Female Bladder Leakage: Solutions to Get Control‎ | Christopher Tarnay, MD | UCLAMDChat

UCLA Health

20 Oct 201732:17

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TLDRDr. Christopher Tarnay, Chief of Uro-Gynecology at UCLA, discusses female bladder leakage, also known as urinary incontinence, in a comprehensive webinar. He explains the impact of estrogen on vaginal tissue and how its decrease can lead to incontinence. The webinar covers the prevalence of the condition, affecting over 200 million people worldwide, with 25 million in the U.S. experiencing significant symptoms. Tarnay emphasizes that while urinary incontinence is not life-threatening, it can severely affect a woman's quality of life, leading to physical, psychological, and social challenges. He outlines various treatment options, including pelvic floor muscle exercises (Kegels), lifestyle modifications, medications, Botox injections, and surgical procedures like slings and bulking agents. Tarnay also highlights emerging therapies like stem cell-based treatments. The discussion aims to raise awareness, encourage open dialogue, and provide solutions to help women regain control and improve their quality of life.

Takeaways

🌟 Dr. Christopher Tarnay, chief of uro-gynecology at UCLA, discusses female bladder leakage and solutions for urinary incontinence.
📍 The Blue Ridge Mountains share a common topography with the vagina, highlighting the importance of vaginal tissue structure and its changes due to estrogen levels.
🚺 Urinary incontinence affects over 200 million people worldwide and is more common in women, with a lifetime risk of two out of three women.
🤰 Pregnancy and childbirth, particularly vaginal delivery, can increase the risk of urinary incontinence due to physical changes in the pelvic floor.
💧 Estrogen decrease during menopause, breastfeeding, or after childbirth can lead to vaginal tissue flattening, impacting bladder control.
🚫 Urinary leakage is not normal, despite its commonality, and should not be considered an isolated issue as it can significantly affect quality of life.
🤔 Many women and healthcare providers do not openly discuss urinary incontinence, leading to underdiagnosis and delayed treatment.
💊 Direct-to-consumer marketing by pharmaceutical companies is helping to raise awareness and offer solutions for urinary incontinence.
🏋️‍♀️ Pelvic floor muscle exercises, also known as Kegel exercises, are the first line of treatment for urinary incontinence and can be effective when done correctly.
🔍 Identifying and removing bladder triggers from the diet, such as caffeine, alcohol, and spicy foods, can help manage overactive bladder symptoms.
⚕️ For patients who do not respond to pelvic floor exercises or dietary changes, treatments like Botox, neuromodulation, and posterior tibial nerve stimulation are available.

Q & A

What is the common issue shared by the Blue Ridge Mountains and the vagina?
-The Blue Ridge Mountains and the vagina share a similar topography. In the vagina, estrogen creates a thickening that results in small buckling of the tissue, forming tiny folds called rugae, which is similar to the peaks and valleys found in the Blue Ridge Mountains.
How does a decrease in estrogen levels affect the vagina?
-A decrease in estrogen levels, which can occur during menopause, breastfeeding, or after childbirth, leads to a loss of elasticity in the vagina. The vaginal tissues can flatten, and the rugae that provide functionality also flatten, making the vagina thinner and drier, which can cause challenges with bladder control and other issues.
What is urinary incontinence?
-Urinary incontinence is the involuntary leakage of urine, or experiencing the urge to urinate at inappropriate times. It is a common condition that affects a significant number of women, with two out of three women having a lifetime risk of suffering from it.
Why is urinary incontinence often underdiagnosed and underreported?
-Urinary incontinence is underdiagnosed and underreported because it often develops gradually and insidiously, leading many women to believe it is a normal part of aging. Additionally, there is a reluctance among both patients and healthcare providers to discuss the issue openly, causing delays in seeking treatment.
How does urinary incontinence impact a woman's quality of life?
-Urinary incontinence can significantly affect a woman's quality of life in various domains, including physical activities, psychological well-being, social interactions, and occupational functioning. It can lead to reduced self-esteem, higher rates of depression, avoidance of intimacy, and increased use of padding and undergarments.
What are the two main types of urinary incontinence?
-The two main types of urinary incontinence are stress urinary incontinence, which involves the loss of urine with physical exertion such as coughing, laughing, or sneezing, and urge urinary incontinence, also known as overactive bladder, which involves a sudden and strong urge to urinate that can lead to leakage.
What role do the pelvic floor muscles play in managing urinary incontinence?
-The pelvic floor muscles play a crucial role in managing urinary incontinence. Strengthening these muscles through exercises like Kegels can help increase resistance around the urethra, improve bladder control, and reduce urgency, which can be beneficial for both stress and urge incontinence.
What is the significance of estrogen in maintaining vaginal health?
-Estrogen is significant in maintaining vaginal health as it promotes the thickening of vaginal tissues, creating rugae or folds that allow for lubrication, secretions, and stretching during childbirth and intercourse. A decrease in estrogen levels can lead to a loss of this elasticity, which may contribute to issues like urinary incontinence.
What are some conservative, non-surgical therapies for urinary incontinence?
-Conservative, non-surgical therapies for urinary incontinence include pelvic floor muscle exercises (Kegels), dietary modifications, fluid management, and lifestyle changes. These therapies form the foundation for all treatments and can be effective in managing mild to moderate cases of incontinence.
What is the role of a physical therapist in treating urinary incontinence?
-A physical therapist, particularly one trained in women's health issues, can help patients learn how to perform pelvic floor muscle exercises correctly. They can provide biofeedback to ensure the patient is targeting the right muscles and can offer guidance on maintaining a consistent exercise routine for optimal results.
What are some surgical options for treating urinary incontinence?
-Surgical options for treating urinary incontinence include the use of slings, which are small pieces of material or the patient's own tissue placed under the urethra to provide support and prevent urine loss. Other options include laparoscopic surgery known as Burch, and bulking agents that are injected near the bladder neck to increase resistance and reduce leakage.

Outlines

00:00

😀 Introduction to Female Bladder Leakage

Dr. Christopher Tarnay, Chief of Uro-Gynecology at UCLA, introduces the topic of female bladder leakage, also known as urinary incontinence. He emphasizes the commonality of the condition, affecting two out of three women, and discusses the importance of addressing this issue for women's health. Tarnay also touches on the physical and psychological impacts of incontinence and the need for better communication and awareness.

05:03

📈 Prevalence and Impact of Urinary Incontinence

The video discusses the prevalence of urinary incontinence, noting that it affects over 200 million people worldwide and is underdiagnosed. It highlights the increased risk with age, especially after menopause, and the significant impact on quality of life, including physical activities, psychological well-being, and social interactions. The speaker also addresses the lack of open dialogue and the importance of changing societal attitudes towards discussing and treating incontinence.

10:06

🌐 Anatomy and Risk Factors of Urinary Incontinence

Dr. Tarnay delves into the anatomy involved in urinary incontinence, explaining the role of the vagina's rugae and how changes in estrogen levels can affect bladder control. He outlines the risk factors for incontinence, including age, pregnancy, medical conditions, occupational exposures, obesity, and genetics. The video also covers the impact of childbirth on the pelvic floor and the various treatments available for urinary incontinence.

15:09

💪 Pelvic Floor Exercises and Treatment Options

The speaker emphasizes the importance of pelvic floor muscle exercises, also known as Kegel exercises, as a first-line treatment for urinary incontinence. He discusses the effectiveness of these exercises and the role of physical therapists in teaching patients how to perform them correctly. Additionally, Dr. Tarnay mentions minimally invasive surgical options and emerging treatments such as stem cell-based therapy for restoring urinary function.

20:11

🍫 Dietary and Lifestyle Modifications for Bladder Control

Dr. Tarnay discusses the role of diet in managing overactive bladder and urinary incontinence. He outlines a bladder diet that eliminates common bladder irritants such as caffeine, alcohol, carbonated beverages, acidic juices, spicy foods, and chocolate. The video also covers the use of medications, Botox, neuromodulation, and posterior tibial nerve stimulation as treatment options for those who do not respond well to pelvic floor exercises or dietary changes.

25:16

🤔 Addressing Patient Questions and Concerns

The video concludes with Dr. Tarnay addressing specific patient questions about urinary incontinence. He discusses the conservative approach to treatment, the use of neuromodulation for overactive bladder, the safety and effectiveness of mesh slings for stress incontinence, and the evaluation process for determining the need for surgical intervention. He also provides guidance on how to properly perform Kegel exercises and the importance of addressing post-void dribbling.

Mindmap

Keywords

💡Urinary Incontinence

Urinary incontinence refers to the involuntary leakage of urine or the inability to control urination. It is a prevalent condition that affects a significant number of women, particularly as they age. In the video, Dr. Tarnay emphasizes that while it is not life-threatening, it is 'quality of life threatening' and can lead to social isolation and a decrease in physical activities due to the fear of leakage.

💡Estrogen

Estrogen is a hormone that plays a crucial role in the female reproductive system and is also linked to the health of the vaginal tissues. The script mentions that as estrogen levels decrease, typically during menopause, breastfeeding, or after childbirth, the vaginal tissues can lose elasticity, leading to thinning and drying, which can contribute to urinary incontinence.

💡Rugae

Rugae are small, fold-like structures in the vagina that are influenced by estrogen levels. They are important for the vagina's functionality, allowing for lubrication and stretching during childbirth and intercourse. The script explains that a decrease in estrogen can lead to the flattening of rugae, which may contribute to bladder leakage issues.

💡Stress Urinary Incontinence

Stress urinary incontinence is a type of incontinence where urine leakage occurs due to increased abdominal pressure, such as during coughing, laughing, sneezing, or physical activity. The video discusses that this condition often arises after pregnancy, particularly following a vaginal delivery, and is caused by a lack of support to the urethra.

💡Urge Urinary Incontinence

Urge urinary incontinence, also known as overactive bladder, is characterized by a sudden and intense urge to urinate, which can lead to involuntary leakage. The video explains that this condition is due to inappropriate signaling of the bladder, causing it to contract before it is socially convenient or possible to find a toilet.

💡Pelvic Floor Muscle Exercises

Pelvic floor muscle exercises, commonly known as Kegel exercises, are recommended as a first-line conservative therapy for urinary incontinence. They involve contracting the muscles that support the pelvic organs. The video stresses the importance of performing these exercises correctly and consistently to improve bladder control.

💡Bladder Diet

A bladder diet is a dietary modification that aims to reduce bladder overactivity by eliminating potential irritants. The video lists common triggers such as caffeinated, alcoholic, and carbonated beverages, as well as spicy foods and chocolate. By avoiding these, individuals can gain better control over their bladder function.

💡Sling Procedure

A sling procedure is a surgical treatment for urinary incontinence that involves placing a supportive structure under the urethra to prevent urine loss during exertion. The video describes it as a minimally invasive, short procedure that can be performed as an outpatient service with a high success rate.

💡Neuromodulation

Neuromodulation is a therapy for overactive bladder that involves the use of an implantable device to deliver mild electrical pulses to nerves associated with bladder control. The video explains that this treatment can significantly reduce urgency and frequency of urination and is an alternative for patients who do not respond well to medications.

💡Posterior Tibial Nerve Stimulation

Posterior tibial nerve stimulation is an office-based treatment that uses a small acupuncture needle and mild electrical stimulation to affect the nerves that control bladder function. The video discusses that this method can be as effective as medication for reducing urinary urgency and frequency, and it is a non-invasive option for patients who cannot tolerate medications.

💡Botox

Botox, well-known for cosmetic purposes, is also used in medical treatments. In the context of the video, it is mentioned as a treatment for overactive bladder. Botox injections into the bladder can reduce urinary urgency and increase bladder capacity. However, the effects are temporary, typically lasting about six months, after which the treatment may need to be repeated.

Highlights

Dr. Christopher Tarnay, chief of uro-gynecology at UCLA, discusses female bladder leakage and its impact on quality of life.

Female bladder leakage, or urinary incontinence, affects over 200 million people worldwide, with a significant portion being women.

Estrogen levels influence the vaginal tissue's elasticity, which can impact bladder control during times of hormonal change.

Urinary incontinence is underdiagnosed and underreported, with many women experiencing it but not seeking treatment.

The condition can lead to social isolation, depression, and a decrease in physical activities due to fear of leakage.

Pelvic floor muscle exercises, also known as Kegel exercises, are a foundational treatment for urinary incontinence.

Surgical options for urinary incontinence include slings and bulking agents, with high effectiveness rates.

Urge urinary incontinence is characterized by a strong urge to urinate and can disrupt sleep patterns.

Lifestyle modifications, such as diet changes, can significantly impact bladder control for those with overactive bladder.

Pharmaceutical companies are increasingly marketing directly to consumers, raising awareness about treatment options for urinary incontinence.

Neuromodulation therapy, akin to a bladder pacemaker, can significantly reduce urgency and frequency for patients with overactive bladder.

Botox injections in the bladder can improve bladder capacity and reduce urgency in patients with overactive bladder.

Posterior tibial nerve stimulation is an office-based treatment that uses mild electrical impulses to affect bladder function.

Dr. Tarnay emphasizes the importance of proper Kegel exercise technique, which can be challenging to perform correctly without guidance.

Removing bladder triggers from the diet, such as caffeine and alcohol, can help manage urinary incontinence symptoms.

The use of mesh in surgical procedures for stress urinary incontinence is considered safe and effective, unlike its use in prolapse surgery.

Post-micturition leakage, or dribbling after urinating, may indicate incomplete bladder emptying and can be addressed with medical evaluation.

Transcripts

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Related Tags

Bladder Leakage Urinary Incontinence Women's Health Estrogen Impact Kegel Exercises Surgical Options Pelvic Floor Webinar Insights Health Awareness Treatment Strategies Quality of Life Medical Solutions