Episode Transcript
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Speaker 1 (00:03):
Did you know that it is never normal to leak urine?
Hi, I'm Maureen McGrath,registered nurse, nurse,
continence advisor and sexualhealth educator, and tonight we
are talking about urinaryincontinence.
It's a very common condition,particularly among women and
older adults.
Prevalence rates vary, butgenerally range from 25 to 45%
(00:23):
in women and are higher in olderage groups and in
institutionalized settings.
It's a multifactorial condition, with stress and urge
incontinence being the mostcommon types, and, may I say,
diagnosis is key.
It affects millions ofCanadians, including new moms,
women during and after menopauseand women managing chronic
(00:45):
conditions.
Yet most people tend to sufferin silence because of stigma,
shame or lack of information.
With World Continence Week uponus, june 16th to 20th, this
story I knew would resonatewidely with so many of you, and
it's a chance to bringvisibility to something many
women carry quietly along with alot of other load in their life
(01:09):
as well.
I'm excited to have twoincredible voices with valuable
perspectives on stigma, mentalhealth and the importance of
community and also progress inthe treatment arena.
Katie Glab is a Guelph residentliving with multiple cirrhosis
and she is going to talk aboutthe wide range of symptoms
people with chronic conditionslike MS may face and why
(01:31):
conversations around issues likeurinary incontinence matter and
we don't really talk about itbecause there's so much shame
and stigma associated with it.
But I love that Katie is goingto talk about it because she is
so compassionate, she has acommunity-centered perspective
on living with ms and advocatingfor visibility.
My other guest is casey gardner, associate director of medical
(01:53):
affairs at bd, canada, and she'sgoing to provide expert
insights into how innovation ischanging the way urinary
incontinence is treated andmanaged, making it more
accessible and less isolating.
Welcome to the podcast, ladies.
Thank you, you are so welcome,katie.
I want to ask you.
First, I want to thank you somuch for joining the program and
(02:13):
talking about this, because itis an embarrassing condition and
you know a lot of women don'ttalk about it.
I often say you know we don'treally share this.
You're not going to go to adinner party and say, hey, how
are you?
And while I'm leaking urine,things aren't so great.
I'm losing sleep.
I'm, you know, not able toexercise.
It's really impacting myquality of life.
Why do you think urinaryincontinence remains such a
(02:34):
taboo subject, even though itaffects millions of Canadians?
Speaker 2 (02:39):
See, I find this so fascinating because I I don't
know if it starts with pottytraining, like.
I have no idea, but I feel likewomen inherently just keep this
quietly to ourselves, whetheror not it has to do with the
embarrassment factor, like youpointed out earlier, whether it
has to do with you know, wedon't talk about it with our
(03:01):
spouses because you know we wantto remain desirable and that's
not an easy topic to talk aboutwith you know, your husband or
your or your spouse, and it's sonuanced in.
No, I'll just keep this quiet,I'll just manage this myself, I
don't need to talk about it, andmaybe talking about it makes it
(03:22):
real.
It makes it something that youactually have to deal with,
which is not really how weperceive ourselves.
Also, I don't know if there'san element of maybe being a
burden that we don't want to.
We don't want to feel likewe're something that has to be
taken care of.
Women inherently are caregivers.
(03:42):
So as soon as you know we'reasking for support from other
people about something asdifficult to talk about, as
stigmatized as urinaryincontinence it becomes, we're
asking for help.
And I don't know about mostwomen out there, but I struggle
with doing the very same thing.
So, and frankly, it's notsomething that our doctors are
proactively speaking about withus either.
(04:05):
I didn't know, as somebody withMS, that I am probably going to
be impacted by urinaryincontinence until Casey told me
that it was something that Imay have to tackle later in life
.
Speaker 1 (04:19):
So I don't think that there's proactive conversations
no-transcript years to see herdoctor about urinary
(04:50):
incontinence and oftentimes theresponse is because physicians
haven't been trained in medicalschool about it.
You know the response can belike can you live with it or do
Kegels, neither of which can beall that effective for many
women and women withneurological conditions like MS
and Parkinson's.
Yes, many don't realize thatthey may actually be affected by
(05:13):
urinary incontinence.
Casey, what are some of theemotional or psychological
impacts of that silence?
Speaker 3 (05:20):
I think it's a lot of other similar to a of other
things, like even infertilityfor females, where that impact
of sort of suffering in silenceand feeling like you're alone in
this journey does make itharder to reach out and get help
.
I know there's, I think you justmentioned, like a lot of
studies have shown, and onCanadian adults as well, that
like 41% don't even know thathelp is available if they are
(05:42):
urinary incontinent and if theyare only 50%ontinent and if they
are, only 50% of them willinitiate a conversation with
their healthcare provider.
So that like sort of sufferingand silence, I think is really
strong.
I think the misconception thatit's like a natural part of
aging or post-pregnancy andthere's really nothing you can
do about it probably just takesa toll on that sort of isolation
(06:03):
and feeling like you're alonein this journey and, like Katie
alluded to before, there's somany people going through this
and also there's like a lot ofstudies out there that link kind
of depression, social anxietyand isolation to urinary
incontinence.
So it's one of those thingsthat's sort of well documented
in literature but not still notwell discussed.
Speaker 1 (06:22):
You couldn't be more correct on that and not to
mention increased laundry,increased use of pads, because
there's a lot of money pouredinto advertising on television
about the only thing you can doabout urinary incontinence is
use pads, which can lead to skininfections and it can actually
lead to that depression and lossof dignity.
But we're going to be talkingabout some of the great
(06:45):
treatment options today, whichis why I'm so delighted to have
both of you on the program.
Katie, can you share a littlebit about your journey with MS
and how you felt when youlearned that bladder health and
leakage of urine may become apart of your experience?
Speaker 2 (07:03):
For sure I'd be happy to.
I think that my journey totowards diagnosis was probably
very similar to a lot of peopleout there.
It started with eye pain anddoctors telling me, ah, it's
just dry eyes.
Until I started losing myvision and realized that it
wasn't really dry eyes at all.
And then, just like again mostpeople out there, it took years
(07:26):
for me to be diagnosed and I wasdiagnosed right after the birth
of my son, my second child, andit was terrifying.
It was, you know.
All of a sudden it's thisjourney of the unknown.
You have no idea what's goingto happen tomorrow and you just,
it cripples you because youdon't know how to even almost
(07:51):
get out of bed when you knowyour eyes aren't working you.
And then you don't know if it'sgoing to get better.
You don't know if you're goingto get worse.
And going back to my commentearlier, am I just going to
become something that peoplehave to take care of?
And I had, I had a four monthold at home and that was
terrifying and just.
And then the one ifs right,just the toll on your mental
(08:13):
health.
Luckily I'm so blessed with anamazing MS specialist who just
really reassured me that thiswas going to be okay and that I
was going to be able to tomanage this.
But to Casey's point earlier,and not talking about things,
I'm not feeling, you know, beingable to be open and honest.
(08:35):
I did shelter myself and closemyself off because it felt
easier to pretend likeeverything was okay.
It felt easier to admit that Iwas strong when I really wasn't.
And what ended up happening wasI ended up going to my first MS
walk with my family andrealized how much I had actually
(08:57):
prevented them from showing upfor me by telling them that I
was strong and by telling themthat I had it all.
They didn't even really feellike that they could support me,
despite how much they wanted to.
And it was a really powerfulmoment for me to realize that I
could, you know, drop thatstrength.
I could be weak.
(09:18):
I could open up to my mom, mydad, my husband, my brother to
say my mom, my dad, my husband,my brother, to say, hey, I'm,
I'm not okay and they would bestrong for me.
And what drove that wasrealizing that if I can own this
and I can own that, I'm dealingwith this.
It led me to being open andprobably committing what most
(09:39):
people would say is a, you know,a career suicide, which is I
opened up at work.
I talked to my boss about my MSdiagnosis, I talked with my
team and and sort of opened upyeah, I live with MS and I live
with it every day, and some daysare better than others.
Some days I feel incrediblyfatigued.
Sometimes I you know I strugglewith motherhood and a husband
(10:01):
with a demanding career, andthey rallied around me.
It was really powerful and itdrove Casey getting involved in
this conversation, and I don'tknow if other people out there
have a Casey in their lives, butI highly recommend finding one.
This woman goes dives intoresearch and that it was this
(10:23):
entire group of people who go.
I bet we can do more.
And then, sitting there withCasey and go, she says you know,
did you know that this wasgoing to be something?
That urinary incontinence isnot something that I may
encounter, but it's something Iprobably will encounter.
It's something I need to preparefor.
And Casey sits back and goesencounter, it's something I need
(10:46):
to prepare for.
And Casey sits back and goeslet's talk about all of the
things that you can do to helpprevent urinary incontinence in
the future, or things that youcan do to help mitigate it.
And I'm sitting there with myjaw dropped and I'm going I'm
sorry, pardon.
Not only are you teaching methat there are things that I can
do to help prepare for myfuture, but this isn't something
that I knew as my part of myown diagnosis.
(11:08):
I go in, I see my, you know, Isee my MS specialist.
He's amazing.
He asks me Through everyphysical hey, do you have any
bladder problems?
But he's not telling me why.
He doesn't.
You know, and maybe that's myfeeling, I'm not asking, I just
go no, and I carry about my day.
But then Casey opens up thisdoor of conversations and now
it's not something to be ashamedof, it's something that the
(11:29):
people around me are saying hey,let's not only have this
conversation, let's see if wecan tackle this problem.
It was really powerful.
Speaker 1 (11:38):
Absolutely.
And you know a lot of womenpresent with bladder problems as
a first symptom of MS.
And I see that in my clinicalpractice where they're having
difficulty emptying or they're,you know, leaking or having
tight kind of overactive bladder, kind of overstretched bladder
symptoms as well, and so it'soften and I'm often thinking, oh
(12:03):
, could this be MS?
You know, because there's somany nerves in the bladder.
And so when women present withparticular bladder symptoms, you
know sometimes they need areferral to a neurologist.
You know they may need tocatheterize to fully effectively
empty their bladder to preventurinary tract infections.
And so I'm so glad that we'rehaving this conversation because
(12:25):
I also have many patients withchronic neurological conditions,
like Parkinson's disease forexample, and then they have the
diagnosis and they are dealingwith, you know, pain and
movement issues and balanceissues and gait issues, and then
all of a sudden bladder issuespresent for them and you know
they're shocked and surprisedand downright depressed.
(12:48):
They, you know this also, youknow, adds, you know, insult to
injury, if you will.
It just makes things much worse.
And sometimes women will geturinary incontinence unrelated
to a neurological condition.
So you know it can be a doublewhammy.
If you will, they may have itas a result of decreased
estrogen in the urogenital tractand they may have it because of
(13:11):
a chronic neurologicalcondition.
You've become an advocate,katie, for visibility and
community.
And what do you wish morepeople understood about living
with chronic conditions like MSand those invisible symptoms?
Speaker 2 (13:40):
your find your people that'll rally around you and
accept that.
You know, if you can have thesedifficult conversations with
your people your ride or dies,whether it's your, your partner,
whether it's your best friend,whether it's whether it's your
Casey and you find somebody andand and open up about it.
All of a sudden it becomes now,it becomes real.
And these symptoms you need totalk about it with your doctor
(14:01):
because there's so many thingsthat we don't know.
And if you can open yourself upto the opportunity for
treatments and to open upyourself to these, for these
difficult conversations, you canstart to to find a new way to
deal with it.
Start to to find a new way todeal with it which isn't just in
(14:22):
silence, right, You're not justdealing with it in, you're
opening yourself up to options.
And that's the biggest thing, Ithink, is we don't know what we
don't know.
So I didn't realize that someof my symptoms were MS related
until I asked my doctor.
And if we I know so many womenin my lives, in my life, that
are experiencing urinaryincontinence and they just
(14:44):
assume it's a result ofmotherhood oh, I pushed out a
couple of kids.
This is just how I deal with it.
No, talk to your doctor, see,if this is something that you
have to live with or if thereare things that you can be doing
, this is it's so important forus to be able to connect with
the people around us and becauseof this feeling oh, it's just
(15:05):
something else that I need todeal with.
There is sort of and, Maureen,I'm sure you see a lot of this,
but you almost get to this pointof just medical fatigue, like
medical decision-making fatigue,like you just don't want to
deal with something else andit's easier to pretend it's not
happening and just deal with itin silence than opening up and
talking about it, because you'realready dealing with your I
(15:27):
mean for MS, specifically yourDMTs, your you know, you're
going in for your injections oryou're going in for blood work,
you're going in for your MRIs,and you're just exhausted and
just don't want to deal withsomething else.
But if you can get over thathurdle, you can improve your
quality of life and this doesn'tbecome something that's.
(15:49):
You know, this hidden thing youjust have to deal with in
silence.
Speaker 1 (15:54):
Exactly, and I think you made a great point earlier
too like it's okay to say yes tohelp, and oftentimes, as women,
we don't do that.
Casey, from your perspective asthe medical affairs expert at
BD, how has innovation changedthe landscape for people
managing urinary incontinence?
(16:14):
I'm so interested in this.
Speaker 3 (16:16):
Yeah, I think and I have to give kudos to Katie for
coming out with her story andbeing so open with it, cause I
think that ultimately,innovation thrives on a better
understanding of the need andthe patient population that can
benefit from new products andsort of ways of thinking of how
we care for these patients.
So having Katie be so vocal andlike under, like asking
(16:37):
questions and like know can thisbe better, what options are
available, I think ultimatelythat whole scenario of open
dialogue just uh seedsinnovation.
But I think we kind of you knowthere's a breadth of new
products that are on the themarket from, and I think you
know there's an awareness,obviously, as we talked about
before, that incontinence is areal issue um, I think a
heightened awareness too, aroundthe complications of managing
(16:59):
incontinence in inappropriatelyin terms of like CAUTI, urinary
tract infections, incontinenceassociated dermatitis, like that
sort of.
Also, I think that awarenesswill facilitate future
innovation.
And then, obviously, our agingpopulation.
It's something that just reallyneeds to be addressed.
I'll give like a couple examples.
(17:19):
Obviously, there's, you know,we talk about it sort of in our.
My thought process goes youknow, what can you do per
prevent, what can you do totreat and what can you do?
to management and there's somany different options in each
category, very simple options.
You talked about is Kegels.
From a socioeconomic standpoint, anybody can do that, you know.
Depending on the specifics ofyour incontinence it's more or
less effective or effective.
(17:41):
I can see percutaneous tibialnerve stimulation, or PTNS, is
one that I hear more and moreabout and that can be
exceptionally impactful for someurinary incontinence.
So it's sort of an electricalstimulation that stimulates the
tibial nerve kind of around yourankle which can help regulate
bladder function and the nervesthat control it.
(18:02):
There's actually a coupledifferent electrical stimulation
sort of modalities that havedone series of trials on them
and that are all fairlyeffective.
The PTNS is a little bit lessnon-invasive, it doesn't require
an implant.
So these types of sort ofpreventative approaches or early
interventions are becoming moreand more accessible, I think,
as more companies sort of areinvesting in that technology to
(18:26):
see better outcomes.
And then I'll maybe pitch one ofBD's products that I think is a
really great one and it's anexternal catheter system.
It's called PureWick and it wasactually initially designed
specifically for women.
They have, prior to this, hadno external options for other
(18:47):
than diapers or briefs to manageurinary incontinence, and this
is essentially?
It's a non-invasive option.
It's an absorbent wick thatsort of, from a visual
perspective, looks kind of likea tampon and it sits between
your legs and it's connected toa wall suction and that wall
suction sucks the urine awayfrom that area to avoid wetness,
which can really help toprevent incontinence-associated
(19:10):
dermatitis and, because youdon't have an indwelling
catheter, it can prevent thingslike CAUTIs.
So things like that can reallygive patients kind of their
dignity back, avoidcomplications, and it's
exceptional support to your alsosupport system.
Who say, if you suffered fromnocturnal aneurysms at night,
(19:30):
you would apply this PureWikdevice and then essentially your
caregiver doesn't have to be upwith you in the middle of night
either changing sheets orhelping you to the bathroom.
And we've we've heard from alot of customers that that is
exceptionally helpful from justsort of a quality of life
perspective for both the patientand the care provider.
So that was just kind of adabbling of it.
Yeah, go ahead Right.
Speaker 1 (19:50):
I was just.
I love the Pure Wick and Irecommend it to my patients, and
you've just reminded me I haveanother patient that I'm going
to actually call her todaybecause it has so many other
benefits in addition to just thereduction of contact dermatitis
.
But it can actually reducelaundry and costs and you know,
it can prevent exhaustion aswell, especially for caregivers.
So that's, that is an awesomeproduct.
(20:12):
I have to say I've used that orrecommended it many times in my
clinical practice.
Yeah, and you know just someother simple ones like
preventing chronic constipation,for can prevent urinary
incontinence, and localizedestrogen therapy, for women as
well, can actually reduceurgency and nocturia getting up
(20:33):
at night to avoid.
So there's lots of things andI'm so happy that BD is
innovating in this area becauseit's not the sexiest subject,
let me tell you, it's not beeneasy being a sex educator
talking about urinaryincontinence in my career, but
nonetheless, somebody's got todo it.
So, casey, what are some of themost promising developments or
(20:56):
products that help makecontinence care less isolating?
Are there some things comingdown the pipeline?
Speaker 3 (21:02):
And I also wanted to ask you if you wouldn't mind
just defining what CAUTI is,c-a-u-t-i catheter-associated
urinary tract infections, whichpretty much defined it there,
but if you could cast a littlebit more light on that, yeah, so
essentially what you said is ifyou have an indwelling catheter
and that catheter sort ofultimately seeded an infection
that you then get a UTI orurinary tract infection from,
(21:25):
they're sort of bucketed in thatcategory versus if you had a
UTI and you didn't have acatheter in there's US versus
Canada, there's some differentsort of motives around awareness
around CAUTI.
As Canada, there's somedifferent sort of motives around
awareness around CAUTI.
The US hospitals are penalizedif they have, if they, if a
patient gets a CAUTI or acquiredin the hospital.
(21:46):
So as a result, there's aheightened awareness around
tracking them and aroundpreventing them.
Unfortunately, like that's notthe case in Canada, there's
definitely a lack of awarenessof their prevalence and probably
the economic impact that theyhave on the hospital, because
they are very common and I thinksome hospitals do a decent job
of tracking them but there's nopenalties, I'd say, for them if
(22:09):
a patient gets them in thehospital.
So there's pros and cons ofdoing both, but obviously when
you know more you can do betterknow more, you can do better,
and that link helps a lot.
Speaker 1 (22:26):
I think the penalty is the cost associated with
long-term hospitalizations andalso you know many patients who
are admitted with a UTI orurinary tract infections.
You know they have a greaterlength of stay.
They are at increased risk offalls and fractures.
They can.
It can of falls and fractures.
It can lead to other chronicconditions.
It can lead to them not beingable to live independently
anymore and having to go intolong-term care.
(22:47):
So I think it is very importantthat hospitals address urinary
tract infections and I think itcan be done really in the
emergency department.
But also a product likePureWeck could help as well to
all those hospitaladministrators listening out
there.
Check out this device.
Access is often a barrier,whether it's access to
(23:09):
information, care or products.
Is there anything being done tobridge that gap and what still
needs to happen?
I mean, besides opening up thisconversation and opening up the
floodgates to this conversation?
Speaker 3 (23:21):
Yeah, I full and Katie feel free to jump in.
I think the connection, thehigher prevalence in women for
urinary incontinence, I think,tethered with everything else
that seems to disproportionatelyaffect women and the lack of
awareness around it, bd isdefinitely really trying to
focus our efforts on women'shealth and promote better women
(23:41):
women's health and advocacythrough sharing conversations
like what Katie is doing, andjust really advocating for
better care and for women.
I think you know it reallyfeels like the time is now to
have these conversations.
It's becoming more open, moreaware.
Postpartum postpartum urinaryincontinence, menopauseinary
incontinence, like you mentionedbefore, there's so many um
versions of this thatdisproportionately affect women.
(24:03):
Even women aredisproportionately affected by
ms and so like it does, I think,layer on these conversations
that we need to advocate forbetter solutions for women, um
for companies to specificallydevelop products for women, not
do sort of design and trials onmen and then include women as
like an afterthought or sort ofwill this work on them?
(24:24):
I think that will really fosterinnovation.
But also I think, especially aswe are starting to shift care
from the hospital to outside ofthe hospital and like having
appropriate funding, sort ofmatch, where that care is
delivered, is like still a keybarrier, especially in Canada.
I don't think the funding athome or in long-term care really
matches the need for thatpatient population right now.
Speaker 1 (24:46):
Right, I couldn't agree with you more.
And, Katie, what would you sayto somebody who's struggling
with urinary incontinence buthasn't yet spoken to a
healthcare provider about it, oris just suffering in silence
and just carrying on with theirlives leaking, wearing pads
trying to hide it?
You know, missing out on events.
I had a patient the other daysay to me, you know, if this,
(25:07):
she was being fitted for apessary, which is a small
medical grade silicone devicethat's inserted into the vagina
to support the mid urethra inher case, and she said if this
doesn't help me, I'm not goingto go to this birthday party
that I've been invited to onTuesday.
And I said no, no, no, you must, you must.
If it doesn't help, you call meback, We'll fit you with
something else.
You know, people really missout on life when they are living
(25:28):
with urinary incontinence.
So what would you say tosomebody?
Speaker 2 (25:31):
Oh, my goodness, All I want to say is that you feel
so alone right now, but what'sinteresting is you're probably
not and you're probably like.
The people around you areprobably either somebody near
you that's probably goingthrough maybe not necessarily
with, with a chronic disease,like but we're all impacted by
(25:57):
your incontinence in some wayand I think that that I know you
feel alone right now, butyou're not.
There's so many people outthere that are going through the
same thing.
And I feel like to Casey'spoint earlier.
The mental toll it takes onstaying silent and dealing with
this without talking to yourhealthcare provider is so heavy.
(26:19):
But I also completelyappreciate how hard it is to
take that first step, to go andtalk to your doctor about it,
and I think the only realmessage I want to say is yes,
you're struggling, but you don'tneed to struggle alone and if
you're not ready to open upabout it, you have to be the
first person to take that step.
(26:39):
I can understand that, but Ijust want to hope that you
understand that most, that thereare people out there that are
going through the same thing andI don't want you to feel so
completely alone.
And when you're ready to talkto your doctor.
That's it, yeah.
Speaker 1 (26:58):
And it's often the first step in a in a pathway of
many care providers.
Speaker 2 (27:03):
The other thing that, going back to what Casey was
saying about, you know, accessto care.
We are, we as women, need toreally rally around one another
as we, you know we're stepsbehind really changing the
medical landscape and havingeither OBGYNs or even
(27:24):
neurologists to sit there andproactively say, hey, you've
just had a couple of babies oryou've been, you know, diagnosed
with MS.
Have you heard about pelvicfloor therapies?
Have you heard about thesedifferent things?
This is something that you maywant to consider and because
that's not quite happening yet,we as women need to really drive
those conversations and rallyaround one another.
We have the power to supportand empower the women in our
(27:48):
lives.
My best friend had a baby andsaid, hey, have you heard about
pelvic floor therapy?
And I said, what are youtalking about?
And she helped educate me onwhat that's like postpartum.
We need to be able to be betterat supporting one another and
opening these doors forconversation organically and
educating each other as women.
Speaker 1 (28:09):
Absolutely, and sharing stories is so empowering
.
Casey, if you could make onebold change culturally,
medically or policy wise tobetter support women living with
urinary incontinence, whatwould that be?
Speaker 3 (28:22):
I don't know if I have one.
I would say awareness andaccess is kind of the key that
stand out for me, you know,awareness of conditions that
specifically affect women andaccess for women to get those
medically appropriate treatmentsfor them.
Speaker 1 (28:38):
Awesome information Ladies.
Thank you both so much forjoining me on the podcast
tonight.
I really appreciated yourvoices and the information, and
I'm going to share some of thisinformation with my patients
just today.
So thanks for the reminderabout the PureWik.
Speaker 3 (28:53):
Thank you for having us.
Thank you so much.
Speaker 1 (28:55):
You are both so welcome.
My guests were Katie Glab she'sa Guelph resident living with
MS, and she spoke about the widerange of symptoms for people
who live with chronic conditionslike MS and she's not only
facing those symptoms but maybepossibly, quite honestly,
probably looking at living withurinary incontinence at some
(29:19):
point in her life.
And my other guest was CaseyGardner, Associate Director of
Medical Affairs at BD Canada,and she provided so eloquently
expert insights into howinnovation is changing the way
urinary incontinence is treatedand managed.
If you feel that this episodecould help somebody else, feel
free to share it with yourmothers, your friends, your
daughters, your sisters.
(29:40):
We've got to make this moreaccessible and less isolating
for people.
And thanks so much for tuningin.
I'm Maureen McGrath, registerednurse, nurse, contents advisor
and sexual health educator.
You can get more information atmy website, maureenmcgrathcom,
or you can head on over to myYouTube channel or find me on
Instagram, Facebook, wherever.
And thanks so much for tuningin.
(30:00):
Helping women's bladders onesqueeze at a time here, ladies.
Until next time, I'm MaureenMcGrath.
Did you know that it is never normal to leak urine?
Hi, I'm Maureen McGrath,registered nurse, nurse,
continence advisor and sexualhealth educator, and tonight we
are talking about urinaryincontinence.
It's a very common condition,particularly among women and
older adults.
Prevalence rates vary, butgenerally range from 25 to 45%
(00:23):
in women and are higher in olderage groups and in
institutionalized settings.
It's a multifactorial condition, with stress and urge
incontinence being the mostcommon types, and, may I say,
diagnosis is key.
It affects millions ofCanadians, including new moms,
women during and after menopauseand women managing chronic
(00:45):
conditions.
Yet most people tend to sufferin silence because of stigma,
shame or lack of information.
With World Continence Week uponus, june 16th to 20th, this
story I knew would resonatewidely with so many of you, and
it's a chance to bringvisibility to something many
women carry quietly along with alot of other load in their life
(01:09):
as well.
I'm excited to have twoincredible voices with valuable
perspectives on stigma, mentalhealth and the importance of
community and also progress inthe treatment arena.
Katie Glab is a Guelph residentliving with multiple cirrhosis
and she is going to talk aboutthe wide range of symptoms
people with chronic conditionslike MS may face and why
(01:31):
conversations around issues likeurinary incontinence matter and
we don't really talk about itbecause there's so much shame
and stigma associated with it.
But I love that Katie is goingto talk about it because she is
so compassionate, she has acommunity-centered perspective
on living with ms and advocatingfor visibility.
My other guest is casey gardner, associate director of medical
(01:53):
affairs at bd, canada, and she'sgoing to provide expert
insights into how innovation ischanging the way urinary
incontinence is treated andmanaged, making it more
accessible and less isolating.
Welcome to the podcast, ladies.
Thank you, you are so welcome,katie.
I want to ask you.
First, I want to thank you somuch for joining the program and
(02:13):
talking about this, because itis an embarrassing condition and
you know a lot of women don'ttalk about it.
I often say you know we don'treally share this.
You're not going to go to adinner party and say, hey, how
are you?
And while I'm leaking urine,things aren't so great.
I'm losing sleep.
I'm, you know, not able toexercise.
It's really impacting myquality of life.
Why do you think urinaryincontinence remains such a
(02:34):
taboo subject, even though itaffects millions of Canadians?
Speaker 2 (02:39):
See, I find this so fascinating because I I don't
know if it starts with pottytraining, like.
I have no idea, but I feel likewomen inherently just keep this
quietly to ourselves, whetheror not it has to do with the
embarrassment factor, like youpointed out earlier, whether it
has to do with you know, wedon't talk about it with our
(03:01):
spouses because you know we wantto remain desirable and that's
not an easy topic to talk aboutwith you know, your husband or
your or your spouse, and it's sonuanced in.
No, I'll just keep this quiet,I'll just manage this myself, I
don't need to talk about it, andmaybe talking about it makes it
(03:22):
real.
It makes it something that youactually have to deal with,
which is not really how weperceive ourselves.
Also, I don't know if there'san element of maybe being a
burden that we don't want to.
We don't want to feel likewe're something that has to be
taken care of.
Women inherently are caregivers.
(03:42):
So as soon as you know we'reasking for support from other
people about something asdifficult to talk about, as
stigmatized as urinaryincontinence it becomes, we're
asking for help.
And I don't know about mostwomen out there, but I struggle
with doing the very same thing.
So, and frankly, it's notsomething that our doctors are
proactively speaking about withus either.
(04:05):
I didn't know, as somebody withMS, that I am probably going to
be impacted by urinaryincontinence until Casey told me
that it was something that Imay have to tackle later in life
.
Speaker 1 (04:19):
So I don't think that there's proactive conversations
no-transcript years to see herdoctor about urinary
(04:50):
incontinence and oftentimes theresponse is because physicians
haven't been trained in medicalschool about it.
You know the response can belike can you live with it or do
Kegels, neither of which can beall that effective for many
women and women withneurological conditions like MS
and Parkinson's.
Yes, many don't realize thatthey may actually be affected by
(05:13):
urinary incontinence.
Casey, what are some of theemotional or psychological
impacts of that silence?
Speaker 3 (05:20):
I think it's a lot of other similar to a of other
things, like even infertilityfor females, where that impact
of sort of suffering in silenceand feeling like you're alone in
this journey does make itharder to reach out and get help
.
I know there's, I think you justmentioned, like a lot of
studies have shown, and onCanadian adults as well, that
like 41% don't even know thathelp is available if they are
(05:42):
urinary incontinent and if theyare only 50%ontinent and if they
are, only 50% of them willinitiate a conversation with
their healthcare provider.
So that like sort of sufferingand silence, I think is really
strong.
I think the misconception thatit's like a natural part of
aging or post-pregnancy andthere's really nothing you can
do about it probably just takesa toll on that sort of isolation
(06:03):
and feeling like you're alonein this journey and, like Katie
alluded to before, there's somany people going through this
and also there's like a lot ofstudies out there that link kind
of depression, social anxietyand isolation to urinary
incontinence.
So it's one of those thingsthat's sort of well documented
in literature but not still notwell discussed.
Speaker 1 (06:22):
You couldn't be more correct on that and not to
mention increased laundry,increased use of pads, because
there's a lot of money pouredinto advertising on television
about the only thing you can doabout urinary incontinence is
use pads, which can lead to skininfections and it can actually
lead to that depression and lossof dignity.
But we're going to be talkingabout some of the great
(06:45):
treatment options today, whichis why I'm so delighted to have
both of you on the program.
Katie, can you share a littlebit about your journey with MS
and how you felt when youlearned that bladder health and
leakage of urine may become apart of your experience?
Speaker 2 (07:03):
For sure I'd be happy to.
I think that my journey totowards diagnosis was probably
very similar to a lot of peopleout there.
It started with eye pain anddoctors telling me, ah, it's
just dry eyes.
Until I started losing myvision and realized that it
wasn't really dry eyes at all.
And then, just like again mostpeople out there, it took years
(07:26):
for me to be diagnosed and I wasdiagnosed right after the birth
of my son, my second child, andit was terrifying.
It was, you know.
All of a sudden it's thisjourney of the unknown.
You have no idea what's goingto happen tomorrow and you just,
it cripples you because youdon't know how to even almost
(07:51):
get out of bed when you knowyour eyes aren't working you.
And then you don't know if it'sgoing to get better.
You don't know if you're goingto get worse.
And going back to my commentearlier, am I just going to
become something that peoplehave to take care of?
And I had, I had a four monthold at home and that was
terrifying and just.
And then the one ifs right,just the toll on your mental
(08:13):
health.
Luckily I'm so blessed with anamazing MS specialist who just
really reassured me that thiswas going to be okay and that I
was going to be able to tomanage this.
But to Casey's point earlier,and not talking about things,
I'm not feeling, you know, beingable to be open and honest.
(08:35):
I did shelter myself and closemyself off because it felt
easier to pretend likeeverything was okay.
It felt easier to admit that Iwas strong when I really wasn't.
And what ended up happening wasI ended up going to my first MS
walk with my family andrealized how much I had actually
(08:57):
prevented them from showing upfor me by telling them that I
was strong and by telling themthat I had it all.
They didn't even really feellike that they could support me,
despite how much they wanted to.
And it was a really powerfulmoment for me to realize that I
could, you know, drop thatstrength.
I could be weak.
(09:18):
I could open up to my mom, mydad, my husband, my brother to
say my mom, my dad, my husband,my brother, to say, hey, I'm,
I'm not okay and they would bestrong for me.
And what drove that wasrealizing that if I can own this
and I can own that, I'm dealingwith this.
It led me to being open andprobably committing what most
(09:39):
people would say is a, you know,a career suicide, which is I
opened up at work.
I talked to my boss about my MSdiagnosis, I talked with my
team and and sort of opened upyeah, I live with MS and I live
with it every day, and some daysare better than others.
Some days I feel incrediblyfatigued.
Sometimes I you know I strugglewith motherhood and a husband
(10:01):
with a demanding career, andthey rallied around me.
It was really powerful and itdrove Casey getting involved in
this conversation, and I don'tknow if other people out there
have a Casey in their lives, butI highly recommend finding one.
This woman goes dives intoresearch and that it was this
(10:23):
entire group of people who go.
I bet we can do more.
And then, sitting there withCasey and go, she says you know,
did you know that this wasgoing to be something?
That urinary incontinence isnot something that I may
encounter, but it's something Iprobably will encounter.
It's something I need to preparefor.
And Casey sits back and goesencounter, it's something I need
(10:46):
to prepare for.
And Casey sits back and goeslet's talk about all of the
things that you can do to helpprevent urinary incontinence in
the future, or things that youcan do to help mitigate it.
And I'm sitting there with myjaw dropped and I'm going I'm
sorry, pardon.
Not only are you teaching methat there are things that I can
do to help prepare for myfuture, but this isn't something
that I knew as my part of myown diagnosis.
(11:08):
I go in, I see my, you know, Isee my MS specialist.
He's amazing.
He asks me Through everyphysical hey, do you have any
bladder problems?
But he's not telling me why.
He doesn't.
You know, and maybe that's myfeeling, I'm not asking, I just
go no, and I carry about my day.
But then Casey opens up thisdoor of conversations and now
it's not something to be ashamedof, it's something that the
(11:29):
people around me are saying hey,let's not only have this
conversation, let's see if wecan tackle this problem.
It was really powerful.
Speaker 1 (11:38):
Absolutely.
And you know a lot of womenpresent with bladder problems as
a first symptom of MS.
And I see that in my clinicalpractice where they're having
difficulty emptying or they're,you know, leaking or having
tight kind of overactive bladder, kind of overstretched bladder
symptoms as well, and so it'soften and I'm often thinking, oh
(12:03):
, could this be MS?
You know, because there's somany nerves in the bladder.
And so when women present withparticular bladder symptoms, you
know sometimes they need areferral to a neurologist.
You know they may need tocatheterize to fully effectively
empty their bladder to preventurinary tract infections.
And so I'm so glad that we'rehaving this conversation because
(12:25):
I also have many patients withchronic neurological conditions,
like Parkinson's disease forexample, and then they have the
diagnosis and they are dealingwith, you know, pain and
movement issues and balanceissues and gait issues, and then
all of a sudden bladder issuespresent for them and you know
they're shocked and surprisedand downright depressed.
(12:48):
They, you know this also, youknow, adds, you know, insult to
injury, if you will.
It just makes things much worse.
And sometimes women will geturinary incontinence unrelated
to a neurological condition.
So you know it can be a doublewhammy.
If you will, they may have itas a result of decreased
estrogen in the urogenital tractand they may have it because of
(13:11):
a chronic neurologicalcondition.
You've become an advocate,katie, for visibility and
community.
And what do you wish morepeople understood about living
with chronic conditions like MSand those invisible symptoms?
Speaker 2 (13:40):
your find your people that'll rally around you and
accept that.
You know, if you can have thesedifficult conversations with
your people your ride or dies,whether it's your, your partner,
whether it's your best friend,whether it's whether it's your
Casey and you find somebody andand and open up about it.
All of a sudden it becomes now,it becomes real.
And these symptoms you need totalk about it with your doctor
(14:01):
because there's so many thingsthat we don't know.
And if you can open yourself upto the opportunity for
treatments and to open upyourself to these, for these
difficult conversations, you canstart to to find a new way to
deal with it.
Start to to find a new way todeal with it which isn't just in
(14:22):
silence, right, You're not justdealing with it in, you're
opening yourself up to options.
And that's the biggest thing, Ithink, is we don't know what we
don't know.
So I didn't realize that someof my symptoms were MS related
until I asked my doctor.
And if we I know so many womenin my lives, in my life, that
are experiencing urinaryincontinence and they just
(14:44):
assume it's a result ofmotherhood oh, I pushed out a
couple of kids.
This is just how I deal with it.
No, talk to your doctor, see,if this is something that you
have to live with or if thereare things that you can be doing
, this is it's so important forus to be able to connect with
the people around us and becauseof this feeling oh, it's just
(15:05):
something else that I need todeal with.
There is sort of and, Maureen,I'm sure you see a lot of this,
but you almost get to this pointof just medical fatigue, like
medical decision-making fatigue,like you just don't want to
deal with something else andit's easier to pretend it's not
happening and just deal with itin silence than opening up and
talking about it, because you'realready dealing with your I
(15:27):
mean for MS, specifically yourDMTs, your you know, you're
going in for your injections oryou're going in for blood work,
you're going in for your MRIs,and you're just exhausted and
just don't want to deal withsomething else.
But if you can get over thathurdle, you can improve your
quality of life and this doesn'tbecome something that's.
(15:49):
You know, this hidden thing youjust have to deal with in
silence.
Speaker 1 (15:54):
Exactly, and I think you made a great point earlier
too like it's okay to say yes tohelp, and oftentimes, as women,
we don't do that.
Casey, from your perspective asthe medical affairs expert at
BD, how has innovation changedthe landscape for people
managing urinary incontinence?
(16:14):
I'm so interested in this.
Speaker 3 (16:16):
Yeah, I think and I have to give kudos to Katie for
coming out with her story andbeing so open with it, cause I
think that ultimately,innovation thrives on a better
understanding of the need andthe patient population that can
benefit from new products andsort of ways of thinking of how
we care for these patients.
So having Katie be so vocal andlike under, like asking
(16:37):
questions and like know can thisbe better, what options are
available, I think ultimatelythat whole scenario of open
dialogue just uh seedsinnovation.
But I think we kind of you knowthere's a breadth of new
products that are on the themarket from, and I think you
know there's an awareness,obviously, as we talked about
before, that incontinence is areal issue um, I think a
heightened awareness too, aroundthe complications of managing
(16:59):
incontinence in inappropriatelyin terms of like CAUTI, urinary
tract infections, incontinenceassociated dermatitis, like that
sort of.
Also, I think that awarenesswill facilitate future
innovation.
And then, obviously, our agingpopulation.
It's something that just reallyneeds to be addressed.
I'll give like a couple examples.
(17:19):
Obviously, there's, you know,we talk about it sort of in our.
My thought process goes youknow, what can you do per
prevent, what can you do totreat and what can you do?
to management and there's somany different options in each
category, very simple options.
You talked about is Kegels.
From a socioeconomic standpoint, anybody can do that, you know.
Depending on the specifics ofyour incontinence it's more or
less effective or effective.
(17:41):
I can see percutaneous tibialnerve stimulation, or PTNS, is
one that I hear more and moreabout and that can be
exceptionally impactful for someurinary incontinence.
So it's sort of an electricalstimulation that stimulates the
tibial nerve kind of around yourankle which can help regulate
bladder function and the nervesthat control it.
(18:02):
There's actually a coupledifferent electrical stimulation
sort of modalities that havedone series of trials on them
and that are all fairlyeffective.
The PTNS is a little bit lessnon-invasive, it doesn't require
an implant.
So these types of sort ofpreventative approaches or early
interventions are becoming moreand more accessible, I think,
as more companies sort of areinvesting in that technology to
(18:26):
see better outcomes.
And then I'll maybe pitch one ofBD's products that I think is a
really great one and it's anexternal catheter system.
It's called PureWick and it wasactually initially designed
specifically for women.
They have, prior to this, hadno external options for other
(18:47):
than diapers or briefs to manageurinary incontinence, and this
is essentially?
It's a non-invasive option.
It's an absorbent wick thatsort of, from a visual
perspective, looks kind of likea tampon and it sits between
your legs and it's connected toa wall suction and that wall
suction sucks the urine awayfrom that area to avoid wetness,
which can really help toprevent incontinence-associated
(19:10):
dermatitis and, because youdon't have an indwelling
catheter, it can prevent thingslike CAUTIs.
So things like that can reallygive patients kind of their
dignity back, avoidcomplications, and it's
exceptional support to your alsosupport system.
Who say, if you suffered fromnocturnal aneurysms at night,
(19:30):
you would apply this PureWikdevice and then essentially your
caregiver doesn't have to be upwith you in the middle of night
either changing sheets orhelping you to the bathroom.
And we've we've heard from alot of customers that that is
exceptionally helpful from justsort of a quality of life
perspective for both the patientand the care provider.
So that was just kind of adabbling of it.
Yeah, go ahead Right.
Speaker 1 (19:50):
I was just.
I love the Pure Wick and Irecommend it to my patients, and
you've just reminded me I haveanother patient that I'm going
to actually call her todaybecause it has so many other
benefits in addition to just thereduction of contact dermatitis
.
But it can actually reducelaundry and costs and you know,
it can prevent exhaustion aswell, especially for caregivers.
So that's, that is an awesomeproduct.
(20:12):
I have to say I've used that orrecommended it many times in my
clinical practice.
Yeah, and you know just someother simple ones like
preventing chronic constipation,for can prevent urinary
incontinence, and localizedestrogen therapy, for women as
well, can actually reduceurgency and nocturia getting up
(20:33):
at night to avoid.
So there's lots of things andI'm so happy that BD is
innovating in this area becauseit's not the sexiest subject,
let me tell you, it's not beeneasy being a sex educator
talking about urinaryincontinence in my career, but
nonetheless, somebody's got todo it.
So, casey, what are some of themost promising developments or
(20:56):
products that help makecontinence care less isolating?
Are there some things comingdown the pipeline?
Speaker 3 (21:02):
And I also wanted to ask you if you wouldn't mind
just defining what CAUTI is,c-a-u-t-i catheter-associated
urinary tract infections, whichpretty much defined it there,
but if you could cast a littlebit more light on that, yeah, so
essentially what you said is ifyou have an indwelling catheter
and that catheter sort ofultimately seeded an infection
that you then get a UTI orurinary tract infection from,
(21:25):
they're sort of bucketed in thatcategory versus if you had a
UTI and you didn't have acatheter in there's US versus
Canada, there's some differentsort of motives around awareness
around CAUTI.
As Canada, there's somedifferent sort of motives around
awareness around CAUTI.
The US hospitals are penalizedif they have, if they, if a
patient gets a CAUTI or acquiredin the hospital.
(21:46):
So as a result, there's aheightened awareness around
tracking them and aroundpreventing them.
Unfortunately, like that's notthe case in Canada, there's
definitely a lack of awarenessof their prevalence and probably
the economic impact that theyhave on the hospital, because
they are very common and I thinksome hospitals do a decent job
of tracking them but there's nopenalties, I'd say, for them if
(22:09):
a patient gets them in thehospital.
So there's pros and cons ofdoing both, but obviously when
you know more you can do betterknow more, you can do better,
and that link helps a lot.
Speaker 1 (22:26):
I think the penalty is the cost associated with
long-term hospitalizations andalso you know many patients who
are admitted with a UTI orurinary tract infections.
You know they have a greaterlength of stay.
They are at increased risk offalls and fractures.
They can.
It can of falls and fractures.
It can lead to other chronicconditions.
It can lead to them not beingable to live independently
anymore and having to go intolong-term care.
(22:47):
So I think it is very importantthat hospitals address urinary
tract infections and I think itcan be done really in the
emergency department.
But also a product likePureWeck could help as well to
all those hospitaladministrators listening out
there.
Check out this device.
Access is often a barrier,whether it's access to
(23:09):
information, care or products.
Is there anything being done tobridge that gap and what still
needs to happen?
I mean, besides opening up thisconversation and opening up the
floodgates to this conversation?
Speaker 3 (23:21):
Yeah, I full and Katie feel free to jump in.
I think the connection, thehigher prevalence in women for
urinary incontinence, I think,tethered with everything else
that seems to disproportionatelyaffect women and the lack of
awareness around it, bd isdefinitely really trying to
focus our efforts on women'shealth and promote better women
(23:41):
women's health and advocacythrough sharing conversations
like what Katie is doing, andjust really advocating for
better care and for women.
I think you know it reallyfeels like the time is now to
have these conversations.
It's becoming more open, moreaware.
Postpartum postpartum urinaryincontinence, menopauseinary
incontinence, like you mentionedbefore, there's so many um
versions of this thatdisproportionately affect women.
(24:03):
Even women aredisproportionately affected by
ms and so like it does, I think,layer on these conversations
that we need to advocate forbetter solutions for women, um
for companies to specificallydevelop products for women, not
do sort of design and trials onmen and then include women as
like an afterthought or sort ofwill this work on them?
(24:24):
I think that will really fosterinnovation.
But also I think, especially aswe are starting to shift care
from the hospital to outside ofthe hospital and like having
appropriate funding, sort ofmatch, where that care is
delivered, is like still a keybarrier, especially in Canada.
I don't think the funding athome or in long-term care really
matches the need for thatpatient population right now.
Speaker 1 (24:46):
Right, I couldn't agree with you more.
And, Katie, what would you sayto somebody who's struggling
with urinary incontinence buthasn't yet spoken to a
healthcare provider about it, oris just suffering in silence
and just carrying on with theirlives leaking, wearing pads
trying to hide it?
You know, missing out on events.
I had a patient the other daysay to me, you know, if this,
(25:07):
she was being fitted for apessary, which is a small
medical grade silicone devicethat's inserted into the vagina
to support the mid urethra inher case, and she said if this
doesn't help me, I'm not goingto go to this birthday party
that I've been invited to onTuesday.
And I said no, no, no, you must, you must.
If it doesn't help, you call meback, We'll fit you with
something else.
You know, people really missout on life when they are living
(25:28):
with urinary incontinence.
So what would you say tosomebody?
Speaker 2 (25:31):
Oh, my goodness, All I want to say is that you feel
so alone right now, but what'sinteresting is you're probably
not and you're probably like.
The people around you areprobably either somebody near
you that's probably goingthrough maybe not necessarily
with, with a chronic disease,like but we're all impacted by
(25:57):
your incontinence in some wayand I think that that I know you
feel alone right now, butyou're not.
There's so many people outthere that are going through the
same thing.
And I feel like to Casey'spoint earlier.
The mental toll it takes onstaying silent and dealing with
this without talking to yourhealthcare provider is so heavy.
(26:19):
But I also completelyappreciate how hard it is to
take that first step, to go andtalk to your doctor about it,
and I think the only realmessage I want to say is yes,
you're struggling, but you don'tneed to struggle alone and if
you're not ready to open upabout it, you have to be the
first person to take that step.
(26:39):
I can understand that, but Ijust want to hope that you
understand that most, that thereare people out there that are
going through the same thing andI don't want you to feel so
completely alone.
And when you're ready to talkto your doctor.
That's it, yeah.
Speaker 1 (26:58):
And it's often the first step in a in a pathway of
many care providers.
Speaker 2 (27:03):
The other thing that, going back to what Casey was
saying about, you know, accessto care.
We are, we as women, need toreally rally around one another
as we, you know we're stepsbehind really changing the
medical landscape and havingeither OBGYNs or even
(27:24):
neurologists to sit there andproactively say, hey, you've
just had a couple of babies oryou've been, you know, diagnosed
with MS.
Have you heard about pelvicfloor therapies?
Have you heard about thesedifferent things?
This is something that you maywant to consider and because
that's not quite happening yet,we as women need to really drive
those conversations and rallyaround one another.
We have the power to supportand empower the women in our
(27:48):
lives.
My best friend had a baby andsaid, hey, have you heard about
pelvic floor therapy?
And I said, what are youtalking about?
And she helped educate me onwhat that's like postpartum.
We need to be able to be betterat supporting one another and
opening these doors forconversation organically and
educating each other as women.
Speaker 1 (28:09):
Absolutely, and sharing stories is so empowering
.
Casey, if you could make onebold change culturally,
medically or policy wise tobetter support women living with
urinary incontinence, whatwould that be?
Speaker 3 (28:22):
I don't know if I have one.
I would say awareness andaccess is kind of the key that
stand out for me, you know,awareness of conditions that
specifically affect women andaccess for women to get those
medically appropriate treatmentsfor them.
Speaker 1 (28:38):
Awesome information Ladies.
Thank you both so much forjoining me on the podcast
tonight.
I really appreciated yourvoices and the information, and
I'm going to share some of thisinformation with my patients
just today.
So thanks for the reminderabout the PureWik.
Speaker 3 (28:53):
Thank you for having us.
Thank you so much.
Speaker 1 (28:55):
You are both so welcome.
My guests were Katie Glab she'sa Guelph resident living with
MS, and she spoke about the widerange of symptoms for people
who live with chronic conditionslike MS and she's not only
facing those symptoms but maybepossibly, quite honestly,
probably looking at living withurinary incontinence at some
(29:19):
point in her life.
And my other guest was CaseyGardner, Associate Director of
Medical Affairs at BD Canada,and she provided so eloquently
expert insights into howinnovation is changing the way
urinary incontinence is treatedand managed.
If you feel that this episodecould help somebody else, feel
free to share it with yourmothers, your friends, your
daughters, your sisters.
(29:40):
We've got to make this moreaccessible and less isolating
for people.
And thanks so much for tuningin.
I'm Maureen McGrath, registerednurse, nurse, contents advisor
and sexual health educator.
You can get more information atmy website, maureenmcgrathcom,
or you can head on over to myYouTube channel or find me on
Instagram, Facebook, wherever.
And thanks so much for tuningin.
(30:00):
Helping women's bladders onesqueeze at a time here, ladies.
Until next time, I'm MaureenMcGrath.
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