Urinary incontinence can be an embarrassing problem, but it’s not an uncommon one, especially for women over the age of 50. While it’s normally associated with the aging process, it is very often a response to disease, illness or medication, as well as lifestyle-related issues.
Today there are more treatments for urinary incontinence than ever before; including surgery and exercises that can be performed at home. At Florida Hospital, our doctors and nurses have the experience and technology to diagnose your condition and help alleviate your symptoms.
Julie Schneider, MD, discusses the treatment options available at Florida Hospital for urinary incontinence that may offer a better quality of life for those that suffer with this highly treatable condition.
Selected Podcast
Do You Suffer From Urinary Incontinence?
Featured Speaker:
Learn more about Julie Schneider, MD
Julie Schneider, MD
Julie Schneider, MD, is a board-certified gynecologist and urogynecologist with HealthCare Partners at Florida Hospital Memorial Medical Center. She received her Bachelor of Arts degree in biology at Washington University in St. Louis, Missouri, and her medical degree from Loyola University Chicago Stritch School of Medicine in Maywood, Illinois.Learn more about Julie Schneider, MD
Transcription:
Do You Suffer From Urinary Incontinence?
Melanie Cole (Host): Many Americans suffer from urinary incontinence. Some may be hesitant to seek treatment as they may be embarrassed about this condition or they may think nothing can be done. However, seeking treatment may offer a better quality of life for those that suffer with this highly treatable condition. My guest today is Dr. Julie Schneider. She's double-board certified in female pelvic medicine and reconstructive surgery with Florida Hospital. Welcome to the show, Dr. Schneider. So, what are some of the different types of incontinence and what do we know about the causes?
Dr. Julie Schneider (Guest): Well, most importantly, I would bring up to start with is the incontinence of urine is the sudden release of urine when you're not expecting it and it is never normal. Many people feel that when you get older it's just a natural part of aging but that is actually incorrect. The type is varied. It can be that you have a mixture, which is what we commonly see of anywhere of one to five different varieties. For instance, there is stress urinary incontinence, which commonly people will equate with coughing, laughing, sneezing, jogging--anything that exerts pressure on the lower pelvis. The second most common kind is urgency incontinence where you can't control getting to the bathroom, even though you're not moving or doing anything, in particular. You could be sitting in a chair and your bladder will just simply start releasing before you get any warning or if you get warning, it's certainly not enough to get you to the bathroom. Then, there's some that are more functional when a person is just not able nor capable to walk to the bathroom and that's something that you have to change their walker, for instance, or where the commode is next to the bed, that sort of thing. There's a mixed picture, then there's overflow which is where you have retention. Men seem to suffer with that a little bit more because of the prostate, but women can also experience it for different reasons, particularly with a condition similar to multiple sclerosis, let's say. That sort of thing.
Melanie: Are women more at risk for certain types because of being pregnant? Does that contribute to this for us?
Dr. Schneider: Yes, actually, it does. Commonly, if you've done some kind of childbearing, even the pregnancy itself can exert pressure on the pelvic floor musculature and the labor process and the pressure in that area can do some denervation, which means the nerves themselves can be damaged and that, later in life, similar to what we experience when we layout and we sunburn as children, you usually don't have your problem until later--similar situation with this condition. It will happen oftentimes after menopause but it really can happen at any time. And even one baby, even a small baby, can cause a difficulty with this issue at any time.
Melanie: So, if somebody does notice that they have this, and maybe they don't feel that it's bad enough yet to see a physician about it, what do you recommend that they do at home? Are there some exercises they can try? Do you want them to practice voiding and stopping because there's some controversy on that? What do you like us to do at home to work on this, right at the outset?
Dr. Schneider: Right at the outset, the very first thing I tell everybody is, if you have a few extra pounds on, lose weight. The number one cure, or at least moderation that you can do to correct this problem, to hopefully never need surgery or take medication, all types of incontinence as a general rule, with the exception of some very rare ones, are made better, maybe not 100%, by weight loss. So, that would be the first thing I tell all my patients. The second most important thing is dietary habits that we all sometimes participate in, caffeine being number one. It can be spicy foods, alcohol, different foods, many people are irritated by cranberry juice, which is, of course, what many people feel that they should be doing to help their problem, and in fact, they are making it worse. There are many diets that can be found that will show you things that are bladder irritants, and if you try to avoid those sorts of things, that will help. Those two are the number one and number two things that I recommend. Then, the Kegel exercises, which are pelvic floor exercises, can help. You have to do quite a number of them. They say somewhere around 12 per rep, and five reps per day, so that's approximately 60 or more every day to see some strengthening in the pelvic floor musculature.
Melanie: Can you explain a little bit about the Kegel exercise for people? Because they don't always know how this is done or what it's supposed to feel like.
Dr. Schneider: Well, it's actually best if you have your gynecologist show you when you're doing them how it's best done. Most times people think you go and you go to the bathroom and you stop and start your urine flow. That may be it, but oftentimes, what they are doing is squeezing their abdominal muscles more than their pelvic muscles, and that's where, if you just speak with your physician to get a good sense that you're doing them correctly, it doesn't take long to figure it out, but most of the time, I have found that people come in using more of their abdominal muscles than their actual pelvic floor muscles. Sometimes, it's hard to differentiate the two.
Melanie: So, then what? If they've tried some of these things--lost weight, they've worked on their intake of fluids, maybe they've done their Kegels, and it's still not working. What's the first line of defense that you would use with them? Are there some medications they can try? What do you tell them?
Dr. Schneider: Well, first you have to separate, or tease apart, which of the problems they have. So, for instance, if they have a retention problem secondary to a neurogenic situation, the last thing you would do would be start medication. But, if you have an overactivity of your bladder, which would be muscle spasms, or I like to call them like twitches of your pelvis, then a medication to help with an antispasmodic property may help correct that problem. If that's the case, you may get great relief from a very mild medication. So, that would be for those two instances. If you're talking about stress incontinence, then sometimes a simple surgery, a minor surgery will help, or you can even do collagen injections that can help. There are a lot of options, but most importantly, it's not a one-size-fits-all. You simply have to be evaluated to be certain that what we're treating is the correct diagnosis.
Melanie: You mentioned collagen injections. People hear about Botox, but they don't realize that this could be a treatment for this. Speak about that a little bit?
Dr. Schneider: Botox is used for the treatment of detrusor instability, or overactive bladder. It is not considered a first or second line--it's a third line therapy. It works extremely well but you first have to try some other things prior to the Botox injections. Those injections can be given--it's similar to Botox given anywhere else. It does wear off and it does have some side effects and not everyone is a candidate for Botox but it's the newest in the things that we have that are now approved for the use and insurances are paying for. So, it's new to the arsenal of treatments and we use it if it's appropriate for the patient.
Melanie: So, then, wrap it up for us Dr. Schneider, with your best advice for people suffering from urinary incontinence, what you want them to know about not being embarrassed about this condition, and coming in and seeking help when they need it.
Dr. Schneider: Most importantly, it needs to be explained and understood that 33 million women, at least--that's just the number we know--have this condition. There's nothing to be embarrassed about and it's absolutely so common that there's some great therapies. Even if you've been looked at and evaluated in the past, things have changed and you should never accept that this just is a thing you're going to have to live with and that it's normal because you’re growing older. It's never normal, at any age, and if you haven't sought the care of a professional who deals in urinary incontinence, you should because this is something that will get you back into a normal, functioning life, and will keep you from not participating in things with your friends and family. Move on and get some help and get yourself back into who you want to be and live the life you want.
Melanie: Thank you so much, Dr. Schneider, for being with us today. It's really such important information. You're listening to Health Chat by Florida Hospital and for more information, you can go to www.floridawomenshealthcenter.com. That's www.floridawomenshealthcenter.com. This is Melanie Cole. Thanks so much for listening.
Do You Suffer From Urinary Incontinence?
Melanie Cole (Host): Many Americans suffer from urinary incontinence. Some may be hesitant to seek treatment as they may be embarrassed about this condition or they may think nothing can be done. However, seeking treatment may offer a better quality of life for those that suffer with this highly treatable condition. My guest today is Dr. Julie Schneider. She's double-board certified in female pelvic medicine and reconstructive surgery with Florida Hospital. Welcome to the show, Dr. Schneider. So, what are some of the different types of incontinence and what do we know about the causes?
Dr. Julie Schneider (Guest): Well, most importantly, I would bring up to start with is the incontinence of urine is the sudden release of urine when you're not expecting it and it is never normal. Many people feel that when you get older it's just a natural part of aging but that is actually incorrect. The type is varied. It can be that you have a mixture, which is what we commonly see of anywhere of one to five different varieties. For instance, there is stress urinary incontinence, which commonly people will equate with coughing, laughing, sneezing, jogging--anything that exerts pressure on the lower pelvis. The second most common kind is urgency incontinence where you can't control getting to the bathroom, even though you're not moving or doing anything, in particular. You could be sitting in a chair and your bladder will just simply start releasing before you get any warning or if you get warning, it's certainly not enough to get you to the bathroom. Then, there's some that are more functional when a person is just not able nor capable to walk to the bathroom and that's something that you have to change their walker, for instance, or where the commode is next to the bed, that sort of thing. There's a mixed picture, then there's overflow which is where you have retention. Men seem to suffer with that a little bit more because of the prostate, but women can also experience it for different reasons, particularly with a condition similar to multiple sclerosis, let's say. That sort of thing.
Melanie: Are women more at risk for certain types because of being pregnant? Does that contribute to this for us?
Dr. Schneider: Yes, actually, it does. Commonly, if you've done some kind of childbearing, even the pregnancy itself can exert pressure on the pelvic floor musculature and the labor process and the pressure in that area can do some denervation, which means the nerves themselves can be damaged and that, later in life, similar to what we experience when we layout and we sunburn as children, you usually don't have your problem until later--similar situation with this condition. It will happen oftentimes after menopause but it really can happen at any time. And even one baby, even a small baby, can cause a difficulty with this issue at any time.
Melanie: So, if somebody does notice that they have this, and maybe they don't feel that it's bad enough yet to see a physician about it, what do you recommend that they do at home? Are there some exercises they can try? Do you want them to practice voiding and stopping because there's some controversy on that? What do you like us to do at home to work on this, right at the outset?
Dr. Schneider: Right at the outset, the very first thing I tell everybody is, if you have a few extra pounds on, lose weight. The number one cure, or at least moderation that you can do to correct this problem, to hopefully never need surgery or take medication, all types of incontinence as a general rule, with the exception of some very rare ones, are made better, maybe not 100%, by weight loss. So, that would be the first thing I tell all my patients. The second most important thing is dietary habits that we all sometimes participate in, caffeine being number one. It can be spicy foods, alcohol, different foods, many people are irritated by cranberry juice, which is, of course, what many people feel that they should be doing to help their problem, and in fact, they are making it worse. There are many diets that can be found that will show you things that are bladder irritants, and if you try to avoid those sorts of things, that will help. Those two are the number one and number two things that I recommend. Then, the Kegel exercises, which are pelvic floor exercises, can help. You have to do quite a number of them. They say somewhere around 12 per rep, and five reps per day, so that's approximately 60 or more every day to see some strengthening in the pelvic floor musculature.
Melanie: Can you explain a little bit about the Kegel exercise for people? Because they don't always know how this is done or what it's supposed to feel like.
Dr. Schneider: Well, it's actually best if you have your gynecologist show you when you're doing them how it's best done. Most times people think you go and you go to the bathroom and you stop and start your urine flow. That may be it, but oftentimes, what they are doing is squeezing their abdominal muscles more than their pelvic muscles, and that's where, if you just speak with your physician to get a good sense that you're doing them correctly, it doesn't take long to figure it out, but most of the time, I have found that people come in using more of their abdominal muscles than their actual pelvic floor muscles. Sometimes, it's hard to differentiate the two.
Melanie: So, then what? If they've tried some of these things--lost weight, they've worked on their intake of fluids, maybe they've done their Kegels, and it's still not working. What's the first line of defense that you would use with them? Are there some medications they can try? What do you tell them?
Dr. Schneider: Well, first you have to separate, or tease apart, which of the problems they have. So, for instance, if they have a retention problem secondary to a neurogenic situation, the last thing you would do would be start medication. But, if you have an overactivity of your bladder, which would be muscle spasms, or I like to call them like twitches of your pelvis, then a medication to help with an antispasmodic property may help correct that problem. If that's the case, you may get great relief from a very mild medication. So, that would be for those two instances. If you're talking about stress incontinence, then sometimes a simple surgery, a minor surgery will help, or you can even do collagen injections that can help. There are a lot of options, but most importantly, it's not a one-size-fits-all. You simply have to be evaluated to be certain that what we're treating is the correct diagnosis.
Melanie: You mentioned collagen injections. People hear about Botox, but they don't realize that this could be a treatment for this. Speak about that a little bit?
Dr. Schneider: Botox is used for the treatment of detrusor instability, or overactive bladder. It is not considered a first or second line--it's a third line therapy. It works extremely well but you first have to try some other things prior to the Botox injections. Those injections can be given--it's similar to Botox given anywhere else. It does wear off and it does have some side effects and not everyone is a candidate for Botox but it's the newest in the things that we have that are now approved for the use and insurances are paying for. So, it's new to the arsenal of treatments and we use it if it's appropriate for the patient.
Melanie: So, then, wrap it up for us Dr. Schneider, with your best advice for people suffering from urinary incontinence, what you want them to know about not being embarrassed about this condition, and coming in and seeking help when they need it.
Dr. Schneider: Most importantly, it needs to be explained and understood that 33 million women, at least--that's just the number we know--have this condition. There's nothing to be embarrassed about and it's absolutely so common that there's some great therapies. Even if you've been looked at and evaluated in the past, things have changed and you should never accept that this just is a thing you're going to have to live with and that it's normal because you’re growing older. It's never normal, at any age, and if you haven't sought the care of a professional who deals in urinary incontinence, you should because this is something that will get you back into a normal, functioning life, and will keep you from not participating in things with your friends and family. Move on and get some help and get yourself back into who you want to be and live the life you want.
Melanie: Thank you so much, Dr. Schneider, for being with us today. It's really such important information. You're listening to Health Chat by Florida Hospital and for more information, you can go to www.floridawomenshealthcenter.com. That's www.floridawomenshealthcenter.com. This is Melanie Cole. Thanks so much for listening.