Dr. Brandeis in the Contra Costa Times

Urinary incontinence: A common problem

By Laura Casey
Contra Costa Times

Urinary incontinence is an awkward thing to talk about. It's an even more awkward thing to live with.

To prevent an accident, women who suffer from it stop doing things they love, such as running or playing sports. Some stop drinking the water they need to live a healthful life. Some are even nervous about leaving the house.

"There's a lot of shame, a lot of embarrassment," says Esther Dolowich, a physical therapist who specializes in pelvic floor dysfunction at Alta Bates Summit Medical Center in Oakland. "Somehow they feel that they are damaged goods. They are not OK."

When just a sneeze or a cough can bring on unintentional wetting, so-called stress urinary incontinence is an embarrassing condition that affects 15 million women, according to the National Association for Continence. Women are often hesitant to bring up the issue during doctor visits but, experts say, if they do, there are several options for treating the problem.

Surgical interventions

When education and physical therapy don't work, some women turn to surgery. The two most common are sling procedures and the Burch procedure, a bladder neck suspension surgery.

Dr. Judson Brandeis, a urologist with Pacific Urology in Concord, performs the sling procedure. He says all women should practice mindfulness and Kegel exercises postpartum. If those exercises and nonmedical interventions fail, a sling procedure can be an answer.

"It adds an extra layer of strength and compression of the urethra," which helps control urine flow, Brandeis says. He performs sling procedures on soccer players and Taekwondo experts, runners and athletes, many of whom have stopped doing their favorite things for fear of wetting themselves. Brandeis says women shouldn't have the sling procedure done while they're still trying to have children, but once they feel their family is complete, stress urinary incontinence can be addressed with a sling, and a person's normal routine usually can be resumed.

The sling is a mesh support that creates a sort of hammock around the bladder neck and the urethra and helps keep it closed when a woman coughs or sneezes. It is inserted into the body in an outpatient procedure that usually takes about 20 minutes. Women can go back to work within days and exercise within a month or so.

There have been many complications with the sling procedure since it was first introduced nearly 20 years ago, leading to a black box warning for doctors because of the risk. Brandeis says the current generation of slings use a synthetic polypropylene material which is much safer than older models.


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