For Elberta Sutton, even laughing was a cause for worry. Sutton, a 67-year-old elementary school teacher, suffered from incontinence—A laugh, a cough, a sneeze—any one could trigger a leakage. A sudden movement, a slight stumble, or a startled moment: again, leakage.
As a result, she carried a constant “uneasiness and concern” with her, even as she carried a supply of pads. She just never knew.
“I was not a person to just not go somewhere because of the inconvenience, but I always had to be close to a bathroom,” she said. “If my husband and I took a car trip, we had to stop every hour.”
And a teacher of third-graders is hardly able to leave her classroom every time a sense of urgency calls. “I had very soggy pads during school hours,” Sutton recalled.
But there were times when even the pads weren't enough. “I was constantly worried about the embarrassment,” she said.
You need a urologist, Sutton's primary-care physician told her. You need a gynecologist, said the urologist. You need both, said the gynecologist. Fortunately, Sutton was referred to Richard Hill, M.D. FACOG, Gynecology and Urogynecology at Saint Luke's.
Who's most likely to lose control
Incontinence comes in two forms, stress and urgent. Stress incontinence is more common in women, while the urgent type affects both men and women.
Dr. Hill performed urodynamic diagnostic testing to assess Sutton's condition. She didn't have one type or the other. She was suffering from both.
“Although it may sound complex, Elberta's case was not unusual,” Dr. Hill said. “And although incontinence is more common as we get older, it can happen at a young age, too. Genetics also plays a part, because one factor is how strong your connective tissue is.” (One more reason not to smoke: It weakens this tissue.)
Dr. Hill recommended surgery for Sutton. He performed a vaginal hysterectomy and repaired the wall between her bladder and vagina to help rebuild her pelvic floor. He also put in place a sling bladder neck suspension, a narrow piece of mesh that recreates the backstop of the urethra.
‘Mind over bladder'
“Both kinds of Elberta's incontinence were cured,” said Dr. Hill. “She had great success.”
And little post-operative pain.
“I was expecting a great deal of pain just from movement, but it was minor,” Sutton said.
In fact, Sutton felt so good when she got home from the hospital after two days, she had to make herself not do things. But one thing she did do was bake Dr. Hill and his staff a cherry pie from scratch.
“I teased him and said if I had to go home with a catheter, he'd only get half,” she said. “But since it was just for the weekend, he got the whole pie.”
Dr. Hill cautions patients not to turn into weightlifters after this surgery, which has a two- to six-week recovery period. He also has patients of the urgent type learn some simple techniques for “retraining” their bladders—an approach he calls “mind over bladder.”
For Sutton, having the surgery completely changed her life. “I can't imagine anyone not having this fixed if they can,” Sutton said. “I no longer have to adhere to a rigid schedule or worry about whether I should be changing a pad. It's so freeing.”
But she does have to go now—back to her classroom at Lakewood Elementary in Overland Park, where her students are waiting.
There are two kinds of incontinence; both can be cured
What it is: An overactivity in the nerves of the bladder, urgent incontinence manifests itself in that “have-to-go” feeling that comes on long before it normally would. It's as if the warning light goes off too early. Though the cause is unknown, a major predisposing factor is “prolapse,” or an organ's slipping or falling out of place. For women, this can mean the uterus or vaginal walls—or both—slip or fall down.
What Can Be Done: It may be possible to live with it, if symptoms aren't severe. Women can also opt for a vaginal pessary, a soft, nonsurgical device that fits in the vagina and holds the organs in place. The surgical option, said Richard Hill, M.D., FACOG, Gynecology and Urogynecology at Saint Luke's, is to rebuild the pelvic floor and “put things back where they belong.”
What it is: A loss of support in the connective tissue around the urethra can result in stress incontinence. The urethra acts as a backstop for the flow of urine. “If you take a running garden hose and set it on the driveway, you can step on the hose and block the flow,” Dr. Hill explained. “Now imagine there's no driveway, so you can't block the flow. The urethra is the driveway.”
What Can Be Done: Certain exercises can help. Surgically, a sling bladder neck can create the backstop that's needed to stop the leakage.