When someone says, “I laughed so hard I pee’d my pants”, it may have been spoken not only in jest, but in truth as well.
57% of women between 40-60 years old have reported at least one incident of urinary incontinence in the past year.
There are 3 types of urinary leakage; stress, urge and combine.
Stress incontinence is particularly common in younger women after childbirth… Really?! Why?! What’s causes this?
Can a woman prevent urinary incontinence? Do men suffer from it too? What options are there to treating it?
Suja Roberts, MD, an Aspirus Medford Hospital OB/GYN, is here to answer these and other great questions.
Selected Podcast
Don’t Make Me Laugh: Preventing Urinary Incontinence
Featured Speaker:
Suja Roberts, MD, FACOG
Dr. Suja [Sue-Ja, rhymes with gouda] Roberts is an Aspirus Medford Hospital OB/GYN with a special interest in urinary incontinence. She has a passion for women’s health and caring for all aspects of female reproductive health. Compassionate, kind, and approachable, she finds special joy in helping women achieve their dreams of motherhood, better health, and a better life. In her free time, Dr. Roberts enjoys reading, music, and spending time with her husband, grown daughter and golden retrievers. Transcription:
Don’t Make Me Laugh: Preventing Urinary Incontinence
Melanie Cole (Host): When someone says, “I laughed so hard I peed in my pants,” it may have been spoken not just been spoken not only in jest but in truth as well. Fifty-seven percent of women between the ages of 40 and 60 have reported at least one incident of urinary incontinence in the past year. My guest today is Dr. Suja Roberts. She is an Aspirus Medford Hospital OB/GYN with a special interest in urinary incontinence. Welcome to the show, Dr. Roberts. So, tell us a little bit about the different types of urinary incontinence and why you think people are so hesitant to seek help when this is something they suffer from.
Dr. Suja Roberts (Guest): Hi, Melanie. Thanks for having me again. Yes, urinary incontinence is quite a frequent common problem that we see in women and surprisingly it’s not a symptom or a condition that is seen in older women, like people normally think. It is not a condition that is associated with aging because surprisingly a lot of younger women, and especially pregnant women, do have at least one episode of urinary incontinence on a weekly basis. So, just to keep it very simple, there are three main kinds of incontinence. The first one is your stress incontinence. This is where, “Oh, I laughed. I’m sneezing. I’m coughing or jumping,” and you’re peeing in your pants. You have to wear protection. That is called “stress incontinence”. The second type is urgent incontinence where you have the sudden urge to go and if you don’t, then you leak. So, that is called urgent incontinence. There is a third kind which is mixed. Many women have both have an element of both stress and urge associated incontinence. That would be the mixed incontinence. There are other varieties of incontinence like overflow incontinence that is mainly seen in older women in a nursing home having Alzheimer’s or dementia where they do not feel the bladder distending and, as a result, the bladder overfills and then, they leak. But we are mainly talking today about the three very common kinds of incontinence: the stress, the urge and mixed.
Melanie: So, why do you think women are so hesitant and when do you want them to come to see someone like you? At what point, when they are suffering from incontinence, do they go see somebody and seek treatment?
Dr. Roberts: You’re right. Women are hesitant to talk about any kind of incontinence--definitely urinary--and when it comes to fecal incontinence, they definitely do not share that or they do not seek help. I guess it could be, one is, when you’re younger and you’re having urinary leakage, you associate that with getting old and many times women accept that as a part of aging. “I’m getting old so I’ll have to wear Depends for the rest of my life.” But that’s not the case because you do not have to depend on Depends. That’s what I tell my patients. Urinary incontinence is not a disease. Nobody dies from it but it is the quality of life. So, if you think that you are not able to exercise; if you think you are not able to enjoy coffee without wearing protection; if you’re not able to take long vacations or road trips because you have to stop at every gas station to go, that means you do have a serious problem and that can be fixed. We can definitely help with incontinence. We have many, many good treatment options. I recommend all patients to watch out for this and not hesitate to reach out to their doctor, they can start off with their primary care provider. It could be a nurse practitioner or a family practice doc but at least that would be a starting point. Many times, they do end up in an OB/GYN’s office where we can take them further into evaluation and treatment. Another way of screening for this incontinence is when I get patients for my annual gynecological exams, I do give them a bladder health questionnaire. That captures a lot of questions and we have found that it’s a very good way to have patients start the discussion, by answering these questions. Definitely, the women have to understand that it is not something that they will have to live with the rest of their life. They do not have to depend on wearing protection for the rest of their life and they should reach out to their primary care provider or their OB/GYN to talk more about the treatment options.
Melanie: Let’s start talking about some of the first lines of defense. If we’re talking about pelvic muscle strengthening and women have heard about Kegel exercises, Dr. Roberts. I would like you to discuss starting with those kinds of exercises and then moving your way into diet changes and then medication, if necessary.
Dr. Roberts: Kegel exercises or pelvic floor exercises are the basics. Every woman has to do them every day religiously for her entire lifespan. We emphasis this in the context of pregnancy check-ups, in the context of gynecological check-ups – anytime we come into patient contact we do emphasize on doing daily pelvic floor exercises. A lot of women do it in the wrong fashion, so they need help to understand what muscles need to be toned. Pointing them out to the right muscle group is important. Most all healthcare providers can assist them with knowing what to do. There are some good internet resources, as well. Daily Kegels or pelvic floor exercises is a must. This is a very good treatment to tone up the pelvic floor muscles and, therefore, is a good way to prevent stress urinary incontinence where the bladder neck rotates due to pelvic floor deficiency. Then, if you are overweight, losing weight is very important because, basically, it’s a risk factor for urinary and fecal incontinence. Weight loss is a must. Women have to aim at maintaining their weight in a normal BMI range. Then, medications. Many times, women are put on diuretics for high blood pressure or edema or something like that. So, they may be producing more urine and, therefore, they may be having more leakage. They need to look over their medications, discuss with their doctors to see if they can substitute or replace some of the medications. That would help. Then, smoking. What I say to women who are smoking is that definitely smoking is a big risk factor for urinary incontinence mainly because of the cough and the lung issues. Avoiding constipation is very important. We call this a valsalva, meaning that when women have to strain to have a bowel movement, you are setting up the stage for urinary incontinence. So, avoiding any kind of valsalva maneuvers like constipation can help in preventing urinary incontinence.
Melanie: When does it come to the point of surgical intervention? When is it something that you say, “Okay. I think that we’re going to have to help you with this. Medication hasn’t seemed to help and your quality of life is really suffering,” and, as you say, someone doesn’t want to have to depend on Depends?
Dr. Roberts: Surgical options are mainly for stress urinary incontinence and there are some other newly available surgical techniques or interventions for urge incontinence as well. To come to this stage in treatment, we take our patients, like you said, right from the basics like pelvic floor exercises and she has done everything that she has to do but she is still not able to control her leakage and it is taking over her life. Then, we do decide, “Okay. This is the time,” and we do go into giving you some help with surgery mainly to support the bladder neck. The most commonly done procedure for stress incontinence is called a “mid-urethral sling”. It is a little piece of tape or mesh that is placed around the bladder neck and that acts as a speed bump so whenever you cough or sneeze or laugh, it moves up like a speed bump and it will prevent urine from escaping from the bladder. That is the most common surgical intervention that is being done in today’s day and age. For urge incontinence, we do have a number of treatments like for women who failed medical treatment and other non-invasive options, there are some good treatment options in the form of Botox. Botox injections relax the muscles. These women can have the Botox injected into the bladder base. That is one way of helping with the urge incontinence. There is a nerve stimulator. It is called sacral neuromodulation where we place a nerve stimulator which will help to stimulate the nerves which will relax the bladder. Those are the three surgical options that are available to women with stress and urge incontinence.
Melanie: In the few minutes, Dr. Roberts, please give your best advice for people suffering from, whether it is stress or urge incontinence and really what you want them to know about this and why they should come to Aspirus for their care.
Dr. Roberts: I want women to know that it’s not a normal part of aging and if you notice incontinence, reach out. Know your options, get some basic evaluations done and that way you can prevent it from getting worse. Maybe you can also prevent it from going to the point where you need more invasive surgeries.
Melanie: Thank you so much. It’s is such great information. You're listening to Aspirus Health Talk and for more information, you can go to Aspirus.org. That's Aspirus.org. This is Melanie Cole. Thanks so much for listening.
Don’t Make Me Laugh: Preventing Urinary Incontinence
Melanie Cole (Host): When someone says, “I laughed so hard I peed in my pants,” it may have been spoken not just been spoken not only in jest but in truth as well. Fifty-seven percent of women between the ages of 40 and 60 have reported at least one incident of urinary incontinence in the past year. My guest today is Dr. Suja Roberts. She is an Aspirus Medford Hospital OB/GYN with a special interest in urinary incontinence. Welcome to the show, Dr. Roberts. So, tell us a little bit about the different types of urinary incontinence and why you think people are so hesitant to seek help when this is something they suffer from.
Dr. Suja Roberts (Guest): Hi, Melanie. Thanks for having me again. Yes, urinary incontinence is quite a frequent common problem that we see in women and surprisingly it’s not a symptom or a condition that is seen in older women, like people normally think. It is not a condition that is associated with aging because surprisingly a lot of younger women, and especially pregnant women, do have at least one episode of urinary incontinence on a weekly basis. So, just to keep it very simple, there are three main kinds of incontinence. The first one is your stress incontinence. This is where, “Oh, I laughed. I’m sneezing. I’m coughing or jumping,” and you’re peeing in your pants. You have to wear protection. That is called “stress incontinence”. The second type is urgent incontinence where you have the sudden urge to go and if you don’t, then you leak. So, that is called urgent incontinence. There is a third kind which is mixed. Many women have both have an element of both stress and urge associated incontinence. That would be the mixed incontinence. There are other varieties of incontinence like overflow incontinence that is mainly seen in older women in a nursing home having Alzheimer’s or dementia where they do not feel the bladder distending and, as a result, the bladder overfills and then, they leak. But we are mainly talking today about the three very common kinds of incontinence: the stress, the urge and mixed.
Melanie: So, why do you think women are so hesitant and when do you want them to come to see someone like you? At what point, when they are suffering from incontinence, do they go see somebody and seek treatment?
Dr. Roberts: You’re right. Women are hesitant to talk about any kind of incontinence--definitely urinary--and when it comes to fecal incontinence, they definitely do not share that or they do not seek help. I guess it could be, one is, when you’re younger and you’re having urinary leakage, you associate that with getting old and many times women accept that as a part of aging. “I’m getting old so I’ll have to wear Depends for the rest of my life.” But that’s not the case because you do not have to depend on Depends. That’s what I tell my patients. Urinary incontinence is not a disease. Nobody dies from it but it is the quality of life. So, if you think that you are not able to exercise; if you think you are not able to enjoy coffee without wearing protection; if you’re not able to take long vacations or road trips because you have to stop at every gas station to go, that means you do have a serious problem and that can be fixed. We can definitely help with incontinence. We have many, many good treatment options. I recommend all patients to watch out for this and not hesitate to reach out to their doctor, they can start off with their primary care provider. It could be a nurse practitioner or a family practice doc but at least that would be a starting point. Many times, they do end up in an OB/GYN’s office where we can take them further into evaluation and treatment. Another way of screening for this incontinence is when I get patients for my annual gynecological exams, I do give them a bladder health questionnaire. That captures a lot of questions and we have found that it’s a very good way to have patients start the discussion, by answering these questions. Definitely, the women have to understand that it is not something that they will have to live with the rest of their life. They do not have to depend on wearing protection for the rest of their life and they should reach out to their primary care provider or their OB/GYN to talk more about the treatment options.
Melanie: Let’s start talking about some of the first lines of defense. If we’re talking about pelvic muscle strengthening and women have heard about Kegel exercises, Dr. Roberts. I would like you to discuss starting with those kinds of exercises and then moving your way into diet changes and then medication, if necessary.
Dr. Roberts: Kegel exercises or pelvic floor exercises are the basics. Every woman has to do them every day religiously for her entire lifespan. We emphasis this in the context of pregnancy check-ups, in the context of gynecological check-ups – anytime we come into patient contact we do emphasize on doing daily pelvic floor exercises. A lot of women do it in the wrong fashion, so they need help to understand what muscles need to be toned. Pointing them out to the right muscle group is important. Most all healthcare providers can assist them with knowing what to do. There are some good internet resources, as well. Daily Kegels or pelvic floor exercises is a must. This is a very good treatment to tone up the pelvic floor muscles and, therefore, is a good way to prevent stress urinary incontinence where the bladder neck rotates due to pelvic floor deficiency. Then, if you are overweight, losing weight is very important because, basically, it’s a risk factor for urinary and fecal incontinence. Weight loss is a must. Women have to aim at maintaining their weight in a normal BMI range. Then, medications. Many times, women are put on diuretics for high blood pressure or edema or something like that. So, they may be producing more urine and, therefore, they may be having more leakage. They need to look over their medications, discuss with their doctors to see if they can substitute or replace some of the medications. That would help. Then, smoking. What I say to women who are smoking is that definitely smoking is a big risk factor for urinary incontinence mainly because of the cough and the lung issues. Avoiding constipation is very important. We call this a valsalva, meaning that when women have to strain to have a bowel movement, you are setting up the stage for urinary incontinence. So, avoiding any kind of valsalva maneuvers like constipation can help in preventing urinary incontinence.
Melanie: When does it come to the point of surgical intervention? When is it something that you say, “Okay. I think that we’re going to have to help you with this. Medication hasn’t seemed to help and your quality of life is really suffering,” and, as you say, someone doesn’t want to have to depend on Depends?
Dr. Roberts: Surgical options are mainly for stress urinary incontinence and there are some other newly available surgical techniques or interventions for urge incontinence as well. To come to this stage in treatment, we take our patients, like you said, right from the basics like pelvic floor exercises and she has done everything that she has to do but she is still not able to control her leakage and it is taking over her life. Then, we do decide, “Okay. This is the time,” and we do go into giving you some help with surgery mainly to support the bladder neck. The most commonly done procedure for stress incontinence is called a “mid-urethral sling”. It is a little piece of tape or mesh that is placed around the bladder neck and that acts as a speed bump so whenever you cough or sneeze or laugh, it moves up like a speed bump and it will prevent urine from escaping from the bladder. That is the most common surgical intervention that is being done in today’s day and age. For urge incontinence, we do have a number of treatments like for women who failed medical treatment and other non-invasive options, there are some good treatment options in the form of Botox. Botox injections relax the muscles. These women can have the Botox injected into the bladder base. That is one way of helping with the urge incontinence. There is a nerve stimulator. It is called sacral neuromodulation where we place a nerve stimulator which will help to stimulate the nerves which will relax the bladder. Those are the three surgical options that are available to women with stress and urge incontinence.
Melanie: In the few minutes, Dr. Roberts, please give your best advice for people suffering from, whether it is stress or urge incontinence and really what you want them to know about this and why they should come to Aspirus for their care.
Dr. Roberts: I want women to know that it’s not a normal part of aging and if you notice incontinence, reach out. Know your options, get some basic evaluations done and that way you can prevent it from getting worse. Maybe you can also prevent it from going to the point where you need more invasive surgeries.
Melanie: Thank you so much. It’s is such great information. You're listening to Aspirus Health Talk and for more information, you can go to Aspirus.org. That's Aspirus.org. This is Melanie Cole. Thanks so much for listening.