by Matthew Brady

Judy, a 51-year-old Orland Park [Ill.] resident, did something her 85-year-old mother would never dream of doing - she talked to a doctor about her leaking bladder and underwent surgery to fix it.

Her mother, on the other hand, chooses to wear adult diapers and refuses to seek treatment. "It's surgery and in her generation, that's a part of your body you don't talk about," says Judy, who asked that her last name not be used.

Up to 20 percent of women experience some kind of bladder issue in their lifetimes, says Dr. Sandra Culbertson, a highly rated gynecologist at the University of Chicago Medical Center. "It's really, really common," she says.

Judy suffered from "stress incontinence," a condition often prompted by a sneeze, cough or exercise. It is one of two types that account for most female incontinence. She says she noticed her leaky bladder after the birth of her second son.

"It was a running joke between my husband and I - 'I couldn't sneeze in public' and that kind of stuff," she says. "I never knew you could fix it surgically."

Culbertson provided one of the most popular and effective solutions - the pubovaginal sling - and Judy says she's been dry ever since. "Not having to worry about it is huge," she says.

The sling - a synthetic strip that supports the bladder and keeps the urethra shut during spasms like a sneeze or cough - can be inserted in a 20-minute, outpatient procedure. "About 85 percent of women will be completely dry," Culbertson says.

The fair market price for the procedure is $4,710, according to Healthcare Blue Book. The fair price represents what a health service provider typically accepts from insurance companies as full payment, which is substantially less than the billed amount. Insurance typically covers the procedure, Culbertson says.

Judy's mother suffers from the other most common type of female incontinence - "urge incontinence." or "overactive bladder." It often affects older, post-menopausal women, says highly rated Dr. Roger Goldberg, director of urogynecology research at NorthShore University Health System in Evanston [Ill.].

Risk factors for both include childbirth, hormonal changes, age, heredity and body structure, Goldberg says. "For the vast majority of women, we can bring it under control," he says. "They just need to take the first step."

Kegel exercises - designed to tighten the pelvic floor muscles - help both types. "We are not going to cure a lot of people totally with that, but it's a good first-line therapy," Culbertson says. The exercises, combined with medication and dietary changes, are the most common treatments for urge incontinence.

Diane Isackson, 58, of Lemont [Ill.] says she waited eight years before going to Culbertson for help with stress incontinence. A different doctor, who performed her hysterectomy, lifted and anchored her bladder to her abdominal wall during that procedure. "Unfortunately, over time gravity takes its toll and the symptoms started coming back and progressively got worse," she says.

Culbertson prescribed Kegel exercises and medication, then finally surgery.

"She tries the more conservative ways first. That's what I like about her," Isackson says.