There Is Life After a Pelvic Floor Disorder

Debra Hiett has completed 13 marathons. But each time the victory of crossing the finish line was dampened by incontinence—the unintended loss of urine or “leaking.”

“I was always soaked!” said Hiett, a 54-year-old mother of three. “I would take my Mylar blanket at the finish line and wrap it around my waist to avoid embarrassment.”

Hiett had a common type of urinary incontinence called “stress incontinence.” It is caused by weakness in the pelvic floor muscles caused by childbirth or aging. For Hiett, it began almost 25 years ago when she was pregnant with her second child. “I thought it was normal. It happened when I sneezed and coughed,” she explained. “I stopped going to the track workouts at my running club. When I walked my dog, if she pulled on the leash I would leak. My whole life was controlled by my bladder.”

But this fall she will be running her first “dry” marathon. And she will dedicate her run to Dr. May Wakamatsu, chief of the Division of Urogynecology and Pelvic Reconstructive Surgery at Mass General. According to Wakamatsu, stress incontinence is generally seen in women who have given birth. However, weight gain, age and menopause can also be blamed. It is caused when the muscles surrounding the urethra or pelvic floor weaken, allowing urine to escape.

Women Often Suffer Silently

“In the past, incontinence was something women just suffered through silently. But today more and more women are learning that there are many options, both surgical and nonsurgical, to address a variety of pelvic floor disorders,” said Wakamatsu.

Hiett had learned to cope with her situation until a brief encounter with a nurse at a neighborhood cookout. “She told me she had her bladder suspended and I thought, it’s preventable! And I was over the moon.”

Dr. Wakamatsu recommended a minimally invasive 30-minute surgical procedure to correct Hiett’s incontinence. A small vaginal incision and tiny punctures in the lower abdomen were made and a “tension-free vaginal tape sling” placed under her urethra. The sling acts like a hammock to tighten muscles and keep urine from escaping. Hiett was discharged the same day and was able to resume running after just six weeks.

“Women runners should know this procedure is available. I think gynecologists should bring it up during appointments, because women are too embarrassed to talk about it,” said Hiett. “I feel a sense of freedom since having the procedure.”

Many Treatment Options

A recent study found that nearly one-third of all American women have one or more pelvic floor disorders such as urinary incontinence, fecal incontinence or pelvic-organ prolapse. At the Pelvic Floor Disorders Service at Mass General, a multidisciplinary team of gastroenterologists, urogynecologists, colorectal surgeons, urologists, a physiatrist (a doctor that specializes in musculoskeletal problems) and a nurse practitioner evaluates patients to determine the best course of therapy. The center offers a range of nonsurgical options, including bladder training, biofeedback, electrical stimulation, physical therapy, medication, vaginal support rings and weighted cones that address stress incontinence. When nonsurgical options fail or the patient prefers surgery, the most advanced, minimally invasive procedures are used.

“Most of our patients tell us they’re sorry they waited so long to seek treatment,” said Dr. Wakamatsu.

Hiett wants women to know that they are not alone—and that their urge doesn’t have to run their lives. “I feel so liberated. I’m not a slave to my bladder anymore,” she says. “I’m not a slave to the bathroom anymore!”