Giving Back Control

Simple measures change lives curtailed by incontinence

By Patricia Kelly

Melinda Monigold remembers an elderly patient she visited years ago as a home care nurse: “I was treating her for a wound, but I noticed she had newspapers all over the floor,” she says. “I thought, ‘She must have a puppy!’ But as time went on, I realized she leaked urine with every step she took. She never went anywhere. She never had anyone over. I think about her quite a bit … she was someone we could have helped.”

Today, Monigold, an instructor with the School of Nursing, works as a nurse practitioner with the Minnesota Continence Associates (MCA) to help people regain their quality of life. An estimated 34 million Americans—most of  them women—have some form of urinary incontinence. “Many people suffer in silence,” says Monigold. “They become depressed. They curtail their activities. They isolate themselves. They think there is nothing to do about it. But we can do a lot that can make a tremendous difference.”

At MCA, Monigold and Clinical Director Jean Wyman provide comprehensive evaluations and nonsurgical treatments for women and men with incontinence. Located in the Women’s Health Clinic in the Phillips- Wangensteen Building, MCA is operated by the School of Nursing in collaboration with University of Minnesota Physicians and the University of Minnesota Medical Center, Fairview.

When MCA opened last October, it marked an exciting first for the School of Nursing. “A lot of places around the country do what we are doing,” says Wyman, “but we are unique in that we are a clinical practice led by the faculty of a school of nursing.”

Wyman and Monigold specialize in conservative measures for incontinence, including pelvic floor muscle exercises and behavioral techniques. There are different forms of incontinence, and each type calls for a different treatment.

“The key is the majority of people can be treated by simple measures,” says Wyman. For example, sometimes patients can regain control by doing a quick series of pelvic-floor contractions and redirecting their mental focus when they feel the urge. This basically short-circuits the brain by not rewarding the urge, Wyman says.

Monigold and Wyman refer patients who need more invasive measures to the University of Minnesota Physicians, who, in turn, refer patients to MCA. Urologic surgeon Chadwick Huckabay says he refers one or two patients each week. “I’m probably making them busier than they want to be right now,” he says with a laugh. “I send them a lot of patients who have never had any treatment—because a lot of patients can improve their quality of life tremendously just by modifying their behaviors, with no medication or surgeries.”

Wyman and Monigold also have begun a nursing-home consultation practice, just in time to help homes meet new federal guidelines for the treatment of incontinent nursing home residents.

Although most MCA patients are older women, Monigold sees a number of younger women and a few men. “I hear people say, ‘I used to go to the bathroom 15 times a day; I know every bathroom in town; I’m too young for this!’ And they get better. When you can give them back control of their lives … it makes you want to come to work every day.”