Maggie McKay (Host): Welcome to the Better Health Podcast from Tidelands Health. I'm your host, Maggie McKay. Today, we're discussing Women's Health with Tideland's Health Urogynecologist, Dr. Annaceci Peacher. Thank you so much for being here.

Annaceci Peacher, MD: Thank you so much for having me.

Host: Of course. Let's start with what are some common signs of incontinence issues?

Annaceci Peacher, MD: So, women in general start noticing either a rushing to the restroom, not getting there in time, maybe intervals of voiding has become a little bit more short, and then, leaking on the way to the restroom, those are signs of urge incontinence. There's also activity-based leakage, which is called stress incontinence, that is leaking with coughing, sneezing, laughing, bending, lifting. Those are both general big types of leakage that patients can experience.

Host: And what causes incontinence issues? Because my friends who have had a lot of kids, they say that's what it is, but I want to hear what it is from the expert.

Annaceci Peacher, MD: So, it depends on the type of leakage you're talking about. So, urge incontinence, generally, it can be caused by a lot of things. So, it could be nerve ending issues. So, it's almost like a neuropathy of the bladder. Anything that affects nerve endings will affect the bladder. So, hypertension, diabetes will cause bladder urge picture or, say, somebody spinal cord injury or back surgery that affected nerves in their back, that always presents in the bladder as an urgency frequency.

Most of these patients also experience this more after menopause. So, the lack of estrogen in the body can really precipitate some of the issues. That's urge incontinence. Now, the one that people usually say is from childbirth is the activity base: coughing, sneezing, laughing, bending. That one is more associated with weakness around the urethra. So, the urethra, the tube we pee out of, is not as supported as it used to be. And with that, there is increased risk of activity-based leakage. So, there's two different types, and those are usually the big predisposing factors to both.

Host: And I know a lot of people think incontinence is just something they have to learn to live with as they get older. Is that true?

Annaceci Peacher, MD: No. So, I have a lot of patients that have had issues for years and they don't see anybody because they think it's normal. Now, I will tell you that I like to tell patients that it is not normal, it is common. There is a difference between the two. So when I have patients that basically rule their lives around where they know bathrooms are, they take extra clothes with them, they don't do certain things in their life because they know they are nervous about the scenario or if they're going to get to a bathroom in time, that is not normal. And definitely, when I tell people when it is starting to affect your quality of life, that's when you should do something about it.

Host: And what are some common ways to treat this condition?

Annaceci Peacher, MD: So, it depends on the type that we're talking about. So urge incontinence, it can come from a couple of different things. One, it could be just hypercontraction of nerves to the bladder in that scenario. Usually, the first thing we try are lifestyle modifications. I ask everybody what they're drinking throughout the day. Some people are drinking coffee all day long. That is going to affect your bladder, that's going to significantly worsen your urgency because you're drinking a bladder irritant. So, sometimes it's lifestyle modifications, sometimes it is timed voiding. Sometimes people aren't going pee enough. They're voiding every four hours. Keep your bladder a little bit more on the empty side and it will help. So, those are basic kind of interventions. And then, we move to medication. Medication works to relax the bladder so that patients aren't getting to the bathroom, and having those incontinent episodes.

Beyond that, there are procedures. One is bladder botox. That's where we inject botox in the muscle of the bladder, but it's not permanent. It works for about six to nine months, and then we repeat it if it's effective for the patient. The next option is using something that's like a pacemaker for the bladder. So, this is the one that people kind of take aback to this option. Now, this is something that corrects the overfiring nerves of the bladder. It is our most effective option, meaning somebody with refractory incontinence, it is going to help the most. We do a trial phase of it first to see if it's effective for the patient. That is a big aspect of urge incontinence.

Sometimes people have prolapse, so prolapse is a relaxation in the vagina. Either the uterus, the top of the vagina or the bladder or top of the rectum can all relax into the vagina. So, patients aren't emptying their bladder completely. So because of that, that could predispose them to urge incontinence. So, that's urgency. And then, activity-based leakage is different. That comes from weakness around the urethra. So, mainstay options that we start with are conservative, like pelvic floor exercises like Kegels, pelvic floor, physical therapy where there are hands-on techniques for those exercises. And then, we move to procedures.

One procedure is something called periurethral bulking where there is an agent that is injected directly into the urethra to help bulk it up. And then, our gold standard management is a sling procedure. So, that is placed under the urethra so the urethra is like this, and a sling kind of helps to support, so it decreases that mobility of the urethra. So those are the two main types with management options on both.

Host: You touched on this a little bit, but how can a person tell if what they're experiencing is normal or if they've developed incontinence issues that can be fixed?

Annaceci Peacher, MD: I would say if somebody's going throughout their life and they're noticing that it's really inhibiting their daily life, it's not normal. That is when you should really seek intervention, and kind of assess whether it is something that you are worsening with kind of your lifestyle or if it's something that you really need further management for.

Host: In closing, is there anything else you'd like to add that you think people need to know?

Annaceci Peacher, MD: Everything I do is about quality of life improvement. It is really sad when women think they're the only one, they think this is only affecting them, nobody else has this issue. And this is what my subspecialty training was for, is exactly these issues. So, it is so common that it fills my every day with managing. So, I want women to know that it is not just them, it is extremely common. It is something that they could have significant improvement with any kind of assistance.

Host: That's encouraging and don't be embarrassed to go if they are having these issues. I think a lot of people avoid it, because they're embarrassed. Well, thank you so much for sharing your expertise today. It's such an important topic, and we really appreciate your time.

Annaceci Peacher, MD: Thank you. Thank you for having me.

Host: Again, that's Dr. Annaceci Peacher. Learn more or book an appointment at tidelandshealth.org or call 1-866-TIDELANDS. If you found this podcast helpful, please share it on your social channels and check out our entire podcast library for topics of interest to you. Thanks for listening to the Better Health Podcast from Tidelands Health.