experience loss of urethral support until years after giving birth. “Our bodies are better at recovering when we’re younger.” The most common treatment of stress incontinence is the surgical placement of a sling around the urethra. The sling, crafted from a narrow strip of a synthetic material called polypropylene, is inserted through the vagina and held in place by tissue surrounding the urethra and bladder, according to interviews with doctors and marketing materials from American Medical Systems Inc., a manufacturer of a brand of the sling. While the sling procedure is widely practiced and considered safe, after receiving complaints of pain and injury among women who had undergone the surgery, the U.S. Food and Drug Administration released a statement last year urging doctors and patients to proceed with caution. Slings have a less than 1 percent chance of eroding and breaking through the vaginal wall, a result more commonly seen with larger meshes used to treat prolapse, where all the pelvic organs need to be lifted back into place, said Moorman. “People
are hesitant to use meshes. The bigger the mesh, the more problems you could have with them.” URGE INCONTINENCE IS CAUSED BY A MIS-
communication among bladder nerves, the central nervous system and the brain, resulting in an overwhelming urge to urinate, said Moorman. Much less is understood about its origins and the best way to treat it. Women with neurological damage caused by strokes, Parkinson’s disease, multiple sclerosis, spinal cord injuries—even diabetes, as high blood sugar levels can impair nerves—may struggle with urge incontinence. “The bladder is saying to the brain, ‘you’ve got to go,’” even if the bladder isn’t full, said PillaiAllen. Two-thirds of women who incessantly feel the need to urinate, also known as overactive bladder or urgency frequency syndrome, don’t actually wet themselves, she said. Yet they may be running to the bathroom dozens of times a day. “We have to teach them to overcome the urge and to enable their bladder to fully expand,” said Lynne Schill, a physical therapist at FMH
Crestwood in Frederick who treats women with incontinence. “The more they void without their bladder being full, the more the bladder feels like it has to void without being full.” Medications can temporarily calm the bladder’s hyperactivity but have significant side effects, such as dry mouth and constipation, said Moorman. In those cases, doctors may recommend InterStim Therapy. InterStim Therapy stimulates nerves that control the bladder by sending electrical pulses through a thin wire inserted near the tailbone. During a trial period, the pulses are generated through a device a woman wears externally, according to Medtronic, which manufactures the device. If the therapy proves successful, as a long-term solution, a neurostimulator can be surgically implanted under the skin of the upper buttock. While InterStim has proven life changing for many patients, doctors say it won’t guarantee dryness 100 percent of the time. “They will still have good days and bad days,” said Moorman. “If you were [continued on 28]
GAZETTE.NET
Summer 2012 | Gazette Health 15