New Help for Incontinence

New devices are alleviating this embarrassing problem.

Any time 57-year-old Brenda Cayton of Grimesland, NC, went on a road trip, she had to study her route carefully to make sure she could find a restroom every half hour or so.

"If I so much as sneezed, I would absolutely drown myself," Cayton says.

Cayton suffered from "stress incontinence" -- a condition where urine leaks when a woman coughs, sneezes, laughs, runs, or lifts something heavy. It's surprisingly common, but difficult for patients to discuss. According to the American Urological Association in Washington, D.C., an estimated 10 million women in the United States aged 25 and above suffer from some form of incontinence.

Most often, stress incontinence develops when the pelvic floor muscles weaken as a consequence of childbirth or normal aging, says Andrew Duxbury, M.D., assistant professor of Gerontology and Geriatric Medicine at the University of Alabama, Birmingham.

Urge incontinence, another form, affects mainly older women and occurs when the pelvic muscles contract inappropriately. It results in an unexpected, often uncontrollable urge to urinate. Some women also suffer from mixed incontinence, a combination of the two.

In any form, incontinence is likely to isolate a woman who has it. Cayton, for instance, often skipped social gatherings because of her condition.

The good news? You don't have to suffer in silence. According to the Center for Aging at the University of Alabama, incontinence can be cured or controlled 80% of the time. Physicians usually recommend the least aggressive treatments first: behavioral modification, such as biofeedback, or physical therapies, such as electrical stimulation or different types of Kegel exercises. Some medications also prove helpful.

More invasive treatments include the injection of collagen, which causes the tissues surrounding the urethra to swell and close off the base of the bladder. If pelvic tissues or sphincter muscles have collapsed, doctors may suggest reconstructive surgery. In other cases, surgical devices can be inserted or tissues tucked to relieve pressure on weak or stressed muscles.

What's New

One of the latest therapies for incontinence is a device known as the NeoControl, an office chair fitted with magnets in its seat. Approved by the Food and Drug Administration in June 1998 for the treatment of all forms of incontinence in women, the NeoControl was studied at the Cleveland Clinic and at hospitals and medical clinics in Chicago, Philadelphia, and Orlando.

The patient sits fully clothed on the chair, and the device exercises and strengthens the pelvic floor muscles. Explains NeoControl co-inventor, Niall Galloway, M.D., associate professor of Urology at Emory University in Atlanta, "By creating a pulsating magnetic field, the new procedure induces strong contractions in the pelvic floor. This builds strength and endurance in muscles that have been weakened by childbirth, surgery, or injury."

One study on NeoControl appeared in the June 1999 issue of the journal Urology. Researchers at Emory University in Atlanta observed 83 women, aged 35 to 83, diagnosed with stress incontinence. Patients used the NeoControl device for 20 minutes twice weekly for six weeks. At the study's end, physician researchers found that 34% had no leakage all, and overall incidents of leakage were reduced from 3.3 to 1.7 daily.

Tension-Free Tape

After one unsuccessful surgery, Cayton decided to try a procedure known as tension-free transvaginal tape (TVT). In this procedure, a surgeon makes an incision in the vaginal wall and inserts a synthetic tape, usually made of prolene, between the vaginal and abdominal walls. In four to six weeks, tissue grows around the tape and holds it in place. The tape, in turn, supports the neck of the bladder.

"The tape creates a supporting sling so the urethra can be more easily squeezed shut," says Carl G. Klutke, M.D., associate professor of Urologic Surgery at Washington University School of Medicine in St. Louis.

In a recent Norwegian study, 84 women (aged 34 to 78 years) with proven stress incontinence had the TVT procedure. Four months after the surgery, 79 out of 82 patients (96%) were cured or had improved considerably, and no serious complications occurred during a year and a half of follow-up. TVT, however, is not without risks. Occasional cases of tissue perforation, infection, and erosion (when the tape is expelled from the body because it is rejected) have been reported. The researchers concluded that further long-term studies should be conducted.

For Cayton, though, the procedure has made a big difference. Now when she takes to the open road, her qualms are a thing of the past.