It doesn't take much to trigger a leak: sneezing, laughing, lifting a child. So the millions of Americans with stress incontinence are constantly on guard, never knowing when the next wet patch will appear.
Exercises and medication are the first line of treatment. But if they fail, surgery may be best. Many procedures have been developed, but a new outpatient procedure called TVT (tension-free vaginal tape) now is being tested on female patients. The tape forms a hammock for the bladder.
Carl G. Klutke, M.D., associate professor of urologic surgery at Washington University School of Medicine in St. Louis, reviewed his experience with TVT on April 30, 1999, at the annual meeting of the Society for Urodynamics & Female Urology in Dallas. He reported that the majority of his patients who have undergone the procedure are either cured of stress incontinence or have improved a great deal.
"So I am very optimistic that this will be a major advance in incontinence care," says Klutke, who in September 1998 became one of the first American surgeons to use TVT. His study is the largest in this country to date.
When you hurt your arm, you don't stand much chance of pushing someone away because your muscles can't push as hard as they are being pushed. And when the circular sphincter muscle that closes the bladder gets weakened by, say, childbirth or aging, it also doesn't stand a chance. The contents of the bladder push hard when the bladder is full and sudden movement raises intra-abdominal pressure. Unable to resist the force, the sphincter gives way, and urine spurts from the bladder.
Stress incontinence accounts for about half of the estimated 10 million cases of incontinence among American women. And whereas other forms affect mainly older women, stress incontinence also plagues young women, threatening careers, social lives and relationships with family members.