Sling Provides Confidence

By Roberta Strickler

For women with stress incontinence, surgical procedure offers fix to problem some wouldn’t even confess to their best girlfriends

Embarrassment often gets in the way of remedies for stress incontinence in women. Also called “leakage” in roundabout terms, stress incontinence involves urine leaking when a person coughs, sneezes, laughs or lifts something.

“It’s a tough topic,” according to Sharee Livingston-Anderson, a gynecologist whose office is located near Lititz-based Heart of Lancaster, where she is a surgeon. “We have trouble getting the word out. “

Women don’t like to admit they have leakage, even on a questionnaire, she said. There is the matter of privacy. But more important, she said, “To women, incontinence represents aging. And aging is voodoo to a woman. It makes her feel like her body is giving up on her.”

The muscular floor of the pelvis weakens with age, and a low estrogen state (such as menopause or stages of estrus) plays a role in the weakening, she said.

Men – and some women – have a form of incontinence that comes from overload, she said. “The tube gets smaller and the bladder gets larger. That’s called urge incontinence.”

Livingston-Anderson knew at age 5 that she was destined to work with women’s health. She was alone with her grandmother, who went into a diabetic coma and died shortly thereafter.

Livingston-Anderson didn’t like that feeling of being unable to help a woman in crisis. She resolved to become a physician, went to Philadelphia College of Osteopathic Medicine and took an internship in OB/GYN at Hershey Medical Center.

She takes time to explain the options to women, who are often unwilling to communicate their embarrassment about leakage, even in writing.

Yet, she said, continual refinement of surgical materials and procedures allows physicians to create a new, more solid floor for the female bladder in a procedure that laymen often call “the sling.”

“In medical terms, a transvaginal sling is created to support the neck of the bladder, using a permanent structure of polypropylene mesh,” Livingston-Anderson said.

She calls the procedure “my sweetheart,” because it is minimally invasive surgery, usually done as an outpatient procedure to minimize costs.

A surgeon makes a tiny slit, about the width of a penny, in the groin and creates a channel “like two small tunnels along the side of the vagina” through which the mesh is inserted, she explained.

“Over time,” she said, “the mesh forms a scar and creates a new bed across the weakened tissue of the urethra.”

Kara Jones, a local gynecologist, agrees it’s important to separate other reasons for leakage before a patient can be treated. Urge incontinence, for example, is a different form of the condition in which the actual muscle of the bladder is having spasms, she explained.

Jones often recommends that patients with mild stress incontinence learn ways to improve muscle tone or try biofeedback to analyze the problem. “Why you are having the leakage determines whether treatment can be approached with medicine, with rehab or it is a surgical situation,” Jones said.

“The perimenopausal or menopausal woman gets stress incontinence,” Livingston-Anderson said. “This happens in the fifth decade of life.”

One of Livingston’s patients, “Grace,” a 55-year-old woman, who asked to remain anonymous, endured this “daily, all the time problem” for five years. She didn’t want to take medicine because she has rheumatoid arthritis. She didn’t consider herself to be “so old that I needed to use Depends.”

Grace just needed someone to talk to. “Even with girlfriends, you don’t say you are having difficulty,” she said. She avoided the subject, even ignoring it on a written new-patient questionnaire, until she finally decided to discuss the problem of leakage with Livingston-Anderson.

As soon as she heard about the surgical procedure, she signed up for it. She had very little soreness or pain and her insurance paid for the less-than-an-hour surgery at Heart of Lancaster.

Surgical procedures are getting better and better, according to Eileen Herman, a physical therapist for 24 years. She works at the Incontinence Clinic at Lancaster General’s Health Campus. “A good surgeon will give a good result,” she said.

“Even after or even before surgery, you can learn exercises that will help,” Herman said.

“We teach women how to push babies out but not how to pull back after gravity, age and menopause affect the ability of the soft tissue to close the bladder.”

The right kind of advice is important, she said. “It needs to be taught because the kind of advice you get from magazines often suggests you should practice using muscle control while you are urinating.” That is not good advice, according to Herman.

Instead, she said, women need to learn how to strengthen the base of the pelvic floor. There may be a movement dysfunction or disorder. “It is not just about muscular contraction,” Herman added.

Although age and the effect of lower estrogen are the big factors, younger women are showing stress incontinence, said Livingston-Anderson. “Where there is a high degree of smoking with a chronic cough, that person has pounded that muscle for years and it loses tone.

“Younger people who work out a lot or women with jobs that include constant standing or lifting, begin to have symptoms at an earlier age. Many weight lifters say they leak urine,” she said.

E-mail: Roberta.Strickler@yahoo.com

Originally published by Intelligencer Journal Staff.

(c) 2007 Intelligencer Journal. Provided by ProQuest Information and Learning. All rights Reserved.