June 15, 2001

Noel Bradley is a Florida resident who prides herself on being — and staying — active. Yet for years, Bradley's lifestyle was compromised by a condition she feared would be permanent: urinary incontinence.

Incontinence affects approximately 60 percent of women older than 60 years of age in the United States — and yet, it often is shrouded by a sense of silence and shame. Thanks to an innovative procedure offered by the MGH, however, an increasing number of women are able to confront their incontinence and find a lasting, convenient remedy.

While incontinence can occur in a number of circumstances, the most common — particularly in older women — is stress incontinence. In this type of condition, the bladder is pressured and stressed by such routine daily activities as coughing, sneezing or lifting heavy objects. Childbirth, weight gain and pelvic surgery also are frequent causes.

"There is a stigma about seeking treatment for incontinence," says Joseph Grocela, MD, of MGH Urology. "Many women don't realize that they can be treated, or that there are many options available to them. It is no longer necessary to undergo major surgery or take a pill every day to combat this condition."

Grocela, along with May Wakamatsu, MD, of the MGH Vincent Obstetrics and Gynecology Service, is using a procedure called the "tension-free vaginal tape" (TVT), a type of sling that wraps around the urethra to support the bladder and prevent stress incontinence. The sling is made of prolyene mesh and often can be inserted under general anesthesia.

"It is minimally invasive and extremely effective," says Wakamatsu. "Patients typically stay one night, and sometimes even are discharged the same day."

Grocela adds: "There is a decent record of improvement for women who have the TVT. Eighty-five percent are cured or see significant improvement." Among that 85 percent is Bradley, who underwent the TVT surgery at the MGH last year. "When Dr. Grocela explained to me that this procedure could completely cure my difficulties, it seemed like an impossible dream, but it came true," Bradley says.

Today, she notes, "I can walk five miles a day, play 18 holes of golf, dance, cough, sneeze and probably jump rope if I chose to — all without any difficulties with my bladder."

Despite being somewhat embarrassed about her condition, Bradley says: "I am willing to talk openly about incontinence because, quite simply, now there is a solution. I have encountered so many women who have this problem to some degree or another, and no longer do they have to live a life made increasingly miserable. The TVT is a miracle."

Grocela emphasizes that incontinence is not something patients have to endure alone. "Women suffering from incontinence often are shy about it, and may wait 10 or 12 years to seek treatment," he says. "Meanwhile, the odds are that they can be treated or even cured, thanks to innovations like the TVT. With a good dialogue between patients and physicians, we can help them find an answer."