Joey Wahler (Host): It's an important part of overall wellness, so we're discussing women's pelvic and bladder health. Our guest is Dr. Matthew Karlovsky. He's a urologist and urogynecologist and Chair of the surgery Department for Wickenburg Community Hospital and Clinics. This is WickCare Talks, the podcast from Wickenburg Community Hospitals and clinics, dedicated to helping our community lead healthier, more active lives.

In each episode, we connect you with trusted health experts to share valuable insights on a wide range of topics, from managing chronic conditions to simple tips for everyday wellness. We're here to provide practical information to support you on your health journey. Be sure to follow us so you never miss an episode. Thanks so much for being with us. I am Joey Wahler. Hi, Doctor. Welcome.

Matthew E. Karlovsky, MD, FACS: Hi. Thank you. How are you?

Host: Excellent. We appreciate the time. So first, this is a specialty of yours, so a perfect topic for you. In a nutshell, to get us started, what exactly encompasses women's pelvic and bladder health, and why is it important for our audience to understand these areas?

Matthew E. Karlovsky, MD, FACS: So, women's pelvic and bladder health traditionally was the domain of the gynecologist. And usually, with Pap smears and childbirth, those are the general ideas that women had in terms of pelvic and bladder health. We can say, even though the bladder is a separate organ than the uterus, as the population wants to remain healthy as they're getting older, the functions of the three main pelvic organs in women, whether it's the bladder, the rectum, and the vagina and uterus together change with time and change as you get older. And trying to maintain good function of all those organs is very important for many women, whether they're single or married, whether they've had surgery or they didn't have surgery on their pelvis. Trying to maintain health focus on these organs helps maintain the lifestyle that many women want to maintain, so they can be with their families, travel, do sports, have romantic relationships. And it's very important as people want to maintain these lifestyles as they get older.

Host: So, having said that, what are the most common signs and symptoms of pelvic and bladder health issues that women should not ignore, Doctor?

Matthew E. Karlovsky, MD, FACS: Well, we're focusing mainly on people who may be over 50 or 60, but really this is also true for women in their 30s and 40s. It's proper urinary function. This may sound so silly, but going to the bathroom when you have to go, try not to hold it too long. Any pain or burning with urination, that could be a sign of urinary tract infection. Maybe it's a sign of estrogen changes, which may be perimenopausal. It also could be a sign of overactive bladder, other types of issues going on in the urinary tract, which could be what I call fake outs, kidney stone, interstitial cystitis. There are a lot of things which the bladder may bring itself to your attention, but figuring out which one of those conditions it is is the job of the urologist or urogynecologist because the bladder only communicates in a certain way, urgency, frequency to urinate, maybe pain or stream changes. And so, any one of these things can bring to light, "Oh, maybe my bladder is acting up. Maybe I should look into that."

In the same vein, is the female patient going through menopause, perimenopause? Do they have hot flashes? Does their groin feel a little bit different? Do they feel that they're having pain with sex? Are they now becoming constipated? Do they have pressure in the pelvis, like they're going to have a childbirth? And that could indicate prolapse of one of the pelvic organs. So, people get used to how their body feels. And as you get older, or if you take on exercise, you do new activities, if something happens, something changes, sometimes people blow it off, "Okay, maybe this will go away in a day or in a week or in a month." If it doesn't go away, it's important to get it investigated. And sometimes just some questions and a simple exam will figure it out and can allay people's concerns.

Host: Well, you mentioned, Doctor, how age can be a factor here. How about lifestyle choices? How do those contribute to the risk of developing some of these issues?

Matthew E. Karlovsky, MD, FACS: Sure. So, there are people who are sedentary and they may be overweight. Sometimes, being overweight is connected to urinary leakage, bladder leakage, or bladder incontinence, certain dietary habits, drinking a lot of soda, a lot of coffee, a lot of tea. Even if you think you're being healthy and drinking a lot of water, that'll create a lot of urgency, frequency, what we like to call overactive bladder.

If the bladder is getting older, it can't handle the volume of the fluids, the amount of coffee people like to drink or water, and they feel like their bladder is not controlling it until they get to the bathroom, they may feel like they'll have a leakage episode. So, they need to take a look at what they're putting in their body. Spicy foods, everybody loves them-- mexican food, Thai food, but sometimes these could be very irritating for the bladder and can sometimes cause pain, sometimes just overact the bladder and people saying, "Oh, why is my bladder acting up? I quit coffee last year," and you take a look at your diet. And of course, 5% of Americans have diabetes, I think that's the proper percentage. And changes with menopause and diabetic changes can cause overactive bladder. Interestingly, people who have neurological conditions, multiple sclerosis, even if they've had a small stroke or the types of neuropathies, they can cause urinary changes. Sometimes the medications you take can cause urinary changes, diuretics, blood pressure pills, they can cause overactive bladder. So when evaluating these concerns, you have to take a broad, holistic approach. What is really causing the trouble here in the general background of aging is menopause occurring.

Now we're talking on the flip side, an active person, somebody likes to play tennis, run marathons, golf, they're doing jumping jacks, they're at the gym, high impact, they're going to put a lot of pressure on their pelvis. It may cause bladder pain. It can sometimes cause incontinence. It can sometimes cause prolapse. If women have had more than one child even, or even one child or more than one child, that may not manifest when someone is younger in their 30s, but in the 50s and 60s. That can lead to problems with bladder control and pelvic health.

Also, control of constipation. People who strain usually will find themselves a little bit later in life, they may have urinary incontinence. They are straining. Just like straining that happens in sports, it's not uncommon to find gymnasts who are in their 20s who have urinary incontinence because of all the straining and jumping they're doing. And now translate that into somebody who is active in tennis and other types of sports where they're running and jumping. And they may end up developing urinary incontinence, but yet they're trying to stay healthy with tennis, which is considered the healthiest sport.

So, sometimes you may not win on either side, but it's certainly healthier for every organ in your body to maintain a balanced diet and a good lifestyle. I wouldn't be a good doctor if I didn't say quit smoking if you still do smoke. Smoking decreases blood flow and decreased blood flow to your pelvic organs. It willl decrease the function of those organs, whether it's the vagina, the bladder, the rectum. And so, that's just a general health piece of advice, above and beyond the fact that smoking is just not healthy in general.

Host: Absolutely. So, what current diagnostic techniques are used to assess pelvic and bladder health?

Matthew E. Karlovsky, MD, FACS: Well, a very thorough question and answer between the doctor and the patient. That's where 90% of the information and the diagnostic considerations come from just what the patient is saying. A physical exam, a pelvic exam, checking the bladder, seeing with a small ultrasound in the office, seeing how well the bladder empties and works, making sure the patient has good bowel movement history, figuring out what the patient's medications are, what surgery have they had, and of course, checking your urine test. These are the basic general things that we usually be able to figure out most of what's going on. If somebody has complaints, they're having pain with intercourse, they're having problems with bowel movements, problems with pressure or pain in the pelvis, those are very time-tested, reliable, very common, minimally invasive ways to figure out what is bothering most people.

Host: So, once that's complete, what are the most effective treatment options today for some of these health issues and how would you say they've evolved over time in the period in which you've been practicing?

Matthew E. Karlovsky, MD, FACS: Well, I've been doing urology after fellowship and training for about 20 years; if you include residency and fellowship, seven years. And so for nearly three decades, I've been able to see the access of how female pelvic health has evolved, and it has evolved a lot. It has come out from the darkness into the light. It's a subject that we discuss very freely. I would say the crux of pelvic health is a good general health overview, which is true for most people. Making sure that your medical profile, your health is in line because, from that, everything else flows. So, checking your medical, surgical history, medications, and your diet and what you're consuming, food and drink, and are you allergic? You have environmental allergens or anything else that can irritate the bladder.

Once you have those out of the way, and if those do help control your bladder or improve your pelvis, then you're fine. But above and beyond that, if women are having symptoms of menopause in the vagina, painful intercourse, topical estrogen is considered very low risk and it is very easy to use. And by that, a cream that could be put on or in the vagina. There are a host of different types of procedures and exercises, which are minimally invasive, non-invasive, and more invasive, which can be used for improving bladder function, helping incontinence of urine, helping incontinence of stool, and even non-invasive non-surgical treatments for prolapse, dropping organs, if the bladder's dropping, if the rectum's dropping.

The concepts don't change over time, but how we first address them and with what has evolved over time. So just to address, more than a decade ago, there was a health crisis essentially with what we used to call pelvic mesh. There were a lot of kits, surgical kits on the market. They were not well studied. The FDA had multiple investigations into them. And by and large, most of these surgical kits have been withdrawn from the market. There are safe things to do surgically. There are safe exercises you can do such as Pilates, pelvic floor, physical therapy that generally helps your core. It helps with breathing and concentration. It helps strengthen the bladder and the pelvic floor for people who have incontinence or may have painful intercourse. So, there are a lot of non-invasive things, which can be done, which are very popular. You can jump into a Pilates class or do pelvic floor physical therapy, strengthening the pelvic floor muscles in women can contribute to better urinary control, stool control, less fear of having pain with intercourse. And so aside from all the surgical treatments which are available, there's a lot of nice natural ways to deal with bladder and pelvic health.

Host: A couple of other things for you. First, when we talk about diagnosis and treatment of these conditions, any recent technological advancements or any innovative tools or apps or platforms that assist women in monitoring or improving their pelvic and bladder health? Because it seems like these apps and platforms nowadays, Doctor, they are a big help both on the patient and the physician side, right?

Matthew E. Karlovsky, MD, FACS: Correct. There are a lot of apps out there which can help people keep track of calories and what food they're eating, and you can put into AI what's the best food if they want to do this, or keeping track of your fluids. And drinking water is healthy, it's reparative. Drinking too much water will contribute to constant urination. So, by and large, people have common sense and they're able to self-regulate how much they eat and drink. There are plenty of apps for that in terms of calorie counting.

When it comes to monitoring, there really isn't anything technologically very advanced. It's keeping track of your dietary and daily habits. There are a lot of new modern techniques for treating urinary or stool incontinence. But like I said, pilates is one of the most popular exercises people do, and it does help with core strength, concentration, breathing control, pelvic floor strength. I personally don't do this, but a lot of patient's do and they find that it's very useful for them. It also helps mind-body control how you can have mind, what they call cognitive wellness. If somebody has pelvic pain, it helps to connect the mind and the pelvic floor in a more deliberate way.

So, there are a lot of things out there. It's not bad to be investigative. Go on chat and search out what is the best thing for X, Y, and Z. Try all those things. If you still find that you're having difficulty controlling bladder health or something else, come into the urologist, and we can figure out what the next possible steps are.

Host: So in summary here, Doctor, it seems like one of the main takeaways here is if it's good for your overall health, it's likely great as well for addressing these conditions and hopefully preventing them, right?

Matthew E. Karlovsky, MD, FACS: That's always true. I think a healthy lifestyle will always contribute to better function of your organs, no matter which organ that is. If there are other medical conditions which are bothering your kidneys, your liver, they may be affecting your bladder. So, maybe a bladder overactivity could be a sign of something else. Even if it's not the bladder's fault, could it be a red flag for something else? So, just being in tune with your body and keeping up-to-date with your health, tracking down all the red flags and making sure they don't represent something worse.

Host: Folks, we trust you are now more familiar with women's pelvic and bladder Health. Dr. Karlovsky, thanks so much again. Keep up all your great work.

Matthew E. Karlovsky, MD, FACS: Thank you so much.

Host: And for more information, please visit wickhosp, W-I-C-K-H-O-S-P.com/wickcaretalks. We hope today's discussion has provided you with valuable insights to support your wellbeing. Remember, every step you take is a step toward a healthier life. To ensure you don't miss future episodes, please follow us on your favorite podcast platform and connect with us on social media. We appreciate you being part of our community. Thanks again for being part of WickCare Talks. Until next time, stay well.