Urinary incontinence is the accidental release of urine triggered by a cough, laugh or sneeze, during exercise, or not getting to the bathroom in time.
While UI is not a major health problem, it can cause significant embarrassment and limit a person’s ability to enjoy favorite activies.
Women are affected nearly twice as often as men by UI.
Rhonda Walsh, M.D., Summit Medical Group urologist, discusses the types, causes and treatment for urinary incontinence, paying special attention to the needs of women with this condition.
Selected Podcast
Do You Suffer from Female Incontinence? There is Help!
Featured Speaker:
Dr. Walsh is a member of the American Urological Association, Society of Women in Urology, Society of Laparoscopic Surgeons, Society of Urodynamics, and Alpha Omega Alpha Honor Medical Society. She is the coauthor of articles and abstracts that are published in prestigious, peer-reviewed scientific journals, including Journal of Urology, Journal of Endourology, and International Urogynecology Journal and Pelvic Floor Dysfunction. She has delivered national invited presentations in her field.
Dr. Walsh says, "At the end of the day, I love knowing that my work as a physician has made a difference in the lives of my patients." She adds, "I treat my patients the way I would like to be treated, including giving them the most up-to-date care possible."
Dr. Walsh is the recipient of the University of Texas Health Science Center Urology Academic Excellence Award and Janet M. Glasgow Memorial Achievement Citation.
When she is not working with her patients, Dr. Walsh enjoys knitting, running, and reading.
Rhonda Walsh, MD
Rhonda M. Walsh, MD, specializes in urinary incontinence, female pelvic prolapse, and kidney stones / endourology.Dr. Walsh is a member of the American Urological Association, Society of Women in Urology, Society of Laparoscopic Surgeons, Society of Urodynamics, and Alpha Omega Alpha Honor Medical Society. She is the coauthor of articles and abstracts that are published in prestigious, peer-reviewed scientific journals, including Journal of Urology, Journal of Endourology, and International Urogynecology Journal and Pelvic Floor Dysfunction. She has delivered national invited presentations in her field.
Dr. Walsh says, "At the end of the day, I love knowing that my work as a physician has made a difference in the lives of my patients." She adds, "I treat my patients the way I would like to be treated, including giving them the most up-to-date care possible."
Dr. Walsh is the recipient of the University of Texas Health Science Center Urology Academic Excellence Award and Janet M. Glasgow Memorial Achievement Citation.
When she is not working with her patients, Dr. Walsh enjoys knitting, running, and reading.
Transcription:
Do You Suffer from Female Incontinence? There is Help!
Melanie Cole (Host): While urinary incontinence is not a major health problem, it can cause significant embarrassment and limit a person’s ability to enjoy their favorite activities and if you suffer from female incontinence, you are not alone. My guest today is Dr. Rhonda Walsh. She specializes in urinary incontinence at Summit Medical Group. Welcome to the show, Dr. Walsh. Tell us a little bit about incontinence. What are the types and what are the causes of it?
Dr. Rhonda Walsh (Guest): We generally talk about two different types of incontinence although there are other types, but the types that generally affect females are going to be urge incontinence and stress incontinence. Generally, urge incontinence is that feeling where you suddenly have to go to the bathroom and you have to run for it and sometimes you leak a little bit, whereas stress incontinence is the leakage that you get when you cough or sneeze or exercise or do jumping jacks or things like that.
Melanie: So what are the reasons that we suffer from this? Are some women predisposed to incontinence?
Dr. Walsh: Well, unfortunately, we don't know exactly what all the causes are although there are certain things that make people predisposed to get it and the two types can certainly coexist together. We do know that having children unfortunately can increase someone’s risk for getting stress incontinence and a lot of my patients notice that after they have their first or second child, they have a little bit of trouble when they try to run or when they laugh or cough. Urge incontinence tends to be a little bit more associated with aging, although some people do notice that it happens after they have children as well, but the urgency generally happens in more than elderly population.
Melanie: When is it time to see a doctor, Dr. Walsh?
Dr. Walsh: I always tell my patients that no one ever died from wetting themselves, but if it’s something that really affects your ability to live the kind of life that you want to live then it’s generally time to do something about it. And you know, doing something about it doesn’t necessarily mean having surgery. We have a lot of different options and so people can pick and chose what they want to do or how far they want to go with it.
Melanie: Let’s speak about some treatments in the first line of defense. You said not everyone needs surgery so let’s back up and go with what you would do as the first line of defense whether this is bladder training or Kegel exercises or medications. What’s involved?
Dr. Walsh: Generally, whenever we talk about treating incontinence, urge incontinence often is treated with medication and stress incontinence is often treated with either Kegel exercises or surgery, although those are not mutually exclusive of course. But for people who have urge incontinence, the most important things to remember are that there are certain things that will make your bladder irritable. I always tell my patients to avoid caffeinated beverages as much as they can and just recognize that coffee is going to make them urinate more. Artificial sweeteners are a big bladder irritant that people, a lot of times, don't think about. And there are certain behavioral things that you can do to kind of decrease your risk of having urge incontinence as far as managing your fluids if you’re going to be in a car for a long time or be on a train or be out in the city and not able to find a bathroom easily. Other than doing behavioral modification, we also have a program in our office where people are able to learn how to do Kegel exercises. It’s called biofeedback and we have a woman that worked with people to learn how to control those urges and have a little bit fewer accidents. If that’s not something that people want to commit the time to, we do have a number of medications that work well for urge incontinence. A lot of people have seen the advertisings on television about got to go right now and things like that and there are a number of medications, all of which work in generally the same way that will generally reduce someone’s urge incontinence by about half and people who have mild incontinence, a lot of times, that will go away completely. Beyond that, if people have very severe urge incontinence, we have a lot of other kinds of treatments after medication including -- we can actually botox a bladder these days, which as a lot of people do or don't know, is something that paralyzes muscles. So when we inject botox into the lining of the bladder, it actually paralyzes the bladder muscle a little bit so that you don't get that uncontrolled contraction of the bladder that causes urge incontinence. Finally, we have some things called neuromodulation where we actually try to modulate the nerves that feedback on the bladder to try to decrease the bladder contractions. If we’re talking about stress incontinence, the behavioral modification and biofeedback generally works very well for people who have mild stress incontinence. By mild, we usually mean either people who don't wear pads or don't leak everyday or only have it when they’re running or things like that. Beyond that, often you’re talking about having some kind of surgical procedure to fix it and the ones that we do these days are really pretty minimal. The most popular one is something called the mid-urethral sling. What we do is we actually make three tiny incisions, one in the vagina and two in the skin and put this little piece of -- it’s kind of like a hammock that goes underneath the urethra that holds it in place so that whenever you cough and sneeze, you do not leak and that works about 80 % of the time for most people. At the half hour, you’re in and out of the surgery center very quickly. And for people that are not a good candidate for that, we also have some materials that we can inject into the urethra. The one that I generally use is called macroplastique. The old one was collagen although that’s not made anymore, but that doesn’t work as well as the sling does.
Melanie: How long can people expect these -- whether it’s the procedures or medication or even the pelvic floor muscle exercises to -- how long can you expect these to start to work? How long do you have to do the exercises before they will start to work for you? Because this is something that can affect people every single day and be quite embarrassing, what’s the turnaround time?
Dr. Walsh: Generally, what I tell people is to expect for it to take about two months until they notice that there really is a significant difference and that’s if they do them everyday consistently. Most people need to do them about 10 Kegel exercises three times a day in order to show a lot of benefit. What I tell people to do is just make it part of their daily activities. If you’re eating the corn flakes in the morning, you’re doing your Kegel exercises and while you’re eating lunch or sitting at a stop light, you’re doing your Kegel exercises and then do them before you go to sleep at night. And if you do them consistently three times a day, they really will show some benefit. As far as medications and the other kinds of treatments go, medications usually take about a month to work and as long as you continue taking the medication, it generally will work for you. However, for a lot of people, that’s difficult to do over years and years.
Melanie: And if they do opt for surgery, is this something that lasts for the rest of your life or is it something that might have to be redone?
Dr. Walsh: What I always tell people is that the surgery itself is going to last probably forever because we do have good 15-year data on these kinds of slings that we do these days and they stay in place. They continue doing what they’re doing, but people’s body use to change over time so I do have patients that develop urge incontinence after they’ve had slings for stress incontinence. And as I said before, urge incontinence a lot of times, is just associated with aging unfortunately and so it’s not necessarily because you had a sling that you’re getting that or because the sling is not working. It’s just something that your body develops over time. But generally, if you have some kind of procedure for stress incontinence, it’s quite durable at least about 15 years as far as we know now.
Melanie: And what about botox? How long does that work for because if you’re using it for cosmetic purposes, you have to get it redone quite frequently and what about for female incontinence?
Dr. Walsh: The nice thing about botox is a lot of my patients that get it done have been on medications and they’re tired of taking the medication every day. Some of the medications have side effects like dry mouth and constipation and so if you get botox, it means you don't have to take a pill every day for that. The general length of time that we quote for that is about three to six months for the first injection so you should notice an effect of it after about two weeks and it should last approximately three to six months. And we do know that as you get more botox injections over time, they tend to last longer. So the second injection might last 6 to 12 months and then people who continue to get it might get a year out of it. So it’s really not as frequent as you think.
Melanie: Dr. Walsh, in just the last few minutes, please give the listeners your very best advice for those suffering with female incontinence and why they should come to Summit Medical Group for their care.
Dr. Walsh: Well, I think the great thing about Summit Medical Group is there’s so many different kinds of specialties that we’re really able to communicate with each other and to see exactly what is going on with someone’s health care and all of the other areas of their life. And I would say that someone should seek help for this if they feel like it’s affecting the way that they’re able to live their life. A lot of the women that I talked to say, “Oh, well I leak a little bit but that’s just because I’m old.” And you know, that may be the case but it doesn’t mean that you have to leak and it’s not something that you do just have to live with, because a lot of people are under the mistaken impression that there’s not anything that they can do about it or that doing anything about it is going to involve something that’s arduous or painful.
Melanie: Thank you so much, Dr. Rhonda Walsh. You’re listening to SMG Radio. For more information, you can go to summitmedicalgroup.com, that’s summitmedicalgroup.com. This is Melanie Cole. Thanks so much for listening and have a great day.
Do You Suffer from Female Incontinence? There is Help!
Melanie Cole (Host): While urinary incontinence is not a major health problem, it can cause significant embarrassment and limit a person’s ability to enjoy their favorite activities and if you suffer from female incontinence, you are not alone. My guest today is Dr. Rhonda Walsh. She specializes in urinary incontinence at Summit Medical Group. Welcome to the show, Dr. Walsh. Tell us a little bit about incontinence. What are the types and what are the causes of it?
Dr. Rhonda Walsh (Guest): We generally talk about two different types of incontinence although there are other types, but the types that generally affect females are going to be urge incontinence and stress incontinence. Generally, urge incontinence is that feeling where you suddenly have to go to the bathroom and you have to run for it and sometimes you leak a little bit, whereas stress incontinence is the leakage that you get when you cough or sneeze or exercise or do jumping jacks or things like that.
Melanie: So what are the reasons that we suffer from this? Are some women predisposed to incontinence?
Dr. Walsh: Well, unfortunately, we don't know exactly what all the causes are although there are certain things that make people predisposed to get it and the two types can certainly coexist together. We do know that having children unfortunately can increase someone’s risk for getting stress incontinence and a lot of my patients notice that after they have their first or second child, they have a little bit of trouble when they try to run or when they laugh or cough. Urge incontinence tends to be a little bit more associated with aging, although some people do notice that it happens after they have children as well, but the urgency generally happens in more than elderly population.
Melanie: When is it time to see a doctor, Dr. Walsh?
Dr. Walsh: I always tell my patients that no one ever died from wetting themselves, but if it’s something that really affects your ability to live the kind of life that you want to live then it’s generally time to do something about it. And you know, doing something about it doesn’t necessarily mean having surgery. We have a lot of different options and so people can pick and chose what they want to do or how far they want to go with it.
Melanie: Let’s speak about some treatments in the first line of defense. You said not everyone needs surgery so let’s back up and go with what you would do as the first line of defense whether this is bladder training or Kegel exercises or medications. What’s involved?
Dr. Walsh: Generally, whenever we talk about treating incontinence, urge incontinence often is treated with medication and stress incontinence is often treated with either Kegel exercises or surgery, although those are not mutually exclusive of course. But for people who have urge incontinence, the most important things to remember are that there are certain things that will make your bladder irritable. I always tell my patients to avoid caffeinated beverages as much as they can and just recognize that coffee is going to make them urinate more. Artificial sweeteners are a big bladder irritant that people, a lot of times, don't think about. And there are certain behavioral things that you can do to kind of decrease your risk of having urge incontinence as far as managing your fluids if you’re going to be in a car for a long time or be on a train or be out in the city and not able to find a bathroom easily. Other than doing behavioral modification, we also have a program in our office where people are able to learn how to do Kegel exercises. It’s called biofeedback and we have a woman that worked with people to learn how to control those urges and have a little bit fewer accidents. If that’s not something that people want to commit the time to, we do have a number of medications that work well for urge incontinence. A lot of people have seen the advertisings on television about got to go right now and things like that and there are a number of medications, all of which work in generally the same way that will generally reduce someone’s urge incontinence by about half and people who have mild incontinence, a lot of times, that will go away completely. Beyond that, if people have very severe urge incontinence, we have a lot of other kinds of treatments after medication including -- we can actually botox a bladder these days, which as a lot of people do or don't know, is something that paralyzes muscles. So when we inject botox into the lining of the bladder, it actually paralyzes the bladder muscle a little bit so that you don't get that uncontrolled contraction of the bladder that causes urge incontinence. Finally, we have some things called neuromodulation where we actually try to modulate the nerves that feedback on the bladder to try to decrease the bladder contractions. If we’re talking about stress incontinence, the behavioral modification and biofeedback generally works very well for people who have mild stress incontinence. By mild, we usually mean either people who don't wear pads or don't leak everyday or only have it when they’re running or things like that. Beyond that, often you’re talking about having some kind of surgical procedure to fix it and the ones that we do these days are really pretty minimal. The most popular one is something called the mid-urethral sling. What we do is we actually make three tiny incisions, one in the vagina and two in the skin and put this little piece of -- it’s kind of like a hammock that goes underneath the urethra that holds it in place so that whenever you cough and sneeze, you do not leak and that works about 80 % of the time for most people. At the half hour, you’re in and out of the surgery center very quickly. And for people that are not a good candidate for that, we also have some materials that we can inject into the urethra. The one that I generally use is called macroplastique. The old one was collagen although that’s not made anymore, but that doesn’t work as well as the sling does.
Melanie: How long can people expect these -- whether it’s the procedures or medication or even the pelvic floor muscle exercises to -- how long can you expect these to start to work? How long do you have to do the exercises before they will start to work for you? Because this is something that can affect people every single day and be quite embarrassing, what’s the turnaround time?
Dr. Walsh: Generally, what I tell people is to expect for it to take about two months until they notice that there really is a significant difference and that’s if they do them everyday consistently. Most people need to do them about 10 Kegel exercises three times a day in order to show a lot of benefit. What I tell people to do is just make it part of their daily activities. If you’re eating the corn flakes in the morning, you’re doing your Kegel exercises and while you’re eating lunch or sitting at a stop light, you’re doing your Kegel exercises and then do them before you go to sleep at night. And if you do them consistently three times a day, they really will show some benefit. As far as medications and the other kinds of treatments go, medications usually take about a month to work and as long as you continue taking the medication, it generally will work for you. However, for a lot of people, that’s difficult to do over years and years.
Melanie: And if they do opt for surgery, is this something that lasts for the rest of your life or is it something that might have to be redone?
Dr. Walsh: What I always tell people is that the surgery itself is going to last probably forever because we do have good 15-year data on these kinds of slings that we do these days and they stay in place. They continue doing what they’re doing, but people’s body use to change over time so I do have patients that develop urge incontinence after they’ve had slings for stress incontinence. And as I said before, urge incontinence a lot of times, is just associated with aging unfortunately and so it’s not necessarily because you had a sling that you’re getting that or because the sling is not working. It’s just something that your body develops over time. But generally, if you have some kind of procedure for stress incontinence, it’s quite durable at least about 15 years as far as we know now.
Melanie: And what about botox? How long does that work for because if you’re using it for cosmetic purposes, you have to get it redone quite frequently and what about for female incontinence?
Dr. Walsh: The nice thing about botox is a lot of my patients that get it done have been on medications and they’re tired of taking the medication every day. Some of the medications have side effects like dry mouth and constipation and so if you get botox, it means you don't have to take a pill every day for that. The general length of time that we quote for that is about three to six months for the first injection so you should notice an effect of it after about two weeks and it should last approximately three to six months. And we do know that as you get more botox injections over time, they tend to last longer. So the second injection might last 6 to 12 months and then people who continue to get it might get a year out of it. So it’s really not as frequent as you think.
Melanie: Dr. Walsh, in just the last few minutes, please give the listeners your very best advice for those suffering with female incontinence and why they should come to Summit Medical Group for their care.
Dr. Walsh: Well, I think the great thing about Summit Medical Group is there’s so many different kinds of specialties that we’re really able to communicate with each other and to see exactly what is going on with someone’s health care and all of the other areas of their life. And I would say that someone should seek help for this if they feel like it’s affecting the way that they’re able to live their life. A lot of the women that I talked to say, “Oh, well I leak a little bit but that’s just because I’m old.” And you know, that may be the case but it doesn’t mean that you have to leak and it’s not something that you do just have to live with, because a lot of people are under the mistaken impression that there’s not anything that they can do about it or that doing anything about it is going to involve something that’s arduous or painful.
Melanie: Thank you so much, Dr. Rhonda Walsh. You’re listening to SMG Radio. For more information, you can go to summitmedicalgroup.com, that’s summitmedicalgroup.com. This is Melanie Cole. Thanks so much for listening and have a great day.