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Urinary Incontinence Explained: Symptoms, Causes, and When to Seek Help · Flourish- A Prisma Health Podcast

• 0:01
  Maggie McKay (Host): Welcome to "Flourish," a podcast from Prisma Health.
• 0:05
  I'm your host, Maggie McKay.
• 0:07
  Joining us today is Dr.
• 0:08
  Johnny Wright Jr.,
• 0:10
  urogynecologist, to discuss urinary incontinence.
• 0:14
  Thank you so much for being here today.
• 0:16
  Dr Johnnie Wright, Jr.:
• 0:16
  invitation,
• 0:18
  Maggie McKay (Host): Let's dive right in.
• 0:19
  What exactly is urinary incontinence, and how common is it, especially among women?
• 0:25
  Dr Johnnie Wright, Jr.:
• 0:25
  Urinary incontinence is defined as the involuntary leakage of
• 0:29
  urine, meaning the bladder leaks when a person doesn't want it to.
• 0:33
  Okay?
• 0:33
  It's extremely common.
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  we believe that it's, something that one in three women will
• 0:38
  experience during her lifetime.
• 0:41
  We do see, more patients present a-as they age, after childbirth, and as
• 0:47
  they, uh, approach menopause, but it's certainly not limited to older adults.
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  beyond the medical diagnosis, you know, urinary incontinence can significantly
• 0:55
  affect the patient's quality of life.
• 0:57
  they may avoid exercise, social activities, travel, or even
• 1:01
  structure daily routines around it.
• 1:03
  So it is something that, that we are certainly are welcome the
• 1:07
  opportunity to, address for them.
• 1:10
  Maggie McKay (Host): Right.
• 1:10
  Yeah, it really can take over your life.
• 1:12
  There are different types of urinary incontinence.
• 1:15
  Can you explain the main types and how they differ in everyday life for patients?
• 1:20
  Dr Johnnie Wright, Jr.:
• 1:20
  Yes.
• 1:21
  the two most common types of urinary incontinence are gonna be stress urinary
• 1:25
  incontinence, which is leakage of urine with any increase in abdominal pressure.
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  I tell them, coughing, sneezing, laughing, lifting, exercise,
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  anything that, increases your belly pressure generates leakage.
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  the pathophysiology, we believe, has more to do with the waning
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  or decreased, urethral support or support to the tube that connects
• 1:46
  the bladder and the outside world.
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  Certainly something that we see more commonly in younger patients,
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  and women of childbearing age.
• 1:54
  the next most common type of urinary incontinence we see is urge-related
• 1:59
  incontinence, and it's just how it sounds.
• 2:03
  Patient gets a strong urge to void and, leaks before she has the opportunity
• 2:07
  to get to the bathroom, to urinate.
• 2:09
  We believe pathophysiology around that is multifactorial.
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  we tend to see more of these symptoms in menopause, so we think that there's
• 2:18
  some downregulation of hormones/estrogen receptors, that kind of predispose them
• 2:25
  to a little more urgency or frequency.
• 2:27
  There's also some thoughts around, the myelin sheath or the covering of nerves
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  that are some-sometimes contributes to interruption of communication between
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  the bladder And the pontine micturition center or that center in our brain
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  that governs, our voiding function.
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  And then probably the next most common type of incontinence is, a mixed picture,
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  where a patient can have a combination of urge and stress, or in our older patients,
• 2:52
  we see a little more of what we call functional incontinence, meaning they
• 2:56
  leak not because that there's something wrong, but just because they don't have
• 3:00
  the physical, ability to get to the bathroom as quickly, and the, mobility
• 3:04
  is typically limited in those patients.
• 3:07
  Maggie McKay (Host): Well, many people assume urinary leakage is just a
• 3:09
  normal part of aging or childbirth.
• 3:11
  Is that true?
• 3:12
  And when should someone seek help?
• 3:15
  Dr Johnnie Wright, Jr.:
• 3:15
  Of course, urinary leakage is common, but it should not be simply accepted
• 3:18
  as quote unquote "normal" for us.
• 3:20
  we tend to see aging and childbirth as risk factors, but not something that,
• 3:24
  automatically, commits you to having urinary incontinence down the road, okay?
• 3:29
  There are many treatments that are super effective, and patients should
• 3:32
  seek evaluation whenever symptoms become bothersome or they begin,
• 3:37
  affecting their overall quality of life.
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  for me, it's as simple as, explaining to the patients that if your leakage
• 3:44
  is affecting their quality of life, it is worth having that discussion
• 3:47
  with the provider so that you kinda understand what's out there.
• 3:51
  facts are your friends, and an evaluation does not obligate you to intervention.
• 3:55
  Maggie McKay (Host): Facts to your friends.
• 3:56
  I love that.
• 3:57
  what are the most effective non-surgical treatment options available
• 4:01
  today, and how do you decide which approach is right for each patient?
• 4:05
  Dr Johnnie Wright, Jr.:
• 4:05
  Yeah.
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  So I for sure approach it in an individualized kind of fashion.
• 4:09
  not every intervention will work for everyone, but I take the patient
• 4:13
  symptom type, severity, her goals for intervention, and her overall medical,
• 4:18
  history and conditions into consideration.
• 4:20
  Common non-surgical approaches for management include, pelvic
• 4:25
  floor muscle therapy and/or pelvic floor muscle exercises.
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  in certain parts of the country, we've got, pelvic floor physical
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  therapy, which is a, known subspecialty within physical therapy, and those
• 4:37
  individuals can offer guided therapy, for patients with both, commonly urge
• 4:43
  and, stress-related incontinence.
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  We also have simple behavioral modification techniques and
• 4:49
  bladder training exercises.
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  We talk a lot about fluid and caffeine optimization.
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  and then, yes, there are medications for management of urge-related incontinence.
• 5:00
  There's a whole category of those with, some newer agents, you know,
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  truly old school anticholinergics and then some beta agonists, with more
• 5:09
  targeted effect on bladder itself And then we offer most patients, unless
• 5:13
  there's a contraindication, some vaginal estrogen therapy, because we
• 5:18
  do know that we see a lot more urge and urge-related symptomatology in
• 5:22
  patients who have general urinary symptoms associated with menopause.
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  many patients experience meaningful improvement without surgery and
• 5:31
  adopting one or a combination of these non-surgical approaches.
• 5:35
  Maggie McKay (Host): That sounds like a lot of good options.
• 5:37
  how does urogynecology differ from urology or OB-GYN care when it comes
• 5:42
  to treating urinary incontinence?
• 5:45
  Dr Johnnie Wright, Jr.:
• 5:45
  That's a great question.
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  What I would say is the treatment, thank goodness to the board, subspecialty
• 5:50
  and the emphasis on treating urinary incontinence in the subspecialty as a
• 5:53
  whole, should not differ tremendously.
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  What I will share, though, is a urologist who goes on to do
• 6:00
  urogynecology fellowship, has a little bit different exposure than
• 6:04
  a, obstetrician gynecologist who goes on to do a urogynecology fellowship.
• 6:09
  For starters, both do a total of seven years of training,
• 6:12
  but that split is different.
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  So for a general, urology residency, it's about five years with two years of
• 6:19
  additional training in the fellowship.
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  For general OB-GYN, it's four years of, residency and three years of
• 6:27
  fellowship for that total of seven.
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  But during those, general or formative years, an obstetrician gynecologist is
• 6:33
  gonna focus lot on obstetrics and then on general, GYN and, gynecologic disorders
• 6:40
  with some emphasis in, just incontinence and management of incontinence.
• 6:44
  The fellowship itself for both will give you a lot more, the nuances of the
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  pathophysiology, the different approaches, and you see a lot of higher level,
• 6:55
  complex patients with multifactorial kind of presentations for their care.
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  And then the same thing for urology.
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  They, manage general, urology presentations and very respectfully,
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  manage more of the male population, as opposed to females with, GYN disorders.
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  Maggie McKay (Host): So for patients who do need procedures or surgery,
• 7:16
  what advances have been made to improve outcomes and recovery?
• 7:20
  Dr Johnnie Wright, Jr.:
• 7:20
  I think it's an exciting time, in the subspecialty.
• 7:24
  probably the biggest, contribution and change, or surgical intervention that's
• 7:29
  completely revolutionized how we manage female stress incontinence has been
• 7:33
  the advent of the midurethral sling.
• 7:35
  And while we've been doing it for over twenty years, we went from requiring an
• 7:40
  abdominal incision, six-week recovery to being able to offer treatment that
• 7:45
  was equally or even more efficacious with, 20-minute outpatient procedure.
• 7:51
  the other advancement which continues to evolve is, really more so in the
• 7:56
  management of urge-related incontinence.
• 7:59
  We now use intradetuser, botulinum toxin or, Botox therapy,
• 8:02
  which has been a game-changer.
• 8:04
  we have been using sacral neuromodulation since 2011 for the management of
• 8:09
  urge and urge-related incontinence.
• 8:11
  we've also, recently, seen implantable posterior tibial nerve kind of stimulators
• 8:17
  that, don't require a patient to come into the office weekly for 12 weeks in a row.
• 8:22
  so many of the procedures are outpatient-based, a relatively rapid
• 8:27
  return to normal activity, which has been, s-super for the patients, super
• 8:31
  for the providers, and super exciting time overall for just women's health.
• 8:36
  Maggie McKay (Host): That's really encouraging.
• 8:37
  what advice would you give to someone who's been living with
• 8:39
  urinary incontinence, but they feel embarrassed or hesitant to
• 8:43
  bring it up with their provider?
• 8:44
  Dr Johnnie Wright, Jr.:
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  I think it's certainly, worth them hearing that urinary incontinence is one of the
• 8:48
  most common conditions encountered in, gynecology and pelvic floor medicine.
• 8:53
  patients should truly understand that they're not alone.
• 8:56
  These conversations are something that should be commonplace or
• 9:00
  routine for all healthcare providers.
• 9:03
  and, as mentioned before, there's some super exciting options that are out there.
• 9:07
  And so, simply bringing up the topic should be their first step
• 9:11
  toward a major improvement in the overall quality of life.
• 9:14
  Maggie McKay (Host): Well, thank you so much for sharing your expertise today.
• 9:16
  This has been so informative and helpful.
• 9:18
  We appreciate you.
• 9:19
  Dr Johnnie Wright, Jr.:
• 9:19
  Great.
• 9:20
  Thank you for the invitation.
• 9:21
  Look forward to the next.
• 9:22
  Maggie McKay (Host): Absolutely.
• 9:24
  Again, that's Dr.
• 9:25
  Johnny Wright Jr.
• 9:26
  For more information, please visit prismahealth.org/podcast.
• 9:29
  And if you found this podcast And if you found this podcast helpful, please
• 9:33
  share it on your social channels and check out our entire library of
• 9:37
  podcasts for topics of interest to you.
• 9:40
  I'm Maggie McKay.
• 9:41
  Thank you for listening to "Flourish" from Prisma Health.