Selected Podcast
Stress Urinary Incontinence
Dr. Jaspreet Singh discusses what Stress Urinary Incontinence is, how it differs from general Urinary Incontinence, and possible ways to prevent it.
Featured Speaker:
Jaspreet Singh, DO
Dr. Jaspreet Singh is a board certified urologist. He obtained his medical degree from the New York College of Osteopathic Medicine and completed his clinical internship at Brookdale University Hospital and Medical Center followed by general surgery and urologic surgical residencies at Albert Einstein Medical Center, and Hahnemann University Hospital. Dr. Singh has also completed clinical externships at Memorial Sloane Kettering Cancer Center and the Children Hospital of Philadelphia during his residency. Dr. Singh pursued additional fellowship training at Thomas Jefferson University Hospital in PA. His training includes experience and proficiency with minimally invasive robotic and laparoscopic procedures. He has a special interest in the diagnosis and treatment of ED (erectile dysfunction) prostate, bladder and kidney cancers, and urinary incontinence. Throughout residency and afterwards, Dr. Singh has sought to further advance his knowledge and surgical skill by continued training under the nation’s leading urologists and gynecologists. Transcription:
Stress Urinary Incontinence
Caitlin Whyte (Host): Stress urinary incontinence is the unintentional loss of urine usually occurring during physical movement or activity like coughing, laughing or sneezing. Dr. Jaspreet Singh is here to tell us a bit more about this condition. He is the Co-Director of Men's Health and Urology Services at Montefiore St. Luke's Cornwall. This is Doc Talk, the podcast from Montefiore St. Luke's Cornwall Hospital. I'm your host, Caitlin Whyte. To start us off, tell us what stress urinary incontinence is, what makes it different from general urinary incontinence?
Jaspreet Singh, DO (Guest): So, urinary incontinence itself is defined as the loss of urine an involuntary loss. And the general broad term of urinary incontinence is as just stated is that it's just an involuntary loss of urine, but there's subtypes. There are different subtypes that we treated as urologists that may include or be preceded with an uncontrollable urge to find a bathroom, which we define then as urinary urge incontinence or the most common type of incontinence people face in the United States is what we label as stress incontinence. And that's the type of leakage that occurs with any sort of activity such as coughing, sneezing, laughing, bending over. Anything that creates an additional pressure on the bladder or any, any sort of activity that creates pressure on the bladder, then that causes the escape or leakage of urine.
Host: That leads me into my next question. What are some signs a person might have that show their condition is stress induced?
Dr. Singh: So, you know, when, anytime I see a patient in the office, getting a good history is still imperative. And most patients that have stress incontinence will describe the story that goes along with this. Doc, I sleep at night. I typically don't get up perhaps maybe once at night, I'm not incontinent at night time, but as soon as I get up in the morning, or as I'm walking over to the bathroom, I may notice leakage of urine or I'm hanging out with my friends, we're having drinks and we're laughing. And all of a sudden I have to cross my legs and really hold the urine because otherwise, if I laugh too heavy, it's going to leak out. So, the clear differentiation between urge incontinence, which may be related to what we define as overactive bladder or bladder that's just is not storing urine is stress incontinence is preceded with some activity.
Host: Now this condition is more common in women after childbirth or during menopause, but do men experience it as well?
Dr. Singh: Men do experience it. Typically the average male should not, but men who face prostate cancer or have had treatment for prostate cancer, specifically removal of the prostate may experience stress incontinence. And the reason why that happens often when men undergo surgery for prostate removal, the muscles that are really important in controlling the urine are damaged or injured.
And, despite a surgeon's care and being careful about removing the prostate. So, when these muscles get injured, that ability to store the urine gets, gets weakened or lost. You know, it's very simply put when I talk to patients, it's the bladder is like a balloon and the balloon has a neck that if you squeeze, you should not have any leakage of air, but if you don't squeeze strong enough, you know, air is going to leak out. In a similar way, the bladder has a muscle that keeps, when tight, keeps the urine within the bladder. And when that muscle is weak and any sort of pressure on the bladder, it's going to cause the urine to leak out. And that's what men may experience is that the muscle gets injured after prostate removal for prostate cancer.
Host: So just how can we fix this non-surgically? What are some first steps?
Dr. Singh: So, I think before we even talk about non-surgical treatment options, I think it's worthwhile to understand what risk factors are for typically women.
Host: Oh, of course, please.
Dr. Singh: You know, of course we all recognize that childbirth increases the risk of stress incontinence, childbirth itself, vaginal delivery. I've had patients who have even held pregnancy to the end and have led to C-section may also experienced stress incontinence. And what's happening is these pelvic muscles in the female body are being stressed as carrying gravid uterus and carrying the baby. Age has something to do with it. So, as women get older, the muscles themselves, weaken and needless to say that I typically see women as they age, typically in their fifties, sixties and above that will start reporting that the leakage of urine with activity. Being overweight is crucial. Obesity itself. The higher the BMI, the higher the risk and obesity itself is two times the risk for developing stress urinary incontinence. And then finally some sort of pelvic surgery such as a hysterectomy, and the data shows that the risk for stress incontinence after the uterus is removed is upwards of five to six times than somebody who hasn't had pelvic surgery. So, you know, these are the risk factors and some of these are controllable and some of these are not. And of course, if a woman has to undergo removal of the uterus for benign conditions, has fibroids or even malignant conditions, you know, we, we don't have that control, but what we do have in control is our weight. Controlling our weight, losing weight is important. Some of the other non-surgical ways that take the time to review with patients as far as lifestyle changes, you know, you want to make sure that you're drinking healthy fluids, things like caffeine, spicy foods can irritate the bladder and cause an unnecessary strain on the bladder.
So, you may even notice some improvement in, in leakage of urine with just some lifestyle changes. One of the easiest things that I discuss with patients, that's obviously nonsurgical is the use of Kegel exercises. And many of my patients remember Kegel exercises perhaps described to them shortly after the delivery of their baby. Kegel exercises are pelvic floor exercises that we instruct patients to perform on a daily basis.
And, and the next question, patients ask us, well, what are Kegel exercises? Am I doing them right? How do I do them? And the easiest way to recognize the muscle that's so important in controlling the urine is, as one is urinating, you can stop the urine and release. That's the muscle that helps, control the urine, when we're talking about urinary incontinence. And so you can work on those muscles. We have in the office, a dedicated staff member that performs what we call biofeedback and biofeedback is almost like going to the gym and having a personal trainer. You know, you can go to the gym and lift weights and lift them the wrong way and then come home and saying, hey, how come I'm not getting anywhere because you're not doing the weightlifting properly. In the same way, you have a physical trainer or a personal trainer, that's going to guide you through it. You maximize your learning on how to exercise these muscles.
Same way we have nursing staff that performs by feedback. So, these are the early important non-surgical interventions. And unfortunately by no means a home run and the data shows that perhaps 15 to 20% of women may notice an improvement to their urinary incontinence and typically early in their spectrum, perhaps early stressing incontinence, as opposed to something where somebody is wearing multiple pads per day.
Host: Great. Well, thank you for bringing that up doctor. And what if those options don't work? Are there surgical paths?
Dr. Singh: So, we have actually, fortunately as urologists, we have several options that are so important to and have demonstrated great success. I guess the spectrum of surgical options range from less invasive to perhaps more invasive. One of the first things that I do in the office and when we identified a patient, who's struggling with stress incontinence is a pelvic exam to make sure that the bladder itself is where it's supposed to be. And we all recognize that this entity of pelvic organ prolapse also increases as a woman gets older and that usually entails the bladder or the uterus to kind of fall into the vagina.
And so that needs to be addressed separately. If somebody has just pure stress incontinence, we have bulking agents that we use. The advantage to bulking agents, are that they're fairly quick, they can be done as an outpatient setting with minimal anesthesia and some patients, not even any anesthesia, just some local anesthetic.
And what we're doing during that time is inserting a small camera into the urethra and injecting a material that's not absorbable. Think about it like a pillow, we're inflating, a pillow to provide the extra compression that the urethra needs to keep the muscle tight so that the leakage of urine is improved.
Host: Great. Well, doctor, is there anything else we didn't touch on that you'd like to add?
Dr. Singh: Yeah. So, that being the minimally invasive, also what we would describe as minimally invasive, which I think I've had great success with and long-term improvement. You know, the downside to bulking agents is sometimes the repetitive need for the procedure.
It may last for two years and patients come back needing more. And so the longterm data is not as robust. When we talk about long-term improvement of stress incontinence, moving, we're talking about a sling procedure. And a sling is a piece of strong material that's placed under the urethra and it provides like a hammock, a support system to, to the urethra.
And it allows the compression of the urethra. Now, the reason why this works so well is that it's providing direct compression of the urethra. The sling material itself gets healed and scarred in to that area and then provides really long-term improvement of these conditions. The success rate of sling procedure for women and this has been demonstrated over the last 20 years we've been doing sling surgery is upwards of 85% improvement of your incontinence and at five years. So, we're talking about long-term improvement and it can really help restore that confidence, you know. And, and so, as we're talking about urinary incontinence, you know, why even, why even treat it, you know, many women will say that Doc, I'm getting older and this is kind of what I've accepted and wearing cards per day.
But, you know, the women that come talk to me really have regained their confidence, you know, and that maybe just taking the grandkids out and not being worried about changing pads and not being worried about going to the park and having an accident, or even hanging out with friends.
And so it's really a restoration of confidence or quality of life that's regained. Yes, these changes, we all recognize as our bodies get older as part of the quote unquote aging process, but you know, we don't have to be reminded of our aging process everyday by choosing pads and really can fix the issue.
Host: Well, thank you so much for this insight. That was Dr. Jaspreet Singh. He is the Co-Director of Men's Health and Urology Services at Montefiore St. Luke's Cornwall. Learn more about us online at montefioreslc.org. And if you found this podcast helpful, please share it on your social channels and be sure to check out all the other Doc Talk episodes. This has been Doc Talk, the podcast from Montefiore St. Luke's Cornwall Hospital. I'm Caitlin Whyte. Stay well.
Stress Urinary Incontinence
Caitlin Whyte (Host): Stress urinary incontinence is the unintentional loss of urine usually occurring during physical movement or activity like coughing, laughing or sneezing. Dr. Jaspreet Singh is here to tell us a bit more about this condition. He is the Co-Director of Men's Health and Urology Services at Montefiore St. Luke's Cornwall. This is Doc Talk, the podcast from Montefiore St. Luke's Cornwall Hospital. I'm your host, Caitlin Whyte. To start us off, tell us what stress urinary incontinence is, what makes it different from general urinary incontinence?
Jaspreet Singh, DO (Guest): So, urinary incontinence itself is defined as the loss of urine an involuntary loss. And the general broad term of urinary incontinence is as just stated is that it's just an involuntary loss of urine, but there's subtypes. There are different subtypes that we treated as urologists that may include or be preceded with an uncontrollable urge to find a bathroom, which we define then as urinary urge incontinence or the most common type of incontinence people face in the United States is what we label as stress incontinence. And that's the type of leakage that occurs with any sort of activity such as coughing, sneezing, laughing, bending over. Anything that creates an additional pressure on the bladder or any, any sort of activity that creates pressure on the bladder, then that causes the escape or leakage of urine.
Host: That leads me into my next question. What are some signs a person might have that show their condition is stress induced?
Dr. Singh: So, you know, when, anytime I see a patient in the office, getting a good history is still imperative. And most patients that have stress incontinence will describe the story that goes along with this. Doc, I sleep at night. I typically don't get up perhaps maybe once at night, I'm not incontinent at night time, but as soon as I get up in the morning, or as I'm walking over to the bathroom, I may notice leakage of urine or I'm hanging out with my friends, we're having drinks and we're laughing. And all of a sudden I have to cross my legs and really hold the urine because otherwise, if I laugh too heavy, it's going to leak out. So, the clear differentiation between urge incontinence, which may be related to what we define as overactive bladder or bladder that's just is not storing urine is stress incontinence is preceded with some activity.
Host: Now this condition is more common in women after childbirth or during menopause, but do men experience it as well?
Dr. Singh: Men do experience it. Typically the average male should not, but men who face prostate cancer or have had treatment for prostate cancer, specifically removal of the prostate may experience stress incontinence. And the reason why that happens often when men undergo surgery for prostate removal, the muscles that are really important in controlling the urine are damaged or injured.
And, despite a surgeon's care and being careful about removing the prostate. So, when these muscles get injured, that ability to store the urine gets, gets weakened or lost. You know, it's very simply put when I talk to patients, it's the bladder is like a balloon and the balloon has a neck that if you squeeze, you should not have any leakage of air, but if you don't squeeze strong enough, you know, air is going to leak out. In a similar way, the bladder has a muscle that keeps, when tight, keeps the urine within the bladder. And when that muscle is weak and any sort of pressure on the bladder, it's going to cause the urine to leak out. And that's what men may experience is that the muscle gets injured after prostate removal for prostate cancer.
Host: So just how can we fix this non-surgically? What are some first steps?
Dr. Singh: So, I think before we even talk about non-surgical treatment options, I think it's worthwhile to understand what risk factors are for typically women.
Host: Oh, of course, please.
Dr. Singh: You know, of course we all recognize that childbirth increases the risk of stress incontinence, childbirth itself, vaginal delivery. I've had patients who have even held pregnancy to the end and have led to C-section may also experienced stress incontinence. And what's happening is these pelvic muscles in the female body are being stressed as carrying gravid uterus and carrying the baby. Age has something to do with it. So, as women get older, the muscles themselves, weaken and needless to say that I typically see women as they age, typically in their fifties, sixties and above that will start reporting that the leakage of urine with activity. Being overweight is crucial. Obesity itself. The higher the BMI, the higher the risk and obesity itself is two times the risk for developing stress urinary incontinence. And then finally some sort of pelvic surgery such as a hysterectomy, and the data shows that the risk for stress incontinence after the uterus is removed is upwards of five to six times than somebody who hasn't had pelvic surgery. So, you know, these are the risk factors and some of these are controllable and some of these are not. And of course, if a woman has to undergo removal of the uterus for benign conditions, has fibroids or even malignant conditions, you know, we, we don't have that control, but what we do have in control is our weight. Controlling our weight, losing weight is important. Some of the other non-surgical ways that take the time to review with patients as far as lifestyle changes, you know, you want to make sure that you're drinking healthy fluids, things like caffeine, spicy foods can irritate the bladder and cause an unnecessary strain on the bladder.
So, you may even notice some improvement in, in leakage of urine with just some lifestyle changes. One of the easiest things that I discuss with patients, that's obviously nonsurgical is the use of Kegel exercises. And many of my patients remember Kegel exercises perhaps described to them shortly after the delivery of their baby. Kegel exercises are pelvic floor exercises that we instruct patients to perform on a daily basis.
And, and the next question, patients ask us, well, what are Kegel exercises? Am I doing them right? How do I do them? And the easiest way to recognize the muscle that's so important in controlling the urine is, as one is urinating, you can stop the urine and release. That's the muscle that helps, control the urine, when we're talking about urinary incontinence. And so you can work on those muscles. We have in the office, a dedicated staff member that performs what we call biofeedback and biofeedback is almost like going to the gym and having a personal trainer. You know, you can go to the gym and lift weights and lift them the wrong way and then come home and saying, hey, how come I'm not getting anywhere because you're not doing the weightlifting properly. In the same way, you have a physical trainer or a personal trainer, that's going to guide you through it. You maximize your learning on how to exercise these muscles.
Same way we have nursing staff that performs by feedback. So, these are the early important non-surgical interventions. And unfortunately by no means a home run and the data shows that perhaps 15 to 20% of women may notice an improvement to their urinary incontinence and typically early in their spectrum, perhaps early stressing incontinence, as opposed to something where somebody is wearing multiple pads per day.
Host: Great. Well, thank you for bringing that up doctor. And what if those options don't work? Are there surgical paths?
Dr. Singh: So, we have actually, fortunately as urologists, we have several options that are so important to and have demonstrated great success. I guess the spectrum of surgical options range from less invasive to perhaps more invasive. One of the first things that I do in the office and when we identified a patient, who's struggling with stress incontinence is a pelvic exam to make sure that the bladder itself is where it's supposed to be. And we all recognize that this entity of pelvic organ prolapse also increases as a woman gets older and that usually entails the bladder or the uterus to kind of fall into the vagina.
And so that needs to be addressed separately. If somebody has just pure stress incontinence, we have bulking agents that we use. The advantage to bulking agents, are that they're fairly quick, they can be done as an outpatient setting with minimal anesthesia and some patients, not even any anesthesia, just some local anesthetic.
And what we're doing during that time is inserting a small camera into the urethra and injecting a material that's not absorbable. Think about it like a pillow, we're inflating, a pillow to provide the extra compression that the urethra needs to keep the muscle tight so that the leakage of urine is improved.
Host: Great. Well, doctor, is there anything else we didn't touch on that you'd like to add?
Dr. Singh: Yeah. So, that being the minimally invasive, also what we would describe as minimally invasive, which I think I've had great success with and long-term improvement. You know, the downside to bulking agents is sometimes the repetitive need for the procedure.
It may last for two years and patients come back needing more. And so the longterm data is not as robust. When we talk about long-term improvement of stress incontinence, moving, we're talking about a sling procedure. And a sling is a piece of strong material that's placed under the urethra and it provides like a hammock, a support system to, to the urethra.
And it allows the compression of the urethra. Now, the reason why this works so well is that it's providing direct compression of the urethra. The sling material itself gets healed and scarred in to that area and then provides really long-term improvement of these conditions. The success rate of sling procedure for women and this has been demonstrated over the last 20 years we've been doing sling surgery is upwards of 85% improvement of your incontinence and at five years. So, we're talking about long-term improvement and it can really help restore that confidence, you know. And, and so, as we're talking about urinary incontinence, you know, why even, why even treat it, you know, many women will say that Doc, I'm getting older and this is kind of what I've accepted and wearing cards per day.
But, you know, the women that come talk to me really have regained their confidence, you know, and that maybe just taking the grandkids out and not being worried about changing pads and not being worried about going to the park and having an accident, or even hanging out with friends.
And so it's really a restoration of confidence or quality of life that's regained. Yes, these changes, we all recognize as our bodies get older as part of the quote unquote aging process, but you know, we don't have to be reminded of our aging process everyday by choosing pads and really can fix the issue.
Host: Well, thank you so much for this insight. That was Dr. Jaspreet Singh. He is the Co-Director of Men's Health and Urology Services at Montefiore St. Luke's Cornwall. Learn more about us online at montefioreslc.org. And if you found this podcast helpful, please share it on your social channels and be sure to check out all the other Doc Talk episodes. This has been Doc Talk, the podcast from Montefiore St. Luke's Cornwall Hospital. I'm Caitlin Whyte. Stay well.