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Prakash Chandran: People joke about laughing so hard that you wet yourself. But for some it's a serious matter. If you ever had a got to go to the bathroom feeling that you can't control, you may have incontinence. We're going to learn about it today with Obstetrician Gynecologist Dr. Angela Halusic. I'm Prakash Chandran. So first of all, Dr. Halusic, what exactly is incontinence?

Dr. Halusic: So urinary incontinence is the involuntary leakage of urine. There is a variety of factors that can cause that, but that's really, it's just really as simple as that, just involuntary leakage of urine.

Host: Okay. So how does it actually occur? Is it that you're just sitting and you pee a little bit or are you doing something to cause the urinary incontinence to happen? Tell us a little bit more about how it occurs.

Dr. Halusic: So there's different types of urinary incontinence. The main ones are I'll talk about the details of each one, but the main ones are three different types. There's stress urinary incontinence, there's urge urinary incontinence and there's mixed, which is combination of both. Stress Urinary incontinence is when someone has leakage of urine, when they cough or sneeze or do jumping jacks or associated with activity. Laughing or anything where you're putting like having sort of increased intra abdominal pressure and the urge urinary incontinence is more, you have a strong urge to urinate and with the strong urges, sometimes you leak associated with just the feeling of having to go to the bathroom. So often women will say I have a strong urge to urinate and they can't always make it to the bathroom and I just wet myself. That's urgency incontinence and mixed, some people can have both types of incontinence. And sometimes it can be mostly stress-related, so mostly with coughing, laughing, sneezing. But then occasionally will have a strong urge, tyranny and let themselves, or it could be the other way around where it's mostly urgency related. But they also have occasional episodes of stress, urinary incontinence where they cough or sneeze and then wet themselves,

Host: I see. And do we actually know what causes incontinence?

Dr. Halusic: So in terms of the cause, so with stress urinary incontinence, that's most commonly something called urethral hypermobility, but basically it's that the angle of the urethra changes really easily and it changes when you have the increased pressure in your belly. So like when you cough or sneeze, that'll sort of change the angle of the urethra. And with that change in the angle of the urethra urine can just come out. And usually when that happens that's some small drops. But that's the most common cause of stress urinary incontinence. Incontinence associated with urgency. It's unclear, but it's unclear exactly what leads to it. But it's basically just you have these involuntary bladder muscle spasms.

Host: You know, we have a nine month old and I recall that after my wife gave birth she experienced a little incontinence and for example, was afraid to go to yoga because you know, she didn't want to pee during the class. And I imagine that it affects many women who give birth because there's so much pressure being put on the stomach. And I know that that urethra is probably pretty easily modified afterwards, at least until the body heals. So can you speak to that a little?

Dr. Halusic: Yeah, it's a common and actually, yeah, childbirth is one of the major risk factors for having stress urinary incontinence later on in life. And I mean there are other risk factors too, like obesity, chronic constipation, heavy lifting, basically just over time, anything that, where you're having just a lot of putting a lot of pressure on your belly can just sort of weaken some of the connective tissue and like events supporting the urethra, which can cause it to be really mobile. And so yeah, pregnancy is a really common risk factor. And yeah, with increasing pregnancy, like with the more pregnancies you have, the higher risk you have for having stress urinary incontinence later on in life.

Host: So how is incontinence actually diagnosed? Like is it just that a person is sitting there and they pee a little bit and it's necessarily incontinence or could it be something else?

Dr. Halusic: Yeah. So it's most commonly incontinence, but sometimes just having a urinary tract infection can cause these symptoms, so with everyone who comes in with involuntary leakage of urine it's pretty routine to run a urine culture just to make sure that that's not the cause. But yeah, most commonly it is an incontinence of some sort.

Host: So let's talk a little bit about treatment. If you do have incontinence, what are the treatment options available to you?

Dr. Halusic: So yeah, so the options actually vary depending on what type it is. And so but with either type, often just conservative measures, just like behavioral modifications can really make a difference. So if someone is having bothersome episodes of leakage often just sort of modulating how much fluid they're taking, drinking in a day and trying to limit beverages to no more than a few hours before bedtime can often help. Especially like if people are getting up at night to urinate or having incontinence in the morning. Just sort of keeping track of when you're drinking the most fluids and trying to not have so many fluids close to bedtime that can really help. Weight loss has also been shown to help with stress urinary incontinence just because you're taking some of the pressure basically off your abdomen to help with that urethral hyper mobility. And so yeah, conservative measures like fluid modification, weight loss, and even just home Cagle exercises have been shown to help with the stress urinary incontinence.

And if someone or fixing some of the risk factors if someone does a lot of heavy weight lifting seeing if there are other activities where if they always leak with heavyweight lifting to see if there's other activities that they would find enjoyable that wouldn't require such heavy lifting or if someone's chronically constipated and having stress urinary incontinence having them have a good bowel regimen can sort of at least slow the progression of stress urinary incontinence. Pelvic floor physical therapy can actually help with either stress or urge urinary incontinence. And some studies have shown that with just conservative measures and even pelvic floor physical therapy, people can have a reduction in their symptoms by 50 to 70%. And so conservative measures can work really well. In terms of medications, medications are really just for urge urinary incontinence. They're not really effective for stress urinary incontinence. So there are medications that you can also give and there's surgeries as well. And the most common type of surgery is called a sling procedure and that's really good for stress urinary incontinence.

Host: I see. So it seems like in most cases there's a way to mitigate or to reduce incontinence over time, but is there a way to get rid of it completely?

Dr. Halusic: I wouldn't say that we can guarantee ridding it completely, but we can certainly improve symptoms.

Host: Okay. And is there anything that people can do to or lessen the chance of developing the condition?

Dr. Halusic: It's really unclear. I think also a lot of the effects that you see are just age and genetics. And so there's not a whole lot. I think in terms of probably the easiest thing to do it just be if someone is chronically constipated, to really, really work with the doctor in getting a good bowel regimen so that someone's not chronically constipated. Cause that's a pretty easily modifiable risk factor. But, and that weight loss can sort of reduce your risk as well. But, no, a lot of stress or urge urinary incontinence is due to genetics and so, and the risk increases with age. And so, you know, we can't say if you do this one thing you won't, we will not get and some people just get it.

Host: Understood. And you know, you talked a little bit about the age that incontinence affects, can you talk to us a little bit about those demographics? Like what is the typical age range where you see it more often than others?

Dr. Halusic: Yeah, so basically the older a woman gets the more common it is to see and continence of some sort. And so the percentage sort of increases. And also just, one thing is that the percentage overall is often under-reported just because women can sometimes be reluctant to discuss these symptoms because it can be really embarrassing. And so we don't really know the true prevalence of urinary incontinence in general, but overall we do notice age-related effects. So but it can happen in young woman. There was often young women like in their 20s or even in high school can have stress urinary incontinence and usually that's associated with high impact physical activity. There've been some survey data that's gone out to women who were engaged, who are elite athletes that were in high school or in college. And up to 25% of elite athletes at that age group have some sort of stress urinary incontinence and so you can see it as young as women in their 20s or even like late teens. But once you hit like middle age, like it's most commonly seen sort of after 40 to 50 the prevalence of like middle-aged and postmenopausal women and it's like 40 to 60%.

Host: And, you know, just as we wrap up here, there may be an audience member who is struggling with incontinence and after having seen many cases yourself, what is the one piece of advice that you might give them?

Dr. Halusic: That definitely go in for an evaluation because there are a lot of things that we can do that would help with those symptoms. And so don't just, don't be resigned to feeling like you have to just live with bothersome incontinence. Like there's a lot of treatment options.

Host: You know. And another thing that I'm hearing is that people are not alone in this, that many people experience incontinence and they may not be reporting it because it is embarrassing. But luckily there are things that you can do to lead a better lifestyle and to mitigate the amount that an individual does experience it, wouldn't you say?

Dr. Halusic: Yes, absolutely. Absolutely.

Host: All right. Dr. Halusic. Well, I really appreciate your time today. That's obstetrician-gynecologist Dr. Angela Halusic. Thanks for checking out this episode of Healthy Conversations. If you found this podcast helpful, please share it on your social channels and be sure to check out the entire podcast library for topics of interest to you. Thanks, and we'll talk next time.

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