Transcription:
Leaky Bladder?

Melanie Cole (Host): If you experience urinary leakage, you’re not alone. Pelvic floor disfunction is a common condition experienced by so many women however, so many of us don’t discuss it with our physicians because we may be uncomfortable, we may think it’s a normal part of aging or we’re just not sure what kind of specialist to see. My guest today, is Dr. Andrea Crane. She’s a physician with WakeMed Urogynecology.

Dr. Crane, I’m so glad to have you with us to discuss this topic today. First tell us, What is a Urogynecologist?

Andrea Crane, MD, FACOG (Guest): Well thanks for having me Melanie. It’s great to be here. A urogynecologist is somebody who plays a fairly unique role in women’s health. This is a specialty that involves the urology or the urinary tract issues as well as gynecology and specifically we are dedicated to the care of women with pelvic floor problems. Pelvic floor disorders can involve difficulty with controlling their bladder, or their bowel as well as a weakening of pelvic muscles that causes their internal organs to drop down and have lack of support.

Host: Well as I said in my intro, that we might think that these types of things urinary leakage, are a part of aging. I’m a woman in my 50s that has had two babies. So, I know what it’s like when you sneeze or cough, right. I mean we’ve all had that. Tell us, is incontinence like this a normal part of aging? What’s the prevalence of it and tell us about some of the main causes.

Dr. Crane: So, it is relatively common. But it is not normal. And many women who have had children, that being one of the risk factors and as you get older, you had mentioned in the 50s, the average age for menopause is about 51 years old; and as you transition through this time, your ligaments, connective tissue can be weaker. And some women suffer from this more than others. As many as one in three women, believe it or not, can have at least one type of pelvic floor disorder.

And so, it’s a large portion of women that are suffering from this. And there are treatment options that they may not be aware of.

Host: Well Dr. Crane, since many women do not want to discuss this, they may be embarrassed; do you think that physicians should be asking, like maybe gynecologists should be asking are you having trouble when you cough or sneeze or exercise or any of these things? How can we start this discussion with our physician or have the physician start the discussion with us?

Dr. Crane: That is a great point. I think of that as a medical society, we have become more aware of this as an issue and it’s not just gynecologists. Primary care physicians often they do a full review of systems as part of their care for patients when they go to their annual and they ask them are these some issues that you have been dealing with. And so I do see patients that come – are referred by a primary care physician, heh, I’ve been struggling with this actually for five, ten, twenty years and this is the first referral they’ve had to be sent to me.

Host: So, when would we know it’s time to seek help from a specialist such as yourself? And once we do, how do you determine what type of incontinence that someone has and then discussing the various treatment options?

Dr. Crane: Yes, so, these conditions are the conditions that affect your quality of life. It’s not a life or death situation but your quality of life, right. And it varies per person how much this affects them. After they’ve delivered a child, they might have issues with controlling their bladder to a certain extent, but if they are to the extent that they cannot play with their kids, they can’t jump on a trampoline, they can’t go running and they enjoy exercising, of course overall that’s good for your health; when you start realizing that you are limiting on what you can do because you don’t want to suffer from this, that is I think when you should seek out treatment.

And there are conservative treatment options versus a little bit more advanced and we discuss that with each patient depending on their severity when they come in for an evaluation.

Host: So, if we are going to go in, should we do things ahead of time like keep a voiding diary of when we are going, when we leak, what happens, that sort of thing? And then I’d like you to talk about Kegel exercises, because we all hear about them, that we are supposed to be doing them, people don’t even really know how to do them. I’m an exercise physiologist and it’s hard to teach them even, so I know a lot of women don’t know how to do them.

Dr. Crane: Yes. So, that’s a good point. I think we are as a society, also a very knowledgeable society. There’s a lot of things online. So, there’s a lot of apps now you look up and heh, this is how you record a voiding diary, and this is how you do Kegel’s and there’s a lot of materials that people can find online and buy. So, definitely there are a lot of patients who have come to see me, and they have tried some of these more conservative methods.

I think it again depends on the severity of the conditions. The voiding diaries can be just helpful to see the pattern of how you are emptying your bladder and it makes patients a little bit more aware of how much they are drinking, how often they are voiding, are they waiting too long to go to the bathroom, are they drinking all the way up to going to bed which can affect a lot of nighttime symptoms. So, there is some value in voiding diaries but it’s not something you have to do prior to coming in to get evaluated.

As far as Kegel exercises, that’s a difficult one because even if you have the kind of the handouts and the instructions on how to do it; sometimes, you are still not using the right muscles and often this goes hand in hand I work very closely with pelvic floor physical therapists. These are physical therapists who did some extra training particularly in the pelvic area and they work with patients to do an external evaluation, how do they walk, how do they carry themselves as well as an internal evaluation to see how they recruit their muscles and are they using the right muscles appropriately when they are thinking they are doing a Kegel’s exercise.

There’s definitely a couple of other devices out there that give something called biofeedback where they put the device in their vagina. It tries to show them if they are doing it correctly or not and these can be useful. It’s typically helpful to have it initially used with the guidance of a pelvic physical therapist, at least to have that initial evaluation with them and there are patients who go directly to a pelvic physical therapist from their general gynecologist before they come and see me.

Host: So, there’s exercises and pelvic PT, and we’ve even heard they say there is relaxation, there are medications that we see in the media, but then there’s also other things like pessaries, and slings which has gotten a bad name. Can you speak about some of the minimally invasive procedures that you might consider with someone if it’s gotten to the point where none of those other things work?

Dr. Crane: Sure. Sure. So, there are two main types of urinary leakage. I want to start off with that. The first type is something called stress urinary incontinence. This is a type of leakage when it comes from physical exertion activities like coughing, sneezing, laughing, jumping or running. Anything that puts some extra stress on the bladder and causes leakage. The other type is urge urinary incontinence or you feel the urge, you got to go, you got to go, you can’t get to the bathroom in time. And commonly, this is associated with a nerve issue with the diagnosis of overactive bladder.

And the treatment options for them are different. So, to start off with stress urinary incontinence; that is an issue of lack of support and in one way or another, whether we rebuild the support with pelvic physical therapy or using a device to as like a prosthesis to help support that or using surgery with a form of a sling to help support that, that is the main treatment options for stress urinary incontinence.

For overactive bladder, being it’s more of a nerve issue; actually the treatment options are different for that. The mainstays of treatment are actually medications. Medications to calm the nerves of the bladder. And if medications are not effective or don’t work well for patients with some side effects; then some advanced treatment options are procedural but in a different stance and not the sling so to speak; but more Botox of the bladder or a neural modulation device something called an InterStim is also an option. So, I wanted to just outline the different types of urinary leakage here between the leakage with activity which is stress urinary incontinence and with the urge which is overactive bladder.

In regards to stress urinary incontinence, yes, there’s been a lot of negative media particularly surrounding slings. This is the advanced treatment options for stress urinary incontinence. And this is valid in the sense that surgery is not a walk in the park. Of course, there’s always risk for complications, however, the use of mid-urethral slings or the mesh slings are still our gold standard and what makes it a gold standard is it is high benefit for a low risk when you take a look at all factors. And so, it’s a part of the discussion that we have with patients, the pros and cons of surgery and what it actually involves. And unfortunately, sometimes it’s not just a sling that is involved. Patients have other pelvic floor issues such as pelvic organ prolapse. I alluded to it in the beginning in regards to pelvic floor relaxation and there might be other internal organs that come down whether it’s the bladder, the uterus, the rectum and this can make the surgeries a little bit more complex.

Host: Wow, what a great description. You are a great educator Dr. Crane. Thank you for all of that great information. As we wrap up, what would you like women, that are suffering from these types of urinary incontinence to know about coming to see a specialist and when it’s time and the things that they can do and that this is not just a normal part of aging and there are treatment options.

Dr. Crane: I would say if you are a woman who is dealing with difficulty controlling your bladder and you want to live life to the fullest and this is impacting your quality of life in any way; don’t suffer in silence. There are treatment options for you. The first step is just to get you evaluated and see what are the options out there. And you can take it as conservative of a treatment plan as you would like versus a little bit more aggressive or advanced depending on how severe your symptoms are.

Host: What great information. Thank you so much Dr. Crane for coming on and sharing your expertise with us today. I'm Melanie Cole with WakeMed Voices, brought to you by WakeMed Health & Hospitals in Raleigh, North Carolina. To learn more about the urogynecology services that we offer or to schedule an appointment head on over to our website at www.wakemed.org for more information and to get connected with one of our providers. If you found this podcast informative as I did, please share on your social media and be sure to check out all the other interesting podcasts in our library. .