Scott Webb (Host): If you suffer from bladder leakage and find yourself avoiding activities that you used to love, maybe jumping on the trampoline, this is the podcast for you as

Scott Webb: As I'm joined today by Dr. Brent Swasey.

Scott Webb (Host): He's a urogynecologist. And he's here to explain the causes of bladder leakage and how he can help.

 This is the Franciscan Health DocPod. I'm Scott Webb. Doctor, thanks so much for your time today. We're going to talk about a few topics here, bladder leakage and some other things. And I know that you're a urogynecologist, so you're the right doctor, the right expert to have on. Let's start there. Is bladder leakage like a medical condition in and of itself? Is it a sign of something else? Maybe is it both?

Dr. Brent Suozzi: Well, Scott, it could actually be both. There are some conditions where people will develop leaking of urine and that of itself can be the problem. And in other conditions, it may be a sign that there's something else going on, like an infection. So yeah, it can actually be both.

Host: Yeah. So either way, right? As I was telling you before we got started here, we want folks to speak with their own providers. So if they're suffering from bladder leakage, it's a sign of something. Whether it's just that the bladder leakage needs to be addressed or that it's a sign or a symptom of something else, makes me wonder is urinary incontinence common? It feels like it is. Is it common?

Dr. Brent Suozzi: Oh, it's really common. Yeah, if we just had a audience full of people and we were to tell them to close their eyes and raise their hands, if they leaked, we would see an awful lot of hands raised. And so yeah, extremely common condition. It seems to get worse as people get older. There are some risk factors that can end up causing people to develop it, childbirth, things like that, and probably undertreated and part of that is due to some awareness issues. And so, I'm really thankful to be on this podcast, because I think the more we can put these things out in front, the more likely people may be to seek treatment for it and not just think it's a normal sign of aging.

Host: Yeah. I think there's so much of that. I'm 55, and there's just things that I just chalk up and I say, "Well, I'm 55. What are you going to do?" And I think that happens to a lot of folks that there's just things that we experience and we figure it's just a natural part of aging, but come to find out when I speak with experts, I find out that it's actually not necessarily a normal part of aging and that there's actually things that can be done. But as you say, we have to talk about it. We have to educate, folks have to be diagnosed and treated. Wondering what activities or lifestyle habits you mentioned that there are some risk factors. So, what are folks doing that maybe can trigger bladder leakage?

Dr. Brent Suozzi: Yeah. So, some things are things that you just can't control. After you've had a baby, you can't unhave a baby. So, those kinds of risk factors are important, but may not be modifiable. There are other risk factors which are modifiable, and those things are kind of all the things that make life worth living. Caffeine is a big risk factor for developing leakage. Sometimes alcohol consumption can cause people to leak. Being a little overweight can cause people to leak. And so, those are modifiable risk factors. Sometimes two people can have a weak pelvic floor musculature that can result in some leakage. And those are things that can be changed.

Host: Yeah. As you say, some of this we may think anecdotally that it is a part of aging, but it probably isn't. And as you say, you can't unhave a baby and that's a good thing. I love both of my kids. I wouldn't want to unhave them. But when we think about the leakage that's related to giving birth and being a mom and how awesome that is, then what can those women do? What can those patients do if they're suffering from leakage after giving birth?

Dr. Brent Suozzi: Yeah. So, that kind of comes in two flavors. One is just the immediately postpartum issues, and those will typically resolve if you give it a little bit of time. Somewhere in that three to six-month range, a lot of patients will return to a baseline. But then, there's some people that after having a baby, maybe even years down the line, will start developing leakage of urine, frequently with physical activities such as jumping or sneezing or coughing or lifting. And obviously, if you're a young mother who's running around chasing kids, that can be extremely problematic and symptomatic. And there's a point where it's a little and then it becomes a little bit more and then it becomes a lot. And when it gets to the point where it's bothering people, that's when I tell them, you know, "Maybe we should do something about it." And those options vary. Especially for the leaking with sneezing, coughing, that's called stress urinary incontinence. And so, when we say that, we're not necessarily talking about being stressed out. It's more of a mechanical stress on the system that's causing the leakage. And so, those patients can do actually quite well with things like weight loss, sometimes some physical therapy can help with that and occasionally, we need to resort to surgical management. And the good news there is that the cure rates for those surgeries are fairly high, up to about 85%. So, you can make a massive improvement in somebody's quality of life with a pretty quick and simple intervention. It's one of my favorite conditions to treat just because your impact factor is so high. You take somebody who's running around chasing their kids and having issues and holding back. You know, they're not getting on the trampoline, they're not playing volleyball, they're not dancing at the wedding, those kinds of things because of fear of leakage. And then, you know, if you can do a 20-minute procedure and then undo that, then you really give people a tremendous amount of quality of life back to them. And so, that's a very gratifying thing.

Host: I'm sure. Yeah, that's exactly the phrase that was in my head. Like things that folks can suffer with and maybe sort of handle themselves at home. But ultimately, these things, as you say, chasing kids around, sneezing, they're just things that are part of life for many of us and they just can't be avoided. And we will come back and talk just a little bit more about surgery. But from what I'm hearing, it sounds like there are different types of incontinence. Do I have that right?

Dr. Brent Suozzi: Yeah. There's some esoteric ones, but the big, broad categories would be something called stress incontinence like we just talked about. And then, the other big one is something called overactive bladder. And that's a condition that's more neurologic in nature that would be defined as leaking urine with strong urge to void that's uncontrollable. That's the classic gotta-go. You know, you get a strong urge, you can't hold it back, you're trying to get to the door, but can't get the keys in the door fast enough, that kind of thing. Or you get close to the toilet and the closer you get, the worse you have to go and you can't quite get to the toilet in time and, you know, urine starts coming out before you can even get there. And that's also very treatable and what we see an awful lot of, you know, both forms of incontinence. And that disease condition is managed fairly successfully with some conservative interventions.

Once again, physical therapy, there's some medicines. And a lot of times when we do a self-check of our own poor habits, there's some room to clean up there with caffeine consumption, perhaps tobacco use; once again, being a little overweight can play a role in there. And so, those things are reversible and patients do get better when they adopt a healthier lifestyle.

So yeah, there's also refractory overactive bladder, meaning that you tried all the easy stuff and you're still having issues and there are some surgeries there, too. And typically, myself included, most urogynecologists try to practice from a conservative to more aggressive fashion, so we always try with the easy stuff first and see how far we get.

Scott Webb: Right. So, just some housekeeping here. Different types of incontinence, different treatment options. As you say, start conservative, non-invasively and then work your way towards surgery. So, let's finish up there. When should a woman, when should someone, reach out to their provider? When should they see them, see a specialist, try to be diagnosed? You know, and when they're confronted with the options, or they've tried the conservative treatment options, when it comes to surgery, why would you strongly recommend that?

Dr. Brent Suozzi: Most people, when I ask them how long these things have been going on, it's rare that they answer in something like hours or days or weeks. It's usually months or even frequently years., And so, it's the kind of thing that it's a sneaky little guy because it starts off just a little bit once in forever. And then, it just keeps getting worse and worse over time. And so, we're very focused on quality of life and the impact that has with these conditions.

When patients are getting to a point where it's slowing them down, making it to where they're not doing the things that they want to do, skipping out on fun activities, I mean, that's when it's time to start really assessing, "Should I get this fixed or not?" Surgery is kind of one of these things that there's risks like anything, and they're rare to have any kind of poor outcome, but they're still there. And if you're a guy who does a lot of surgery, then you do see these things. And so, you're keenly aware, or at least I am of the real risks involved in these kinds of things. And so, you just have to make sure that you can educate your patients well enough that you can convey that and then, also that when you're presented with the option of surgery and the risks, that it still sounds like a good deal to the patient.

For example, if I told you that there was a one in a million risk of something, but that your chances of improvement were 99%, you'd probably take that deal all day long. It's not quite that good, but still there's the concept of just trying to balance the risk, make sure that it's worth it. And what you're looking to get out of it too, what kind of rewards are there at the end of the tunnel? And once again, when you can make somebody's incontinence better, that's a pretty big leap in somebody's quality of life.

Host: absolutely. That's perfect. Yeah, as you say, weighing out the risk and reward, and being able to do those things that we used to be able to do, whether it's jump on the trampoline or dance at children's Weddings or whatever it might be, getting that quality of life back. You can see how you, whether it's the conservative treatment or even surgery, whatever the odds are, you can see how you could get there. So, thank you so much for your time today and you stay well.

Dr. Brent Suozzi: Yeah. Thank you, Scott.

Host: And for more information, visit franciscanhealth.org and search urogynecology or pelvic health

And if you found this podcast helpful, please share it on your social channels and be sure to check out the full podcast library for additional topics of interest. This is the Franciscan Health Doc Pod. I'm Scott Webb. Stay well, and we'll talk again next time.