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Women Don't Have to Live With Stress Incontinence

Posted on: Tuesday, 26 April 2005, 15:00 CDT

It was raining when speed-skater Bonnie Blair recently pulled into a Target parking lot with her two young children. Holding onto the kids, she ran from the car to the store entrance and arrived with her pants dry - at least on the inside. This was a major triumph for Blair, 41, who has five Olympic gold medals and had held the title of world sprint champion.

From 1998 until 2003, Blair could hardly run at all without leaking urine, because of a condition known as stress urinary incontinence. She stopped skipping rope. She modified her workouts. On daily runs, she'd keep to country roads so she could dart into bushes and empty her bladder to avoid soaked shorts.

She couldn't even hit a golf ball, pick up a laundry basket or carry her little ones without dribbling.

"I used to limit my intake of fluids if I went on a long run," she said at a recent interview at Teaneck's Marriott Glenpointe hotel, where she later spoke to women about SUI and the surgical treatment that cured her. "Now, was that real smart?" she said. "No, but I'd have fewer accidents."

SUI is the loss of urine when coughing, sneezing, laughing, exercising, lifting or making any other movement that puts stress on the bladder. One in three women between 30 and 59 can expect to experience this or another form of incontinence, but SUI is the most common kind in women.

"It all has to do with pressure," said Dr. Patrick Ciccone of the Urology Society of New Jersey. "The continence mechanism is designed so that until the bladder reaches a certain pressure it won't have leakage. With SUI, that amount of pressure gets lower and lower" as pelvic muscles supporting the bladder and urethra get damaged or weakened.

Medical experts say SUI is increasing among younger patients. That's partly because of unhealthy factors such as obesity. Mostly, though, it's because active, healthy women are putting more pressure than ever on their pelvic muscles, said Dr. Sam Hessami, a urogynecologist with Urology Specialty Care, Fair Lawn.

Women who lift weights or do other strenuous activities are at greater risk for SUI, he said, citing a recent study of female paratroopers. And women are carrying heavier babies through pregnancy.

"Babies are bigger now than they were 50 years ago," said Hessami, "and more babies are born at term. But the size of a woman's pelvis has remained the same." Widespread use of epidural anesthesia during childbirth also can lead to damaged muscles because women can't push effectively.

Younger women usually are too embarrassed to admit they have a problem.

"You'll see a woman impeccably dressed, in her 40s or 50s, come to see you for a different reason, and when you question her you find out she has this," said Ciccone. "She'd wear napkins and have to know where every bathroom in the world was to keep her bladder empty." In fact, surveys show that women are buying more sanitary pads for incontinence than for menstruation.

Blair said her unusually firm muscle tone may have contributed to her problem. "I had a rough delivery with my first baby," she said, "and that may have been because my muscles were so tight."

At first, Blair tried techniques such as physical therapy and biofeedback. But after her second baby, with the condition no better, Blair decided to have a procedure where a surgeon inserts a supportive mesh sling under the urethra, allowing it to remain closed when appropriate. Ciccone performs six to eight of these procedures every month, and they are covered by insurance.

"It takes 15 to 30 minutes and you'll never believe how dramatic it is for a lady to come back and she can cough, laugh, dance - and she's dry," said Ciccone, who has an office in Belleville. "They're the most thankful patients we have in our practice."

Blair had the surgery in a Milwaukee hospital in December 2003 and hasn't had any leakage since.

Hessami said the procedure has an 86 percent success rate, with 93 percent of patients reporting at least some improvement. Those who don't, he said, likely were poor candidates for the surgery. Women with different forms of incontinence or certain physical or neurological conditions, as well as elderly women who are not medically stable, aren't good candidates.

Other treatment options for incontinence include medication, pelvic-floor exercises, electrical stimulation, biofeedback and frequently emptying the bladder (instead of restricting fluid intake, which can lead to constipation - another risk factor for SUI). These options are recommended in milder cases and for women who cannot have the surgery, such as those planning to get pregnant.

Blair, who now limits her skating to sessions with her kids, was back to weightlifting and running - even trampoline-jumping - within weeks after getting the sling implanted. Her golf game, she joked, has gotten no better since the surgery, but she can swing a club without leaking urine.

"People don't die of urinary incontinence," said Hessami. "But it's a quality-of-life issue, and that's very important, too."

Blair is touring the country urging women to confide in their ob/ gyns or internists, so they can be referred to a urologist for treatment.

"I hope women will look at me and realize if this can happen to an Olympic athlete, it could happen to anybody," said Blair. "I found a way to fix it, and it put a smile back on my face."

* *

(SIDEBAR, page F01)

It's not part of the aging process

* Of some 13 million Americans affected by urinary incontinence, 85 percent are women.

* The majority of patients begin to experience involuntary loss of urine between the ages of 30 and 50. Bladder leakage is not a natural part of aging but a medical condition.

* Stress urinary incontinence (SUI) is the most common form of urinary incontinence and the most likely to affect women. It can happen because of anatomical problems or muscle damage. Women are more susceptible because of their physiology, but men can develop it after removal of the prostate.

* Other forms of incontinence include urge (also called overactive bladder) - an abrupt, uncontrollable need to discharge caused by a disconnect between the brain and nerve endings; mixed - a combination of stress and urge incontinence; and overflow - the loss of urine from an overfilled, paralyzed bladder.

* One in four women over age 18 has experienced an episode of SUI.

* Most women with SUI endure it for three to 10 years before seeking medical help.

* Managing and treating incontinence costs $17.5 billion per year.

Sources: National Association for Continence; Dr. Sam Hessami; U.S. Department of Health and Human Services

E-mail: leichman@northjersey.com

Source: Record, The; Bergen County, N.J.

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