September 10, 2025 • 43 mins
Have you ever wondered why urinary issues seem to affect women differently than men? The answer lies in our unique anatomy and hormonal makeup — factors that make female urinary health both fascinating and complex.
Dr. Holly Thacker takes listeners on a comprehensive journey through the most common urologic conditions affecting women during Urology Awareness Month. From the annoying but potentially dangerous urinary tract infections to the embarrassing reality of pelvic organ prolapse that affects up to one in eight women, this episode breaks down what's happening and why.
"Everyone needs a bladder that works," Dr. Thacker emphasizes as she explores how bladder health connects to overall wellness and quality of life. She tackles taboo topics with medical precision while offering practical advice for prevention and management. You'll learn why maintaining pelvic floor strength matters even if you've never been pregnant, how hormonal changes dramatically affect urologic health, and why sexual function is inextricably linked to bladder health.
Subscribe to the Speaking of Women's Health Podcast wherever you listen to podcasts and visit speakingofwomenshealth.com for more resources on taking charge of your health.
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Episode Transcript
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Speaker 1 (00:06):
welcome to the speaking of women's health
podcast.
I'm your host, dr holly thacker, and I am back in our sunflower
house for a new edition of ourspeaking of women's health
podcast and on this new podcastfor the month of September,
(00:30):
which is Urology Awareness Month, we're going to specifically
talk about female urologyconditions.
Certainly there's a lot that wecould talk about for male
urology and there are someoverlaps, but they are quite
different and we do have someurologists that specialize in
(00:53):
what's called female urology.
So they're not necessarilyfemales, they could be male
physicians or female physicians,but they specialize in problems
that women and females have inthe urologic system.
And some of the more commonissues in women include the
(01:14):
common and annoying andsometimes dreaded urinary tract
infections.
Overactive bladder is anothervexing and sometimes annoying
problem.
Interstitial cystitis, whichkind of overlaps with chronic
pelvic pain, can be challengingsometimes to diagnose and manage
(01:39):
.
Pelvic organ prolapse becausewomen have a vagina, that's a
hole in the pelvic floor.
It can lead to the uterus kindof coming down if there's not
adequate support, and evencoming out of the vagina.
In fact, up to one in eightwomen can experience the need
(02:00):
for hysterectomy and pelvicsurgery because of prolapse and
certainly if you have a familymember that's a blood relative
with pelvic prolapse, that'simportant information to give to
your healthcare team.
Urinary incontinence oruncontrolled bladder leakage,
whether it's stress,incontinence from coughing or
(02:21):
urge incontinence or postpartumbecause of all the major changes
that have happened in thepelvis and also kidney stones,
they affect both men and women.
So the reason women are moreprevalent to some of these types
of conditions is in partbecause of the female anatomy of
(02:44):
the pelvis, as well as hormones.
Now, in terms of urinary tractinfections, in June, as you may
recall, I did a podcast onurinary tract infections called
From Solutions to Symptoms.
That went in a lot of depth oneverything that you need to know
about bladder infections andurinary tract infections.
(03:08):
So if you haven't listened tothat one, I think that's a good
one to go back to listen to.
And if you don't alreadysubscribe to our free podcast,
just hit follow or subscribe, soevery time there's a new
podcast, you'll get notified.
So a urinary tract infection iswhen the bladder or the urethra,
or even all the way upascending to the kidneys, can be
(03:31):
infected, usually with bacteria, and this can progress to
pyelonephritis, sepsis and evendeath.
So it's more than just a minorannoyance.
It's more than just a minorannoyance, and women get urinary
tract infections easier thanmen because the urethra is so
much smaller in women and it'sobviously in close proximity to
(03:53):
the skin of the vulva, theperianal area, and normal
bacteria from the skin or fromthe perianal area can enter into
the urethra, which is a sterilearea where there's not supposed
to be bacteria.
Some of the symptoms caninclude burning, frequent
urination, feeling the need tourinate even when there's an
(04:16):
empty bladder, pain in thepelvic area or even the lower
back or upper back.
If it's spreading.
There can be blood in the urine, fever, chills, even fatigue or
confusion or nausea or vomiting, and sometimes, in older
persons, they may not have afever.
Their mental status may justchange.
(04:38):
So in order to help preventbladder infections and more
serious urinary tract infections, it's important to stay
hydrated.
Avoid dehydration.
Drink enough water so that theurine is lighter in color, not a
dark yellow, so that you'reflushing out any bacteria that
might be trying to creep up intothe bladder, and don't hold
(05:00):
your urine.
Try to urinate every four tosix hours.
Always wipe from front to back,especially urinating before and
after any pelvic exams.
Sexual activity, any kind ofvulva manipulation is important.
We also recommend that womenavoid douching.
(05:22):
Avoid any feminine hygienesprays.
These can be irritating andthey can change the pH of the
vagina when you're menstruating.
If you're still menstruating,it's important to regularly
change pads and tampons and notleave them in or on your body
too long.
Your body too long.
(05:47):
Wearing cotton white underwear,loose-fitting clothes anything
that's super tight creates moreof a moist environment which can
promote bacterial growth.
It's also important to keepyour nutrition up, your vitamin
D up, getting enough rest.
Now, in terms of minor urinarytract infections, sometimes they
can go away on their own.
Some women might start on likea cranberry extract or a
(06:08):
D-mannose which inhibits E coli,but most of the time they do
need to be treated with anantibiotic and you may need to
get a clean catch urine.
And that's when you wipe thevulva clean with a special wipe
and you urinate a little bitinto the toilet.
Then you open up a sterilecontainer and get the middle
(06:32):
part of the stream in to getenough of a specimen and close
the lid and then you can sitdown and finish urinating and
emptying your bladder, becausethen that isn't contaminated
with vaginal secretions or skinbacteria and your express care
(06:52):
or urgent care or doctor'soffice can usually accomplish
this.
Now, overactive bladder is whenyou have that strong urge to
pass urine, even when yourbladder is not very full, and it
can be frequent.
If you feel the need to have tourinate more than eight times a
(07:13):
day, you may have overactivebladder and you should see your
health care team.
You don't necessarily have tostart with a female urologist or
a urogynecologist.
That's a gynecologist that'sgone on to specialize more
intensely in the urinary systemand pelvic prolapse.
(07:35):
So there's a lot of differentpotential causes of overactive
bladder.
When the bladder muscles startto contract without warning, and
sometimes not only does thatlead to the urge to urinate, but
it can actually lead toinvoluntary urine leakage or
so-called urinary incontinence.
(07:56):
Now, overactive bladder can be asymptom of other neurologic
problems, such as diabetes,multiple sclerosis, parkinson's
disease, or it can be the firstsign of a bladder infection,
urinary tract infection.
Some medicines like diuretics,which are sometimes prescribed
(08:20):
to get extra fluid off the body,can worsen symptoms.
Excessive caffeine intake isvery irritating to the bladder.
So is alcohol, any kind ofnicotine products and
constipation, which isrelatively common in women.
All can contribute tooveractive bladder.
And my very first podcast thatwasn't my book or was not
(08:44):
medical CME that I did in seasonone in 2023 was about
constipation, and constipationis definitely more common in
women.
Women tend to have a moresluggish colon and it is really
imperative for good bladderfunction and good pelvic tone to
not have constipation.
(09:05):
So some of the symptoms ofoveractive bladder or that
irritating sensation of an urgeto urinate going too often or if
you get up more than twice anight to urinate, it is
important to get enough fluidintake, but not excessive fluid
(09:28):
intake.
And in order to help preventoveractive bladder, it's
important to do appropriatepelvic floor strengthening.
They've been dubbed the Kegelexercise and when you go in for
your pelvic exam with yourwomen's health care nurse
practitioner or physician, thatclinician can check for your
(09:50):
pelvic tone and see if you knowhow to contract the pelvic floor
, the levator ani muscles.
Getting regular daily physicalactivity is helpful.
Limiting bladder irritants,especially caffeine and alcohol,
helpful.
Limiting bladder irritants,especially caffeine and alcohol.
Maintaining a healthy weight,because obesity pressure in the
abdomen is not good for thebladder or the whole pelvic
(10:12):
floor, and managing chronicconditions such as diabetes may
help, and also avoiding caffeine.
Now there are other treatmentsbesides those general hygienic
measures that I mentioned.
Behavioral therapies likebiofeedback and bladder
retraining can be very helpful.
(10:33):
Sometimes people need moreintensive therapies, like
intermittent catheterization, orthey may need medications to
treat overactive bladder.
But it's always best to startgenerally with lifestyle and
with pelvic physical therapy,and there are specialized
(10:55):
physical therapists some of themare doctors of physical therapy
that specialize in pelvic PT,which could be a whole other
topic which hopefully we'll beable to get to in the future.
I mean up to 20% of womenexperience pelvic pain in their
life after delivery, afterbladder infections, after
(11:16):
vaginal infections, after anykind of surgery or trauma.
Endometriosis can lead to pelvicpain and chronic pelvic pain
and it's always better to treatthis comprehensively and
holistically and earlier ratherthan later.
And if you didn't hear my priorpodcast this season on
(11:38):
endometriosis, that is a goodone to go back to.
That is a good one to go backto and listen to, and you have
been listening to the Speakingof Women's Health podcast and
I'm your host, dr Holly Thacker,in the Sunflower House, and we
(11:58):
are talking about Female Urologyand Urology Awareness Month.
We all need a working bladder.
In fact, when I will treatwomen for genitourinary syndrome
of menopause, vaginal atrophy,hormonal thinning of the vulva,
the urethra, the vagina, thebase of the bladder.
(12:21):
I always ask the woman ifthey're seeing me because
they're concerned about beingable to comfortably be sexually
active.
And a lot of women say yes,absolutely.
And I say, well, if you weren'tsexually active and you were a
nun, would you be here to see me?
And they kind of think, andmost of them say no, they
wouldn't have come to see me.
And that's when I say to themwouldn't have come to see me.
(12:48):
And that's when I say to themum, well, we don't really
medically care what, uh, anadult consenting does with their
genitals, um, in the privacy oftheir own home, or if they do
anything at all, or if they're anun or not.
But everyone needs a bladderthat works and that's healthy
and needs a healthy vulva.
So it's important not to justseparate sex from the health of
(13:10):
the whole pelvic floor and thewhole urinary tract system and
the sexual functioning, boweland bladder.
They're all very intertwinedthe nerves that supply the
pelvic floor, the muscles thatsupport them, the bony structure
, the connective tissue, thebladder, the uterus.
(13:30):
If you still have a uterus, oreven if you have had surgery and
don't have a uterus, you'restill a female and you need a
comprehensive exam.
There's nothing that annoys memore is when a woman tells me
that her physician orgynecologist has sent her away
saying you don't have a uterus,you don't need pap smears or
(13:51):
gynecologic exams.
That is not true.
It's important, when you're awoman and you're not sure if
it's a bladder problem or apelvic problem or a gynecologic
problem or a nerve revolverproblem, to generally start with
your women's health clinicianfirst.
(14:11):
Now, if it's suspected that youhave interstitial cystitis,
which has also been dubbedpainful bladder syndrome, this
is another common and many timesunder-recognized condition of
chronic pelvic pain, and thelonger someone has pain and
(14:35):
those pain circuits reverberate,there can be central pain with
the brain, peripheral pain fromthe nerves or some local problem
, and even after sometimes theoriginal problem is treated,
whether it's endometriosis orwhether it's a bladder infection
or a vaginal infection orpost-birth trauma, sometimes
(14:56):
that pain reverberates.
In terms of interstitialcystitis, which is this very
painful bladder condition,there's not really been one
single underlying cause that'sbeen identified.
We do know that it is morecommon in women than in men, and
(15:19):
some of the factors that areassociated with the higher risk
of interstitial cystitis is onebeing a female.
Yes, your sex.
Women are diagnosed withinterstitial cystitis more
frequently than men.
In fact, women generally havemore pelvic pain than men, but
(15:43):
kind of like how osteoporosis issometimes ignored in men and
they can have osteoporosis andthey need evaluation and
treatment, but it's so much morecommon in women that it's more
focused in women.
That's kind of the same thingwith pelvic pain as well.
Generally, when men havepainful bladder syndrome it's
(16:03):
more likely associated that theyhave inflammation of their
prostate gland.
Prostatitis from perhaps abacterial infection, sometimes a
bacterial prostatitis is acatch-all term for pelvic pain,
which many times isneuromuscular in origin.
In men.
Now, your age is also a factor.
(16:27):
Most people with interstitialcystitis are diagnosed during
their 30s or older.
And if you already have achronic pain disorder,
interstitial cystitis can beassociated with other pain
conditions like irritable bowelsyndrome, fibromyalgia.
(16:47):
So sometimes irritable bowelfibromyalgia, chronic pelvic
pain, kind of like a lowserotonin syndrome.
Migraine headaches cansometimes cluster in certain
individuals that are predisposed, luster in certain individuals
(17:10):
that are predisposed.
Now, some of the symptoms of icyinterstitial cystitis is a
constant need to urinate, painwith urination, unexplained
painful intercourse, a tendersuprapubic area where the
bladder is and of course, theseare very similar to a bladder
infection.
So of course, the urine needsto be dipped, either by your
(17:32):
primary care physician orgynecologist or a
urogynecologist.
If there is the concern thatyou have interstitial cystitis,
then you generally need to see aspecialist like a
urogynecologist or a femaleurologist, and not all of those
physicians even specialize ininterstitial cystitis.
(17:54):
A lot of times you need acomplete team a medical
physician, a bladder specialist,a pelvic physical therapist,
sometimes even a pain managementphysician, and it can seem
overwhelming to people who havepain.
And while interstitial cystitisitself cannot be simply
(18:19):
prevented, it can definitely bemanaged and flare-ups can be
managed.
You need a kind ofcomprehensive, holistic approach
Through lifestyle changes,potential dietary modifications.
It's always important to helpreduce stress, because some
(18:40):
people, when they're stressed,they get a tension, headache or
pain in their neck.
Other people hold it in theirpelvis, and the strategies of
reducing stress exercise deepbreathing, yoga.
We have a lot of goodinformation on yoga on our
website Tai Chi massage,aromatherapy just having time
(19:08):
for yourself.
A lot of my patients are sopressed to the wire they don't
even have five or 10 minutesjust to themselves a day, and I
can sometimes identify with someof those days 12 plus hour work
days, rushing here, helpingtake care of my grandchildren,
running my fellowship,supervising and directing and
(19:31):
leading this non nonprofitSpeaking of Women's Health.
It can be a very, very fulllife and many people are
volunteering or they're takingcare of elderly relatives or
sick relatives or friends ordoing a lot of community work
and sometimes there's just somuch excitement in life to want
(19:53):
to pack so much in that youreally do have to plan for
adequate sleep time, adequaterelaxation and, if you haven't
heard our podcast where I'veinterviewed sleep experts and
talked extensively about sleep,that is important, I think.
(20:15):
Keeping a diary when you havechronic pain, whether it's
pelvic pain or interstitialcystitis or migraine headaches,
fibromyalgia.
Keeping a journal and payingattention to triggers, changes
in your physical activity orsexual activity, diet, reminding
yourself to maintain adequatehydration.
Different foods and beveragescan definitely aggravate the
(20:40):
bladder and some of the morecommon bladder irritants include
caffeine, alcohol, spicy foods,citrus fruits, artificial
sweeteners and also um, therecan be certain uh, tropical
(21:01):
fruits that can irritate peoplethat have a high histamine
content.
Also, I found that certainvitamins and b-complex vitamins,
which are excreted in the urineand concentrated in the bladder
, and if you have, like your bcomplex vitamin and you wash it
down with a lot of caffeine andthen a swig of orange juice, you
might not only get heart burn,but you may your bladder may
(21:24):
burn as well.
So it is important to be yourown little detective and sleuth.
Now, in terms of interstitialcystitis treatments, medications
such as Elmiron have beenprescribed.
They're taken three times a day.
There have been some retinalside effects and some doctors
(21:45):
don't like to prescribe this.
I usually always recommendfirst that calcium citrate
supplements be considered.
The citrate salt is soothing tothe bladder.
Now you don't want to overdoseon calcium and usually we
recommend that you get yourcalcium in your diet, but
sometimes cutting back on somedairy products and using calcium
(22:08):
citrate can soothe the bladder.
There can be bladderinstallations of DMSO, which is
a very potent solvent, andthat's one of the medicinal uses
of DMSO.
That's, like you know, anofficial medical practice.
Many people have used DMSOtopically for musculoskeletal
(22:32):
problems, but since it is sowell absorbed, you have to make
sure there's not other things onyour skin that you don't want
to penetrate into your bodydeeply.
Sometimes implantableelectrical stimulation devices
are used.
This is more invasive and aless common option and a less
(22:58):
common option.
Sometimes low doses oftricyclic antidepressants are
used not for depression but totry to rework the nerve
irritation.
I have found that inpostmenopausal women who have
interstitial cystitis orvulvodynia or chronic pelvic
pain that they usually needhigher doses of estrogen than
the average woman.
So many times we can use lowdoses of estrogen for menopausal
(23:22):
hormones to stop hot flashesand help the bone, but it's not
enough for a highly sensitivegenitourinary system and
embryologically the vagina andthe base of the bladder and the
vulva and the urethra, which isthe tube that carries out the
urine from your bladder, have avery high concentration of
(23:44):
estrogen receptors, and so thestandard menopausal hormone
therapy is not enough.
So I usually have pretty gooddoses of vaginal estrogen as
well as systemic, and sometimesI'll use vaginal DHEA which will
boost not just estrogen buttestosterone which can help the
muscles in the pelvic floor.
(24:06):
Pelvic organ prolapse POP youdon't really want to be popping
out your organs down through thevagina and unfortunately it's a
pretty common condition andhalf of women who've had
children by a vaginal deliverymay notice things coming down.
(24:26):
I had my first two children 18months apart, and I remember
going for my postpartum visitand I was like mortified to find
out that there was some slightdroppage of the pelvic organs
and I was instructed by thenurse practitioner on how to
appropriately do Kegel exercisesand avoid heavy lifting, which
(24:47):
was kind of hard to do because Iwould be carrying these two
babies of mine, which are nowpretty big men, and then a third
one came after that, so thatpelvic floor with pregnancy and
delivery and carrying youngchildren around can really
affect the pelvic floor.
So you must treat it with care.
You must have adequate strength, not too much strength.
(25:10):
We don't want the pelvic floorto be in spasm which can cause a
lot of pain.
But I was happy after you know,getting adequate hormones back,
because when you breastfeedhormone levels are low and that
can make the tissue thinner.
The combination of that and goodnutrition and physical therapy
doing Kegels kind of snappedeverything back in place.
(25:33):
Doing kegels kind of snappedeverything back in place.
But we can't change gravity andage.
You can change the activitiesthat you do and how healthy your
pelvic floor is and your boweland bladder function.
You can work on that and all ofthat really helps if you're
light-eyed and thin, pale skinand you've got a family history
(25:57):
of prolapse, your connectivetissue may not be quite as
sturdy as other people's andeven without childbearing, I
have seen women who've neverbeen pregnant, who are normal
body weight, have prolapse.
And if you're someone whoreally likes to do a lot of
jumping and spiking with yourphysical activity you're a
(26:18):
gymnast, you're a long distancerunner, hitting that hard
concrete and pavement for milesand miles on end that causes a
fair bit of trauma to yourpelvic floor and may make the
prolapse worse, and it can bethe bladder that drops down the
rectum, the uterus, the cervix,and it can be complete, which is
(26:44):
very distressing.
I can do an exam on a woman andeight months later she's calling
me, telling me something'shanging down there, and so it's
very good to get an assessment,even if you don't need a pap
smear, that you still need apelvic exam at least every one
(27:06):
to two years for sure, whetheror not you have a cervix or not.
And if you didn't hear ourpodcast and our reprisal podcast
on cervical cancer screening,that's really important.
I'm seeing women every singleday who are past the three-year
mark and many even past thefive-year mark, after age 30, of
(27:28):
getting their pap smears andit's concerning to me because
since we stopped obsessivelyhaving to do them every year,
once we started to do HPVtesting, I've just seen there
just be more of a lackadaisicalapproach and really we can
prevent deaths from cervicalcancer if you're getting
(27:49):
screened early, screened early.
So make sure that you know ifyou've had a pap smear and that
you have the results and youdon't just think, oh, I had a
pelvic exam.
I mean, putting a speculum inor doing a palpation or a
bimanual exam is important, butthat's not scraping the cervix
and doing a pap smear.
(28:13):
So the cause of pelvic organprolapse?
Certainly childbirth andpregnancy has a lot to do with
it, especially vaginal delivery.
But advancing age, obesity,hysterectomy, chronic straining
and just abnormalities of theconnective tissue and
(28:36):
abnormalities of the repair ofconnective tissue can predispose
some women and just disruptionand stretching of the connective
tissue, which is usually due topregnancy and childbirth but
also can be from surgery or anyother kind of traumas.
The symptoms can vary dependingon which organs are involved.
(29:01):
Urinary incontinence frequency,a weak or prolonged urinary
stream, feeling like incompleteemptying or needing to change
positions to fully empty thebladder can be another symptom.
Having trouble defecating orneeding to put support on the
(29:22):
perineum or even put fingers inthe vagina to push the rectocele
or rectum to support it so thatstool can be evacuated through
the rectum.
There can be a feeling of abulge or even a protrusion,
sexual activity can becomepainful or more difficult.
(29:45):
So, in order to prevent this,you definitely want to have a
good pelvic floor and strongmuscles, certainly long before
pregnancy and delivery, andcertainly rehab afterwards, and
it's important to manage yourweight.
It's normal to gain 25 to 30pounds.
Of course, with pregnancythat's expected, but
(30:07):
unfortunately, most women gainthat much weight after they're
done childbearing, at the timeof perimenopause, and so it's
important to weigh yourself oncea week and realize the older
you get, the less calories thatyou generally need and the more
you need to focus on musclebuilding activities as opposed
(30:27):
to just aerobic activities.
Managing the weight is veryimportant.
Sometimes five or ten pounds ofweight loss and correcting
constipation can dramaticallyimprove urinary and urinary
function, and if you haven'tlistened to our prior podcast on
weight management, weight lossthat is like the number one
(30:50):
concern women have, and we havea lot of really great resources
on our website,speakingwomenshealthcom, on our
podcast, and it's important tomonitor your physical activity
and avoid activities that put alot of extra strain on the
pelvic area jumping, spiking anykind of Valsalva maneuver,
(31:14):
bearing down, avoiding heavylifting and not transmitting all
that pressure to the pelvicfloor down through the vagina.
Quit smoking if you smoke andlisten to our podcast on
quitting smoking, becausetobacco damages the collagen and
that's why smokers look a lotolder than non-smokers, because
(31:38):
they lose a lot of collagen intheir face.
It's why smokers don't heal aswell after surgeries and even a
cigarette or two a week is stilldamaging.
Taking care of chronic coughingI mean many women are not
incontinent, but if they get aninfection or reactive airways or
(32:01):
a flare of their asthma andthey start coughing, that can
trigger pelvic prolapse symptomsand or incontinence.
So how do we treat pelvicprolapse?
Well, if it doesn't bother you,your doctor may not say
anything needs to be done otherthan Kegels, avoiding
constipation and coming back foryearly exams.
(32:23):
But surgery is an option whenyour quality of life is being
affected.
In terms of medications, we wantto treat vaginal thinness,
dryness, genitourinary syndromeof menopause.
Vaginal estrogen can be helpfuland I find that vaginal DHEA,
(32:44):
which boosts estrogen andtestosterone, that the
testosterone can help themuscles.
There's only five bands ofmuscle that support your bladder
neck, so women tend to start tolose muscle mass after age 45.
Pessaries, which are a silicontype device that can be put up
in the vagina to push things up,can be used in women who want
(33:06):
to avoid surgery.
Many times find this veryhelpful and then surgery is more
definitive.
In season two of our podcast, Idid do a podcast on urinary
incontinence, talking aboutmaking bladder leakage a thing
of the past, and so if you'rehaving trouble with bladder
(33:28):
leakage, that is an importantone to go back to.
So at the time of this podcasttaping, we don't have the pelvic
stimulating devices that Ipreviously used to recommend to
women the ATTAIN device, whichwas like biofeedback and
stimulation of the pelvic floorto strengthen the pelvic floor,
which was not a treatment forprolapse but an excellent
(33:51):
treatment for stressincontinence and urge
incontinence and urgeincontinence and mixed
incontinence.
And if we can get through thismicrochip shortage and get these
devices, if they're back on themarket by the company, I will
be sure to let women know andthat's why I always say bookmark
my website and periodicallycheck our news and listen to our
(34:14):
podcast.
So involuntary leakage of urineis not normal.
It's not a part of aging, eventhough maybe half of your
friends have this problemChildbirth, age, hormonal
changes, family history certainmedications can make it worse,
like some of the medicines givento men who have a big prostate,
(34:36):
bph.
There are some medicines thatkind of relax the internal
urethral sphincter and thatmight be great for an older man
with a big prostate but not fora woman.
And some of those times thosemedicines might be used for high
blood pressure orpost-traumatic stress disorder
and that can make incontinenceworse.
(34:57):
I've also seen women developcough from ACE inhibitors, which
are more likely to cause coughin women.
They're a blood pressuremedicine and so if you're
coughing more that can makeincontinence worse.
So of course any cough shouldbe evaluated worse.
(35:18):
So of course any cough shouldbe evaluated.
Minor, occasional leaks of urinegenerally can be just treated
with better bladder hygiene andKegel exercises.
But if it's more common youneed further evaluation.
And please go back and listento that Urinary incontinence
podcast on stress incontinence,urge and mixed.
But it's always a good idea toavoid bladder irritants like
(35:41):
caffeine and alcohol.
A little bit of caffeine isgood.
It may be good for the brain,for fatty liver, for energy for
pain control, but excessivecaffeine is not, and alcohol is
also an irritant and a toxin andmaintaining a healthy body
weight goes a long way atreducing a lot of medical
(36:04):
conditions and ideally prior topregnancy, it's good to have
your health care clinician checkto see if you know how to do a
Kegel correctly, because about10 to 20 percent of women, even
women who are physicians andnurses or who know pelvic
anatomy and physiology, can't dothe Kegel.
Sometimes you need instructionand biofeedback.
(36:26):
Biofeedback and there are lotsof treatments for incontinence
medical, physical, pessarysurgery.
Biofeedback can be veryeffective and that's why I love
those Attain devices because itwas like self-biofeedback.
But pelvic floor, femalephysical therapists for women
(36:48):
and there are males whospecialize in the pelvic floor
and can treat men and women aswell, although many times a
woman might feel morecomfortable with a woman, male
might feel more comfortable witha male physical therapist.
Really what's most important ishaving someone who's specially
trained and who you can feelcomfortable talking about bowel
(37:09):
and bladder and sexual issues,because all of that stuff is
involved with your whole pelvicfloor and sexual dysfunction can
occur at any age and there aretreatments.
We have a sex therapist at theCleveland Clinic who we've
(37:30):
interviewed on our podcast, andshe talks about being able to
talk comfortably about sexualfunction and some of the causes
of sexual dysfunction.
Medications can affect hormones,like oral contraceptives,
chemotherapy, blood pressuremedications, hormonal changes
(37:55):
with lack of sex hormones, likein menopause.
It always amazes me how, whenwomen move past childbearing and
they lose their sex hormonesand they're just shocked that
they've lost their sex drive,which you know the purpose of
the sex drive is to reproduce.
And so when you've lost yourreproductive hormones and you're
on no hormones and you haveless hormones then you know you
(38:19):
have had for decades it's notsurprising to lose that sex
drive.
But there are evaluations andtreatments and being sexually
active well into advanced age isa sign of good health, because
diseases like diabetes and highblood pressure, excessive
alcohol, can really ruin the sexlife and vaginal infections and
(38:46):
untreated depression can affectthe sex life and then, sadly,
some antidepressant medicinescan further cause trouble with
climax or sexual desire.
So it's important to kind ofkeep track of what's going on in
your diet, your medication,your physical lifestyle, your
(39:06):
relationship with your partner,and to keep track of this and be
honest and share thisinformation with your healthcare
clinician.
We have had podcasts on sexualdysfunction and treating low
libido.
I think it's important to makean appointment specifically to
(39:32):
talk about that problem, asopposed to adding it on at the
end of a visit that you're therefor an annual exam or another
problem visit and treating thisproblem involves a comprehensive
evaluation, a look at yourmedications many times.
Hormone therapy, vaginal DHEAcan be very helpful.
(39:53):
Pelvic physical therapy can beextremely helpful if there's
chronic pain and sometimes anevaluation and counseling with a
sexual health specialist isneeded.
And lastly, we're going to talkjust briefly about kidney stones
.
I already did a podcast inseason two on kidney stones and,
(40:17):
as an osteoporosis specialist,I'm very interested in calcium
metabolism and many types ofkidney stones are because
someone has a disorder in theircalcium balance and they have
calcium oxalate stones.
But dehydration, a familyhistory, elevated uric acid, a
diet that's too high in salt andsodium and protein can increase
(40:42):
uric acid oxalate levels.
Obesity increases kidney,certain medications, some blood
pressure medicines, as well astype 2 diabetes and gout.
I did do a podcast on uric acidand gout.
It's always good to come inwhen you see your physician with
(41:05):
all your medications and yoursupplements Not just a list or
pictures, but bring them in Now.
Symptoms of a kidney stone canbe intense pain in the lower
back or the abdomen, nausea orvomiting, seeing blood in the
urine, although it might just bemicroscopic pain when urinating
(41:25):
, being unable to urinate,having fever or chills, which
might indicate infection.
Drinking at least 64 ounces ofwater a day is very helpful,
along with reducing sodium andsalt content.
Getting enough citrus andcitrate in your diet is very
(41:45):
important if you've had calciumoxalate stones, managing your
blood pressure and your medicalconditions.
Occasionally, kidney stones canbe painless.
It's unusual because usuallythey're very painful, but they
can just collect in the kidneyand cause kidney damage.
Many times small stones canpass without the need for
(42:06):
specific treatment.
If you pass a stone and you'reable to catch it, keep it
because we can chemicallyanalyze it in the lab.
There are minimally invasiveprocedures that urologists do,
where they can remove the kidneystone or do lithotripsy, trypsy
(42:36):
.
So, in conclusion, urologicproblems in women as well as men
, but especially in women, arepretty common and they can cause
pain and discomfort and theycan affect the quality of your
life and even, occasionally,your longevity, depending on
what the problem is, as acuteinfections can lead to sepsis
and death, but the good news is,most of these conditions are
treatable and your urologist,female urologist or
(42:59):
urogynecologist, along with yourmain principal primary
physician, are important it'simportant to work as a team are
important it's important to workas a team.
So thank you so much forlistening to our Speaking of
Women's Health podcast.
Don't miss a future episode.
So please subscribe whereveryou listen to podcasts Apple
(43:23):
Podcasts, spotify, tuneinwherever you listen to podcasts
and give us a five-star ratingor share our podcast, and you
can go on our websitespeakingofwomenshealthcom and
donate to our nonprofit.
Remember be strong, be healthyand be in charge.
(43:44):
Thanks again and I'll see younext time in the Sunflower House
.
welcome to the speaking of women's health
podcast.
I'm your host, dr holly thacker, and I am back in our sunflower
house for a new edition of ourspeaking of women's health
podcast and on this new podcastfor the month of September,
(00:30):
which is Urology Awareness Month, we're going to specifically
talk about female urologyconditions.
Certainly there's a lot that wecould talk about for male
urology and there are someoverlaps, but they are quite
different and we do have someurologists that specialize in
(00:53):
what's called female urology.
So they're not necessarilyfemales, they could be male
physicians or female physicians,but they specialize in problems
that women and females have inthe urologic system.
And some of the more commonissues in women include the
(01:14):
common and annoying andsometimes dreaded urinary tract
infections.
Overactive bladder is anothervexing and sometimes annoying
problem.
Interstitial cystitis, whichkind of overlaps with chronic
pelvic pain, can be challengingsometimes to diagnose and manage
(01:39):
.
Pelvic organ prolapse becausewomen have a vagina, that's a
hole in the pelvic floor.
It can lead to the uterus kindof coming down if there's not
adequate support, and evencoming out of the vagina.
In fact, up to one in eightwomen can experience the need
(02:00):
for hysterectomy and pelvicsurgery because of prolapse and
certainly if you have a familymember that's a blood relative
with pelvic prolapse, that'simportant information to give to
your healthcare team.
Urinary incontinence oruncontrolled bladder leakage,
whether it's stress,incontinence from coughing or
(02:21):
urge incontinence or postpartumbecause of all the major changes
that have happened in thepelvis and also kidney stones,
they affect both men and women.
So the reason women are moreprevalent to some of these types
of conditions is in partbecause of the female anatomy of
(02:44):
the pelvis, as well as hormones.
Now, in terms of urinary tractinfections, in June, as you may
recall, I did a podcast onurinary tract infections called
From Solutions to Symptoms.
That went in a lot of depth oneverything that you need to know
about bladder infections andurinary tract infections.
(03:08):
So if you haven't listened tothat one, I think that's a good
one to go back to listen to.
And if you don't alreadysubscribe to our free podcast,
just hit follow or subscribe, soevery time there's a new
podcast, you'll get notified.
So a urinary tract infection iswhen the bladder or the urethra,
or even all the way upascending to the kidneys, can be
(03:31):
infected, usually with bacteria, and this can progress to
pyelonephritis, sepsis and evendeath.
So it's more than just a minorannoyance.
It's more than just a minorannoyance, and women get urinary
tract infections easier thanmen because the urethra is so
much smaller in women and it'sobviously in close proximity to
(03:53):
the skin of the vulva, theperianal area, and normal
bacteria from the skin or fromthe perianal area can enter into
the urethra, which is a sterilearea where there's not supposed
to be bacteria.
Some of the symptoms caninclude burning, frequent
urination, feeling the need tourinate even when there's an
(04:16):
empty bladder, pain in thepelvic area or even the lower
back or upper back.
If it's spreading.
There can be blood in the urine, fever, chills, even fatigue or
confusion or nausea or vomiting, and sometimes, in older
persons, they may not have afever.
Their mental status may justchange.
(04:38):
So in order to help preventbladder infections and more
serious urinary tract infections, it's important to stay
hydrated.
Avoid dehydration.
Drink enough water so that theurine is lighter in color, not a
dark yellow, so that you'reflushing out any bacteria that
might be trying to creep up intothe bladder, and don't hold
(05:00):
your urine.
Try to urinate every four tosix hours.
Always wipe from front to back,especially urinating before and
after any pelvic exams.
Sexual activity, any kind ofvulva manipulation is important.
We also recommend that womenavoid douching.
(05:22):
Avoid any feminine hygienesprays.
These can be irritating andthey can change the pH of the
vagina when you're menstruating.
If you're still menstruating,it's important to regularly
change pads and tampons and notleave them in or on your body
too long.
Your body too long.
(05:47):
Wearing cotton white underwear,loose-fitting clothes anything
that's super tight creates moreof a moist environment which can
promote bacterial growth.
It's also important to keepyour nutrition up, your vitamin
D up, getting enough rest.
Now, in terms of minor urinarytract infections, sometimes they
can go away on their own.
Some women might start on likea cranberry extract or a
(06:08):
D-mannose which inhibits E coli,but most of the time they do
need to be treated with anantibiotic and you may need to
get a clean catch urine.
And that's when you wipe thevulva clean with a special wipe
and you urinate a little bitinto the toilet.
Then you open up a sterilecontainer and get the middle
(06:32):
part of the stream in to getenough of a specimen and close
the lid and then you can sitdown and finish urinating and
emptying your bladder, becausethen that isn't contaminated
with vaginal secretions or skinbacteria and your express care
(06:52):
or urgent care or doctor'soffice can usually accomplish
this.
Now, overactive bladder is whenyou have that strong urge to
pass urine, even when yourbladder is not very full, and it
can be frequent.
If you feel the need to have tourinate more than eight times a
(07:13):
day, you may have overactivebladder and you should see your
health care team.
You don't necessarily have tostart with a female urologist or
a urogynecologist.
That's a gynecologist that'sgone on to specialize more
intensely in the urinary systemand pelvic prolapse.
(07:35):
So there's a lot of differentpotential causes of overactive
bladder.
When the bladder muscles startto contract without warning, and
sometimes not only does thatlead to the urge to urinate, but
it can actually lead toinvoluntary urine leakage or
so-called urinary incontinence.
(07:56):
Now, overactive bladder can be asymptom of other neurologic
problems, such as diabetes,multiple sclerosis, parkinson's
disease, or it can be the firstsign of a bladder infection,
urinary tract infection.
Some medicines like diuretics,which are sometimes prescribed
(08:20):
to get extra fluid off the body,can worsen symptoms.
Excessive caffeine intake isvery irritating to the bladder.
So is alcohol, any kind ofnicotine products and
constipation, which isrelatively common in women.
All can contribute tooveractive bladder.
And my very first podcast thatwasn't my book or was not
(08:44):
medical CME that I did in seasonone in 2023 was about
constipation, and constipationis definitely more common in
women.
Women tend to have a moresluggish colon and it is really
imperative for good bladderfunction and good pelvic tone to
not have constipation.
(09:05):
So some of the symptoms ofoveractive bladder or that
irritating sensation of an urgeto urinate going too often or if
you get up more than twice anight to urinate, it is
important to get enough fluidintake, but not excessive fluid
(09:28):
intake.
And in order to help preventoveractive bladder, it's
important to do appropriatepelvic floor strengthening.
They've been dubbed the Kegelexercise and when you go in for
your pelvic exam with yourwomen's health care nurse
practitioner or physician, thatclinician can check for your
(09:50):
pelvic tone and see if you knowhow to contract the pelvic floor
, the levator ani muscles.
Getting regular daily physicalactivity is helpful.
Limiting bladder irritants,especially caffeine and alcohol,
helpful.
Limiting bladder irritants,especially caffeine and alcohol.
Maintaining a healthy weight,because obesity pressure in the
abdomen is not good for thebladder or the whole pelvic
(10:12):
floor, and managing chronicconditions such as diabetes may
help, and also avoiding caffeine.
Now there are other treatmentsbesides those general hygienic
measures that I mentioned.
Behavioral therapies likebiofeedback and bladder
retraining can be very helpful.
(10:33):
Sometimes people need moreintensive therapies, like
intermittent catheterization, orthey may need medications to
treat overactive bladder.
But it's always best to startgenerally with lifestyle and
with pelvic physical therapy,and there are specialized
(10:55):
physical therapists some of themare doctors of physical therapy
that specialize in pelvic PT,which could be a whole other
topic which hopefully we'll beable to get to in the future.
I mean up to 20% of womenexperience pelvic pain in their
life after delivery, afterbladder infections, after
(11:16):
vaginal infections, after anykind of surgery or trauma.
Endometriosis can lead to pelvicpain and chronic pelvic pain
and it's always better to treatthis comprehensively and
holistically and earlier ratherthan later.
And if you didn't hear my priorpodcast this season on
(11:38):
endometriosis, that is a goodone to go back to.
That is a good one to go backto and listen to, and you have
been listening to the Speakingof Women's Health podcast and
I'm your host, dr Holly Thacker,in the Sunflower House, and we
(11:58):
are talking about Female Urologyand Urology Awareness Month.
We all need a working bladder.
In fact, when I will treatwomen for genitourinary syndrome
of menopause, vaginal atrophy,hormonal thinning of the vulva,
the urethra, the vagina, thebase of the bladder.
(12:21):
I always ask the woman ifthey're seeing me because
they're concerned about beingable to comfortably be sexually
active.
And a lot of women say yes,absolutely.
And I say, well, if you weren'tsexually active and you were a
nun, would you be here to see me?
And they kind of think, andmost of them say no, they
wouldn't have come to see me.
And that's when I say to themwouldn't have come to see me.
(12:48):
And that's when I say to themum, well, we don't really
medically care what, uh, anadult consenting does with their
genitals, um, in the privacy oftheir own home, or if they do
anything at all, or if they're anun or not.
But everyone needs a bladderthat works and that's healthy
and needs a healthy vulva.
So it's important not to justseparate sex from the health of
(13:10):
the whole pelvic floor and thewhole urinary tract system and
the sexual functioning, boweland bladder.
They're all very intertwinedthe nerves that supply the
pelvic floor, the muscles thatsupport them, the bony structure
, the connective tissue, thebladder, the uterus.
(13:30):
If you still have a uterus, oreven if you have had surgery and
don't have a uterus, you'restill a female and you need a
comprehensive exam.
There's nothing that annoys memore is when a woman tells me
that her physician orgynecologist has sent her away
saying you don't have a uterus,you don't need pap smears or
(13:51):
gynecologic exams.
That is not true.
It's important, when you're awoman and you're not sure if
it's a bladder problem or apelvic problem or a gynecologic
problem or a nerve revolverproblem, to generally start with
your women's health clinicianfirst.
(14:11):
Now, if it's suspected that youhave interstitial cystitis,
which has also been dubbedpainful bladder syndrome, this
is another common and many timesunder-recognized condition of
chronic pelvic pain, and thelonger someone has pain and
(14:35):
those pain circuits reverberate,there can be central pain with
the brain, peripheral pain fromthe nerves or some local problem
, and even after sometimes theoriginal problem is treated,
whether it's endometriosis orwhether it's a bladder infection
or a vaginal infection orpost-birth trauma, sometimes
(14:56):
that pain reverberates.
In terms of interstitialcystitis, which is this very
painful bladder condition,there's not really been one
single underlying cause that'sbeen identified.
We do know that it is morecommon in women than in men, and
(15:19):
some of the factors that areassociated with the higher risk
of interstitial cystitis is onebeing a female.
Yes, your sex.
Women are diagnosed withinterstitial cystitis more
frequently than men.
In fact, women generally havemore pelvic pain than men, but
(15:43):
kind of like how osteoporosis issometimes ignored in men and
they can have osteoporosis andthey need evaluation and
treatment, but it's so much morecommon in women that it's more
focused in women.
That's kind of the same thingwith pelvic pain as well.
Generally, when men havepainful bladder syndrome it's
(16:03):
more likely associated that theyhave inflammation of their
prostate gland.
Prostatitis from perhaps abacterial infection, sometimes a
bacterial prostatitis is acatch-all term for pelvic pain,
which many times isneuromuscular in origin.
In men.
Now, your age is also a factor.
(16:27):
Most people with interstitialcystitis are diagnosed during
their 30s or older.
And if you already have achronic pain disorder,
interstitial cystitis can beassociated with other pain
conditions like irritable bowelsyndrome, fibromyalgia.
(16:47):
So sometimes irritable bowelfibromyalgia, chronic pelvic
pain, kind of like a lowserotonin syndrome.
Migraine headaches cansometimes cluster in certain
individuals that are predisposed, luster in certain individuals
(17:10):
that are predisposed.
Now, some of the symptoms of icyinterstitial cystitis is a
constant need to urinate, painwith urination, unexplained
painful intercourse, a tendersuprapubic area where the
bladder is and of course, theseare very similar to a bladder
infection.
So of course, the urine needsto be dipped, either by your
(17:32):
primary care physician orgynecologist or a
urogynecologist.
If there is the concern thatyou have interstitial cystitis,
then you generally need to see aspecialist like a
urogynecologist or a femaleurologist, and not all of those
physicians even specialize ininterstitial cystitis.
(17:54):
A lot of times you need acomplete team a medical
physician, a bladder specialist,a pelvic physical therapist,
sometimes even a pain managementphysician, and it can seem
overwhelming to people who havepain.
And while interstitial cystitisitself cannot be simply
(18:19):
prevented, it can definitely bemanaged and flare-ups can be
managed.
You need a kind ofcomprehensive, holistic approach
Through lifestyle changes,potential dietary modifications.
It's always important to helpreduce stress, because some
(18:40):
people, when they're stressed,they get a tension, headache or
pain in their neck.
Other people hold it in theirpelvis, and the strategies of
reducing stress exercise deepbreathing, yoga.
We have a lot of goodinformation on yoga on our
website Tai Chi massage,aromatherapy just having time
(19:08):
for yourself.
A lot of my patients are sopressed to the wire they don't
even have five or 10 minutesjust to themselves a day, and I
can sometimes identify with someof those days 12 plus hour work
days, rushing here, helpingtake care of my grandchildren,
running my fellowship,supervising and directing and
(19:31):
leading this non nonprofitSpeaking of Women's Health.
It can be a very, very fulllife and many people are
volunteering or they're takingcare of elderly relatives or
sick relatives or friends ordoing a lot of community work
and sometimes there's just somuch excitement in life to want
(19:53):
to pack so much in that youreally do have to plan for
adequate sleep time, adequaterelaxation and, if you haven't
heard our podcast where I'veinterviewed sleep experts and
talked extensively about sleep,that is important, I think.
(20:15):
Keeping a diary when you havechronic pain, whether it's
pelvic pain or interstitialcystitis or migraine headaches,
fibromyalgia.
Keeping a journal and payingattention to triggers, changes
in your physical activity orsexual activity, diet, reminding
yourself to maintain adequatehydration.
Different foods and beveragescan definitely aggravate the
(20:40):
bladder and some of the morecommon bladder irritants include
caffeine, alcohol, spicy foods,citrus fruits, artificial
sweeteners and also um, therecan be certain uh, tropical
(21:01):
fruits that can irritate peoplethat have a high histamine
content.
Also, I found that certainvitamins and b-complex vitamins,
which are excreted in the urineand concentrated in the bladder
, and if you have, like your bcomplex vitamin and you wash it
down with a lot of caffeine andthen a swig of orange juice, you
might not only get heart burn,but you may your bladder may
(21:24):
burn as well.
So it is important to be yourown little detective and sleuth.
Now, in terms of interstitialcystitis treatments, medications
such as Elmiron have beenprescribed.
They're taken three times a day.
There have been some retinalside effects and some doctors
(21:45):
don't like to prescribe this.
I usually always recommendfirst that calcium citrate
supplements be considered.
The citrate salt is soothing tothe bladder.
Now you don't want to overdoseon calcium and usually we
recommend that you get yourcalcium in your diet, but
sometimes cutting back on somedairy products and using calcium
(22:08):
citrate can soothe the bladder.
There can be bladderinstallations of DMSO, which is
a very potent solvent, andthat's one of the medicinal uses
of DMSO.
That's, like you know, anofficial medical practice.
Many people have used DMSOtopically for musculoskeletal
(22:32):
problems, but since it is sowell absorbed, you have to make
sure there's not other things onyour skin that you don't want
to penetrate into your bodydeeply.
Sometimes implantableelectrical stimulation devices
are used.
This is more invasive and aless common option and a less
(22:58):
common option.
Sometimes low doses oftricyclic antidepressants are
used not for depression but totry to rework the nerve
irritation.
I have found that inpostmenopausal women who have
interstitial cystitis orvulvodynia or chronic pelvic
pain that they usually needhigher doses of estrogen than
the average woman.
So many times we can use lowdoses of estrogen for menopausal
(23:22):
hormones to stop hot flashesand help the bone, but it's not
enough for a highly sensitivegenitourinary system and
embryologically the vagina andthe base of the bladder and the
vulva and the urethra, which isthe tube that carries out the
urine from your bladder, have avery high concentration of
(23:44):
estrogen receptors, and so thestandard menopausal hormone
therapy is not enough.
So I usually have pretty gooddoses of vaginal estrogen as
well as systemic, and sometimesI'll use vaginal DHEA which will
boost not just estrogen buttestosterone which can help the
muscles in the pelvic floor.
(24:06):
Pelvic organ prolapse POP youdon't really want to be popping
out your organs down through thevagina and unfortunately it's a
pretty common condition andhalf of women who've had
children by a vaginal deliverymay notice things coming down.
(24:26):
I had my first two children 18months apart, and I remember
going for my postpartum visitand I was like mortified to find
out that there was some slightdroppage of the pelvic organs
and I was instructed by thenurse practitioner on how to
appropriately do Kegel exercisesand avoid heavy lifting, which
(24:47):
was kind of hard to do because Iwould be carrying these two
babies of mine, which are nowpretty big men, and then a third
one came after that, so thatpelvic floor with pregnancy and
delivery and carrying youngchildren around can really
affect the pelvic floor.
So you must treat it with care.
You must have adequate strength, not too much strength.
(25:10):
We don't want the pelvic floorto be in spasm which can cause a
lot of pain.
But I was happy after you know,getting adequate hormones back,
because when you breastfeedhormone levels are low and that
can make the tissue thinner.
The combination of that and goodnutrition and physical therapy
doing Kegels kind of snappedeverything back in place.
(25:33):
Doing kegels kind of snappedeverything back in place.
But we can't change gravity andage.
You can change the activitiesthat you do and how healthy your
pelvic floor is and your boweland bladder function.
You can work on that and all ofthat really helps if you're
light-eyed and thin, pale skinand you've got a family history
(25:57):
of prolapse, your connectivetissue may not be quite as
sturdy as other people's andeven without childbearing, I
have seen women who've neverbeen pregnant, who are normal
body weight, have prolapse.
And if you're someone whoreally likes to do a lot of
jumping and spiking with yourphysical activity you're a
(26:18):
gymnast, you're a long distancerunner, hitting that hard
concrete and pavement for milesand miles on end that causes a
fair bit of trauma to yourpelvic floor and may make the
prolapse worse, and it can bethe bladder that drops down the
rectum, the uterus, the cervix,and it can be complete, which is
(26:44):
very distressing.
I can do an exam on a woman andeight months later she's calling
me, telling me something'shanging down there, and so it's
very good to get an assessment,even if you don't need a pap
smear, that you still need apelvic exam at least every one
(27:06):
to two years for sure, whetheror not you have a cervix or not.
And if you didn't hear ourpodcast and our reprisal podcast
on cervical cancer screening,that's really important.
I'm seeing women every singleday who are past the three-year
mark and many even past thefive-year mark, after age 30, of
(27:28):
getting their pap smears andit's concerning to me because
since we stopped obsessivelyhaving to do them every year,
once we started to do HPVtesting, I've just seen there
just be more of a lackadaisicalapproach and really we can
prevent deaths from cervicalcancer if you're getting
(27:49):
screened early, screened early.
So make sure that you know ifyou've had a pap smear and that
you have the results and youdon't just think, oh, I had a
pelvic exam.
I mean, putting a speculum inor doing a palpation or a
bimanual exam is important, butthat's not scraping the cervix
and doing a pap smear.
(28:13):
So the cause of pelvic organprolapse?
Certainly childbirth andpregnancy has a lot to do with
it, especially vaginal delivery.
But advancing age, obesity,hysterectomy, chronic straining
and just abnormalities of theconnective tissue and
(28:36):
abnormalities of the repair ofconnective tissue can predispose
some women and just disruptionand stretching of the connective
tissue, which is usually due topregnancy and childbirth but
also can be from surgery or anyother kind of traumas.
The symptoms can vary dependingon which organs are involved.
(29:01):
Urinary incontinence frequency,a weak or prolonged urinary
stream, feeling like incompleteemptying or needing to change
positions to fully empty thebladder can be another symptom.
Having trouble defecating orneeding to put support on the
(29:22):
perineum or even put fingers inthe vagina to push the rectocele
or rectum to support it so thatstool can be evacuated through
the rectum.
There can be a feeling of abulge or even a protrusion,
sexual activity can becomepainful or more difficult.
(29:45):
So, in order to prevent this,you definitely want to have a
good pelvic floor and strongmuscles, certainly long before
pregnancy and delivery, andcertainly rehab afterwards, and
it's important to manage yourweight.
It's normal to gain 25 to 30pounds.
Of course, with pregnancythat's expected, but
(30:07):
unfortunately, most women gainthat much weight after they're
done childbearing, at the timeof perimenopause, and so it's
important to weigh yourself oncea week and realize the older
you get, the less calories thatyou generally need and the more
you need to focus on musclebuilding activities as opposed
(30:27):
to just aerobic activities.
Managing the weight is veryimportant.
Sometimes five or ten pounds ofweight loss and correcting
constipation can dramaticallyimprove urinary and urinary
function, and if you haven'tlistened to our prior podcast on
weight management, weight lossthat is like the number one
(30:50):
concern women have, and we havea lot of really great resources
on our website,speakingwomenshealthcom, on our
podcast, and it's important tomonitor your physical activity
and avoid activities that put alot of extra strain on the
pelvic area jumping, spiking anykind of Valsalva maneuver,
(31:14):
bearing down, avoiding heavylifting and not transmitting all
that pressure to the pelvicfloor down through the vagina.
Quit smoking if you smoke andlisten to our podcast on
quitting smoking, becausetobacco damages the collagen and
that's why smokers look a lotolder than non-smokers, because
(31:38):
they lose a lot of collagen intheir face.
It's why smokers don't heal aswell after surgeries and even a
cigarette or two a week is stilldamaging.
Taking care of chronic coughingI mean many women are not
incontinent, but if they get aninfection or reactive airways or
(32:01):
a flare of their asthma andthey start coughing, that can
trigger pelvic prolapse symptomsand or incontinence.
So how do we treat pelvicprolapse?
Well, if it doesn't bother you,your doctor may not say
anything needs to be done otherthan Kegels, avoiding
constipation and coming back foryearly exams.
(32:23):
But surgery is an option whenyour quality of life is being
affected.
In terms of medications, we wantto treat vaginal thinness,
dryness, genitourinary syndromeof menopause.
Vaginal estrogen can be helpfuland I find that vaginal DHEA,
(32:44):
which boosts estrogen andtestosterone, that the
testosterone can help themuscles.
There's only five bands ofmuscle that support your bladder
neck, so women tend to start tolose muscle mass after age 45.
Pessaries, which are a silicontype device that can be put up
in the vagina to push things up,can be used in women who want
(33:06):
to avoid surgery.
Many times find this veryhelpful and then surgery is more
definitive.
In season two of our podcast, Idid do a podcast on urinary
incontinence, talking aboutmaking bladder leakage a thing
of the past, and so if you'rehaving trouble with bladder
(33:28):
leakage, that is an importantone to go back to.
So at the time of this podcasttaping, we don't have the pelvic
stimulating devices that Ipreviously used to recommend to
women the ATTAIN device, whichwas like biofeedback and
stimulation of the pelvic floorto strengthen the pelvic floor,
which was not a treatment forprolapse but an excellent
(33:51):
treatment for stressincontinence and urge
incontinence and urgeincontinence and mixed
incontinence.
And if we can get through thismicrochip shortage and get these
devices, if they're back on themarket by the company, I will
be sure to let women know andthat's why I always say bookmark
my website and periodicallycheck our news and listen to our
(34:14):
podcast.
So involuntary leakage of urineis not normal.
It's not a part of aging, eventhough maybe half of your
friends have this problemChildbirth, age, hormonal
changes, family history certainmedications can make it worse,
like some of the medicines givento men who have a big prostate,
(34:36):
bph.
There are some medicines thatkind of relax the internal
urethral sphincter and thatmight be great for an older man
with a big prostate but not fora woman.
And some of those times thosemedicines might be used for high
blood pressure orpost-traumatic stress disorder
and that can make incontinenceworse.
(34:57):
I've also seen women developcough from ACE inhibitors, which
are more likely to cause coughin women.
They're a blood pressuremedicine and so if you're
coughing more that can makeincontinence worse.
So of course any cough shouldbe evaluated worse.
(35:18):
So of course any cough shouldbe evaluated.
Minor, occasional leaks of urinegenerally can be just treated
with better bladder hygiene andKegel exercises.
But if it's more common youneed further evaluation.
And please go back and listento that Urinary incontinence
podcast on stress incontinence,urge and mixed.
But it's always a good idea toavoid bladder irritants like
(35:41):
caffeine and alcohol.
A little bit of caffeine isgood.
It may be good for the brain,for fatty liver, for energy for
pain control, but excessivecaffeine is not, and alcohol is
also an irritant and a toxin andmaintaining a healthy body
weight goes a long way atreducing a lot of medical
(36:04):
conditions and ideally prior topregnancy, it's good to have
your health care clinician checkto see if you know how to do a
Kegel correctly, because about10 to 20 percent of women, even
women who are physicians andnurses or who know pelvic
anatomy and physiology, can't dothe Kegel.
Sometimes you need instructionand biofeedback.
(36:26):
Biofeedback and there are lotsof treatments for incontinence
medical, physical, pessarysurgery.
Biofeedback can be veryeffective and that's why I love
those Attain devices because itwas like self-biofeedback.
But pelvic floor, femalephysical therapists for women
(36:48):
and there are males whospecialize in the pelvic floor
and can treat men and women aswell, although many times a
woman might feel morecomfortable with a woman, male
might feel more comfortable witha male physical therapist.
Really what's most important ishaving someone who's specially
trained and who you can feelcomfortable talking about bowel
(37:09):
and bladder and sexual issues,because all of that stuff is
involved with your whole pelvicfloor and sexual dysfunction can
occur at any age and there aretreatments.
We have a sex therapist at theCleveland Clinic who we've
(37:30):
interviewed on our podcast, andshe talks about being able to
talk comfortably about sexualfunction and some of the causes
of sexual dysfunction.
Medications can affect hormones,like oral contraceptives,
chemotherapy, blood pressuremedications, hormonal changes
(37:55):
with lack of sex hormones, likein menopause.
It always amazes me how, whenwomen move past childbearing and
they lose their sex hormonesand they're just shocked that
they've lost their sex drive,which you know the purpose of
the sex drive is to reproduce.
And so when you've lost yourreproductive hormones and you're
on no hormones and you haveless hormones then you know you
(38:19):
have had for decades it's notsurprising to lose that sex
drive.
But there are evaluations andtreatments and being sexually
active well into advanced age isa sign of good health, because
diseases like diabetes and highblood pressure, excessive
alcohol, can really ruin the sexlife and vaginal infections and
(38:46):
untreated depression can affectthe sex life and then, sadly,
some antidepressant medicinescan further cause trouble with
climax or sexual desire.
So it's important to kind ofkeep track of what's going on in
your diet, your medication,your physical lifestyle, your
(39:06):
relationship with your partner,and to keep track of this and be
honest and share thisinformation with your healthcare
clinician.
We have had podcasts on sexualdysfunction and treating low
libido.
I think it's important to makean appointment specifically to
(39:32):
talk about that problem, asopposed to adding it on at the
end of a visit that you're therefor an annual exam or another
problem visit and treating thisproblem involves a comprehensive
evaluation, a look at yourmedications many times.
Hormone therapy, vaginal DHEAcan be very helpful.
(39:53):
Pelvic physical therapy can beextremely helpful if there's
chronic pain and sometimes anevaluation and counseling with a
sexual health specialist isneeded.
And lastly, we're going to talkjust briefly about kidney stones
.
I already did a podcast inseason two on kidney stones and,
(40:17):
as an osteoporosis specialist,I'm very interested in calcium
metabolism and many types ofkidney stones are because
someone has a disorder in theircalcium balance and they have
calcium oxalate stones.
But dehydration, a familyhistory, elevated uric acid, a
diet that's too high in salt andsodium and protein can increase
(40:42):
uric acid oxalate levels.
Obesity increases kidney,certain medications, some blood
pressure medicines, as well astype 2 diabetes and gout.
I did do a podcast on uric acidand gout.
It's always good to come inwhen you see your physician with
(41:05):
all your medications and yoursupplements Not just a list or
pictures, but bring them in Now.
Symptoms of a kidney stone canbe intense pain in the lower
back or the abdomen, nausea orvomiting, seeing blood in the
urine, although it might just bemicroscopic pain when urinating
(41:25):
, being unable to urinate,having fever or chills, which
might indicate infection.
Drinking at least 64 ounces ofwater a day is very helpful,
along with reducing sodium andsalt content.
Getting enough citrus andcitrate in your diet is very
(41:45):
important if you've had calciumoxalate stones, managing your
blood pressure and your medicalconditions.
Occasionally, kidney stones canbe painless.
It's unusual because usuallythey're very painful, but they
can just collect in the kidneyand cause kidney damage.
Many times small stones canpass without the need for
(42:06):
specific treatment.
If you pass a stone and you'reable to catch it, keep it
because we can chemicallyanalyze it in the lab.
There are minimally invasiveprocedures that urologists do,
where they can remove the kidneystone or do lithotripsy, trypsy
(42:36):
.
So, in conclusion, urologicproblems in women as well as men
, but especially in women, arepretty common and they can cause
pain and discomfort and theycan affect the quality of your
life and even, occasionally,your longevity, depending on
what the problem is, as acuteinfections can lead to sepsis
and death, but the good news is,most of these conditions are
treatable and your urologist,female urologist or
(42:59):
urogynecologist, along with yourmain principal primary
physician, are important it'simportant to work as a team are
important it's important to workas a team.
So thank you so much forlistening to our Speaking of
Women's Health podcast.
Don't miss a future episode.
So please subscribe whereveryou listen to podcasts Apple
(43:23):
Podcasts, spotify, tuneinwherever you listen to podcasts
and give us a five-star ratingor share our podcast, and you
can go on our websitespeakingofwomenshealthcom and
donate to our nonprofit.
Remember be strong, be healthyand be in charge.
(43:44):
Thanks again and I'll see younext time in the Sunflower House
.
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