles do not keep the urethra in the correct position, causing urine to leak when coughing, sneezing, laughing, exercising or doing other activities that pressure the bladder.

Childbirth is “one of the significant risk factors for urinary incontinence,” said Dr. Halina Zyczynski, director of the urogynecology division at Magee-Womens Hospital in Pittsburgh.

A common reversible cause of the condition is obesity and, particularly in elderly women, painless urinary tract infections, which also can impair bladder control, she added.

Blair told her doctor about her symptoms at an annual exam, many months after the symptoms began.

“Most women won’t talk to a doctor (about it) for three to 10 years,” she noted. “So me going to my doctor within a year, I was way ahead of the game.”

She tried strengthening her pelvic floor muscles with Kegel exercises, a physical therapy program, and biofeedback. Such strategies can be effective for women who have mild to moderate incontinence.

After Blair had her second child and was certain she had completed her family, her doctor suggested a surgical approach, one that isn’t done if a woman hasn’t finished childbearing.

She has been free of symptoms since 2003 when she had the “sling” procedure, in which polypropylene mesh is positioned under the urethra to support it. It takes about 20 minutes, and patients go home soon afterward.

“The satisfaction rate is very, very high for what has become a very minimal intervention,” Zyczynski said.

She was part of a research team that determined two-thirds of study participants who had the sling procedure were still “dry,” as she put it, two years later. The findings were published last month in the New England Journal of Medicine.

That study was strict about who met the criteria for a cure, Zyczynski said.

“We had some very, very infrequent leakage that occurred in some women, which defined them as failures,” she explained. “Still, in terms of functionality (and) quality of life, they were quite happy.”

Studies indicate that stress incontinence affects about half of elderly women living in nursing homes, one-third of elderly women living in the community and 15 percent of younger women. Some women curtail activities and become almost social recluses, fearing they will smell bad or embarrass themselves.

“As we get older, more of us leak,” Zyczynski said. “But we don’t have to, and we don’t have to live with it.”