San Francisco resident Ali Weinhouse is sidelined no more. Watching the high school health and physical education teacher in the gym, playing racquetball or power walking in her characteristic "New York strut" reveals no clue that she once suffered a debilitating problem.
Yet for almost 10 years Weinhouse, 51, was dramatically limited in her activities. During that time, she suffered from stress incontinence. Running, jumping, dancing even sneezing could make her leak urine. "At first, the incontinence wasnt so bad," Weinhouse recalled. "I could deal with it."
As years went by, however, her problem grew worse. Worrying about embarrassing leaking prevented Weinhouse from enjoying many of the activities that once filled her life, such as the heavy lifting involved with the remodeling of her home.
"My mother suffered with incontinence," Weinhouse said. "I wasn't really sure you could do anything about it."
Weinhouse is not alone. Urinary incontinence affects 13 million Americans and many suffer in silence unaware of treatment options. A 1994 study of nearly 4,000 adults found that even among those who admitted incontinence to interviewers, less than 40 percent had discussed the problem with their doctor. Overall, 85 percent of people with incontinence are women.
Incontinence can be categorized as one of three types: stress, urge or mixed. Coughing, sneezing, laughing and exercise can cause leaks for women with stress incontinence. Sudden, strong urges to urinate or frequent urination indicate urge incontinence or overactive bladder. It's common for a woman to experience a combination of both stress and urge incontinence symptoms called mixed incontinence, although one type is usually more bothersome than the other.
"My colleagues knew something was wrong," Weinhouse said. "I didn't hide it. Every time I laughed with my students, I needed to cross my legs to prevent any leakage." She became increasingly persistent in her search for information about incontinence, conducting research on the Internet and asking friends. Some responded with embarrassment; few had any helpful advice and most had no clue that there were solutions. Her primary care physician eventually referred Weinhouse to the UCSF Women's Continence Center.
Dr. Sharon Knight was the first to examine Weinhouse at the continence center. "Urinary incontinence is common, but it's not normal at any age," said Knight, an urogynecologist at the UCSF Continence Center.
The continence center uses advanced diagnostics to identify the causes of incontinence. Non-surgical options such as pelvic muscle rehabilitation and surgical options are available.
"Learning pelvic muscle exercises is a good first step," said Knight, "since behavioral treatments are low risk and have no side effects." A physical therapist at the continence center uses biofeedback to help women learn to identify and control the muscles involved in urination. The patient sits, privately, at a computer and wears tiny sensors. Contracting the correct muscle sends a signal that is immediately indicated on the screen. As with all muscles, exercise builds muscle tone, and many patients learn to prevent involuntary loss of urine this way. Other helpful behavioral treatments include losing weight and avoiding diuretics such as coffee.
New medications introduced in the past several years also have proven effective for some women. As part of the UCSF Center of Excellence in Women's Health, all continence center patients have access to the latest clinical research, and all care is coordinated with other doctors at UCSF Medical Center.
Weinhouse learned pelvic exercises and saw some improvement, but she was determined to end the embarrassing leaks. After she discussed her options with Knight, the doctor offered a surgical alternative. "Involving our patients in the treatment decision process is essential," said Knight. The one-hour operation was successful and Weinhouse remains symptom free after almost two years.
"Dr. Knight is a wonderful physician," Weinhouse said. "She's got that old-fashioned human touch, both pre- and post-surgery."
"Women need to know there's help available," Weinhouse said, as she laced up her running shoes. "Open communication with ones physician is so important. I'm glad I asked my doctors, and I'm glad they were so well informed."
Story written in March 2004. Photograph taken by Elisabeth Fall.
Female Pelvic Medicine and Reconstructive Surgery at Mount Zion
2356 Sutter St., Fifth Floor
San Francisco, CA 94143-1754
Phone: (415) 885-7788
Toll-free: (877) 366-8532
Fax: (415) 353-9550