Controlling the Urge to Go

Intro: MemorialCare Health System, excellence in healthcare, presents Weekly Dose of Wellness. Here's your host, Deborah Howell.

Deborah Howell (Host): Hello and welcome to the show. I'm Deborah Howell, and today our guest is Dr. Judy Choi, a urologist at Long Beach Memorial Hospital. Dr. Choi is with us today to talk to us about urinary incontinence, the symptoms, the causes, and what we can do to treat it. Welcome, Dr. Choi.

Judy Choi, MD: Hi, thank you for having me.

Deborah Howell (Host): Oh, my pleasure. First off, what is urinary incontinence?

Judy Choi, MD: So basically, it was defined as the involuntary loss of urine that is a social or hygienic problem. That's defined by the International Continence Society. And basically, it's exactly what it sounds like. It's just unwanted urinary leakage.

Deborah Howell (Host): That's easy enough to understand. What are the different types of urinary incontinence?

Judy Choi, MD: So there are several different types, but the two main ones are stress urinary incontinence and urgency urinary incontinence. So the stress urinary incontinence is the one a lot of people already know about, and that's basically the leakage of urine with any effort or exertion, specifically like sneezing or coughing. They'll notice that a small amount of urine is expelled. And a lot of people know about that one because that's the one that's most common after deliveries. And then the other one is urgency urinary incontinence, and that's when you have urinary incontinence that's accompanied by or preceded by urgency. And that's when you have that sudden urge to run to the bathroom and a lot of times people don't make it to the bathroom in time. And so those are the two main types. You can also have mixed urinary incontinence, and that's when you have both the stress incontinence and the urgency incontinence. And then there's a host of other types. Like some people just have incontinence during sexual intercourse. Some people notice that they have continuous urinary incontinence. Other people have overflow incontinence, which is basically when they have a lot of urine that's retained in their bladder, they can't completely empty their bladder, and it's kind of like carrying around a bowl full of water, it just kind of always sloshes out. So those are the main types, but the most common are stress and urgency incontinence.

Deborah Howell (Host): Okay, got it. What causes urinary incontinence?

Judy Choi, MD: So a lot of different factors. They've looked into a lot of different risk factors for it. I think the biggest ones are probably pregnancy, labor, and vaginal delivery. So usually we see a lot of incontinence in women who have had multiple vaginal deliveries. And a lot of times they'll also report that they had like a prolonged labor. Because it's that descent into the pelvis, it kind of crushes a lot of the structures within the pelvis, including a lot of the urethral support, a lot of the nerves, all of this. And so functionally and anatomically it doesn't provide enough support to have urinary continence. And so those are the main ones. Also, obesity is a big one. Family history and like a, they have like a genetic component to it, that's also a big component. Physical function, which is basically, they've looked at like older women who are less functional, they tend to have more urinary incontinence also. Diabetes, dementia, those are the main risk factors. Potential risk factors are like smoking, depression, constipation, urinary infections, those kinds of things, but that has like a weaker link to urinary incontinence.

Deborah Howell (Host): They pretty much all go hand in hand. So okay, those are the risk factors. Now let's talk about the treatment options, because that's the more happy part of the show. There are things we can do.

Judy Choi, MD: Yes, absolutely. So I guess the first thing is it's really important to define what kind of urinary incontinence that you have. And so a lot of times there's a really extensive list of questions that either the female urologist or urogynecologist, whoever treats this condition, they'll go through a whole barrage of these questions just to figure out which one you have, and there's different tests as well. But if you do have the stress urinary incontinence, that's considered more like an anatomical problem. So some conservative measures that don't require surgery are like pelvic floor exercises, biofeedback, things like that, but the mainstay, basically the gold standard is still surgery. And that's where you have these slings that they have, a lot of times they're a mesh sling, other people use the patient's own fascia, other people use other types of grafts in order to give you a little bit more urethral support, because that's where they think the underlying pathophysiology is. For urge incontinence though, a lot of it is, I think for the most part everybody tries and tries to recommend some lifestyle modifications. So especially like fluid intake, you know now the trend is everybody drinks a lot of water, everyone is carrying around a lot of, they're constantly drinking. I think most people forget that what goes in must come out. And so we have people monitor their fluid intake, sometimes we have them do a bladder or like a voiding diary in which they just record how much they drink, how much they urinate, whether or not they have any leakage episodes. We also have them decrease any bladder irritants like caffeine or alcohol or artificial sweeteners, anything like that that can kind of irritate the lining of the bladder.

Deborah Howell (Host): All the fun stuff.

Judy Choi, MD: Yeah, exactly. I tell everyone, you know, you can drink it, but just know that it might have, nothing is free. And then we also have them, we can have them do timed voiding, which is basically we have them regularly go to the bathroom every couple hours. We also recommend like more of the pelvic floor physical therapy as a potential way to help them. If all of these fail though, we then recommend medications. We consider urgency incontinence kind of related to like the nerves and the muscles of the bladder just kind of spasming a lot. And so some medications can abate that by blocking those receptors. And so there's a whole host of them, and I think a lot of like the ads that you see on TV, a lot of them are directed to overactive bladder. And these will all help, and basically they all act in a very, very similar mechanism. So it's just trying one, seeing if it helps you. If that doesn't help, oftentimes we'll try another one. If that doesn't help, then we talk about other options. If all of those fail, then we talk about some types of surgery or procedure. So some people do Botox injections to the bladder.

Deborah Howell (Host): I was just gonna ask, when you said muscle spasms, I thought, I wonder if Botox could fix that.

Judy Choi, MD: Yeah, so a lot of people, we have them come into the clinic, it can either be done in the clinic or we have them do it in the operating room, whichever one they're more comfortable with. And it's a really, really simple procedure. We just inject Botox into the wall of the bladder. We do a cystoscopy, which is basically we take a camera and look inside the bladder, and then through there we can inject the Botox. And in some patients it works really, really well. The only thing is it's kind of like the Botox that you inject into the skin, so you need some touch-ups every now and then, it's not permanent. And some people really love it, the only problem is you have to keep coming in for that. So another thing that people do is this tibial nerve stimulation, which is basically like acupuncture that can be done in the clinic. And that's thought to kind of activate the nerves that lead to the bladder. And a more permanent solution is this newer type of treatment which is called sacral neuromodulation. And it's basically like a pacemaker for the bladder. So that one's a lot newer, there are a lot of people who really benefit from it now. And it's a really simple procedure also, it requires either a lead placement in the clinic or in the operating room, you see how well it helps you, and then if so, then you have to implant a battery device at a different stage.

Deborah Howell (Host): I'm thinking of getting one for the next time I go to New York City, because you can never find any place.

Judy Choi, MD: Oh yes. Exactly.

Deborah Howell (Host): So if I could just have the temporary pacemaker, please.

Judy Choi, MD: Yeah, exactly.

Deborah Howell (Host): Wow. Okay, so when talking to your physician about urinary incontinence, what type of information should your listeners and our listeners be prepared to share?

Judy Choi, MD: Well, I think first and foremost, it's just important that the patient feels really comfortable with their physician and realizes that what they're experiencing is pretty common and that they're willing to share everything. So when I interview patients, I ask them really detailed questions about when they're having leakage, how it affects their life, what they've noticed, the different lifestyle modifications they've had to make because of it, how many diapers they use, all of that. So there's really no shame involved, and I think that's the most important thing. Because we'll ask quite intimate questions about all of that. You know, also we'll ask about their surgeries and things like that, what they're interested in, we'll go over all the different treatment options to see what to make a plan that's comfortable for both the physician and the patient. I think that's the most critical thing. We'll ask really detailed questions about what their urinary patterns are, and a lot of times patients are like, 'Oh, I actually never thought about that'. You know, things like how frequently you go to the bathroom, whether or not you have to run to the bathroom, whether or not you have to do what we call double voiding, where they go to the bathroom, they realize they're not finished and they have to go back again right afterwards. You know, whether or not they have any dribbling afterwards. I mean, these are a lot of nitpicky questions that make a big difference actually in how we diagnose the type of urinary incontinence that they have.

Deborah Howell (Host): So total honesty, let it all hang out with your doctor.

Judy Choi, MD: Exactly. And no shame. We understand it. This is certainly a quality of life issue, and we've seen it all.

Deborah Howell (Host): Yeah, you're there to help.

Judy Choi, MD: Yeah, exactly.

Deborah Howell (Host): So where can listeners go right now to get more information about treatments available at Long Beach Memorial?

Judy Choi, MD: So, you know, they should either seek out either a female urologist, and when I say female urologist I don't mean like gender, it's a specific subspecialty within urology. Or a urogynecologist, because we all treat the same condition. But you know, for us, we see patients very regularly. Our phone number is 562-933-1877. We're more than happy to see anybody, and yeah, we're basically here for anyone with any of these issues.

Deborah Howell (Host): Well, thank you so much, Dr. Choi. I feel better and I don't even have the problem. I really, I really appreciate you being on the show today.

Judy Choi, MD: No, thank you so much for having me.

Deborah Howell (Host): To listen to the podcast or for more information, please visit memorialcare.org. That's memorialcare.org. Thanks for listening and have yourself a wonderful, wonderful day.