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Fewer follow-up operations and complications for the incontinent
By PATRICK KURP
Copyright 2005 Houston Chronicle. July 27, 2005, 11:30PM
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For Alma Novotny, a part-time instructor in biochemistry and cell
biology at Rice University, her 50s signaled not a mellowing with
age but a time when she was forced, in her words, to undo all the
ravages of the childbearing years.
Novotny, 58, is married and has two sons in their 20s. Her manner
is bluff, and she avoids euphemisms when a stout Anglo-Saxon noun
is handy.
"My uterus was falling out of my body. I could feel
my intestine through my vagina," she said, seven months after surgery
that, among other things, repaired her vaginal hernia.
The symptom most often associated with such hernias is stress incontinence
— an involuntary leakage of urine when coughing, sneezing or lifting.
About 12 percent of U.S. women elect to correct such incontinence
with surgery. Symptoms include increased frequency of urination, incomplete
emptying of the bladder and discomfort during intercourse.
"We
see it most often in women in their 50s. We're learning that it's
a much more common condition than we once believed. After all, the
market for female-incontinence products is a billion-dollar-a-year
industry or more," said Dr. Keith Reeves, an obstetrician-gynecologist
at The Methodist Hospital in Houston.
The condition is most often associated with multiple pregnancies and
the birth of large babies. Novotny's older son, Daniel, weighed 9
pounds at birth; Andrew, a little less than 8 pounds.
"That's
when my troubles started. I still kid them about that," Novotny said.
Contributing factors may include prolonged labor, obesity and a lack
of estrogen in menopause. Preventive measures include pelvic strengthening
exercises during and after pregnancy, estrogen therapy after menopause
and weight control.
Until recently, when surgery was used to correct vaginal hernias the
success rate was compromised because the surgeon would suture together,
in Reeve's words, "weak tissue to weak tissue." In time, the hernia
would return and often require subsequent surgeries.
Reeves uses a pioneering technique involving human tissue from cadaveric
donors or tissue from cows or pigs. Such tissue is sterile and has
been used in other applications, especially in severe burn cases.
In the past year, Reeves and gynecological partner at Methodist Dr.
Denise Nebgen have performed 15 such procedures, all without infections
or subsequent surgeries.
"Once in a while, I can feel a twinge
where one of the sutures was," Novotny said. "Otherwise, it's been
almost pain-free and a complete success."
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The Best Job
in the World.
Article in the Methodist Women's Health magazine. Fall 2005.
Reed
interview with Dr. Denise Nebgen.
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