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Incontinence As a Women Ages

Too many women over 40 think urinary incontinence is a fact of life. Unfortunately, this common problem can have a devastating impact on a woman’s self-confidence and activity level.

Dr. Robert Chan, a urologist at MarinHealth Urology | A UCSF Health Clinic, has helped hundreds of women overcome incontinence. In this podcast, he discusses the different types of incontinence, the impact of childbirth and menopause on a woman’s urinary tract, and various treatment options.
Incontinence As a Women Ages
Featuring:
Robert Chan, MD
Dr. Robert Chan recently moved from Texas to join MarinHealth Urology | A UCSF Health Clinic. Dr. Chan attended Stanford University and graduated with Distinction in the top 15% of his class. He majored in Biology. He attended medical school at Vanderbilt University School of Medicine in Nashville, Tennessee. 

Learn more about Robert Chan, MD
Transcription:

Bill Klaproth (Host): Incontinence can be a physical issue as a woman ages. So, how common is this and how can it be resolved? Let's find out what Dr. Robert Chan, a Urologist at MarinHealth Urology, a UCSF Health Clinic. This is The Healing Podcast brought to you by MarinHealth. I'm Bill Klaproth. Dr. Chan, thank you so much for your time. It is great to talk with you. So, before we get into our topic about women and incontinence can you please give us a bit of background on yourself and your credentials?

Robert Chan, MD (Guest): Thanks for having me Bill. My background is I'm a Fellowship Trained Urologist practicing here in Marin County at MarinHealth, a UCSF Health Clinic. I specialize in neurourology, urinary incontinence and pelvic floor reconstruction.

Host: So, the fact is, we all experience physical changes as we age and for women that can include incontinence. Is that right Dr. Chan?

Dr. Chan: Yes, that's correct. It's one of those unfortunate things that happens as people get older. And as their bodies change.

Host: So, then do we know what causes this in women primarily over 40 years of age and some women may think, gosh, it's only me, but, really it happens to a lot of women. So how common is this?

Dr. Chan: It's a pretty common symptom. They did a study at Michigan about two years ago where they asked women if they have any experience with leakage of urine in the past year and almost half of them reported that they had an episode of it. Now the physical changes that lead to this, as you know, women undergo menopause, usually around age 50. And so some of those hormonal changes can lead to atrophy of some of the vaginal tissues and the pelvic floor tissues. The other thing is that also by this time, in their forties and fifties, a lot of women have had a child and they've had the trauma of having either a vaginal delivery or having like a uterus that's really large.

Host: Right. Let's talk about the symptoms. What should a woman be looking out for or paying attention to?

Dr. Chan: There's two main types of symptoms to kind of be aware of. The first type is what we call stress incontinence, which is leakage when somebody coughs, laughs, sneezes or exercises. And this is the one that most women associate with having a baby. And then there's another one called urge incontinence or overactive bladder. This is the type of symptoms where they have like a strong urge to go to the bathroom. And sometimes they can't make it. This is also kind of manifested by people getting up two, three, four times at night because they feel like they have to go.

Host: And then at what point should a woman decide to see a physician?

Dr. Chan: I think the tipping point is usually when women feel like their incontinence is starting to limit their freedom in the things that they do. I have patients who, because they have to go to the bathroom so often, don't leave the house because they don't know where they're going to be able to find a bathroom in public, especially, you know, during the pandemic.

And then also I have some other women who have stopped exercising because they have some leakage whenever they exercise. And so they've kind of cut out that part of their life. So, I would say that if they notice that like there's just things that they're not doing, places that they're not going anymore because of this issue, then it's a good time to reach out to a physician.

Host: Yeah. I mean, that really does impact the quality of your life. You mentioned women not leaving the house or they've stopped exercising. This must cause active, otherwise healthy women, a lot of added stress and worry. Is that right?

Dr. Chan: Yeah, think just because it's also such an embarrassing and sometimes shameful experience, for them that they don't really want to kind of talk about with other people. So, with the women who used to exercise a lot, they are really worried that now they go exercise, are they going to have like an episode of leakage, like in the gym or in the studio?

Host: Absolutely. And as we've been talking about these issues can cause stress, anxiety, even other issues like sleep problems, functionality issues from sexual to just day to day tasks. I'm sure you hear these concerns all the time, everyday.

Dr. Chan: Definitely. I mean, it's not uncommon to hear this stuff and it's not uncommon to see it in women, especially as they age. I think the things that can really impact quality of life are having to wear a pad throughout the day, just to make sure that there's no accidents or just getting up multiple times a night and just not getting very good sleep.

Host: Right. And can most incontinence issues be resolved and what are the steps and solutions?

Dr. Chan: Fortunately, most of these incontinence symptoms can be taken care of. We usually break it down into the type of incontinence that they have, in terms of how we approach treating it. For stress incontinence, for example, we usually start with Kegel exercises, or pelvic floor muscle exercises. These can often help. Sometimes if they don't, we move on to the next thing, a quick outpatient surgery where you put a sling in underneath the urethra to help compress it. Usually, this is like 90 to 95% successful. And the recovery on this is fairly quick. Now for overactive bladder type symptoms and urge incontinence symptoms, we start with a simple recommendation of cutting out certain things in their diet, like coffee, or irritating foods like spicy foods that might make their bladder more irritated. And if that doesn't work, there's medications that help calm the bladder down. And other procedures that we can do, like Botox or nerve stimulation.

Host: Well, that's important to know that incontinence issues can be resolved, but it takes that first step, right, in having a conversation to get the help needed. So, should a woman speak first to her OB GYN or her primary care physician? Or should they call a urologist first?

Dr. Chan: I think they should reach out to whoever they already have a relationship with, whether it be their primary care doctor or their OB GYN and just bring up these symptoms. If they haven't tried any of the simple stuff first, like medications or getting instructed on exercises, that's a good starting point. Now if a woman's been trying to deal with these symptoms already, with the simple things like Kegel exercises and medications, and isn't seeing much improvement, then I think a visit with a urologist would be really helpful to kind of move on to the next things that we can offer.

Host: Yeah, that makes sense. Well, again, good to know that there is help out there. Well, this has really been interesting, Dr. Chan. Thank you so much for your time. We really appreciate it.

Dr. Chan: Yeah. Thank you so much, Bill.

Host: That's Dr. Robert Chan. And to learn more, please visit mymarinhealth.org. And if you found this podcast helpful, please share it on your social channels and be sure to check out the full podcast library for topics of interest to you. This is The Healing Podcast brought to you by MarinHealth. I'm Bill Klaproth. Thanks for listening.