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A NEW SOLUTION TO AN OLD PROBLEM...
Patricia has a problem and she is too embarrassed
to talk to anyone about it. When she coughs or laughs or bends over or
picks up something heavy -- or does any number of other routine activities
she used to do with ease -- small amounts of urine just suddenly leak out.
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.
What Is It?
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."
"Successful treatment begins with an accurate
diagnosis," Birken stressed, "which requires sharing a complete medical
history, a thorough physical exam and some urodynamic tests. Incontinence
is never normal, it is almost always treatable, and often completely curable."
How is it treated?
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.
Reprinted from yourfamilyshealth.com |
