Taking Back Control

Judith Cook is an incontinence patientJudith Cook, 64, says her life used to literally revolve around hourly trips to the bathroom. The Franklin resident knew the location of every bathroom in every store, and she avoided drinking fluids when she was out running errands. When she marched in the Memorial Day parade last year with her seven-year-old granddaughter’s Daisy Girl Scout troop, she avoided drinking water for hydration out of fear that she’d need a bathroom before the two-hour parade ended. “It affected everything I did,” Judith recalls.

She attempted to dismiss her symptoms as part of the normal aging process; however, it got so bad, Judith couldn’t even make it through the night without getting up multiple times to go to the bathroom. “I thought I just had to cope with it,” she says. “It’s embarrassing as an adult, and it’s so inconvenient.”

Judith tried medication prescribed by her primary care physician to address the problem, but it wasn’t effective, and it made her eyes and mouth very dry. Finally, a friend suggested she meet with Samuel Zylstra, MD, MPH, FACOG, an obstetrician/gynecologist (OB/GYN) at Milford Regional who specializes in urogynecology, including conditions such as stress incontinence (leaking urine when coughing, sneezing or laughing), overactive bladder disorder ( increased frequency in urination or increased pressure to urinate), and prolapse (when pelvic structures, such as the bladder or rectum, bulge or protrude into the vaginal wall).

Heeding her friend’s advice, Judith met with Dr. Zylstra and openly discussed her symptoms during the initial consultation. She felt completely at ease with him. “He has this calm, practical and relaxed demeanor that instills confidence,” she says.

Dr. Zylstra talked in-depth with Judith about her symptoms and sent her home with two forms to complete before the next appointment—a uro-diary to record urine output and her frequency/ urgency to urinate, as well as a quality of life assessment form to gauge the severity of her problem. The uro-diary was an eye-opening experience. “I was really surprised to see on paper how often I went,” she recalls.

During her second appointment, Dr. Zylstra reviewed the forms and also performed a test to determine how much fluid Judith’s bladder could hold. An overactive bladder and/or bladder affected by stress incontinence holds far less fluid than the average bladder. Not surprisingly, Judith’s bladder was able to hold very little fluid. “He told me every step of the way what he was doing and what I was going to feel,” Judith recalls. She was also impressed with the care and compassion shown by Brenda Zylstra, MSN, WHNP, MPH, a women’s health nurse practitioner (and Dr. Zylstra’s wife), who assisted with the procedure.

Through a urodynamic evaluation which includes a pelvic exam, Dr. Zylstra also determined Judith had a rectal prolapse where her rectum was bulging into the back compartment of her vaginal wall. The exam also revealed that the muscles around her bladder neck (the area in which the urethra enters into the bladder) were very weak—another sign that Judith likely had stress incontinence and a bit of overactive bladder disorder as well.
Though Brenda educated her on pelvic muscle exercises to alleviate her incontinence and overactive bladder, Judith knew that surgery was the only way to really resolve her issues. She chose Milford Regional to have her surgery because of its close proximity to her home and Dr. Zylstra’s affiliation with the hospital.

During surgery, Dr. Zylstra corrected Judith’s prolapse by returning the organs affected back to their correct position and strengthening structures around the area with a pliable mesh material. He also corrected Judith’s stress incontinence by inserting a polypropylene sling to stabilize and support the bladder neck. Both procedures were completed in less than an hour. “It was so much easier than I thought it was going to be,” Judith recalls. “The pain was so insignificant.”

Judith also gives high praise to Milford Regional’s nursing staff for their attentiveness during her overnight stay. “The nursing care was beyond compassionate,” she says emphatically. “They were comforting and really on the ball.”

Within a few days, Judith was back to her normal activities, though she was advised not to lift anything heavy or strain herself for seven to ten days. Her prescription for pain medication went unfilled because she didn’t need it. Looking back on the experience, Judith regrets not acting sooner. “I wish I had done this when I first noticed it was becoming an issue,” she says. “I regret that I didn’t address it earlier.”

Judith no longer has to plan her schedule around the accessibility of a bathroom. She’s proud to say that when she marched in this year’s Memorial Day parade, she was able to drink two sodas and a bottle of water without thinking twice. And she is rediscovering what it’s like to sleep through the night without interruption. “It’s so nice,” she says enthusiastically. “My whole life is just so much more comfortable.”

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