Body & Mind: Taking Back Control

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Deanna Bartosh likes her coffee. In fact, she's no sooner through the door of her favorite cafe in Antioch, Ill., than the workers greet her by name and ask whether she's ready for that cup. She laughs and says, no, she'll take it after lunch, and she's sure to remind the waiter midway through her meal, "I want that cup of coffee to go." The high school assistant and mother of three has only recently been able to indulge her passion for java, thanks to surgery last summer to repair a leaky bladder. The problem had plagued Bartosh, 61, ever since the birth of her first child 41 years ago but had grown noticeably worse in the past decade. "Every time I coughed or sneezed," she says, "I had to cross my legs to stop leaking or else die from embarrassment." Bartosh had to limit her liquid intake, and maxi pads became a wardrobe staple. After years of feeling ashamed, she finally saw a urologist. "I was looking for a way to make the quality of my life better."

Bartosh's problem is remarkably common but woefully underdiscussed. According to the American Urological Association, about 1 in 5 U.S. women over age 50 suffers from stress urinary incontinence (SUI), the tendency to leak urine when the bladder is stressed by running, jumping, sneezing, coughing or other activities. Urge incontinence, the sudden unbearable need to urinate, is far less common.

Childbearing is the biggest risk factor for SUI. Experts say approximately 1 of 3 women who have had a vaginal birth--even an uncomplicated one--will develop SUI at some point in their life. Giving birth to twins or bearing more than one child does not necessarily raise the risk because the damage has usually been done with the first child. "The big domino to fall is the first pregnancy," says Dr. Linda Brubaker, an expert in female pelvic medicine and reconstructive surgery at Loyola University in Chicago.

During labor the pelvic-floor muscles are often torn or strained, and nearby nerves can be harmed. Neuromuscular damage can also affect the urethral sphincter, the tiny knot at the base of the bladder that controls flow through the urethra. A woman who had labored but then had a caesarean section is at a slightly lower risk than if she had given birth vaginally. But preliminary studies suggest that SUI is rare in women who underwent scheduled Csections and never entered labor. That finding may be a factor in the rising rate of elective Csections.

Even young women can experience SUI after childbirth, but the problem rarely becomes chronic until much later, often around menopause. The loss of estrogen weakens muscle walls, but that only partly explains the timing. "There are a lot of injuries that happen during childbirth that women learn to compensate for," says Dr. Peggy Norton, chief of urogynecology and pelvic reconstructive surgery at the University of Utah. As a woman grows older, Norton explains, her body's means of compensating for the damage may give way. Her muscles may weaken, her reflexes may not be so sharp, or maybe she has gained some weight. All those factors can contribute to SUI years after the initial injury. Other risk factors include obesity, smoking, a pelvic fracture and severe bouts of coughing or constipation.