Transcription:
Do You Suffer From Incontinence? There is Help!

Melanie Cole (Host): Do you suffer from incontinence? It might seem embarrassing to discuss with your doctor but by doing so you could dramatically improve your quality of life. My guest today is Dr. Monisha Crisell. She’s a urologist and a member of the medical staff at Temecula Valley Hospital. Welcome to the show, Dr. Crisell. So, what is the definition of incontinence?

Dr. Monisha Crisell (Guest): Thank you for having me. The definition of incontinence is any involuntary loss of urine and there are multiple causes of that, but that’s the general definition.

Melanie: So, do you think that in your practice you see that people are hesitant to come to you and discuss this, maybe especially women?

Dr. Crisell: Definitely. It’s a very, very common problem but traditionally it is a very private problem and patients, I find, generally put off evaluation until the problem becomes very severe. Generally, they will bring up the problem to the primary doctor and sometimes the primary doctor can help the patient undergo the initial evaluation and initial treatment. When the problem becomes more severe or perhaps requires a surgical approach, that’s when we get involved.

Melanie: So, what are some of the causes?

Dr. Crisell: Well, there are multiple different general types of incontinence. One major cause of incontinence is something called “urge incontinence” or overactive bladder, when the bladder involuntarily wants to empty when the patient might not be ready to voluntarily empty the bladder. So, urge incontinence symptoms include a sense of having to go to the bathroom frequently, the patient will report, “Oh, I feel like I can’t make it to the bathroom,” and then leakage will occur. That is generally a medical problem and is treated with medical solutions. Another common cause of incontinence is something called “stress incontinence” and that’s more of an anatomic issue where the sphincter muscle that controls the outlet of the urethra and the bladder is no longer very competent. This is more of an anatomic problem that usually requires an anatomic or surgical solution.

Melanie: Let’s just start with stress incontinence and who might be at risk. What happens that causes this?

Dr. Crisell: That’s a very good question because women who have stress incontinence and stress incontinence generally affects women and not as much men, but it is caused by weakness of the pelvic floor muscles. How does that happen? Well the number one reason for weakness of the pelvic floor is childbirth and even just pregnancy. Vaginal childbirth is, perhaps, one of the greatest risk factors in causing stress incontinence but also simply aging. Those sorts of factors keep that muscle from being very strong in times of stress such as coughing and sneezing and laughing. That’s what causes the leakage of urine.

Melanie: So, because women, we make jokes about that, we laugh and we trickle down a little bit or we, you know, cough or sneeze as you say and typically women tend to just say, “Oh, well. I’ll just deal with it.” Is there something that you can do or when do you tell them it’s time to do something about that?

Dr. Crisell: So, stress incontinence, the initial therapy when people begin to start to leak when they laugh or cough or some of those other stressors, the first thing to start doing and even, really, frankly preventively, is Kegel exercises. Kegel exercises can be done by anyone, any woman can perform these Kegel exercises where they tighten their pelvic floor for a few seconds at a time, several times in a row and that, frankly, needs to be done hourly in order for it to be effective. It’s a great therapy for mild stress incontinence where it’s merely a mild bother, it’s just starting and you don’t want it to get worse. However, as it gets worse and the patient is far more bothered, she can definitely seek help and there are multiple different kinds of therapies that we have available.

Melanie: I’d like you to describe the Kegel exercise for us if you would so that women understand that they can do this driving in a car, when they’re getting up in the morning, because some women think, Dr. Crisell, that they’re supposed to stop and start their urine stream. Is that the case?

Dr. Crisell: You’re absolutely right. People do have the misconception that the best time to do a Kegel is when one is urinating and, actually, that’s one of the worst times to do a Kegel. However, if you want to figure out “Which muscle am I supposed to exercise?” That’s actually a good way for the very first time. The muscle that is able to stop the flow of urination, that’s the muscle you want to exercise. So, for the very first time if you want to figure out, okay let me see if I can understand which muscle it is, you can interrupt the stream and then, that’s the muscle that you’ll need to exercise. The exercise is done by sitting down, standing up, really the position doesn’t really matter but one has to tighten the muscles or squeeze them shut, as it were, right around where the bladder, urethra, and the vagina are. And, if a woman can hold that down for about three to five seconds in a row, say, six times in a row, that would give the pelvic floor a nice workout. Of course, that has to be repeated multiple times a day. So, you’re idea of, say, doing it in the car, that’s an excellent trigger. I usually advise my patients every time you stop at a stoplight, every time you see a commercial on TV, any time you’re standing in line at the grocery store, these are great opportunities when you’re simply just waiting to go ahead and exercise that pelvic floor.

Melanie: So now, with urge incontinence, what’s the difference as far as when you tell somebody it’s really time to come see me?

Dr. Crisell: Urge incontinence is part of overactive bladder. It’s very, very common. In fact, it’s more common than heart disease. So, when is the time to see a urologist or seek help for that particular problem is when it starts to become a quality of life issue. Certain factors that impact quality of life include, say, getting up multiple times at night; leaking on the way to the bathroom; using numerous pads; trying to figure out where every toilet in town is--we call that toilet mapping. When it’s starting to really impact whether people can leave the house, there are so many different ways in which urge incontinence can impact quality of life. So, when that starts to happen, then we, besides medications, we use dietary modifications, say, avoiding bladder stimulants; avoiding drinking a lot of water before bedtime--those sorts of things. The other thing that we can do is we can start medication which works, generally, pretty well for urge incontinence. When medications start to fail, that’s when urologists usually become involved and we have minor surgical procedures that we can do that can alleviate the urge incontinence when medications are either not working or they’re not well-tolerated by the patient.

Melanie: What are the medications intended to do?

Dr. Crisell: The reason for using medications for urge incontinence is to allow the bladder muscle to relax a bit. The bladder is, in fact, a muscle and when one takes the medication for overactive bladder, that muscle, then, is allowed to expand and hold more and, usually, there’s a better warning time for the patient to get to the bathroom before any leakage would occur.

Melanie: So, it just gives you time before this would happen?

Dr. Crisell: Yes. It helps to give the patient more of a warning time before having to run to the bathroom and it should increase the interval of time that it would take for a patient to have to go to the bathroom.

Melanie: Can men do the Kegel exercise, doctor?

Dr. Crisell: Men can certainly do the Kegel exercise but they are not usually as afflicted with stress incontinence as women are.

Melanie: What would you like listeners to know about changes in lifestyle that they could make to maybe help? We’ve talked about the Kegel exercise. What else can they do? Are there certain things that would precipitate this type of incontinence, either of the types?

Dr. Crisell: For urge incontinence, that is something that occurs that is nobody’s fault, of course. Dietary and behavioral modifications can definitely improve the quality of life. For example, if someone has been told that they need to drink eight glasses of water a day, that can definitely aggravate the urge incontinence problem and I usually tell my patients, unless there’s a medical issue which requires you to drink that much water, there’s really no reason to so aggressively hydrate. So, moderating food consumption can definitely improve urge incontinence. Other dietary modifications include avoiding bladder stimulants such as spicy foods, citrus, anything with a lot of acid or potassium, or, especially caffeine and soda. So, preventing ingestion of all those sorts of stimulants can help control the bladder as well.

Melanie: Dr. Crisell, in just the last few minutes, what should people who suffer from incontinence think about when seeking care?

Dr. Crisell: The major thing to remember with incontinence is that you’re not alone, that this is a very common problem and that there are multiple different options to help people. So, don’t be afraid to ask for help.

Melanie: Why should they come to Temecula Valley Hospital for their care?

Dr. Crisell: Temecula Valley Hospital involves a great group of physicians and other healthcare providers and nursing staff that can address the whole person, not just the medical needs.

Melanie: Thank you so much. It’s really great information and so important. Thanks for being with us today. You’re listening to TVH Doc Talk with Temecula Valley Hospital. For more information, you can go to TemeculaValleyHospital.com. That’s TemeculaValleyHospital.com. Physicians are independent practitioners who are not employees or agents of Temecula Valley Hospital. The hospital shall not be liable for actions or treatments provided by physicians. This is Melanie Cole. Thanks so much for listening.