Do you find yourself crossing your legs when you laugh or sneeze?
Do you find yourself frequently rushing to the restroom?
Do you relate to those “gotta go” commercials?
If you said yes to any of these questions, then you could be one of over 27 million women nationally who experience bladder leakage.
Listen in as BJ Harris, MD tells you what causes these symptoms, how you can prevent leaks from affecting your quality of life and if you should consider one of the medications that are advertised.
Selected Podcast
Women’s Incontinence: Making Sense of the “Gotta Go” Commercials
Featured Speaker:
BJ Harris, MD - OB/GYN
BJ Harris, MD is a board-certified surgical gynecologist. Her professional interests include pelvic organ prolapse, incontinence, urogynecology, minimally invasive gynecologic surgical procedures and robotic surgery. She was one of the first gynecologists in the Twin Cities to use robotic surgery beginning in 2007. Dr. Harris has also received the Lester J. Bossert teaching award and the V. Bradley Roberts surgical excellence award. Transcription:
Women’s Incontinence: Making Sense of the “Gotta Go” Commercials
Melanie Cole (Host): Do you find yourself crossing your legs when you laugh or sneeze? Do you find yourself frequently rushing to the restroom? Do you relate to those Gotta Go commercials? If you said yes to any of these questions, you could be one of over 27 million women nationally who experience bladder leakage. My guest today is Dr. BJ Harris. She’s a board-certified surgical gynecologist with Allina Health. Welcome to the show, Dr. Harris. Tell us a little bit about what is that bladder leakage. What is incontinence?
Dr. BJ Harris (Guest): Good morning, Melanie. Urinary incontinence is a very common thing. I tell my patients it’s not normal, but it’s common. The good news is that it is not dangerous. It is the involuntary leakage of urine. The two most common types are stress incontinence and urgency incontinence or overactive bladder. Stress incontinence is leakage with coughing, laughing, sneezing. A really common one is exercise. Then urgency incontinence is a bit different. It’s leakage when you just cannot make it to the bathroom, like the Gotta Go ads.
Melanie: What causes it, and are there things that would increase somebody’s risk of suffering from incontinence? It’s such embarrassing situation that many women don’t even want to tell their friends that they’ve got this.
Dr. Harris: Yes, I hear that very commonly. Women are finally coming out and speaking about this sort of stuff. Some of the biggest risk factors are childbearing, obesity, chronic cough, whether it’s from asthma or smoking, chronic constipation, smoking itself. Vaginal delivery and episiotomy are particularly high risk for stress incontinence. Family history and repetitive lifting may also play a role.
Melanie: Okay. So what can we do to find out if it’s really becoming something that’s a problem and you just say, “Okay, I’m not comfortable with this,” whether it’s the urge or stress incontinence, if you’re just not comfortable, then what? What are you going to do as a doctor to help us with this?
Dr. Harris: Sure. When you first come into my office, the diagnosis oftentimes is made with simply a history and a physical. If I see a patient in the office and they have straightforward symptoms, it’s generally safe to make a diagnosis without any extensive testing, sometimes maybe a simple urinalysis to make sure that it’s not an infection increasing the symptoms. If somebody has a complex pattern of symptoms, we can do additional tests right in the comfort of our office.
Melanie: Then what? What are the treatments? What’s the first line of defense?
Dr. Harris: Sure. We have lots of conservative options for both stress and urgency incontinence. The main conservative option for stress incontinence would be Kegels. Kegels don’t have great success rates; however, physical therapy does. What I tell my patients about physical therapy is it’s like having a personal trainer for your pelvic floor. Physical therapy can also be a conservative treatment option for urgency incontinence. Bladder retraining, which is timed voiding during the day and watching one’s intake of caffeinated or carbonated beverages or even alcoholic beverages can play a part in management that is conservative for the urinary incontinence.
Melanie: Okay, so bladder retraining or Kegel exercises and then the caffeinated or alcoholic beverages. When we’re looking at how much we drink in the day, what do you want us to know about that? Does it mean stop drinking coffee, one cup is enough? What about wine at night? Are these things contributing to that incontinence, or are they just adding that diuretic effect, which is already making our incontinence harder to deal with?
Dr. Harris: Yeah. No, it actually can be both. For example, it doesn’t mean that you absolutely can’t have coffee. I generally recommend a reduction in your coffee, but I’m not going to take away your single glass of Java in the morning. That would be cruel and unusual. We know that it doesn’t mean that you can’t have these things. It’s just that when you have these sorts of beverages, you might not expect a “perfect behavior” out of your bladder. If you have alcohol right before bed, maybe you’re not going to have as good of a night. It doesn’t mean you can’t have it. It’s a choice.
Melanie: Okay, now you spoke about Kegel exercises. Somebody who teaches this for part of what I do for a living, give us a little lesson here, if you would, Dr. Harris, for women listening that don’t understand how to do it. Because for some people -- and even men can benefit from this exercise. But just give a little lesson on how you should be doing it and how often.
Dr. Harris: Sure. Kegels are classically learned or taught, for women at least, while you’re urinating to stop your stream. Then that’s the correct set of muscles. If you can pay attention while you urinate to what muscles are required in your bottom to stop the flow, then that’s the correct set of muscles. Now, I don’t generally recommend doing your Kegels while you’re urinating all the time because I think it can teach voiding dysfunction. Once you’ve isolated those muscles, to contract them multiple times a day. Now, our physical therapist has a more wide variety so it doesn’t get quite so boring for the actual Kegels. We use it traditionally, useinstead of six, ten times while you’re sitting at the stoplight. And if you’re moving up and down in the car and the person in the lane next to you can see that you’re doing your Kegel, well then you’ve got the wrong set of muscles isolated. It may be better if you do it at a time when you’re actually paying attention and focusing on these muscles rather than trying to multitask, as we all do in this day and age.
Melanie: We’ve seen those commercials, the women in the golf course and they have to go, they jump in the golf cart and race all the way. They’re talking about medications in those commercials. What do the medications do?
Dr. Harris: The medications affect the nerve and the muscle function in the bladder, causing the bladder muscle to relax. In this way, the meds reduce the frequency and intensity of bladder contractions, thus decreasing unwanted leakage and frequency.
Melanie: So if the bladder relaxes, doesn’t that sound like it would do just the opposite, like it would let loose whatever it is you’re supposed to be holding in there? How do these medications work as far as lifetime? Is it just something you take when you’re suffering, or is it a lifetime thing?
Dr. Harris: Sure. You don’t have to plan on taking it your whole life, not always. If you’re able to make some lifestyle changes, such as weight loss, reduction of caffeinated beverages, able to maintain symptom relief, you can sometimes stop the medicine. In addition, if it’s the reactive bladder that is very, very bothersome and the medicines either aren’t something that you want to take long-term or you have side effects you don’t like, we have some neuromodulators, some things such as InterStim, which would be a surgical option or Urgent PC, which would be something we’d be able to manage the reactive bladder symptoms with in the office. We do have other nonmedical sort of things. It does. It really can vary at different times in women’s lives how much their symptoms are bothersome to them.
Melanie: What about surgery? We’ve heard about the slings and we’ve heard about vaginal meshes. Tell us a little bit about the different forms of surgery. And are they safe? What do they do for us?
Dr. Harris: Sure. The most common type of surgery for stress incontinence is the insertion of a mid-urethral sling. It’s a simple same-day surgery. It’s a small shoestring-sized and shaped piece of mesh that’s inserted via the vagina underneath the urethra. Then it acts like a back stopper, a hand lock to the urethra so that when you laugh or exercise there it’s support to the urethra and prevent the leakage of urine. There are a ton of women out there living a less active lifestyle than they’d like to as a result of stress urinary incontinence. Yes, overall, the surgery is safe. There is no surgery that has zero percent risk, but the FDA does have some warnings regarding vaginal mesh. The main concern is the large pieces of mesh are placed for prolapse into the vagina. The ads you are seeing and hearing are frightening women away from taking treatment for their urinary incontinence. The mid-urethral slings were first developed in 1995. That’s pretty much 30 years ago in Sweden. And since then, they have been an excellent treatment. I’ve continued to use them and still do use them today as one of the gold standards for treatment of stress urinary incontinence.
Melanie: In just the last minute or so, Dr. Harris, give your best advice for women out there who may be a little bit too shy to discuss this with their doctor who might be suffering from one of the types of incontinence we’ve been discussing today. And really, give them your best advice about what they should do about it.
Dr. Harris: Sure. I think that there’s nothing to be embarrassed about. This is very, very common. Come, chat with your gynecologist. Chat with your internal medicine or family practice doctor. Chat with one of us, and we can get you in the right direction. You’ll find that we hear about this pretty much every day, if not every week and we’re going to have some answers for you and at least give you some direction. If nothing else, maybe even some reassurance. The good news is it’s not dangerous and we can work on this together.
Melanie: That’s great information. Thank you so much. You’re listening to the WELLcast with Allina Health. For more information, you can go to allinahealth.org. That’s allinahealth.org. This is Melanie Cole. Thanks so much for listening and have a great day.
Women’s Incontinence: Making Sense of the “Gotta Go” Commercials
Melanie Cole (Host): Do you find yourself crossing your legs when you laugh or sneeze? Do you find yourself frequently rushing to the restroom? Do you relate to those Gotta Go commercials? If you said yes to any of these questions, you could be one of over 27 million women nationally who experience bladder leakage. My guest today is Dr. BJ Harris. She’s a board-certified surgical gynecologist with Allina Health. Welcome to the show, Dr. Harris. Tell us a little bit about what is that bladder leakage. What is incontinence?
Dr. BJ Harris (Guest): Good morning, Melanie. Urinary incontinence is a very common thing. I tell my patients it’s not normal, but it’s common. The good news is that it is not dangerous. It is the involuntary leakage of urine. The two most common types are stress incontinence and urgency incontinence or overactive bladder. Stress incontinence is leakage with coughing, laughing, sneezing. A really common one is exercise. Then urgency incontinence is a bit different. It’s leakage when you just cannot make it to the bathroom, like the Gotta Go ads.
Melanie: What causes it, and are there things that would increase somebody’s risk of suffering from incontinence? It’s such embarrassing situation that many women don’t even want to tell their friends that they’ve got this.
Dr. Harris: Yes, I hear that very commonly. Women are finally coming out and speaking about this sort of stuff. Some of the biggest risk factors are childbearing, obesity, chronic cough, whether it’s from asthma or smoking, chronic constipation, smoking itself. Vaginal delivery and episiotomy are particularly high risk for stress incontinence. Family history and repetitive lifting may also play a role.
Melanie: Okay. So what can we do to find out if it’s really becoming something that’s a problem and you just say, “Okay, I’m not comfortable with this,” whether it’s the urge or stress incontinence, if you’re just not comfortable, then what? What are you going to do as a doctor to help us with this?
Dr. Harris: Sure. When you first come into my office, the diagnosis oftentimes is made with simply a history and a physical. If I see a patient in the office and they have straightforward symptoms, it’s generally safe to make a diagnosis without any extensive testing, sometimes maybe a simple urinalysis to make sure that it’s not an infection increasing the symptoms. If somebody has a complex pattern of symptoms, we can do additional tests right in the comfort of our office.
Melanie: Then what? What are the treatments? What’s the first line of defense?
Dr. Harris: Sure. We have lots of conservative options for both stress and urgency incontinence. The main conservative option for stress incontinence would be Kegels. Kegels don’t have great success rates; however, physical therapy does. What I tell my patients about physical therapy is it’s like having a personal trainer for your pelvic floor. Physical therapy can also be a conservative treatment option for urgency incontinence. Bladder retraining, which is timed voiding during the day and watching one’s intake of caffeinated or carbonated beverages or even alcoholic beverages can play a part in management that is conservative for the urinary incontinence.
Melanie: Okay, so bladder retraining or Kegel exercises and then the caffeinated or alcoholic beverages. When we’re looking at how much we drink in the day, what do you want us to know about that? Does it mean stop drinking coffee, one cup is enough? What about wine at night? Are these things contributing to that incontinence, or are they just adding that diuretic effect, which is already making our incontinence harder to deal with?
Dr. Harris: Yeah. No, it actually can be both. For example, it doesn’t mean that you absolutely can’t have coffee. I generally recommend a reduction in your coffee, but I’m not going to take away your single glass of Java in the morning. That would be cruel and unusual. We know that it doesn’t mean that you can’t have these things. It’s just that when you have these sorts of beverages, you might not expect a “perfect behavior” out of your bladder. If you have alcohol right before bed, maybe you’re not going to have as good of a night. It doesn’t mean you can’t have it. It’s a choice.
Melanie: Okay, now you spoke about Kegel exercises. Somebody who teaches this for part of what I do for a living, give us a little lesson here, if you would, Dr. Harris, for women listening that don’t understand how to do it. Because for some people -- and even men can benefit from this exercise. But just give a little lesson on how you should be doing it and how often.
Dr. Harris: Sure. Kegels are classically learned or taught, for women at least, while you’re urinating to stop your stream. Then that’s the correct set of muscles. If you can pay attention while you urinate to what muscles are required in your bottom to stop the flow, then that’s the correct set of muscles. Now, I don’t generally recommend doing your Kegels while you’re urinating all the time because I think it can teach voiding dysfunction. Once you’ve isolated those muscles, to contract them multiple times a day. Now, our physical therapist has a more wide variety so it doesn’t get quite so boring for the actual Kegels. We use it traditionally, useinstead of six, ten times while you’re sitting at the stoplight. And if you’re moving up and down in the car and the person in the lane next to you can see that you’re doing your Kegel, well then you’ve got the wrong set of muscles isolated. It may be better if you do it at a time when you’re actually paying attention and focusing on these muscles rather than trying to multitask, as we all do in this day and age.
Melanie: We’ve seen those commercials, the women in the golf course and they have to go, they jump in the golf cart and race all the way. They’re talking about medications in those commercials. What do the medications do?
Dr. Harris: The medications affect the nerve and the muscle function in the bladder, causing the bladder muscle to relax. In this way, the meds reduce the frequency and intensity of bladder contractions, thus decreasing unwanted leakage and frequency.
Melanie: So if the bladder relaxes, doesn’t that sound like it would do just the opposite, like it would let loose whatever it is you’re supposed to be holding in there? How do these medications work as far as lifetime? Is it just something you take when you’re suffering, or is it a lifetime thing?
Dr. Harris: Sure. You don’t have to plan on taking it your whole life, not always. If you’re able to make some lifestyle changes, such as weight loss, reduction of caffeinated beverages, able to maintain symptom relief, you can sometimes stop the medicine. In addition, if it’s the reactive bladder that is very, very bothersome and the medicines either aren’t something that you want to take long-term or you have side effects you don’t like, we have some neuromodulators, some things such as InterStim, which would be a surgical option or Urgent PC, which would be something we’d be able to manage the reactive bladder symptoms with in the office. We do have other nonmedical sort of things. It does. It really can vary at different times in women’s lives how much their symptoms are bothersome to them.
Melanie: What about surgery? We’ve heard about the slings and we’ve heard about vaginal meshes. Tell us a little bit about the different forms of surgery. And are they safe? What do they do for us?
Dr. Harris: Sure. The most common type of surgery for stress incontinence is the insertion of a mid-urethral sling. It’s a simple same-day surgery. It’s a small shoestring-sized and shaped piece of mesh that’s inserted via the vagina underneath the urethra. Then it acts like a back stopper, a hand lock to the urethra so that when you laugh or exercise there it’s support to the urethra and prevent the leakage of urine. There are a ton of women out there living a less active lifestyle than they’d like to as a result of stress urinary incontinence. Yes, overall, the surgery is safe. There is no surgery that has zero percent risk, but the FDA does have some warnings regarding vaginal mesh. The main concern is the large pieces of mesh are placed for prolapse into the vagina. The ads you are seeing and hearing are frightening women away from taking treatment for their urinary incontinence. The mid-urethral slings were first developed in 1995. That’s pretty much 30 years ago in Sweden. And since then, they have been an excellent treatment. I’ve continued to use them and still do use them today as one of the gold standards for treatment of stress urinary incontinence.
Melanie: In just the last minute or so, Dr. Harris, give your best advice for women out there who may be a little bit too shy to discuss this with their doctor who might be suffering from one of the types of incontinence we’ve been discussing today. And really, give them your best advice about what they should do about it.
Dr. Harris: Sure. I think that there’s nothing to be embarrassed about. This is very, very common. Come, chat with your gynecologist. Chat with your internal medicine or family practice doctor. Chat with one of us, and we can get you in the right direction. You’ll find that we hear about this pretty much every day, if not every week and we’re going to have some answers for you and at least give you some direction. If nothing else, maybe even some reassurance. The good news is it’s not dangerous and we can work on this together.
Melanie: That’s great information. Thank you so much. You’re listening to the WELLcast with Allina Health. For more information, you can go to allinahealth.org. That’s allinahealth.org. This is Melanie Cole. Thanks so much for listening and have a great day.