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June 7, 2019

Off to New Adventures After Bidding Incontinence Goodbye

By SharingMayoClinic
For years, Catherine Hebert always carried a pair of underwear in her purse. She often needed them. Affected by stress incontinence, she leaked with even slight exertion. Now, after undergoing an outpatient procedure to treat the incontinence with urinary mesh, Catherine stays dry, and her extra undergarments stay at home.

For years, Catherine Hebert always carried a pair of underwear in her purse. She often needed them. Affected by stress incontinence, she leaked with even slight exertion. Now, after undergoing an outpatient procedure to treat the incontinence with urinary mesh, Catherine stays dry, and her extra undergarments stay at home.


This summer, Catherine Hebert is taking the trip of a lifetime, walking 270 miles of the Superior Hiking Trail along Lake Superior's North Shore. Everything she needs for the 25-day adventure she'll carry in a backpack. She's planning to bring socks, pants, shorts and T-shirts, as well as sleepwear and sundries. But one item Catherine is happy to be leaving behind is the protective underwear she used to require due to stress incontinence — the unintentional loss of urine due to physical movement or activity.

For Catherine, who is 35, the absence of this item is notable because the pricey panties have been a daily component of her wardrobe for the past five years. A special-needs teacher from Rochester, Minnesota, Catherine developed incontinence after she delivered her second child.

But that changed in March when Catherine's incontinence was remedied during an outpatient surgical procedure at Mayo Clinic where she received a sling to support her urethra and help keep it closed during daily activities. The improvement since the procedure has been dramatic.

"I get to wear 'normal-people' underwear to work every day," Catherine says. "I can drink a liter and half of water, and I don't pee my pants, which is great."

A problem that can be solved

For patients like Catherine, surgical treatment for incontinence can be life-changing, says Emanuel Trabuco, M.D., in Mayo Clinic's Department of Obstetrics and Gynecology. "People who have stress incontinence leak with physical activities, such as coughing, sneezing or jumping on a trampoline," Dr. Trabuco says. "If it's bothersome enough, there are treatment options."

"For those really bothered by incontinence that affects their quality of life, there are both mesh and non-mesh procedures to treat this condition."

Emanuel Trabuco, M.D.

For decades, Mayo Clinic has provided nonsurgical and surgical treatment for women who have stress incontinence, including polypropylene mesh urinary slings. However, recent media attention on a different product — transvaginal mesh used for pelvic organ prolapse that has been withdrawn from use — has resulted in fewer women seeking consultations for incontinence care, according to Dr. Trabuco.

"There is a lot of confusing information out there that is scaring patients and preventing them from seeking care," Dr. Trabuco says. "For those really bothered by incontinence that affects their quality of life, there are both mesh and non-mesh procedures to treat this condition. Which procedure is right for the patient depends on the risk-benefit discussion that only happens in a consultation."

An uncomfortable inconvenience

Like many new moms, Catherine first experienced occasional incontinence after she gave birth to her first child. Sneezing and coughing sometimes would trigger a leak. But after her second child, Catherine's symptoms steadily grew worse.

"It got to the point where getting in and out of the car, I'd pee a little," Catherine says. "I'd be sitting in a meeting and cross and uncross my legs and pee. It was all the time." Catherine also leaked during sexual intercourse. "It was miserable," she says.

Through the years, Catherine's Mayo Clinic gynecologist recommended a number of exercises and products to manage her incontinence. Catherine performed pelvic floor exercises and tried a device called a urinary pessary, which is designed to fit into the vagina and support the urethra. But the device was hard to place, and the exercises were largely ineffective, Catherine says.

"So I bought pee-proof underwear," she says. "I bought 10 pairs. I always carried a spare with me in my purse. Sometimes I'd be changing them twice a day."

But when Catherine and a friend decided to hike the Superior Trail, she realized staying clean and dry throughout the trip would be problematic. "The underwear would have to be washed thoroughly, and they don't dry well," she says. "I didn't know how to navigate that on the trip. This trip is a big deal for me. I've always wanted to do it. And this was such a stupid reason to struggle with whether I wanted to go or not."

While Catherine had been made aware of surgical options to treat her symptoms years earlier, the complications her condition presented for her trip compelled her to return for another consultation with her health care provider. After a discussion, she decided to move forward with surgery.

A life-altering outcome

During the operation, small incisions were made on either side of Catherine's pubic bone. A 2-centimeter wide piece of mesh was inserted into her pelvis and placed just beneath the urethra. As Catherine healed, the mesh sling was absorbed by her tissues, supporting the urethra and helping to keep it closed.

Although the Food and Drug Administration ordered manufacturers of transvaginal mesh kits for prolapse to stop selling and distributing their products, those items and the slings used to treat urinary incontinence are markedly different, Dr. Trabuco says. Mesh kits used for pelvic organ prolapse are significantly larger, with 4-by-6-inch mesh inserts. They also are placed through the vagina to reinforce the vaginal wall to treat prolapse.

"Dr. Trabuco knew what he was talking about. I trusted that he knew what he was doing."

Catherine Hebert

"They are completely different procedures. The anatomy is different. Where you place the mesh is different," Dr. Trabuco says. "It's an apples-to-pineapples comparison."

Catherine said she had no hesitancy about the surgery. "You need to do minimal research to see these two products are incredibly different and are used for different reasons," Catherine says. "Dr. Trabuco knew what he was talking about. I trusted that he knew what he was doing."

When used appropriately to treat urinary incontinence, mesh slings have between an 80% to 85% success rate at stopping or limiting leaks. Like any operation, receiving a mesh sling to treat incontinence carries some risk. In a small percentage of patients, the mesh can become exposed and protrude into the vagina or it can make emptying the bladder more difficult.

Since the procedure, Catherine's incontinence has all but disappeared. The few times she has leaked were the result of holding too long and were likely avoidable, she says. Now she's able to go on with her life without worrying about how to navigate the inconvenience of incontinence every day. And without that kind of worry, the challenge of 270-mile hike is one Catherine is thrilled to tackle.

Hear more about treatment options for stress incontinence in this video:


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Tags: Dr. Emanuel Trabuco, incontinence, Obstetrics & Gynecology, Pelvic organ prolapse, Transvaginal mesh

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