By Kelin Hall
Photo by David Christopher
Sandra Culbertson, MD, professor of gynecology/obstetrics and Laura Fetzer-Vacek, NP, help women overcome urinary incontinence through lifestyle changes, medication or recommending surgery.
After giving birth to five
children, in her early 30s Penelope Kausal started to notice what she
called “a tiny bit of leakage” when she exercised or laughed.
like most women with urinary incontinence, didn’t tell anyone or do
anything about the condition at first. “It was just a smidge then, but
by the time I was in my 40s I was wearing one of those panty liners all
the time. In my 50s, it was a maxi pad," she said.
having worked as a medical technician for more than 40 years, Kausal had
never heard of a treatment for incontinence. She asked her friends for
advice. Several admitted having similar problems, but no one knew of a
solution; they all assumed it was just a part of getting old.
Culbertson, MD, professor of obstetrics and gynecology at the Medical
Center, said this is one of the common myths about urinary incontinence.
Even women in health care fields don’t realize there are multiple,
effective treatments or that 20 to 30 percent of women experience
incontinence daily or weekly at some point in their lives.
suffer from what’s called stress incontinence when the urethral or
pelvic floor muscles are somehow weakened or damaged. Most often this
occurs during childbirth, but other factors, such as diabetes, radiation
treatments or pelvic surgeries like hysterectomy, also can weaken the
muscles that support the pelvic organs and hold urine in the bladder.
When these muscles lose strength, urine exits the bladder when a woman
laughs, sneezes or exercises vigorously.
The same risk factors
can lead to urethra or bladder prolapse, when the organs press against
the vaginal wall or sag down into the vagina, sometimes causing complete
loss of urinary control, as Kausal, now 68, experienced.
second type of incontinence, called urge incontinence, is also common
and usually affects older women. In these cases, the bladder contracts
prematurely rather than stretching as it fills with urine. As a result,
women experience a sudden and uncontrollable urge to urinate. Urge
incontinence often is caused by neurological problems, such as
Parkinson’s disease, multiple sclerosis or spinal cord injuries, but
also may be caused by bladder cancers or infections. Sometimes, no clear
cause can be identified.
To help women understand and overcome
the incontinence, Culbertson chairs the public relations committee of
the American Urogynecology Society. She holds informative talks and
oversees the content of mypelvichealth.org, which explains what women
can do to prevent incontinence: strengthen the pelvic floor muscles by
doing Kegel exercises, avoid bladder irritants, such as caffeinated and
carbonated beverages, maintain a normal weight and avoid putting
pressure on the bladder through repeated heavy lifting or strained bowel
Culbertson said medical centers have only recently
conducted significant research and outreach about the condition, and
until people are aware of the scope of the problem, women will continue
to feel ashamed.
That’s why she said her nurses play a crucial
role in putting patients at ease. Laura Fetzer-Vacek, NP, has worked
with Culbertson for many years. “We know the diagnostic bladder tests
are embarrassing for patients,” Fetzer-Vacek said, “so we try to get
them to relax. I remember one patient was initially so ashamed, but
pretty soon she was laughing and joking that her five-year-old grandson
had more bladder control than she did.”
Sandra Valaitis, MD,
chief of the Section of Gynecology and Reconstructive Pelvic Surgery,
said the condition has a huge impact on a woman’s quality of life: “Many
women with urinary incontinence feel housebound and depressed, and they
lose their desire to participate in daily activities,” Valaitis said.
“They exercise less and gain weight, and they feel disinclined to be
sexually active because they’re afraid they’ll be incontinent. Women
should know that we offer simple and very effective solutions for
incontinence that will help them gain control over these unpleasant
Though Kausal speaks openly and even jokes about her
condition, she admitted that it changed the way she interacted with the
world. After marrying and having children in Chicago, Kausal divorced
in her 40s and moved to Florida to care for her ailing mother. When her
mother passed away, Kausal moved in with her mourning father whose
health rapidly declined. As Kausal’s incontinence worsened, the
responsibility of taking care of her father made it easy to justify
staying in and associating only with close friends and family.
became pretty reclusive,” she admitted. “I used to be quite active, but
as things got worse I even quit walking very far. I wouldn’t even think
about going dancing. I didn’t try to meet a new partner or even new
friends because I didn’t want them to have to deal with my condition.”
the time she’d reached her 60s, Kausal’s incontinence had gotten so bad
she needed to wear diapers. At that point, she started researching
online and learned about some of the treatments at the Medical Center.
the past 10 years, there have been vast improvements in surgical
treatments. For urge incontinence, surgeons can inject a muscle
relaxant, such as Botox, into the bladder or use neurostimulation to
help regulate the neurological signals that control the bladder’s
contraction. The least invasive surgical treatment for stress
incontinence involves injecting a bulking agent like collagen into the
urethra, which prevents incontinence for several years. The most common
and durable treatment, with an 85 percent success rate, is a minimally
invasive urethral sling surgery. The sling is about an inch wide and six
inches long and provides a backboard of support that helps keep the
Gregory Bales, MD, associate professor of surgery
at the Medical Center, has performed more than 900 sling surgeries. “It
can be done in as little as 25 minutes, and it’s an outpatient procedure
so patients can go right home and resume 95 percent of their normal
activities within a week,” he said. “It’s a very quick recovery.”
June, Kausal stayed with her daughter in Munster, Indiana, and had a
consultation with Bales. “Dr. Bales explained how my bladder could be
surgically restored to its proper position and supported with a sling. I
said, ‘Great! Let’s do this!’” Kausal said.
In late June, Bales
preformed Kausal's surgery at the Medical Center. “The nurses, the
anesthesiologist, everyone was so kind, helpful and funny. They were
completely reassuring,” Kausal said.
Three weeks after surgery,
Kausal said she had more energy than she’d had in years, and she is now
walking almost a mile every day. She gushed that she’d do anything to
get the word out about the treatment. “I just feel so much more
comfortable going about routine activities and being in public. Who
knows, maybe now I’ll even meet me a man!”