November is Bladder Health Month

I recently had the pleasure of speaking with Dr. Sujatha Pathi, a board certified and fellowship-trained specialist in Female Pelvic Medicine and Reconstructive Surgery (also known as Urogynecology), to raise awareness for Bladder Health Awareness Month.

As a specialist in Female Pelvic Medicine and Reconstructive Surgery, Dr. Pathi’s area of focus includes surgical and non-surgical treatments for urinary incontinence, pelvic organ prolapse, voiding dysfunction, fecal incontinence, defecatory dysfunction, pelvic pain, and childbirth-related pelvic floor dysfunction. She specializes in complex vaginal and minimally invasive surgeries.

For our readers, what exactly is female urinary incontinence?

Dr. Pathi: In short, female urinary incontinence is the involuntary leakage of urine

How common is this condition in females?

Dr. Pathi: It’s actually very common and affects 30% - 50% of women. To simplify, there are three types of incontinence - stress incontinence, overactive bladder and mixed incontinence.

• Stress incontinence is loss of urine that occurs at the same time as physical activities that increase abdominal pressure such as coughing, laughing, sneezing, and exercise.
• Overactive bladder is the sudden (and many times frequent) need to urinate and inability to hold urine back.
• Mixed incontinence is a combination of stress incontinence and overactive bladder.

What are the risk factors for urinary incontinence?

Dr. Pathi: There are likely multiple factors that can lead to urinary incontinence in women. Genetics can certainly play role. Pregnancy, vaginal delivery, increasing age, and increasing weight are other risk factors. Certain health issues such as diabetes, chronic constipation, neurological conditions, lung conditions, and history of pelvic surgery can also contribute to a woman’s risk of incontinence.

Why do you think women are hesitant to seek medical attention for this issue?

Dr. Pathi: Many women with urinary incontinence tend not to report their condition due to embarrassment. It can be difficult for women talk about their symptoms even with a health care provider. There is also the misconception that urinary incontinence is a normal part of aging. Although urinary incontinence is common among women, it is NOT normal. Hopefully, with conversations like this, women can understand that urinary incontinence is a medical condition that can be treated.

What if the problem is ignored? Will it just go away on its own?

Dr. Pathi: Unfortunately, in most cases, incontinence will not go away on its own. Overactive bladder is a chronic condition but the symptoms can be managed to a point where it poses minimal bother to the woman. Stress incontinence can improve with weight loss and pelvic floor strengthening, particularly for mild cases. More severe stress incontinence, however, may require further treatment.

When women do seek help, what is ultimately causing them to seek treatment?

Dr. Pathi: Often, the leakage gets so extreme that a woman is no longer able to engage in activities that she enjoys or she has realized she plans her day around available bathrooms. By this point, a woman has suffered for many years with leakage and has slowly altered her life to tolerate the incontinence.

How and where should a woman start the process of getting help? And what type of physician should they be looking for?

Dr. Pathi: She can start by speaking with her primary care physician or ObGyn. They can assess what type of incontinence she has and then start an initial treatment. From there, they can be seen by a Female Pelvic Medicine and Reconstructive Surgery specialist who can provide further evaluation and treatment.

What are a few symptoms/warning signs women should be aware of?

Dr. Pathi: Fortunately urinary incontinence is not life-threatening, however, it can drastically affect a woman’s quality of life. Incontinence is insidious in how it slowly forces a woman to alter her regular activities and daily life. I would advise women to seek evaluation the first time they notice that the incontinence is a regular occurrence.

How is this issue typically treated?

Dr. Pathi: Fortunately, there are wide variety of treatments available depending on the type of incontinence and the woman’s treatment goals.

For all types of incontinence, we would recommend working toward weight loss if overweight and cessation of smoking. Pelvic floor rehabilitation can also be very helpful.

For stress incontinence, there are surgical and non-surgical options. A non-surgical approach is use of a vaginal insert or pessary. A common surgical option is placement of a mid-urethral sling, which has excellent long-term success in treating stress incontinence.

For overactive bladder, diet and behavioral modifications are first line treatments. Patients may also try oral medications. For ongoing symptoms, patients may benefit from advanced treatments such as injection of botox into the bladder, tibial nerve stimulation, or sacral neuromodulation.

What does MarinHealth offer to address these issues?

Dr. Pathi: MarinHealth offers the full spectrum of treatments for every type of urinary incontinence.

If a woman is scared to see her primary care physician because of Covid, can they be treated over a videoconference from home?

Dr. Pathi: Yes, a patient can speak with her provider via telehealth to diagnose her condition and start initial therapy.

Any last words you’d like to leave our readers with?

Dr. Pathi: I think the most important take-home message is a woman does not need to wait until her symptoms are severe before she seeks treatment. There are a variety of treatment options that she can choose from that fit her particular treatment goals. There is no need to suffer alone when there are options that can significantly improve a woman’s quality of life.