Search for answers leads woman to a new life
 Pat Ritter could hardly remember a time since the birth of her son, Chuck, 26 years ago when she hadn’t experienced lower back pain and occasional incontinence. Shortly after her son’s birth, Pat had a hysterectomy for a prolapsed uterus, but her problems continued. Her gynecologist at the time said her bladder had dropped and to wait until it worsened to have it fixed. Over the years, Pat experienced occasional incontinence along with lower abdominal pain and fullness and painful intercourse. Her pleas for help from a number of doctors went unheeded.
To the right: Pat Ritter and her husband, John, celebrate another wedding anniversary
Today, Pat enjoys a healthier, more comfortable life with her husband, John, thanks to the care she finally found through urogynecologists from MWRI’s Women’s Bladder and Pelvic Health Research Program.
It wasn’t that the Beaver County woman didn’t try to get help over the years. At various times, doctors advised her everything from “nothing is wrong” to “have a glass of wine” to resolve her problems. Only Pat’s own proactive attempts for relief by learning Kegel exercises made the bouts with incontinence bearable. She began researching her condition on line to learn more, and she kept a journal to track her health problems, and to vent her frustration that no one could help her.
One warm summer evening in 2007, Pat’s long-troubling condition took a critical turn. After showering, she was shocked to see what looked like a jumbo egg-sized ball of flesh at the opening of her vagina. She took a deep breath and tried to think of what this could possibly mean. “I went on line and typed in ‘prolapsed bladder’,” said Pat. All of her symptoms were there. “I had been going to doctors for over two years complaining of painful intercourse and abdominal pain. Could this be the cause?”
Rattled and cranky from lack of sleep, she called her doctor the next day. Her Beaver County gynecologist diagnosed a prolapsed bladder and rectum and referred her to Magee urogynecologist Gary Sutkin, MD, for surgery. After her first meeting with Dr. Sutkin, Pat believed she had found “a physician who would do whatever was best for me. He took as much time as necessary to make sure I was completely reassured. After all the doctors I had seen who didn’t care at all, he was such a blessing.” The journal Pat was keeping had reached 64 pages at that point.
Dr. Sutkin explained to Pat that her vagina had weakened and her rectum, bladder and small intestine had collapsed into the void left by her vagina moving. She learned that her relief over the incontinence stopping in recent years was actually a red flag that her displaced bladder had formed an awkward kink. The surgery, done through the vagina, would move everything back in place and reinforce the vaginal walls with mesh. The technique used would actually enable loosely woven mesh to integrate with the vaginal wall. It would take several weeks to prepare and strengthen her vaginal walls before the surgery could be performed.
“I also agreed to be part of the research. If there was anything I could do to help understand this problem I wanted to,” Pat said. She met with Rennique Ellison, coordinator of fellow research, MWRI Center for Research in Pelvic and Bladder Health. A tissue sample removed during Pat’s surgery would be studied to determine changes in the pelvic floor that occur following menopause. The results of Pat’s pelvic exams done before and five times after her surgery became part of MWRI’s research to determine the effectiveness and durability of the polypropylene vaginal mesh used to repair the prolapse.
After several weeks of recuperation, Pat resumed normal activities. Her pain was gone, but her incontinence returned with a vengeance. Surgery to correct incontinence often is required following prolapse repair, especially for a problem so severe.
Pat’s stress urinary incontinence was caused by weakened pelvic floor muscle and connective tissue that could not support the urethra in its normal position and prevent involuntary urine loss when she coughed, sneezed or did certain physical activities. Doctors performed a 30-minute outpatient procedure to insert a ribbon-like strip of mesh under the urethra to provide support when the pelvic area was stressed. The mesh sling’s support allowed the urethra to remain closed when appropriate, preventing urine loss.
It’s been a year since Pat had the sling procedure. Her incontinence and her pain are under control. Pat decided to make one last journal entry – a “thank you” to Dr. Sutkin, who she called “my hero for giving me back my life. Despite the pain, restrictions and incontinence, I would not hesitate a second before having the surgery. It has changed my life. I can’t imagine going back to the way things were before.”
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