URINARY STRESS INCONTINENCE:
Dear Sumner:
I have a delightful 92 year old woman as my patient who has had progressive bouts of urinary incontinence over the past 20 or so years. The problem occurs only when she does any physical activities; there is no leakage when she is in bed. This is particularly distressing since one of her great pleasures in life had been attending church, but the embarrassment of wet panties has curtailed this activity. She is very reluctant to undergo any surgical procedures and has asked me whether there is some “non-invasive” procedure which will help her. Let me know what you and she decide is best for her. By the way, Myrtle is one of my favorite patients, and I am sure she will soon be one of yours as well.
Dear Kim:
After meeting and talking with Myrtle, I can certainly understand why she is one of your favorites. Not only is she delightful, she is also very bright and seemed to grasp the entire subject of the various approaches to urinary incontinence. For example, she explained to me that urinary stress incontinence is usually secondary to decreased local support of the urethra and bladder most often occurring in women after multiple vaginal deliveries. We talked about the options for restoring the supporting mechanism. As you know, she wanted a non-surgical approach. We decided to try the “old fashioned” vaginal pesssary, (which is particularly useful for high risk women with medical diseases or for women who just want to avoid any surgical procedures). I told her that sometimes local inflammation can occur with the use of a pessary, and occasionally it can become displaced or even fall out. I asked her what she would do if the pessary popped out when she was walking down the aisle in church. Without a moment’s hesitation she looked at me with a twinkle in her eye and said: “Why, Dr. Marshall, I’d just pick it up off the floor, and hold it up in the air and ask: Did anyone here loose this?”
Happily, the insertion of the vaginal pessary did provide satisfactory local support for her cystourethrocele, resulting in marked improvement of her urinary control (and it stayed in place both during, as well as after, church services!)
