She’s afraid she smells like a wet diaper and it is rapidly getting to the point where she stays home whenever possible. Her golf clubs are in the corner of the garage, and she hasn’t accepted a lunch date in weeks. Having been active all of her 57 years, this "problem" has her depressed and perplexed.

Like many other women who have crossed the threshold into their middle years, it does not occur to Patricia that there might be a medical remedy for her problem. More than 10 million women in this country suffer from incontinence and most wait an average of 5 years before they finally get up enough nerve to do something about it.

Fortunately, the information age is helping to change that scenario. Personal incontinence products crowd the grocer’s and drug store shelves, and constitute a $10.3 billion business today. Everyone is talking about this formerly taboo subject -- in magazine ads and articles, and even on TV.

So, with all this information out there, why don’t women do something about this "problem?"

According to gynecologist Randy A. Birken, M.D., "One of the reasons could be that they fear extensive bladder repair surgery or can’t take time off from work for a lengthy recovery. a friend’s story about months of exercise therapy that didn’t work may provide the rationale for doing nothing," he suggested. "But, for some women, the reason they suffer in silence is that they simply do not feel comfortable talking to their doctor about ‘it.’ I know women are reluctant to bring up the topic of incontinence because they are too embarrassed, or because they believe it just goes with the territory of getting older and believe there’s nothing to be done about it."

Incontinence may not be something we feel comfortable talking about but it is a condition that can put life on hold for millions of people in this country.

Many women believe that incontinence -- the unexpected loss of urine -- is just something to live with; simply a consequence of childbearing and getting older, so they plan their lives around the distance to the nearest bathroom, or wear "protection" to prevent embarrassing leaks.

Simply stated, the term incontinence means passing body wastes involuntarily, and is generally used to refer to the inappropriate release of urine. It is not a disease, but rather a symptom with many potential causes. It may be the result of a birth defect, injury, disease or the predictable physical changes that occur after childbirth or with age, and there are a number of different kinds of incontinence:

Stress incontinence refers to leakage of small amounts of urine when a person coughs or sneezes or does something to cause abdominal pressure to exceed the bladder’s closure mechanism. In this case, the stress has nothing to do with the psychological pressures of daily living but refers instead to the lack of anatomic support for the bladder neck making the bladder opening susceptible to sudden pressure.

Urge incontinence refers to a particularly compelling desire to urinate and the inability to delay the process long enough to get to a bathroom. The tell-tale trail of puddle can cause excruciating embarrassment.

Overflow incontinence is the leakage of small amounts of urine without the urge to void and the inability to urinate normal amounts. The small amount of urine that exceeds the bladder’s capacity simply runs off, but the bladder remains full. This condition, left untreated, may ultimately lead to damage in the urinary system.

Normally, a person’s kidneys produce about a quart of urine each day. In adults, the bladder will hold eight to ten ounces before the brain gets a signal that it is time to release the urine. Unless there is some problem, the brain can consider several options: it is either convenient and appropriate to locate a toilet at that moment, or to make some plans to do so as soon as possible. When the option of postponing a trip to the bathroom is always out of the question, or when a person regularly has "accidents,." day and night, past the age of three years, he or she may be considered incontinent.

"Urinary incontinence is not only a physical problem, " Birken explained, "but it takes an emotional toll, as well. The condition can be so embarrassing that it interferes with the enjoyment of a normal, productive life. Sufferers tend to drop out, becoming more and more isolated from their friends and family, foregoing activities they enjoy because they are afraid they will have an accident, or that odors will offend others."

Traditionally, incontinence has been treated with medication, specialized exercises, or -- in more severe cases -- by surgery. Today, there is a relatively new, minimally invasive, laparoscopic procedure that has demonstrated good results (92 percent) in correcting stress incontinence.

"I think this is a very real alternative for women who may not have considered any other method of treatment," said Randy Birken, M.D. "Stress incontinence is uncomfortable and potentially embarrassing, but it is certainly not life-threatening, so for many people, the prospect of a long recovery period or undergoing a series of therapy sessions to correct the problem just doesn't fit with the demands of their career or lifestyle". 

"This relatively new procedure -- the Laparoscopic Burch Colposuspension, as it is called -- offers an attractive alternative to open surgery because it allows patients to spend very little time in the hospital, to have a much shorter recovery period than they would after open surgery, and lets them get back to their normal routine sooner. Laparoscopic surgery has become much more widely used in the past five years for the treatment of a variety of disorders -- many of which are in the gynecological arena."

Philip L. Leggett, M.D., a board certified surgeon who is an expert in laparoscopic surgery, and Dr. Birken have collaborated to perform a new Burch technique which utilizes mesh reinforcement to support the bladder neck.

"The laparoscope allows the surgeon unobstructed vision of the operative field," Dr. Leggett continued, "and all the members of the operating team can also view the procedure on a large television monitor in the operating room. All the repair work is done from outside the body with the instruments inserted through several tiny incisions in the abdomen, which can be closed with one or two sutures or Band-Aids when the procedure is finished. "

The goal of the surgery is to restore bladder control by repositioning the bladder and, using a cradle of fine prolene mesh, anchoring it with sutures to stable anatomy in order to minimize the pressure on the organ which prompts the urine leakage. There are several suturing techniques that can accomplish this and the one selected will depend on the surgeon, the patient's anatomy and their degree of stress incontinence.

"We are pleased to report excellent results in virtually every patient that has undergone the new procedure," Dr. Birken said. "Complications are rare and, following the procedure, our patients tell us that they are symptom-free. That's a hard combination to beat. Needless to say, we have all been very pleased with the outcomes."

A report on Dr. Birken and Dr. Legget’s modified Burch procedure was published in the journal, Surgical Endoscopy. 
 

Randy A. Birken, M.D., P.A. Gynecology/Urogynecology 17070 Red Oak Drive, Suite 201-A Houston, Texas 77090 (281) 893-1246 drbirken@yourfamilyshealth.com

Dr. Birken graduated Cum Laude from Adelphi University, Garden City, New York and earned his M.D. from the Boston University School of Medicine. He completed his internship and Residency in Obstetrics and Gynecology at Baylor College of Medicine, Houston, Texas, and was then Chief Resident in OB/Gyn at that institution. He completed a Preceptorship in Urogynecology at the University of California, Irvine. Dr. Birken is a Diplomate of the American Board of Obstetricians and Gynecologists, and was recertified in June 1995. He is the father of three sons, and has served as a Little League baseball coach and as team physician for a youth football league.