May 9, 2025 • 30 mins
In this episode of MedStar Health DocTalk, host Debra Schindler tackles a topic that many women face but few discuss: urinary incontinence. With an estimated 25 million American women affected, it's time to break the silence. Joined by MedStar Health urogynecologist Dr. Abigail Davenport, they delve into the myths surrounding incontinence, the different types, and the various treatment options available. From urgency incontinence to stress urinary incontinence, Dr. Davenport provides invaluable insights into how lifestyle changes, physical therapy, and advanced therapies can help women regain control over their lives. Tune in to learn why this common issue shouldn't be a source of shame and how empowering conversations can lead to effective solutions.
To schedule an appointment with Dr. Davenport at MedStar Franklin Square Medical Center, call 443-777-7608.
For more episodes of MedStar Health DocTalk, go to medstarhealth.org/doctalk. Send comments to DocTalk@MedStar.net
For more episodes of MedStar Health DocTalk, go to medstarhealth.org/doctalk.
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Episode Transcript
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(00:03):
Comprehensive, relevant and insightful conversationsabout health and medicine happen here when
MedStar Health doc talk. Theseare real conversations with physician experts from
around the largest healthcare system in the Maryland D.C.
region. Maybe you have a friendlike mine, one who laughs so hard she
(00:23):
cries all the way down her leg. Myfriend has warned me through laughter many times not
to make her laugh because she was about to peerpants that was really funny in high school.
But if its still a problem today, we dont talk aboutit. In fact, most women dont want to talk about
it. Urinary incontinence. Itaffects 25 million American women, with
(00:46):
estimates indicating nearly half the population ofadult females in the United States will
experience some form of urinary incontinence atsome point in their lives. It is not
uncommon. So why is it still a taboosubject? And what are the treatment options?
We are breaking the silence on it today with MedStarHealth euogynecologist Dr. Abigail
(01:07):
Davenport. So hit the pause button,take a quick bathroom break, and let's get to it.
I'm, your host, Debah schindler. Welcome toDocTalk. Dr. Davenport.
>> Dr. Abigail (01:18):
Hi. How are you?
>> (01:19):
Good. I don't think in high school, when my circle of friends and I were all aware
of this friend who would laugh and pee herself thatshe was experiencing in continents, we just didnt
call it that because she was a teenager maybe and she didnt haveany kids yet. There really are myths about
what causes someone to lose their bladder, isntthere?
(01:40):
Yeah, you know, theres a lot of myths around whatcontributes to incontinence. And we do see it more
commonly as women age, as we have menopausalchanges that affect the vagina and the bladder and the urethra,
thats the tub we urinate through. But certainly in younger women,we can see this problem as well for various reasons.
there are certain disorders related to the strengthof tissues and muscles and ligaments that can contribute to it
(02:04):
at a younger age. And other things, likethat cause chronic coughing or bearing down.
But we do tend to see it more in women asthey go through the menopause transition 50 years and
older. That's when it becomes much more prevalent.
There are different kinds of incontinence. Let's go through what theyare.
So incontinence, just to start out with the definitionis involuntary loss of urine.
(02:27):
And it can also involve involuntary lossof stool. If we'talking about fecal incontinence,
the two biggest types of urinary incontinence thatI deal with on the daily are going to
be urgency incontinence and stressurinary incontinence. So I usually say
the urgency incontinence is the gotta go, gotta gokey in the door, you're doing the PP dance, you'trying to make it
(02:51):
there. Urgency and frequency. And thenthere's something called stress urinary incontinence. And that's going to
be the leakage with coughing, sneezing, laughing.
Some women will have it when they jump on a trampoline orthey stand up too quickly, maybe they're lifting something
heavy. And then there's a mix of the two, which iscalled mixed urinary incontinence. And that's a very common type
(03:11):
of incontinence that I see. It's probably the most common havingboth. And then in some women who have
difficulty emptying the bladder, we have somethingcalled overflow incontinence. And the
way I explain that to women, it's almost like having a cupthat's very full of water. Eventually, when you keep
filling that very full cup, a little bit will flow over thetop. So if the bladder isn't emptying well, it can't hold
(03:34):
anymore, it overflows and more comes out.
Are there different kinds of treatment for these different kindsof incontinence?
There are. So the causes of these differenttypes of incontinence are different. So if we talk
about urgency incontinence that, gotta go,got to go. Urinary urgency frequency,
or overactive bladder as a term, some women may haveheard that's caused by spasticity of the bladder.
(03:58):
Because the bladder is a muscle. That's actually how the bladderempties. It squeezes. And almost as if you're
holding a water balloon and you're squeezing at the top to push thewater down, the bladder empties in the same way.
So when we have overactivity of that squeezing, it's going to pushthe urine down and out more and cause that sensation of
urgency and frequency. There are thingsin our lifestyle that can contribute to making the symptoms
(04:21):
worse. And the biggest thing I see isdifferent substances that women drink that are irritating to the
bladder. So caffeine, things that arevery acidic, carbonated beverages,
things with artificial sweeteners. So if you think, youknow, Diet Coke, your coffees, things
like that, the more you drink of that, the more the bladder will be irritated,the more frequently you'll have to go. So we look at behavioral
(04:44):
things. There's also special physicaltherapy for this, there are pelvic floor physical therapists who
are trained in the support of the pelvicorgans and how to reinforce the muscles and
gain bladder control by working on thosemuscles. There's also medications by mouth
that can be given that stop that spasming of thebladder. And if these things are ineffective, we have
(05:07):
more advanced therapies. Those are going to be thingslike Botox for the bladder. We have
an acupuncture for the bladder, and then there'seven a neuromodulator for the bladder that is kind
of like a pacemaker that is inserted under the skinand helps restore the bladder's function and can
last for many years.
How does that work? It affects the muscles of the bladder insome way. Electrically.
(05:30):
Yeah. So there is a tiny electrode that'splaced near the nerves that work on the bladder.
And this electrode basically modulates thesignals from the brain and the spinal cord that are causing
the bladder to contract too frequently.
So it filters out and restores the normal function of thebladder. It's a really nice therapy. It's been around
(05:50):
for more than 20 years. Very, effective andvery safe.
Is it surgically implanted?
It is. So that's a therapy thatcan be tested in the office with something
called a peripheral nerve evaluation, where tiny wiresare placed in the lower back. And women can try
the therapy out for a week with a waterproof dressingapplied to the area and write down their symptoms to see if it works
(06:13):
for them. And if it does, and they're verysatisfied with the results, then they would go on to
have the modulator implanted in the or. And it'sa short procedure. We use a special X
ray and it involves about, a 2 inch incisionin the buttock area to put a battery under the skin, just like a
pacemaker has a battery and then they're good togo.
(06:33):
Is it the same implant that is used for theopposite problem where some women who cannot
release their bladder, they can't let go of urine?
That's a great question. Yes, it is. So that is one of theprimary treatments for urinary retention. That's the term
for the inability to empty as well.
I know someone who has that, and she had that theprocedure. And you can recharge the battery
(06:54):
without having to remove it?
Correct. So there have been newer devicesreleased in the last few years that have an
external charger, just like one of the diss you can place your cellphone on. It's the same concept the you place against the
skin and you can recharge the device every six to 12 months.
And she has a remote control for it.
>> Dr. Abigail Davenp (07:12):
Yep. Yep.
Before we get any further, I did want to ask, what is aurognnecologist, and where does that fit in with the
GYN and the OB gyn?
Yeah, I kind of joke and I sayurogynecology is like having a urologist and
a gynecologist who had a baby. And m. That's what I do.
So I do a little bit of both. But the trackfor urogynecology is one of two ways,
(07:35):
either through an OB GYN residency orthrough a urology residency. So you complete a
residency in one of those two and then go on to do additionalfellowships training. So for me, I went to residency
for general OB GYN for four years, and then I completeda three year fellowship in urog gynecology
and reconstructive pelvic surgery. And there's asimilar program for urologists who want to go into
(07:58):
this. And the, analogous term for that would be femaleurology. They may have done a female urology fellowship.
Did you start medical school to be an OB gyn? Maybe youwere interested in delivering babies and then you.
Oh, interestingly, I was not. I was actuallyinterested more in breast reconstruction or
burn. and then I realized that Iwas very interested in continuity of care. And then I wanted
(08:20):
to have relationships with patients, whichfor a lot of surgeons, if you have a long
history of a relationship with a patient, that's usually a problem. Right. Youdon't want to be seeing people come back that mean something went wrong.
So I realized that wasn't for me. And ob gyn wasonly one of the only surgical subspecialties
where you could have that long term relationship with women.
(08:41):
And I really loved that. And then when I was inmedical school, I happened upon a rotation in
urogynecology at Vanderbilt. Actually,I did a visiting rotation. And I worked with one of
the forefathers of ureoynecology, andhe had me sit and do all of the exams.
We did cystoscopy, which is looking in the bladder together.
(09:01):
And I listened to these women's stories and saw thedistress, the incontinence and other pelvic
issues caused them. And I just found that Ihad a heart for those patients and I really wanted to
be involved more in their care. And then when I went toresidency, I knew from day one that that was what I was going to
pursue.
>> Debra Schindler (09:19):
Interesting.
What was the most distressing thing that you found? These womenwould talk about when they would share with you, you their experience
of incontinence.
> (09:27):
I think incontinence prevents women from living the lives that they want. It's
a major quality of life issue.
I've heard stories of patients who don't want to get inanyones'car because they're afraid of wrecking the seat. I've
heard stories of women who don't want to sit on their own furniturebecause they'afraid of ruining their furniture.
(09:47):
People who can't go out anywhere because they don'tknow where the bathrooms are going to be. So they cant go to the
fair or to the mall. They cant do things with their grandchildrenbecause they cant pick them up. And so
it has a huge impact onthe social relationships in our lives. And so these
women will have depression, anxiety, theyll be athigher risk for admission to nursing homes and
(10:11):
things like that. And it is a fixableissue, but women don't talk about
it. And there is a huge needfor more information about
urogynecology and urology and the solutionto this problem so we can empower women again to take back
their lives, especially as they get older.
What's the reaction to adult diapers?
(10:33):
Or is there a name for that? Is there a better namefor adult diapers?
>> Dr. Abiga (10:37):
Unfortunately, no.
That's probably part of the shame and embarrassment that you,you're at a point where you may need that or It's
suggested even.
>> Dr. Abig (10:45):
Yeah, it's a really shame filled diagnosis for a lot of
women. And that makes me sad. It is common.
You know, we don't talk enoughabout what happens when we have children.
We don't talk about the stress that's puton the pelvis and the muscles,
the bladder, everything inside the pelvisthat lives there. All these organs that are affected when we have a
(11:11):
baby. And those are risksthat I think women need to be informed about and they need to be
given resources early. For example, pelvicfloor physical therapy in the postpartum
period can help mitigate a lot of these things inthe long term and help women recover more quickly
from childbirth. But for some reason in theUnited States, that's not standard of care.
(11:32):
Do you mean Kegel muscle exercises?
Kegel muscle exercises are contractions of thepelvic floor and that is part of pelvic floor physical
therapy. But attending pelvic floorphysical therapy involves evaluation of all the muscles that
support the pelvis as well. The hips, the buttocks, theabdominals. There's many muscles that support
(11:53):
the pelvis and Help stabilize it.
In addition to that, Kegel exercises are verychallenging to perform by oneself. I
would say greater than 90% of the women that I see in theoffice, because I will have them attempt at Kegel, are unable to perform it
on their own. So they require instructionon how to do it correctly in order to have the
(12:13):
benefit of the therapy.
>> (12:15):
What do you tell them to do?
I tell them to squeeze their muscles like they're trying to hold in theirurine. That front door key in the
lock. How am I, am I squeezing it? Butmost women cannot actively contract those muscles
on their own.
Wow. Okay. Would that be considered a moresevere case of incontinence?
No, that's just the average woman out therethinking she's doing it right.
>> Debra Schindler (12:39):
Wow. Okay.
Now, you said in this country, does that, is that to say thatin other countries they are more progressive in that area?
Yeah. And Europe attending pelvic floor physical therapy afterhaving a baby as standard of care, while women are set up with
that.
So, and what does that look like?
> (12:54):
It involves a referral to see a professional, a physical therapist
who specializes in the pelvic floor. So usually they'll do some sortof internal evaluation of the muscles of the
pelvis and also as I mentioned before, the legs,the back, the buttocks, to
evaluate what muscles may need strengthening tohelp increase continents. But it's not just
(13:15):
for continents. It's also to restore thefunction of those muscles before the continnce
occurs.
That's so interesting. Are there any studies that showless prolapse or other pelvic issues that
may come about later in life as a result ofthat postnatal care?
It depends on the severity of whateverproblem there is in the pelvis, but it can help
(13:38):
prevent advancing problems worse, and it can certainlyimprove and ``inence.
I mentioned my friend. I don't think when I was in high school,my circle of friends and I were all aware of this friend of ours who
would laugh so hard she would pee herself thatwe equated that to incontinence. And maybe that
was because we were just teenagers. We didn'thave kids yet, we didn't think about it. But that
(14:00):
really is a myth, isn't it, aboutincontinence that it. It can't happen in younger people
or it can't happen if you don't have children?
Yes, incontinence can happen in anyone ofany age. Although it is more common as we age
and go through menopauseis.
What are some of the other misconceptions about urinaryincontinence.
I think the biggest thing that I see iswomen saying this is just a natural part of
(14:23):
aging and I have to live with it. That'sort of thementality that a lot of women have. They feel
relegated to having this as part of their lives.
And I like to tell patients that while incontinence iscommon, it is treatable as
well. Common doesn't mean that it's normal tohave to wear pads or to wear diapers
(14:44):
all the time. And so Ilike to have a goal of getting them as dry as possible
within six months of seeing me. And that may be acombination of the physical therapy, medications.
There's some other procedures for stress urinaryincontinence. But very rapidly, I like to
progress them along so we can get them as dry as possible.
A woman comes to see you for urinary incontinence the firsttime, what's the first step that you'take in treating her?
(15:10):
We want to talk to her. I want to know how long thesymptoms have been going on. I want to know what type of
symptoms she's having, is at the urgency frequency,the coughing, sneezing, laughing. I want to know what
she's drinking throughout the day, how many times is sheleaking, how many times is she going to the bathroom during the day and
at night, is she having a lot of urinary tractinfections? Has she gotten treatment for this
(15:32):
before? And then I also ask about bowelsymptoms and symptoms of prolapse, other things that can
be associated with incontinence. After that,we perform a bladder ultrasound where we look to see how
well the bladder empties. And then I do a pelvicexam where I look at the skin of the vagina, look at
the urethra again, that tube urinate through. I feel themuscles of the pelvis. I look to see if anything has
(15:56):
dropped and try to identify anyobvious causes of the leakage that's going on.
What would you see if you saw a problemthere?
So, oftentimes I'll see skin changes relatedto menopause. So thinning of the skin, some
irritation. I can see that thebladder has droppedon occasion. Sometimes I'll even
(16:16):
see the leakage happening. A lot of times we'll have patientscough to intentionally try to provoke the leakage
to understand why it's going on.
Should a woman know if she has a prolapse, a bladderprolapse?
The only time we treat prolapse is when it isbothersome to a woman. Or if it making it difficult
for the bladder to empty. And usually that doesnt t happen untila prolapse is very severe, meaning its coming all the way
(16:39):
out. So for most women theycan have prolapse and have no idea and its not affecting
their lives and no treatment is necessary whatsoever.
Oh, how would you know that there is a prolapse? Yousee it in a pelvic exam?
Correct. If it's mild. If it's severe, a woman could feel that itwas coming down.
And there are surgical treatments for that?
There are non surgical treatments as well.
(17:01):
Is that usually the cause for urinary incontinence?
No, they're two separate entities, but they commonly cooccur.
Who then would you prescribe medication for and how doesmedication help? If the problem is because of
weakened muscle and tissues and tendons andage, how does the medication help?
So the medication does not help with womenwho have incontinence from the weakened muscles and age. It
(17:24):
actually helps with women who have spasticity of the bladder,which contributes to the urgency frequency things that
we see with overactivity of the bladder basedon the type of incontinence that they have. I will kind
of put them down that treatmentalgorithm. So if it's overactivity of the bladder, we talk
about behavioral things that can be changed. I'll usually referthem to pelvic floor physical therapy, discuss
(17:46):
starting and medication if they're interested in that. Ifthey have stress urinary incontinence, the coughing, sneezing,
laughing, related leakage. I still talk about behavioralchanges in pelvic floor physical therapy, but I
may have them come in for something like a pessary insertion,which is a vaginal insert that puts a little pressure on
the bladder as a next step as well.
What about lifestyle changes?
(18:08):
It's mostly related to looking at the things weeat and drink that can cause irritation of the
bladder and then also looking at thefrequency of how often we urinate. So
for example, if a woman is holding her urinefor six hours, the bladder is going to be very full
and then it's going to be more difficult to keep the urinein. If she does something that causes leakage.
(18:31):
So she pushes down really hard, her coughs really hard and the bladderis very full, shes more likely to have leakage. So I
may tell a woman, I want you to urinate every twohours to keep your bladder more on the empty side to
prevent that.
For example, lets talk about the differenttherapy options.
O so for women who have urinary urgencyFrequency and leakage associated with that, commonly referred
(18:53):
to as overactive bladder. I typically startwith looking at the things that they're behaviorally doing that could
be contributing. And that's going to go back to what in the diet could beirritating the bladder. Is she going so
often that she's training her bladder to have to gomore often? She's training the nerves to need to
go every time there's even a little bit of urine in the bladder.
(19:14):
And so then we talk about gradually spacing out thefrequency of urination. That's called bladder
retraining. I may send her to a pelvic floor physicaltherapist to teach her some strategies to Kegel
and to have a relaxation when she feels thatcontraction so she regains control of her bladder.
There's medications that affect the spasticity of thebladder and decrease that sensation of urgency and
(19:36):
frequency. And then when those things don't work,sometimes we perform a specialized bladder test called
urynamics to help understand what'sgoing on a little bit better. So we're moving away from the one size
fits all to catering treatments more to what's going on withthe woman's body. Once we have the results of that,
we may talk about percutaneous tibial nervestimulation, which is essentially an
(19:58):
acupuncture for the bladder. And then there'sbladder Botox. So similar to the Botox
being injected in the face, which women are very familiar with, that forcosmetic purposes, where it stops the muscles from moving and it
stops the wrinkles. Botox in the bladderstops the spasming of the strong bladder
muscle. It paralyzes that muscle to stop the urgency andfrequency.
(20:19):
Do you do that in the office? Are they sedated for it?
It sounds like it might be painful.
The Botox is injected through atelescope. It's called cystoscopy. That can be
done in the office. And frequently we will use a topicalanesthetic, a gel in the bladder, and then we'll also
instill a numbing agent inside the bladder itself.
And the whole procedure takes about five minutes. It can be alittle uncomfortable, but it's not horribly painful, and most
(20:44):
women tolerate it just fine. And then after that,we have that other neuromodulator that I'd mentioned
before, which is like a pacemaker for the bladder thatfilters out the abnormal signals from the brain that make
the bladder go more often. So that's theoveractive bladder care pathway's what we call
that.
Getting back to the Botox, I think I'd be afraidthat I would not be able to freeze up the muscles
(21:06):
and not enable me to use the muscles in the sameway. Like it would have a counter effect.
How does it help?
Well, that's why we use a, very low dose when we start withthe Botox. So we titrate it up
if we need to. So we start with a lower dosage and weincrease slowly. The woman doesn't have a
response. We know from big studies looking atthis that the risk of having the
(21:30):
urinary retention or having the bladderovercompensate like you just described by not being
able to empty, is low, less than10%. Probably about more on the 5%
side. So overall the risk of that happeningis low.
So talking about stress incontinence aswell, that's the leakage with coughing, sneezing,
(21:51):
laughing, standing, quickly, trampolines, all of that. Butthe treatments for that also start with looking at things
behaviorally that could be contributing. So isit excessively drinking fluids and
not going frequently enough so the bladder is very full?
Is it related to, pushing down toomuch? Things we call Valsalva activities. So when you're
really increasing the pressure in theabdomen, heavy weight lifters, things like that.
(22:16):
We'll also send a patient to pelvic floor physical therapyto strengthen the muscles of the pelvis. Because with this
problem it can be more of a supportissue. And there is also pessaries for
this, which are vaginal inserts that put a little bit of pressureon the urethra. That's the tube we urinate through
to have some resistance for when we do theactivities that would cause the leakage to occur. There's
(22:39):
also fillers for the urethra to go with the Botox.
Right. But basically it's a gel that's injectedthrough a tiny scope that causes the whole of the urethra to
be a little bit smaller. So there's more resistance when awoman coughs, sneezes or left. And that's a
simple outpatient procedure that can be performedunder lite sedation or some people even do it with, an
anesthetic injection in the office. Andthen finally there's other procedures that are slightly
(23:04):
more invasive, but still are outpatient procedures.
Things like mid urethral slingsthat women may have heard about as well.
>> Debra (23:12):
What is that exactly?
A, midurethhral sling is a small piece of meshthat is placed through about a half
inch sized incision in the vagina. It'snot the mesh of all of the lawsuits that we see on
tv, we don't use that mesh anymore. And it's avery safe and effective procedure. It's considered the
standard of care in the United States for stressurinary incontinence.
(23:36):
can you feel that from the outside of your body?
No. Once its there, you dont know its there at all.
Okay, how long is that procedure and whats therecovery line?
Well, on my end the procedure only takes about 20minutes to do. The recovery is a six
week recovery, but that's mostly weightliftingrestrictions so that everything heals very well
(23:58):
and after that.
They shouldn't have any Urinary incontinence. Is it acure?
It's the most effective procedure we have forstress urinary incontinence. There's always going to be some women
who will still have some leakage, but we're looking atgreater than 80% improve.
Do you have to try the other options firstto suggest that one or do some patients just go
(24:19):
right to the mesh?
Some patients go right to it. It really depends on awoman's goals.
And also insurance issues, of course.
So with this problem being so common,when is the right time for a woman to come to see a
doctor?
If it's impacting a woman's quality of life or herself esteem or it's something that's come
on out of the blue, it's never going to hurt to bringit up to your doctor and seek treatment.
(24:45):
Who's usually your patient? What's the averageage say?
>> D (24:49):
My typical patient is a 60 year old active woman looking to get back
her life.
And she comes in and she goes through the course oftreatment, maybe she gets the sling, maybe she'using
medications. Do they usually go on and prettyhappy? I mean, is the problem truly
solvable?
It's solvable. That's kind of thetragedy of women waiting so long to seek care.
(25:14):
Most of my patients come to me, get treatment and say I wishI did this 10 years ago.
It's life changing then because now they cantravel again and yes. Or whatever
they've given up as a result of thisproblem.
Yes, it is. It's absolutely life changing.
We talked about the difficulty in talking aboutthis problem and the embarrassment for many
(25:35):
women, understandably. When did it first occurto you that that was part of the problem?
>> Dr. (25:41):
I think the time that I heard about it the most and I really understood the
tremendous impact was when I was in residency and Iwas working on a research project
called qualitative research, which is Basically where youjust look at people who have a problem and you call them and you
talk to them, you ask them what is your experiencewith them. And that led me down
(26:04):
the road of talking to dozens of women, abouttheir experiences with bladder control and bladder
treatment and the stories of womenwho couldn't sit in a friend's car or were afraid
of sitting on their own furniture and ruining it.
And hearing these stories made me realize how devastatingthis was for women and also how hard it
(26:24):
was for them going through treatment. Initially,because the treatment algorithm
involves starting with medications which areoften not tolerated well by most women
because of side effects and things like that. But we are limited, ofcourse, by insurance coverage and all of those things and we have to
start there. But it can be reallydisheartening for a lot of women when they start with that
(26:48):
early on and don't allow themselves to get to thetreatments further in the algorithm, that are more effective.
And so I've kind of made it my mission, usingthat research to inform women
early on know we're going to start with these other thingsknowing that it may not be a great long term
solution, but that there are really goodways to fix it long term once we
(27:10):
check those boxes for their insurance and start moreconservatively. So it's been really nice
to see how just starting with those conversationsearly on in my training led me to this
deeper understanding of what it's like for women to be in thisposition with incontinence and go through the treatment, over
the course of, you know, six months to a year.
It's only by talking about it that women are going to findout that there are solutions to the problem and that they don't
(27:35):
have to live a compromised lifestyle. And hope this podcastmakes that clear today.
Yes, it's a tragedy of women's healtharethat we have not empowered women to
talk about what happens with their bodies and that there is a lot ofshame surrounding talking about these issues.
You know, we talk about women's parts as, sort of thisportal to having children. And we forget
(27:58):
the other functions that are there. We forget about thebladder, we forget about having the bowel in
that area. We forget about how sexual function isan important part of our social relationships with
our partners and necessary for families to function.
We've sanitized it in a way that takeswomen's power away from them. And I
(28:18):
would love to see us build this future where weempower women to talk about what's happening with their bodies
without any Shame.
What question do they have most often?
I get asked a lot. Is it cancer?
you mean not being able to.
Hold their bladder, they fear they have cancer?
Yeah, they feel that something life threatening is goingon. And so one of the first things I
(28:41):
do after I do an exam is I say I didn't see anythingdangerous. And this is very common to
allay womens fears. But thats the biggest thingwhen I see women is they usually think something really terrible or
dangerous is going on. And that thats a big part of,I believe, the delay in seeking care.
Is there a concern that urinaryincontinence may be related to fecal incontinence?
(29:03):
Yes, and we do commonly see them togetherbecause maintaining control of bladder
and bowel function are so interrelated. Ifwe see one, were very likely to see the
other. So I have a standardized intakeform for everybody that I see where I
ask questions about urinary incontinenceand also bowel incontinence and
(29:26):
also pelvic organ prolapse because they so often cooccur.
Do you treat the fecal incontinence as well?
>> Dr. Abigail Davenport (29:32):
I do.
>> Debra Schindler (29:32):
Okay.
that's all part of that pelvic floor dysfunction.
We've covered a lot today, but the most importanttakeaway in this, as you said, is female incontinence is
common, manageable, and nothing to be ashamedof. And if you're experiencing symptoms, don't
hesitate to seek help.
Put yourynecology into your Googlesearch, go find a urog gynecologist
(29:53):
and talk to them about what's going on with you.
It can only improve your life, it can only make thingsbetter. And talk to your girlfriends about what's
going on with you so that they don't feel alone andthey don't feel like it's just, them. Because I guarantee you
it's not great advice.
Dr. Dabenport, thank you so much for being here todayand sharing your expertise with us. UN Talk.
(30:16):
If you're in the Baltimore area and you would like to schedule anappointment with Dr. Davenport, call
443-777-7608-443777-77608.
If you would like to provide feedback on this podcastor get more information on incontinence,
send an email to doctalkmedstar.net.
Comprehensive, relevant and insightful conversationsabout health and medicine happen here when
MedStar Health doc talk. Theseare real conversations with physician experts from
around the largest healthcare system in the Maryland D.C.
region. Maybe you have a friendlike mine, one who laughs so hard she
(00:23):
cries all the way down her leg. Myfriend has warned me through laughter many times not
to make her laugh because she was about to peerpants that was really funny in high school.
But if its still a problem today, we dont talk aboutit. In fact, most women dont want to talk about
it. Urinary incontinence. Itaffects 25 million American women, with
(00:46):
estimates indicating nearly half the population ofadult females in the United States will
experience some form of urinary incontinence atsome point in their lives. It is not
uncommon. So why is it still a taboosubject? And what are the treatment options?
We are breaking the silence on it today with MedStarHealth euogynecologist Dr. Abigail
(01:07):
Davenport. So hit the pause button,take a quick bathroom break, and let's get to it.
I'm, your host, Debah schindler. Welcome toDocTalk. Dr. Davenport.
>> Dr. Abigail (01:18):
Hi. How are you?
>> (01:19):
Good. I don't think in high school, when my circle of friends and I were all aware
of this friend who would laugh and pee herself thatshe was experiencing in continents, we just didnt
call it that because she was a teenager maybe and she didnt haveany kids yet. There really are myths about
what causes someone to lose their bladder, isntthere?
(01:40):
Yeah, you know, theres a lot of myths around whatcontributes to incontinence. And we do see it more
commonly as women age, as we have menopausalchanges that affect the vagina and the bladder and the urethra,
thats the tub we urinate through. But certainly in younger women,we can see this problem as well for various reasons.
there are certain disorders related to the strengthof tissues and muscles and ligaments that can contribute to it
(02:04):
at a younger age. And other things, likethat cause chronic coughing or bearing down.
But we do tend to see it more in women asthey go through the menopause transition 50 years and
older. That's when it becomes much more prevalent.
There are different kinds of incontinence. Let's go through what theyare.
So incontinence, just to start out with the definitionis involuntary loss of urine.
(02:27):
And it can also involve involuntary lossof stool. If we'talking about fecal incontinence,
the two biggest types of urinary incontinence thatI deal with on the daily are going to
be urgency incontinence and stressurinary incontinence. So I usually say
the urgency incontinence is the gotta go, gotta gokey in the door, you're doing the PP dance, you'trying to make it
(02:51):
there. Urgency and frequency. And thenthere's something called stress urinary incontinence. And that's going to
be the leakage with coughing, sneezing, laughing.
Some women will have it when they jump on a trampoline orthey stand up too quickly, maybe they're lifting something
heavy. And then there's a mix of the two, which iscalled mixed urinary incontinence. And that's a very common type
(03:11):
of incontinence that I see. It's probably the most common havingboth. And then in some women who have
difficulty emptying the bladder, we have somethingcalled overflow incontinence. And the
way I explain that to women, it's almost like having a cupthat's very full of water. Eventually, when you keep
filling that very full cup, a little bit will flow over thetop. So if the bladder isn't emptying well, it can't hold
(03:34):
anymore, it overflows and more comes out.
Are there different kinds of treatment for these different kindsof incontinence?
There are. So the causes of these differenttypes of incontinence are different. So if we talk
about urgency incontinence that, gotta go,got to go. Urinary urgency frequency,
or overactive bladder as a term, some women may haveheard that's caused by spasticity of the bladder.
(03:58):
Because the bladder is a muscle. That's actually how the bladderempties. It squeezes. And almost as if you're
holding a water balloon and you're squeezing at the top to push thewater down, the bladder empties in the same way.
So when we have overactivity of that squeezing, it's going to pushthe urine down and out more and cause that sensation of
urgency and frequency. There are thingsin our lifestyle that can contribute to making the symptoms
(04:21):
worse. And the biggest thing I see isdifferent substances that women drink that are irritating to the
bladder. So caffeine, things that arevery acidic, carbonated beverages,
things with artificial sweeteners. So if you think, youknow, Diet Coke, your coffees, things
like that, the more you drink of that, the more the bladder will be irritated,the more frequently you'll have to go. So we look at behavioral
(04:44):
things. There's also special physicaltherapy for this, there are pelvic floor physical therapists who
are trained in the support of the pelvicorgans and how to reinforce the muscles and
gain bladder control by working on thosemuscles. There's also medications by mouth
that can be given that stop that spasming of thebladder. And if these things are ineffective, we have
(05:07):
more advanced therapies. Those are going to be thingslike Botox for the bladder. We have
an acupuncture for the bladder, and then there'seven a neuromodulator for the bladder that is kind
of like a pacemaker that is inserted under the skinand helps restore the bladder's function and can
last for many years.
How does that work? It affects the muscles of the bladder insome way. Electrically.
(05:30):
Yeah. So there is a tiny electrode that'splaced near the nerves that work on the bladder.
And this electrode basically modulates thesignals from the brain and the spinal cord that are causing
the bladder to contract too frequently.
So it filters out and restores the normal function of thebladder. It's a really nice therapy. It's been around
(05:50):
for more than 20 years. Very, effective andvery safe.
Is it surgically implanted?
It is. So that's a therapy thatcan be tested in the office with something
called a peripheral nerve evaluation, where tiny wiresare placed in the lower back. And women can try
the therapy out for a week with a waterproof dressingapplied to the area and write down their symptoms to see if it works
(06:13):
for them. And if it does, and they're verysatisfied with the results, then they would go on to
have the modulator implanted in the or. And it'sa short procedure. We use a special X
ray and it involves about, a 2 inch incisionin the buttock area to put a battery under the skin, just like a
pacemaker has a battery and then they're good togo.
(06:33):
Is it the same implant that is used for theopposite problem where some women who cannot
release their bladder, they can't let go of urine?
That's a great question. Yes, it is. So that is one of theprimary treatments for urinary retention. That's the term
for the inability to empty as well.
I know someone who has that, and she had that theprocedure. And you can recharge the battery
(06:54):
without having to remove it?
Correct. So there have been newer devicesreleased in the last few years that have an
external charger, just like one of the diss you can place your cellphone on. It's the same concept the you place against the
skin and you can recharge the device every six to 12 months.
And she has a remote control for it.
>> Dr. Abigail Davenp (07:12):
Yep. Yep.
Before we get any further, I did want to ask, what is aurognnecologist, and where does that fit in with the
GYN and the OB gyn?
Yeah, I kind of joke and I sayurogynecology is like having a urologist and
a gynecologist who had a baby. And m. That's what I do.
So I do a little bit of both. But the trackfor urogynecology is one of two ways,
(07:35):
either through an OB GYN residency orthrough a urology residency. So you complete a
residency in one of those two and then go on to do additionalfellowships training. So for me, I went to residency
for general OB GYN for four years, and then I completeda three year fellowship in urog gynecology
and reconstructive pelvic surgery. And there's asimilar program for urologists who want to go into
(07:58):
this. And the, analogous term for that would be femaleurology. They may have done a female urology fellowship.
Did you start medical school to be an OB gyn? Maybe youwere interested in delivering babies and then you.
Oh, interestingly, I was not. I was actuallyinterested more in breast reconstruction or
burn. and then I realized that Iwas very interested in continuity of care. And then I wanted
(08:20):
to have relationships with patients, whichfor a lot of surgeons, if you have a long
history of a relationship with a patient, that's usually a problem. Right. Youdon't want to be seeing people come back that mean something went wrong.
So I realized that wasn't for me. And ob gyn wasonly one of the only surgical subspecialties
where you could have that long term relationship with women.
(08:41):
And I really loved that. And then when I was inmedical school, I happened upon a rotation in
urogynecology at Vanderbilt. Actually,I did a visiting rotation. And I worked with one of
the forefathers of ureoynecology, andhe had me sit and do all of the exams.
We did cystoscopy, which is looking in the bladder together.
(09:01):
And I listened to these women's stories and saw thedistress, the incontinence and other pelvic
issues caused them. And I just found that Ihad a heart for those patients and I really wanted to
be involved more in their care. And then when I went toresidency, I knew from day one that that was what I was going to
pursue.
>> Debra Schindler (09:19):
Interesting.
What was the most distressing thing that you found? These womenwould talk about when they would share with you, you their experience
of incontinence.
> (09:27):
I think incontinence prevents women from living the lives that they want. It's
a major quality of life issue.
I've heard stories of patients who don't want to get inanyones'car because they're afraid of wrecking the seat. I've
heard stories of women who don't want to sit on their own furniturebecause they'afraid of ruining their furniture.
(09:47):
People who can't go out anywhere because they don'tknow where the bathrooms are going to be. So they cant go to the
fair or to the mall. They cant do things with their grandchildrenbecause they cant pick them up. And so
it has a huge impact onthe social relationships in our lives. And so these
women will have depression, anxiety, theyll be athigher risk for admission to nursing homes and
(10:11):
things like that. And it is a fixableissue, but women don't talk about
it. And there is a huge needfor more information about
urogynecology and urology and the solutionto this problem so we can empower women again to take back
their lives, especially as they get older.
What's the reaction to adult diapers?
(10:33):
Or is there a name for that? Is there a better namefor adult diapers?
>> Dr. Abiga (10:37):
Unfortunately, no.
That's probably part of the shame and embarrassment that you,you're at a point where you may need that or It's
suggested even.
>> Dr. Abig (10:45):
Yeah, it's a really shame filled diagnosis for a lot of
women. And that makes me sad. It is common.
You know, we don't talk enoughabout what happens when we have children.
We don't talk about the stress that's puton the pelvis and the muscles,
the bladder, everything inside the pelvisthat lives there. All these organs that are affected when we have a
(11:11):
baby. And those are risksthat I think women need to be informed about and they need to be
given resources early. For example, pelvicfloor physical therapy in the postpartum
period can help mitigate a lot of these things inthe long term and help women recover more quickly
from childbirth. But for some reason in theUnited States, that's not standard of care.
(11:32):
Do you mean Kegel muscle exercises?
Kegel muscle exercises are contractions of thepelvic floor and that is part of pelvic floor physical
therapy. But attending pelvic floorphysical therapy involves evaluation of all the muscles that
support the pelvis as well. The hips, the buttocks, theabdominals. There's many muscles that support
(11:53):
the pelvis and Help stabilize it.
In addition to that, Kegel exercises are verychallenging to perform by oneself. I
would say greater than 90% of the women that I see in theoffice, because I will have them attempt at Kegel, are unable to perform it
on their own. So they require instructionon how to do it correctly in order to have the
(12:13):
benefit of the therapy.
>> (12:15):
What do you tell them to do?
I tell them to squeeze their muscles like they're trying to hold in theirurine. That front door key in the
lock. How am I, am I squeezing it? Butmost women cannot actively contract those muscles
on their own.
Wow. Okay. Would that be considered a moresevere case of incontinence?
No, that's just the average woman out therethinking she's doing it right.
>> Debra Schindler (12:39):
Wow. Okay.
Now, you said in this country, does that, is that to say thatin other countries they are more progressive in that area?
Yeah. And Europe attending pelvic floor physical therapy afterhaving a baby as standard of care, while women are set up with
that.
So, and what does that look like?
> (12:54):
It involves a referral to see a professional, a physical therapist
who specializes in the pelvic floor. So usually they'll do some sortof internal evaluation of the muscles of the
pelvis and also as I mentioned before, the legs,the back, the buttocks, to
evaluate what muscles may need strengthening tohelp increase continents. But it's not just
(13:15):
for continents. It's also to restore thefunction of those muscles before the continnce
occurs.
That's so interesting. Are there any studies that showless prolapse or other pelvic issues that
may come about later in life as a result ofthat postnatal care?
It depends on the severity of whateverproblem there is in the pelvis, but it can help
(13:38):
prevent advancing problems worse, and it can certainlyimprove and ``inence.
I mentioned my friend. I don't think when I was in high school,my circle of friends and I were all aware of this friend of ours who
would laugh so hard she would pee herself thatwe equated that to incontinence. And maybe that
was because we were just teenagers. We didn'thave kids yet, we didn't think about it. But that
(14:00):
really is a myth, isn't it, aboutincontinence that it. It can't happen in younger people
or it can't happen if you don't have children?
Yes, incontinence can happen in anyone ofany age. Although it is more common as we age
and go through menopauseis.
What are some of the other misconceptions about urinaryincontinence.
I think the biggest thing that I see iswomen saying this is just a natural part of
(14:23):
aging and I have to live with it. That'sort of thementality that a lot of women have. They feel
relegated to having this as part of their lives.
And I like to tell patients that while incontinence iscommon, it is treatable as
well. Common doesn't mean that it's normal tohave to wear pads or to wear diapers
(14:44):
all the time. And so Ilike to have a goal of getting them as dry as possible
within six months of seeing me. And that may be acombination of the physical therapy, medications.
There's some other procedures for stress urinaryincontinence. But very rapidly, I like to
progress them along so we can get them as dry as possible.
A woman comes to see you for urinary incontinence the firsttime, what's the first step that you'take in treating her?
(15:10):
We want to talk to her. I want to know how long thesymptoms have been going on. I want to know what type of
symptoms she's having, is at the urgency frequency,the coughing, sneezing, laughing. I want to know what
she's drinking throughout the day, how many times is sheleaking, how many times is she going to the bathroom during the day and
at night, is she having a lot of urinary tractinfections? Has she gotten treatment for this
(15:32):
before? And then I also ask about bowelsymptoms and symptoms of prolapse, other things that can
be associated with incontinence. After that,we perform a bladder ultrasound where we look to see how
well the bladder empties. And then I do a pelvicexam where I look at the skin of the vagina, look at
the urethra again, that tube urinate through. I feel themuscles of the pelvis. I look to see if anything has
(15:56):
dropped and try to identify anyobvious causes of the leakage that's going on.
What would you see if you saw a problemthere?
So, oftentimes I'll see skin changes relatedto menopause. So thinning of the skin, some
irritation. I can see that thebladder has droppedon occasion. Sometimes I'll even
(16:16):
see the leakage happening. A lot of times we'll have patientscough to intentionally try to provoke the leakage
to understand why it's going on.
Should a woman know if she has a prolapse, a bladderprolapse?
The only time we treat prolapse is when it isbothersome to a woman. Or if it making it difficult
for the bladder to empty. And usually that doesnt t happen untila prolapse is very severe, meaning its coming all the way
(16:39):
out. So for most women theycan have prolapse and have no idea and its not affecting
their lives and no treatment is necessary whatsoever.
Oh, how would you know that there is a prolapse? Yousee it in a pelvic exam?
Correct. If it's mild. If it's severe, a woman could feel that itwas coming down.
And there are surgical treatments for that?
There are non surgical treatments as well.
(17:01):
Is that usually the cause for urinary incontinence?
No, they're two separate entities, but they commonly cooccur.
Who then would you prescribe medication for and how doesmedication help? If the problem is because of
weakened muscle and tissues and tendons andage, how does the medication help?
So the medication does not help with womenwho have incontinence from the weakened muscles and age. It
(17:24):
actually helps with women who have spasticity of the bladder,which contributes to the urgency frequency things that
we see with overactivity of the bladder basedon the type of incontinence that they have. I will kind
of put them down that treatmentalgorithm. So if it's overactivity of the bladder, we talk
about behavioral things that can be changed. I'll usually referthem to pelvic floor physical therapy, discuss
(17:46):
starting and medication if they're interested in that. Ifthey have stress urinary incontinence, the coughing, sneezing,
laughing, related leakage. I still talk about behavioralchanges in pelvic floor physical therapy, but I
may have them come in for something like a pessary insertion,which is a vaginal insert that puts a little pressure on
the bladder as a next step as well.
What about lifestyle changes?
(18:08):
It's mostly related to looking at the things weeat and drink that can cause irritation of the
bladder and then also looking at thefrequency of how often we urinate. So
for example, if a woman is holding her urinefor six hours, the bladder is going to be very full
and then it's going to be more difficult to keep the urinein. If she does something that causes leakage.
(18:31):
So she pushes down really hard, her coughs really hard and the bladderis very full, shes more likely to have leakage. So I
may tell a woman, I want you to urinate every twohours to keep your bladder more on the empty side to
prevent that.
For example, lets talk about the differenttherapy options.
O so for women who have urinary urgencyFrequency and leakage associated with that, commonly referred
(18:53):
to as overactive bladder. I typically startwith looking at the things that they're behaviorally doing that could
be contributing. And that's going to go back to what in the diet could beirritating the bladder. Is she going so
often that she's training her bladder to have to gomore often? She's training the nerves to need to
go every time there's even a little bit of urine in the bladder.
(19:14):
And so then we talk about gradually spacing out thefrequency of urination. That's called bladder
retraining. I may send her to a pelvic floor physicaltherapist to teach her some strategies to Kegel
and to have a relaxation when she feels thatcontraction so she regains control of her bladder.
There's medications that affect the spasticity of thebladder and decrease that sensation of urgency and
(19:36):
frequency. And then when those things don't work,sometimes we perform a specialized bladder test called
urynamics to help understand what'sgoing on a little bit better. So we're moving away from the one size
fits all to catering treatments more to what's going on withthe woman's body. Once we have the results of that,
we may talk about percutaneous tibial nervestimulation, which is essentially an
(19:58):
acupuncture for the bladder. And then there'sbladder Botox. So similar to the Botox
being injected in the face, which women are very familiar with, that forcosmetic purposes, where it stops the muscles from moving and it
stops the wrinkles. Botox in the bladderstops the spasming of the strong bladder
muscle. It paralyzes that muscle to stop the urgency andfrequency.
(20:19):
Do you do that in the office? Are they sedated for it?
It sounds like it might be painful.
The Botox is injected through atelescope. It's called cystoscopy. That can be
done in the office. And frequently we will use a topicalanesthetic, a gel in the bladder, and then we'll also
instill a numbing agent inside the bladder itself.
And the whole procedure takes about five minutes. It can be alittle uncomfortable, but it's not horribly painful, and most
(20:44):
women tolerate it just fine. And then after that,we have that other neuromodulator that I'd mentioned
before, which is like a pacemaker for the bladder thatfilters out the abnormal signals from the brain that make
the bladder go more often. So that's theoveractive bladder care pathway's what we call
that.
Getting back to the Botox, I think I'd be afraidthat I would not be able to freeze up the muscles
(21:06):
and not enable me to use the muscles in the sameway. Like it would have a counter effect.
How does it help?
Well, that's why we use a, very low dose when we start withthe Botox. So we titrate it up
if we need to. So we start with a lower dosage and weincrease slowly. The woman doesn't have a
response. We know from big studies looking atthis that the risk of having the
(21:30):
urinary retention or having the bladderovercompensate like you just described by not being
able to empty, is low, less than10%. Probably about more on the 5%
side. So overall the risk of that happeningis low.
So talking about stress incontinence aswell, that's the leakage with coughing, sneezing,
(21:51):
laughing, standing, quickly, trampolines, all of that. Butthe treatments for that also start with looking at things
behaviorally that could be contributing. So isit excessively drinking fluids and
not going frequently enough so the bladder is very full?
Is it related to, pushing down toomuch? Things we call Valsalva activities. So when you're
really increasing the pressure in theabdomen, heavy weight lifters, things like that.
(22:16):
We'll also send a patient to pelvic floor physical therapyto strengthen the muscles of the pelvis. Because with this
problem it can be more of a supportissue. And there is also pessaries for
this, which are vaginal inserts that put a little bit of pressureon the urethra. That's the tube we urinate through
to have some resistance for when we do theactivities that would cause the leakage to occur. There's
(22:39):
also fillers for the urethra to go with the Botox.
Right. But basically it's a gel that's injectedthrough a tiny scope that causes the whole of the urethra to
be a little bit smaller. So there's more resistance when awoman coughs, sneezes or left. And that's a
simple outpatient procedure that can be performedunder lite sedation or some people even do it with, an
anesthetic injection in the office. Andthen finally there's other procedures that are slightly
(23:04):
more invasive, but still are outpatient procedures.
Things like mid urethral slingsthat women may have heard about as well.
>> Debra (23:12):
What is that exactly?
A, midurethhral sling is a small piece of meshthat is placed through about a half
inch sized incision in the vagina. It'snot the mesh of all of the lawsuits that we see on
tv, we don't use that mesh anymore. And it's avery safe and effective procedure. It's considered the
standard of care in the United States for stressurinary incontinence.
(23:36):
can you feel that from the outside of your body?
No. Once its there, you dont know its there at all.
Okay, how long is that procedure and whats therecovery line?
Well, on my end the procedure only takes about 20minutes to do. The recovery is a six
week recovery, but that's mostly weightliftingrestrictions so that everything heals very well
(23:58):
and after that.
They shouldn't have any Urinary incontinence. Is it acure?
It's the most effective procedure we have forstress urinary incontinence. There's always going to be some women
who will still have some leakage, but we're looking atgreater than 80% improve.
Do you have to try the other options firstto suggest that one or do some patients just go
(24:19):
right to the mesh?
Some patients go right to it. It really depends on awoman's goals.
And also insurance issues, of course.
So with this problem being so common,when is the right time for a woman to come to see a
doctor?
If it's impacting a woman's quality of life or herself esteem or it's something that's come
on out of the blue, it's never going to hurt to bringit up to your doctor and seek treatment.
(24:45):
Who's usually your patient? What's the averageage say?
>> D (24:49):
My typical patient is a 60 year old active woman looking to get back
her life.
And she comes in and she goes through the course oftreatment, maybe she gets the sling, maybe she'using
medications. Do they usually go on and prettyhappy? I mean, is the problem truly
solvable?
It's solvable. That's kind of thetragedy of women waiting so long to seek care.
(25:14):
Most of my patients come to me, get treatment and say I wishI did this 10 years ago.
It's life changing then because now they cantravel again and yes. Or whatever
they've given up as a result of thisproblem.
Yes, it is. It's absolutely life changing.
We talked about the difficulty in talking aboutthis problem and the embarrassment for many
(25:35):
women, understandably. When did it first occurto you that that was part of the problem?
>> Dr. (25:41):
I think the time that I heard about it the most and I really understood the
tremendous impact was when I was in residency and Iwas working on a research project
called qualitative research, which is Basically where youjust look at people who have a problem and you call them and you
talk to them, you ask them what is your experiencewith them. And that led me down
(26:04):
the road of talking to dozens of women, abouttheir experiences with bladder control and bladder
treatment and the stories of womenwho couldn't sit in a friend's car or were afraid
of sitting on their own furniture and ruining it.
And hearing these stories made me realize how devastatingthis was for women and also how hard it
(26:24):
was for them going through treatment. Initially,because the treatment algorithm
involves starting with medications which areoften not tolerated well by most women
because of side effects and things like that. But we are limited, ofcourse, by insurance coverage and all of those things and we have to
start there. But it can be reallydisheartening for a lot of women when they start with that
(26:48):
early on and don't allow themselves to get to thetreatments further in the algorithm, that are more effective.
And so I've kind of made it my mission, usingthat research to inform women
early on know we're going to start with these other thingsknowing that it may not be a great long term
solution, but that there are really goodways to fix it long term once we
(27:10):
check those boxes for their insurance and start moreconservatively. So it's been really nice
to see how just starting with those conversationsearly on in my training led me to this
deeper understanding of what it's like for women to be in thisposition with incontinence and go through the treatment, over
the course of, you know, six months to a year.
It's only by talking about it that women are going to findout that there are solutions to the problem and that they don't
(27:35):
have to live a compromised lifestyle. And hope this podcastmakes that clear today.
Yes, it's a tragedy of women's healtharethat we have not empowered women to
talk about what happens with their bodies and that there is a lot ofshame surrounding talking about these issues.
You know, we talk about women's parts as, sort of thisportal to having children. And we forget
(27:58):
the other functions that are there. We forget about thebladder, we forget about having the bowel in
that area. We forget about how sexual function isan important part of our social relationships with
our partners and necessary for families to function.
We've sanitized it in a way that takeswomen's power away from them. And I
(28:18):
would love to see us build this future where weempower women to talk about what's happening with their bodies
without any Shame.
What question do they have most often?
I get asked a lot. Is it cancer?
you mean not being able to.
Hold their bladder, they fear they have cancer?
Yeah, they feel that something life threatening is goingon. And so one of the first things I
(28:41):
do after I do an exam is I say I didn't see anythingdangerous. And this is very common to
allay womens fears. But thats the biggest thingwhen I see women is they usually think something really terrible or
dangerous is going on. And that thats a big part of,I believe, the delay in seeking care.
Is there a concern that urinaryincontinence may be related to fecal incontinence?
(29:03):
Yes, and we do commonly see them togetherbecause maintaining control of bladder
and bowel function are so interrelated. Ifwe see one, were very likely to see the
other. So I have a standardized intakeform for everybody that I see where I
ask questions about urinary incontinenceand also bowel incontinence and
(29:26):
also pelvic organ prolapse because they so often cooccur.
Do you treat the fecal incontinence as well?
>> Dr. Abigail Davenport (29:32):
I do.
>> Debra Schindler (29:32):
Okay.
that's all part of that pelvic floor dysfunction.
We've covered a lot today, but the most importanttakeaway in this, as you said, is female incontinence is
common, manageable, and nothing to be ashamedof. And if you're experiencing symptoms, don't
hesitate to seek help.
Put yourynecology into your Googlesearch, go find a urog gynecologist
(29:53):
and talk to them about what's going on with you.
It can only improve your life, it can only make thingsbetter. And talk to your girlfriends about what's
going on with you so that they don't feel alone andthey don't feel like it's just, them. Because I guarantee you
it's not great advice.
Dr. Dabenport, thank you so much for being here todayand sharing your expertise with us. UN Talk.
(30:16):
If you're in the Baltimore area and you would like to schedule anappointment with Dr. Davenport, call
443-777-7608-443777-77608.
If you would like to provide feedback on this podcastor get more information on incontinence,
send an email to doctalkmedstar.net.
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