Transcription:
Women's Health in Urology

Cheryl Martin: Many women suffer in silence because it's inconvenient and can be embarrassing. Urinary problems like incontinence, loss of bladder control, it affects twice as many women as men. Coming up a frank discussion about some of the most common urological problems women face and how to treat them. This is Riverside Radio HealthCast, the podcast from St. John's Riverside Hospital. I'm Cheryl Martin, and joining me as urologist, Dr. Matthew Fakhoury. So glad to have you on Doctor to discuss what can be an uncomfortable topic for women, urology concerns.

Dr Mathew Fakhoury: Cheryl, thank you so much for having me here today.

Cheryl Martin: So, doctor, let's begin with urinary incontinence, UI, or loss of bladder control. What causes it and when does it usually occur?

Dr Mathew Fakhoury: So urinary incontinence can come in various, shapes and forms. And the way we typically break it down is we try to take something that's. A bit complicated and obviously very sensitive, for any woman to come into their doctor and discuss. And the way we break it down is basically urinary incontinence can be broken down to urgency or urge urinary incontinence and secondly, or stress urinary incontinence. Now, it's important to make that delineation whenever speaking to a patient because the therapies for each of those vary. One can be solved with bladder training, which I spend a lot of time talking to patients about, because it helps us get back to the basics of how we should be urinating and emptying our bladder.

And as we go on and progress through life, we tend to see that the bladder itself begins to change the way that we urinate. And it happens in such a way as it progresses, we don't even realize that these changes are occurring until there is an issue such as incontinence. And when it comes to urgency or urge urinary incontinence, that's basically where a female may feel as though she has to run to the bathroom or find the nearest location whenever she goes into a new environment because there's always a concern that you may have an accident.

Okay. And then there's stress urinary incontinence, which is related to whenever a female. Cough, sneeze, laugh, or they're doing exercises outside or some gardening work, and they may feel a little tinkle or a little bit of urine coming out as it relates to stress down in the pelvic area.

Cheryl Martin: Doctor, is UI then a normal part of aging?

Dr Mathew Fakhoury: Well, I wouldn't consider it a normal part of aging, but what is normal is changes in the way that we urinate. That is something to be expected in both the female and male population. In its naturalist form we want to empty our bladder adequately and consistently, and sometimes there's issues with urine being left over in the bladder, which is what we refer to as residual urine. That sort of snowballs into the effects of having urinary incontinence.

Cheryl Martin: So do we know why more women than men have this condition twice as many women?

Dr Mathew Fakhoury: We do. So I tend to bring this up quite a bit in the office, men deal with prostates and women deal with pregnancy. And pregnancy is a huge factor in why the pelvic floor muscles change and they become lax. And the usual sphincter mechanisms that allow the pelvic floor muscles to control the urination, end up becoming a bit more lazy, as I say, and as a result, the bladder becomes a little more lazy and looks for a little vacation time. And when that happens, we develop urinary incontinence.

Cheryl Martin: What about an overactive bladder?

Dr Mathew Fakhoury: So under the umbrella of an overactive bladder, which is defined as patients who experience frequency and urgency and sometimes uncontrollable sensations of wanting to urinate even when their bladder may be empty, that falls into more of the urgency incontinent side of things. But I do firmly believe that at the core of. Incontinence patient, there is an overactive bladder. Okay. Overactive bladder is where the tissue and the mucosal of the bladder lining becomes somewhat sensitive to irritation and inflammation, and most patients believe that well Doc, why do I have a bladder?

Because it holds my urine, but I don't want patients to misconstrue that. We were given a bladder in order to hold urine for a certain amount of time and not a very long time, and I typically go through the same three things with every one of my patients in order to help fight the worsening of incontinence or overactive bladder.

Cheryl Martin: So at what point should a woman with any of these symptoms reach out to a

Dr Mathew Fakhoury: physician?

I think at some point if this begins to affect your quality of life, if women feel as though they have to take into account how far their distance of traveling is and where the nearest bathroom might be. And can they play with their grandchildren because they're worried about having an accident. And if at any point they begin to feel as though they need diapers or depends, or Pampers or anything of the sort, it's definitely time to see your local urologist.

Cheryl Martin: And what would the treatment options be doctor, surgical and nonsurgical?

Dr Mathew Fakhoury: So I think this goes back to what we were discussing earlier about taking a complex situation and breaking it down into its simplest forms. When we talked about incontinence, we mentioned urgency incontinence and stress incontinence. When we talk about urgency incontinence, we have to ensure that the patient is emptying the bladder adequately because as I said earlier, urine sitting in the bladder for too long will cause a snowball effective irritation of inflammation, of urinary tract infections, and thereby leading to incontinence. When we discuss urgency, we talk about a bladder training protocol, and I spend a lot of time talking to patients about this.

The first thing I discuss with patients is how often they're using the restroom. Most patients will wait until their bladder tells their brain it's time to go pee. I want patients to retrain that thought process in the bladder. Okay. Where they automatically go to the bathroom every two to three hours and they never go more than three hours during the day without urinating. Because if the bladder is empty and we are consistently doing so, there won't be any urine to leak out. That's step one. Using the restroom every two to three hours, regardless of the sensation.

The second, point we discussed with patients is a term I call double voiding. And that's where a patient, a female, may go to the bathroom, she'll sit down, she will empty her bladder to the best of her ability. And typically I ask the patient to stand up and sort of shimmy a little bit for about 10 to 15 seconds and move around. And what that does is it tricks the bladder into thinking that it's time to pee again, and most patients will then sit down again and wow, I do have a bit more urine coming out.

So I must not be emptying my bladder well, and about 99% of the time, that's typically what patients will come back and tell me after their four to six week trial period of bladder training. Last but not least, I encourage patients to drink as much water as they can during the day. However, two hours before bedtime, I encourage them to minimize the amount of fluid that they intake. And the reason is the following. The kidneys are working well. They're going to make the urine. The kidneys will make the urine. The urine will travel down through the ureter, which is the tube that connects the kidney to the bladder.

When the urine hits the bladder, if it stays in there for a long period of time, such as when we're asleep, will two things will happen. You'll either be woken up and frustrated that you have to go to the bathroom in the middle of the night, or most patients will ignore it and say, I'll just do it in the morning. And by that time, the urine has already sat in the bladder for 3, 4, 5 hours, and that again, will cause more irritation and inflammation, thereby worsening urgency and continents. So once I've discussed the bladder training protocol in detail with patients, I also discuss management of urinary incontinence related to urgency with medications.

Now, there was a point in time where we were prescribing anticholinergics quite often, however, some of the more recent data has showed that these anticholinergic medications that we use to help slow the bladder down to avoid overactive symptoms or urgency and continence, did have some long-term side effects, such as increasing the risk of developing Alzheimer's or dementia. Newer medications such as, Mirbectric or Gemtesa. Target very different receptors that are located only along the bladder lining.

And we are very comfortable utilizing those medications, with one tablet a day in order to minimize the urgency and continents and overactive symptoms such as frequency and urgency. Surgical management, we're gonna change gears now. Surgical management usually involves having to perform a sling placement. A urethral sling, which allows us to deliver a bit more support to the urethra, which increases, our chances of having the patient to be more continent. Now, these are outpatient procedures. Typically, they usually take anywhere from 30 to 45 minutes and patients go home the same day.

Cheryl Martin: Great. And the medications that you mentioned, you do need a prescription for them?

Dr Mathew Fakhoury: Absolutely. Yes. You do need a prescription for those medications.

Cheryl Martin: What are some of the other common urologic problems in women's health? I know one is kidney stones.

Dr Mathew Fakhoury: Absolutely. So kidney stones is a very common, issue that a lot of our patients in the office present with, whether it be because of flank pain or an infected kidney stone, which is an emergent situation. And kidney stones do kill people, so we take them very seriously and we are quite aggressive in how we treat kidney stones. There are certain situations where kidney stones can sort of be hanging out in the kidney, rent free, not causing many problems because they're small. Small enough for the patient to pass on their own.

There are other kidney stones where there's a situation where an obstruction occurs or a clog in the plumbing system and the kidney stone stops urinary flow. And at that point, that is more of an emergent situation where a. Urologist would have to perform a stent placement and deliver medications to the patient to ensure that the infection is cleared. we spend a lot of time talking about kidney stone prevention. Over the last three decades, we've noticed a tremendous increase in the number of patients presenting with kidney stones and complex kidney stones.

And we do believe that that has a lot to do with the dietary behavioral modifications of patients, both men and women. So I think, there's a lot of hustle and bustle out there, and a lot of us may be putting our health second. And obviously we all have our responsibilities, to do what we have to do. But we need to keep in mind that drinking water is probably our best friend. The number one way to prevent kidney stones is to drink enough water. And the American Neurologic Association guidelines clearly dictate.

For patients who have developed one stone, they're automatically at a 50% chance of recurrence. . So if nothing is done for both behavior and dietary modifications, that patient has a 50% chance of coming back with a kidney stone. So we tell them and encourage them, drink as much water as you can enough to make two liters of urine a day. Secondly, less salt in the diet. salt has been shown to increase the risk of development of kidney stones, and the third thing is less red meat. Now, I don't tell patients you can never have a cheeseburger or a steak again, but they have to be cognizant that having a lot of protein in the diet and especially red meats can increase the risk of developing more stones in the future.

Cheryl Martin: This is great information. Now what about, you mentioned prevention for kidney stones, any prevention tips to even prevent UI?

Dr Mathew Fakhoury: For urgency and continents, yes, for all of our listeners out there, really try to pay attention to how often you are urinating. Okay. most patients don't realize that they hold their urine four or five hours at a time, and that is going to unfortunately, have a negative impact on the bladder lining and the mucosa and thereby develop. I used that term earlier, a snowball effect of where the inflammation and irritation and sometimes infections these symptoms may become worse.

Cheryl Martin: Anything else you wanted to add on this topic, doctor?

Dr Mathew Fakhoury: I just want to encourage all our patients out there to try to live as healthy as possible and in order for us to play defense on urological issues, a lot of it starts with just the way that we're urinating, how often we're doing it. Taking our time to make sure we're emptying our bladder adequately because there's a slew of problems that can occur as a result of not emptying our bladder as well. So it's something that I do talk about quite a bit, and I am very thorough when I discuss this with patients.

And a lot of times they'll show up back into the office on follow up, whether it be two or three months later, and they'll tell me that the bladder training worked very well and there is no need for medication because their symptoms have slowly been resolving and as long as progress is being made, that's our only concern.

Cheryl Martin: You think most women are aware of how common and treatable these issues are?

Dr Mathew Fakhoury: I have a firm belief that most women do not believe that this is a common issue because it's sort of something that is very private. And most women are uncomfortable discussing it, especially with their doctors. They don't want to feel as though, they're getting to a point of age where. They have no control over their urination, but I want to be very clear in stating that women of all ages of childbearing age, well into their sixties and seventies, this is something that we can prevent if the steps are taken appropriately and you don't wait until the last minute where you are having to wear depends or diapers in order to catch that urine. I wouldn't wait until that point. I would definitely encourage our patients to see a urologist much sooner than that.

Cheryl Martin: Dr. Matthew Fakhoury. Thank you. I'm certain that women who are experiencing urological problems now realize that they don't have to live with them and that they can improve their quality of life For more information, please call our physician referral service at 914-964-4DOC. That's 914-964-4362, or email us at This email address is being protected from spambots. You need JavaScript enabled to view it.. That's This email address is being protected from spambots. You need JavaScript enabled to view it.. If you found this podcast helpful, please share it with others. And check out other episodes of Riverside Radio HealthCast, the podcast from St. John's Riverside Hospital.