Caitlin Whyte (Host): So many of us women have felt this when we laugh or sneeze or even exercise. You jump too high or laugh too hard, and all of a sudden feel a little dampness. That's right, we're talking today about stress urinary incontinence with Dr. Jaspreet Singh, a board-certified urologist.

 This is DocTalk presented by Montefiore St. Luke's Cornwall. And I'm your host, Caitlin Whyte. Well, doctor, thank you so much for being with us today. To start us off this episode, can you tell us a bit more about stress urinary incontinence? What exactly is that?

Dr. Jaspreet Singh: Yeah. Thanks for having me, Caitlin. Stress urinary incontinence is the involuntary loss of urine that's associated with physical activity. That could be as simple as a strong cough, a sneeze, perhaps a laugh that puts additional pressure on the abdomen. And that pressure then gets transmitted to the bladder. And if you have a full bladder, and it doesn't have to be extremely full, if there's some urine in the bladder, that extra pressure on the bladder will then cause the urine to escape or leak, and involuntary. So, it can often catch people off guard, and it's one of those things that people learn to cross their legs kind of thing. So, that's kind of what we're talking about, the type of leakage, stress urinary incontinence.

Host: Absolutely. Well, how does this leakage or weakness develop? Is it hereditary or is it something that just comes with age? How do we get here?

Dr. Jaspreet Singh: A little bit of all the above. So, you know, stress urinary incontinence, we'll concentrate on female stress urinary incontinence, although this entity can occur in men a little bit different. Stress urinary incontinence, the risk factors do include aging. There is a hereditary factor to that. I've had not only treated patients, but their moms too. And then also, along with aging process, post-menopausal processes, the muscle of the pelvis, that's what's important in being able to hold the urine in weakens with pregnancy. And it doesn't have to be vaginal delivery pregnancy. Pregnancy itself, just the weight of the fetus and enlargement of the uterus puts a lot of pressure on the pelvic floor and that can result in weakening. And when those muscles weaken, then, you know, that's when the bladder can leak urine.

Host: Gotcha. Well, let's dive into some treatment options for women experiencing stress urinary incontinence. And I'd love to begin with our non-surgical options first.

Dr. Jaspreet Singh: Yeah. We always encourage non-surgical options. And, you know, sometimes when you can't control these things, we can't control the fact that we're going to get older, we can't control the fact that we're going to hit menopause. And we can't control our genetics. So, you know, a lot of things, we're working against what is given to us. But there are things, sure. What we can encourage patients are to lose weight. Obesity itself is an additional risk factor for urinary incontinence. That's additional weight around the abdomen that puts pressure. So, losing weight is key. Also, managing your activity, managing fluid intake. Although as a urologist, I can't encourage you not to drink water, but perhaps when you're going out or you're expecting you're going out to hang out with friends, there's going to be laughing and things like that, maybe try to cut down on things that can irritate the bladder such as alcohol or caffeine.

And then, there are certain pelvic floor exercises that we review with patients we encourage them to start. These are what I call low-lying fruit. They're free and, you know, does require commitment, but you're not really investing more than your time and concentration.

So, the pelvic floor is a group of muscles that you think about like a hammock that is keeping the pelvis up. And when these muscles weaken, there are certain exercises that can help strengthen that. Kegel exercises are kind of like the generic term we use. The easy way to pick up on or understand where these muscles are is to stop the urine as one is emptying the bladder. So, as you're urinating, you can stop and go. And that muscle, the sphincter, that pelvic floor muscle is what over a period of time you can learn so that initially you're stopping and going but, you know, we could be sitting, in fact, I'm having a conversation with you and doing these pelvic floor exercises and doing these Kegels. And they come in all sorts of different pauses where you can hold and squeeze and then you do short bursts.

And so, Kegel exercises are very commonly known in women who are pregnant or deliver babies, that initially a lot of women do experience that for a short period of time after delivery. So, Kegel exercises are important. Sometimes, I have patients who have no idea what these muscles are, so we do have a dedicated nursing staff and does something called biofeedback that helps to give patients real time feedback into understanding are they really working on these muscles. But the overall success rate of Kegel exercises is less than ideal, somewhere about 15-20%, so that gives you about one in five women will come back and say that they're better. But, you know, that being said, it's kind of minimal investment when you talk about non-surgical or non-medical options.

Host: I love that. Thank you for that response. Well, looking into surgical options then. When does that come into the conversation? When do we consider surgical options? And then, what are some of those options? What do they look like?

Dr. Jaspreet Singh: Yeah, sure. I think that the biggest thing that transitions patients from conservative intervention to eventually choosing surgery is the quality of life, the impact on the quality of life. You know, initially, patients will try to manage these things with wearing pads, sanitary pads, Depends. But they can be not only expensive, but annoying, bothersome. You're out and about, having to pack these things, going on vacation. So, it really depends on how bothersome and how heavy the incontinence is.

Any women, any of my patients that are looking to become pregnant again, I would discourage surgical intervention, because that again itself worsen stress incontinence even after surgery. So, probably say, hey, "Once you're done with childbearing years, then we can talk about surgery."

There's various options, and we can get into briefly with all of them. There are things that we do as an outpatient in the office that are what's called collectively as bulking agents. These are the most common right now. We're using this polymer type. And historically, we've used things like collagen. What the material does is it helps to compress the urethra. So, we go in with a little camera and we place this agent into the outside of the urethra causing a squeezing or what we call coaptation, and it helps to compress the urethra. And you think about it, Caitlin, like a balloon that you're not pinching the neck off. So, you know, when you squeeze the balloon, the air is going to leak out. So, what we're doing is we're tightening the tissue around the urethra.

And then, there are procedures that are a little bit more invasive, although they're all outpatient and usually take about 20 to 30 minutes. They're collectively called sling procedures. What a sling procedure does, or what we're trying to do with a sling procedure, is actually place in a mesh-like material that it is shaped like a hammock and that helps to then elevate and also cause a further tightening of the muscles and support these weakened muscles that are around the urethra.

Host: Wonderful. Well, it sounds like we have a range of options to deal with both non-surgical and surgical to really get this under control. And as we wrap up here, doctor, is this something that can be considered cured ever or do we just learn to live with it? I mean, when it comes to stress urinary incontinence, once we have it, what does that really mean for us?

Dr. Jaspreet Singh: Yeah. I mean, you know, as we just briefly talked about pelvic floor exercises, Kegel exercises, losing weight, all that, yes, things can get better. But in majority of patients, you know, these conservative measures are not considered long term cure. It may initially get better. But as a progressive problem, a few years down the road, as we're all aging and things like that, the symptoms can worsen.

Surgical options, and this is really to encourage patients to discuss with their doctors what their comfort levels are, what kind of procedures have they done, and what kind of outcomes have they had. But, you know, published literature looks at five-year outcomes of these procedures. And they're pretty good. They range anywhere from about 80-88% long-term success in being able to control the urinary incontinence. So, these are very viable long-term good options in trying to restore some of the quality of life that's lost with this embarrassing problem.

Host: Well, Doctor, wrapping up today, do you have any other thoughts about stress urinary incontinence? Any other wisdom to share with women listening?

Dr. Jaspreet Singh: Yeah. I mean, you know, this is part of the aging process. A lot of people ignore it or adjust to it, but it could mean more. Definitely, the stress urinary incontinence is going to be associated with pelvic organ prolapse, where the bladder drops into the vagina. You can have a rectum that falls into the vagina. So, it could mean more.

So, always encourage patients whenever they have changes in their health to discuss with their medical doctor. And, you know, what's the worst that can happen is you discussed and you know, it's something that's normal, and you get that reassurance. You don't want to take a chance on things like, you know, things with your health.

Host: Absolutely. Well, thank you so much for joining us today and for this information. You can visit montefioreslc.org for more information about our Urology services. And please remember to subscribe, rate, and review this podcast and all the other Montefiore St. Luke's Cornwall podcasts. I'm your host, Caitlin Whyte.