Bill Klaproth (Host): Urinary incontinence is an embarrassing problem. And although common, many women are shy about discussing this and other female urinary conditions. But there are treatments to help improve your quality of life. And if you are hesitant to see a physician, we'll share advice on that too. So, let's talk with Dr. Annaceci Peacher, a Physician at TidelandsH ealth specializing in Women's Health and Urogynecology. Dr. Peacher, thank you so much for your time. We really appreciate it. So, let's start with this. So, can you tell us first off, what is Urogynecology?

Annaceci Peacher, MD (Guest): So, Urogynecology is actually kind of a layman's term for the more academic name of Female Pelvic Medicine and Reconstructive Surgery. So, that one's more explanatory, but basically it's a subspecialty of OBGYN dealing with pelvic prolapse and female incontinence.

Host: Speaking of female incontinence, what are some of the most common conditions that you see?

Dr. Peacher: Urinary incontinence can usually be broken up into urge incontinence and stress incontinence, which are both very common for women.

Host: And what other conditions would you normally see as well?

Dr. Peacher: Pelvic organ prolapse is one that women actually have a hard time kind of explaining or deciphering that's what they're experiencing. That usually happens and presents with a bulge in the vagina, pressure in the vagina. And it's the laxity of the tissue, and the vagina that's coming out.

Host: So, let's stay on that and talk more about symptoms. Can you share with us some of the common symptoms that people might be experiencing with these types of conditions?

Dr. Peacher: Sometimes people are noticing that they're having increased urinary urgency, having to rush to the restroom, leaking on the way to rushing to the restroom. Then stress incontinence actually is a lot of coughing, sneezing, laughing type of leakage, any kind of activity like bending, exercising, things like that, are common with that type of leakage.

Host: And how about pelvic organ prolapse? What about signs and symptoms of that?

Dr. Peacher: Sometimes people actually feel something coming out of the vagina. I've heard patients describe it like sitting on a ball or like you have a tampon in wrong. Those are kind of common symptoms or like a heaviness that gets worse throughout the day because the gravity obviously, it takes more effect throughout the day. So, sometimes people feel like that is worse at the end of the day, as opposed to the morning.

Host: So, for a woman who is experiencing some of the symptoms, when is it time to see a physician?

Dr. Peacher: I think a lot of what I do has to do with improving quality of life. So, really when it starts impeding your day to day, when you start noticing that you're planning your day around where, you know, restrooms are, locations that, you know restrooms are or not going places because you know that you can't get to the bathroom in time.

That's a common reason to see somebody. A lot of times people are also getting recurrent UTIs because they are having a lot of recurrent leakage or not emptying their bladder completely. And sometimes that comes from prolapse.

Host: So, is some of this normal, just as women age or after childbirth? I know some think that is true. Is that right?

Dr. Peacher: I like to tell people that it's not normal, but it's common. So, some women come in saying, well, I thought this was normal. It was something that women have to live with. It's not something that you have to live with. I mean, it's something that can be treated and evaluated and treated properly. So, I think it's kinda sad when women come in thinking that it's just a normal part of aging when it's not.

Host: Okay. That is really good to know. So, let's talk about those treatment options. And I know you said your goal is to basically help people with their quality of life. So, what are the treatment options? What can a woman do who is experiencing one of these conditions?

Dr. Peacher: The treatment is broken up into the different conditions. So, for urge incontinence, that usually happens when their bladder is contracting when it needs to stay relaxed. So, first things that can be done are pretty simple. Like, changing diet, dietary modifications. I like to ask patients what they're drinking throughout the day. If you're drinking a lot of coffee, a lot of tea, a lot of soda, all of those are diruretics and bladder irritants. Together, they're going to make you go pee more. So, if you try to just cut back on those things, usually you have less of an issue. And if you try to go to the bathroom, at least every two hours, sometimes people are having issues just because they're holding their bladder too long.

So, that's kind of like a first place to start for the urge incontinence. For the stress incontinence, that one happens because there's weakness around the ligaments that are supposed to support the urethra, which is the tube you pee out of. And so you can try to build up around that area by doing Kegal exercises to build up the muscle around the weakend ligaments. Sometimes that helps. Sometimes it helps a little bit. And then beyond that we do a sling procedure for that issue.

That's the stress incontinence. And then when we're talking about prolapse, we usually manage when it's bothersome. Sometimes women actually have prolapse are walking around and they just, they don't even know. And it doesn't bother them, which is fine. Once it gets to a point where it's bothersome, there's two management's really. One, the first one is something called a pessary. That's like a soft silicone device. Some women kind of assimilate it to a diaphragm. And they come in different shapes and sizes. They go in the vagina. They help support the vagina when it's in. And as soon as it comes out, the prolapse starts again. And then the next option would be surgery.

Host: Okay. So, that's really good to know. So, when it comes to urge incontinence, you said changing diet is one of the first things you'll try to do. For stress incontinence, it's strengthening the ligaments. And then for pelvic organ prolapse, you talked about inserting a pessary and then also then surgery as well.

So, there are treatment options for all three of these. When it comes to urge incontinence, you said changing diet is one of the first things you do. When it comes to stress incontinence, you said it's all about strengthening those weakened ligaments. And then for pelvic organ prolapse, you talked about inserting a pessary and then the other option is surgery. So, thank you for sharing those with us. And then what advice do you have for someone who might be shy about discussing these types of symptoms and hesitant to see a physician?

Dr. Peacher: I think that it's important to know that a lot of women deal with this and it's something that can be addressed. I see it every day, all day. So, it's not unusual. They're not the only one. And they shouldn't really feel embarrassed about it because it's something that can be dealt with. And it's something that they're not alone in those symptoms.

Host: And that is such good advice. And as we wrap up Dr. Peacher, is there anything you'd like to add?

Dr. Peacher: Well, I just think that it's important to kind of reinstate that it's quality of life. A lot of women are living with these things and living their lives around trying to deal with their incontinence instead of being seen for it and you know, that they can have help for these issues. And so I think it's important that women know that there is somebody that can help and that it's, first steps are pretty simple that can really make a big improvement on their quality of life.

Host: Absolutely. So that's a great way to wrap up and great advice, Dr. Peacher, thank you so much for your time. This has really been informative. Thank you.

Dr. Peacher: Thank you for having me.

Host: And once again, that's Dr. Annaceci Peacher. And if you'd like, to schedule an appointment, just call 1-866-TIDELANDS that's 1-866-TIDELANDS. Or you can learn more at tidelandshealth.org. And if you found this podcast helpful, please share it on your social channels and check out our full podcast library for topics of interest to you. This is the Better Health podcast. I'm Bill Klaproth.

Thanks for listening.