Urinary Incontinence: Not Just a Normal Part of Women's Aging
After giving birth to five children, in her early 30s Penelope Kausal started to notice what she called "a tiny bit of leakage" when she exercised or laughed.
Kausal, like most women with urinary incontinence, didn’t tell anyone or do anything about the condition at first. "It was just a smidge then, but by the time I was in my 40s I was wearing one of those panty liners all the time. In my 50s, it was a maxi pad," she said.
Despite having worked as a medical technician for more than 40 years, Kausal had never heard of a treatment for incontinence. She asked her friends for advice. Several admitted having similar problems, but no one knew of a solution; they all assumed it was just a part of getting old.
Sandra Culbertson, MD, professor of obstetrics and gynecology at the University of Chicago Medicine, said this is one of the common myths about urinary incontinence. Even women in health care fields don’t realize there are multiple, effective treatments or that 20 to 30 percent of women experience incontinence daily or weekly at some point in their lives.
Women suffer from what’s called stress incontinence when the urethral or pelvic floor muscles are somehow weakened or damaged. Most often this occurs during childbirth, but other factors, such as diabetes, radiation treatments or pelvic surgeries like hysterectomy, also can weaken the muscles that support the pelvic organs and hold urine in the bladder. When these muscles lose strength, urine exits the bladder when a woman laughs, sneezes or exercises vigorously.
The same risk factors can lead to urethra or bladder prolapse, when the organs press against the vaginal wall or sag down into the vagina, sometimes causing complete loss of urinary control, as Kausal, now 68, experienced.
A second type of incontinence, called urge incontinence, is also common and usually affects older women. In these cases, the bladder contracts prematurely rather than stretching as it fills with urine. As a result, women experience a sudden and uncontrollable urge to urinate. Urge incontinence often is caused by neurological problems, such as Parkinson’s disease, multiple sclerosis or spinal cord injuries, but also may be caused by bladder cancers or infections. Sometimes, no clear cause can be identified.
To help women understand and overcome the incontinence, Culbertson chairs the public relations committee of the American Urogynecology Society. She holds informative talks and oversees the content of mypelvichealth.org, which explains what women can do to prevent incontinence: strengthen the pelvic floor muscles by doing Kegel exercises, avoid bladder irritants, such as caffeinated and carbonated beverages, maintain a normal weight and avoid putting pressure on the bladder through repeated heavy lifting or strained bowel movements.
Culbertson said medical centers have only recently conducted significant research and outreach about the condition, and until people are aware of the scope of the problem, women will continue to feel ashamed.
That’s why she said her nurses play a crucial role in putting patients at ease. Laura Fetzer-Vacek, NP, has worked with Culbertson for many years. "We know the diagnostic bladder tests are embarrassing for patients," Fetzer-Vacek said, "so we try to get them to relax. I remember one patient was initially so ashamed, but pretty soon she was laughing and joking that her five-year-old grandson had more bladder control than she did."
Sandra Valaitis, MD, chief of the Section of Gynecology and Reconstructive Pelvic Surgery, said the condition has a huge impact on a woman’s quality of life: "Many women with urinary incontinence feel housebound and depressed, and they lose their desire to participate in daily activities," Valaitis said. "They exercise less and gain weight, and they feel disinclined to be sexually active because they’re afraid they’ll be incontinent. Women should know that we offer simple and very effective solutions for incontinence that will help them gain control over these unpleasant conditions."
Though Kausal speaks openly and even jokes about her condition, she admitted that it changed the way she interacted with the world. After marrying and having children in Chicago, Kausal divorced in her 40s and moved to Florida to care for her ailing mother. When her mother passed away, Kausal moved in with her mourning father whose health rapidly declined. As Kausal’s incontinence worsened, the responsibility of taking care of her father made it easy to justify staying in and associating only with close friends and family.
"I became pretty reclusive," she admitted. "I used to be quite active, but as things got worse I even quit walking very far. I wouldn’t even think about going dancing. I didn’t try to meet a new partner or even new friends because I didn’t want them to have to deal with my condition."
By the time she’d reached her 60s, Kausal’s incontinence had gotten so bad she needed to wear diapers. At that point, she started researching online and learned about some of the treatments at the University of Chicago.
In the past 10 years, there have been vast improvements in surgical treatments. For urge incontinence, surgeons can inject a muscle relaxant, such as Botox, into the bladder or use neurostimulation to help regulate the neurological signals that control the bladder’s contraction. The least invasive surgical treatment for stress incontinence involves injecting a bulking agent like collagen into the urethra, which prevents incontinence for several years. The most common and durable treatment, with an 85 percent success rate, is a minimally invasive urethral sling surgery. The sling is about an inch wide and six inches long and provides a backboard of support that helps keep the urethra shut.
Gregory Bales, MD, associate professor of surgery at the University of Chicago Medicine, has performed more than 900 sling surgeries. "It can be done in as little as 25 minutes, and it’s an outpatient procedure so patients can go right home and resume 95 percent of their normal activities within a week," he said. "It’s a very quick recovery."
In June, Kausal stayed with her daughter in Munster, Indiana, and had a consultation with Bales. "Dr. Bales explained how my bladder could be surgically restored to its proper position and supported with a sling. I said, ‘Great! Let’s do this!’" Kausal said.
In late June, Bales preformed Kausal's surgery at the University of Chicago medical center. "The nurses, the anesthesiologist, everyone was so kind, helpful and funny. They were completely reassuring," Kausal said.
Three weeks after surgery, Kausal said she had more energy than she’d had in years, and she is now walking almost a mile every day. She gushed that she’d do anything to get the word out about the treatment. "I just feel so much more comfortable going about routine activities and being in public. Who knows, maybe now I’ll even meet me a man!"