19 Million Women and You

19 Million Women and You

Here’s a fact that might surprise you:  Right now, more than 19 million women in the United States alone are living with bladder leakage. That’s a pretty staggering number, and even more so when you consider how rarely you hear women talk about what it’s like to live with this surprisingly common condition.  Even more staggering is the fact that most of these 19 million women aren’t comfortable talking about their bladder weakness, even with their healthcare providers.  

This is just the beginning of a much larger conversation around women’s health and wellness as we age.  But with so many of us not feeling comfortable raising our bladder support needs with our doctors, we sat down with two of our top medical advisors, Dr. Barbara Frank, an OB/GYN, and Dr. Jeannine Miranne, a Urogynecologist, to go through some of the basics.  Here’s what they had to say:

First of all, what exactly is a uro-gynecologist and how does it differ from an OB/GYN?

Dr. Miranne: An OB/GYN specializes in female reproductive health dealing with everything from vaginal health to pregnancy to menopause. A Urogynecologist specializes in the diagnosis and treatment of pelvic floor disorders, including pelvic organ prolapse (POP) and urinary incontinence (UI).

Why did both of you decide to specialize in these fields?

Dr. Frank: In my field (OB/GYN), you get to see the range and breadth of issues experienced by women, from when your period starts to when it stops. I’m a really open person who likes to talk about everything, which is something I’m proud to bring to the women’s health field. I like to create an environment where women are comfortable talking openly and honestly about their bodies. 

Dr. Miranne: I like the idea of taking care of women because it’s so common in our culture for women to take care of everyone else but not give themselves the same degree of care. 

Both of you are passionate about helping women. It seems that bladder leakage or UI is something that affects mostly women. Why is this? 

Dr. Miranne: Both men and women can have bladder control issues, but women experience these issues more than twice as often. Women’s pelvic floors are much more vulnerable to weakness as a result of differences in their anatomy and the effects of pregnancy, childbirth, and menopause on the pelvic floor. 

How do I know if I have bladder leakage?

Dr. Miranne: Bladder leakage or UI is loss of urine beyond your control. Sometimes women will think they’re leaking urine, but it could be sweat or discharge. If you’re really unsure, you can do a special pad test where you take a medication called phenazopyridine which tints the urine orange. You would then wear a pad, and if you think you are leaking and the pad turns orange, you know you’re experiencing bladder leakage.

Dr. Frank: I’ll add that bladder leakage is an issue only if you think it is an issue. Is it taking away from your quality of life? Are your pants wet when you take them off every day? Are you self-conscious when you work out or in other settings because of the amount of leakage? If so, you should absolutely bring this up with your doctor.  Many women don’t want to broach the subject with their doctors, either because they’re embarrassed or because they are afraid their doctor will make them do something they don’t want to do, like make a major lifestyle change or have surgery.  A good practitioner won’t pressure  you do something you don’t feel is right for you. In this context, more information is helpful, not harmful, and you’d be surprised how many women feel better just hearing from their doctors that it’s a common, often treatable, condition and not something that is dangerous to your health or indicative of a larger health concern. 

What are the most common reasons for bladder leakage?

Dr. Frank: Technically, UI occurs when muscles or connective tissues of the pelvic area weaken or are injured. The most common reasons women experience UI are age, menopause, pregnancy and childbirth, heavy lifting, uncontrolled asthma or other lung problems, and genetics.

What age do you see most women start to see this?

Dr. Miranne: There are women as young as their teens up to their 90s living with UI. The majority of women who experience this issue are in their 30s to 80s.  Younger patients are more likely to experience UI after pregnancy. However, fluid overconsumption, excessive bladder irritant use, and delayed bladder emptying can also contribute to symptoms.  Additionally, women who play high impact sports or who are overweight or obese may have UI. Much more rarely, neurologic disease can play a role.  Multiple sclerosis is one example of a neurologic disease that can contribute to UI, but again that is rare.

Are there treatments that can successfully treat UI?

Dr. Miranne: When we’re looking at treatment, we divide urinary incontinence into two categories: Stress UI, which is leakage that occurs during physical activities like sneezing, coughing, laughing, and exercising, and urgency UI, which is leakage that occurs with a sudden urge to urinate. Both types can be treated with behavioral and dietary modifications, as well as pelvic floor muscle exercises (kegels), and pelvic floor physical therapy. 

For more severe cases of stress UI, women can consider use of intravaginal devices or surgery.  More severe cases of urgency UI can benefit from medications, office procedures like posterior tibial nerve stimulation, and surgery. 

The need for treatment is a personal, individualized choice and of course what treatment is best varies from patient to patient. It really depends on how bothered you are by your symptoms, but the important thing to remember is that you have options.  For a woman who leaks a small amount when she laughs, it might not be a big deal. For an athlete who is leaking excessively every time she runs, it might be a bigger problem. 

We’re always hearing about kegels. What are they and do they really help?

Dr. Miranne: Kegels are exercises where you squeeze or contract the pelvic floor muscles, the muscles surrounding the bladder, vagina, and rectum. You lift or pull these muscles up and in without contracting your abdominal muscles or buttocks. It’s best to do 10 squeezes in a row, 3 times a day. A lot of women are (understandably) not doing kegel exercises correctly. Although it can be difficult for women to isolate their pelvic floor muscles, there are pelvic floor physical therapists who can help women learn the correct technique. 

Dr. Frank: They actually can help, although, like Dr. Miranne said, it’s important you’re doing them correctly for them to be effective. Ask your doctor for more specific guidance on the right form, the same way you would speak to a personal trainer, and have your doctor show you how to do them correctly during a digital exam.  Women can also practice with their partners or try pelvic floor physical therapy. 

In your opinion, what’s the most surprising thing about bladder leakage?

Dr. Frank: That it doesn’t just happen to older women. Leakage is very common for women even in their 30s and 40s. If you’ve gained a lot of weight or you’ve just had a baby, you could be leaking.  

Dr. Miranne: It’s surprising how common it is and how long women live with the problem before seeking help. Some women have had these problems for years before they come in to see me. They don’t realize there are treatment options and just think it’s part of getting older. I see a lot of women who say they have been leaking for 20 years since their last child and this is the first time they’re seeking help.

What is one thing you want women experiencing bladder leakage to know?

Dr. Frank: The majority of women experiencing bladder leakage are using panty liners or pads that are designed for periods. These products aren’t designed to absorb and wick away moisture caused by urine, which is quite different from blood when you think about it. Urine also typically flows much faster than menstrual blood. So there are period products that are specifically designed to capture blood and bladder leakage products that are specifically designed to capture urine.

It makes sense that women would be more comfortable buying period pads. We’ve been doing that for years. Women are often too embarrassed or ashamed to buy bladder leakage products. Beyond just not working very well, wearing a period pad every day to manage bladder leaks can cause a lot of skin irritation because the moisture isn’t wicking away properly. I often see women who wear period pads or panty liners who think they’ve developed a yeast infection when really it’s atopic dermatitis or what we would call a “diaper rash” in babies caused by the products they are using to manage leaks.

Dr. Miranne: If you’re experiencing symptoms of UI, don’t be embarrassed to talk to your doctor.  You don’t have to just live with the problem. Treatment options can decrease the amount of leakage you have and greatly improve your quality of life.  

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