Search for tag: "urogynecology"

Dr. Jones: The problem with feeling like you have to pee all the time or peeing your pants as a grown-up is that it's embarrassing and it's such a 2-year-old thing to do. This is Dr. Kirtly Jones from Obstetrics and Gynecology at University of Utah Health. And this is "The Seven Domains Of Women's Health" on The Scope.

Announcer: Covering all aspects of women's health, this is "The Seven Domains Of Women's Health" with Dr. Kirtly Jones on The Scope.

Dr. Jones: Back to the 2-year-old problem of peeing your pants or being afraid that you will. This is a very common problem for older adults men and women, but you may not know that it's common because your friends and family don't talk about it. Many of us quietly have urgency. But what can we do about it? Today we're going to talk about this as grown-ups. Here in The Scope studio is Dr. Sara Lenherr. She's a urologist at the University of Utah with a special interest in continence in adults, meaning not peeing your pants. Thanks for joining us, Dr. Lenherr. Well, how common is this problem? Is it more common for older people or men or for women or? Tell me about your patients.

Dr. Lenherr: So really overactive bladder or OAB really impacts millions and millions of women and men in the United States. And many patients are tried on medications, but then stop them because they're ineffective or cause bothersome side effects. There are other treatments that are not without side effects, but with appropriate counseling can be very effective at improving their symptoms and quality of life.

Dr. Jones: How common is this problem? Is it more common for older people or for men or for women? Tell me about who comes to see you.

Dr. Lenherr: There are people of all different ages that come to see me about having to pee all the time. They're men, they're women, people that have had this all of their lives or just have it as they get older. We treat so many different people that have to go to the bathroom urgently, frequently, they either lose their urine with incontinence, or they don't have any incontinence. All these different types of people come in for evaluation.

Dr. Jones: Okay. You've used the word overactive bladder, and I really like that term because it sounds so medical rather than peeing your pants or something. So overactive bladder and that's really the umbrella term for the kinds of problems that you specialize in?

Dr. Lenherr: So it basically means that you can't delay the urge to go and pee when all of a sudden you need to go. And then most people also have the frequency that they need to go to the bathroom quite often. So they're having to go every 20 minutes or every one hour as opposed to being able to hold their urine for a reasonable amount of time, like four or five hours.

Dr. Jones: Right. So tell me a story, the common kinds of things. You mentioned that sometimes people try to treat this by not drinking, but sometimes people maybe drink so much.

Dr. Lenherr: Some people drink a lot more fluid than they realize their body really needs or really can handle. And they also sometimes drink fluids that can be very irritating for the bladder, like a lot of coffee, tea, things with artificial sweeteners, sodas with caffeine. All those things can irritate the bladder, and they just don't realize that it's impacting their bladder health.

Dr. Jones: Right. The Big Gulp is the big pee. Right?

Dr. Lenherr: Exactly.

Dr. Jones: Oh, yeah, yeah. So how do people come to you? They've been in trouble for a couple of years or they had it once or they have to be referred by their doctor?

Dr. Lenherr: Many people decide they've had enough and they come and seek an evaluation with a urologist right off the bat. But some people have been struggling this for their entire lives and they just haven't had the time to tackle it on their own or their primary care physician hasn't been successful with helping them just yet.

Dr. Jones: Yeah, yeah. Well, what kinds of things begin? I just want to retrain my brain and my bladder the way I did my 2-year-old. So I just like to say, "Stop. I want to start over." Because I train my 2-year . . . well, actually, it was my mother-in-law trained my 2-year-old in a weekend. I want to retrain my bladder to behave. So what kinds of things can be done?

Dr. Lenherr: So, first, I always start off with evaluating an individual's risk factors or reasons that they have an overactive bladder. Is it because of their fluid intake or the types of fluids that they're drinking, or are they delaying urination and they just don't realize that they should have gone a while ago and then they're bothered by having that all of a sudden urgency that they need to go?

The other thing that can really contribute to overactive bladder or that sensation that you need to go pee more often is chronic constipation, so having difficulties with bowel movements, and it basically becomes a space issue in the pelvis. And so if your pelvis is full of poop, you don't necessarily have enough room to store the urine down there in your bladder.

Dr. Jones: Right. And then for women, sometimes they have a fibroid or a big uterus that's leaning on the bladder, or for men, they might have a big prostate.

Dr. Lenherr: Exactly.

Dr. Jones: So people don't know that there are many kinds of things. So the evaluation process is for each person. That's something that not all primary care docs or even some urologists can do. So I was worried because we know that 2-year-olds have problems holding their urine and we try to train them out of it. But we also know that 80 and 90-year-olds as they kind of get demented, their brain isn't as good at calling it quits and say, "I'm holding this for another half an hour." So, as you get older, is your brain just not so good?

Dr. Lenherr: Oftentimes the sensation and the awareness that you need to go is a little bit more unclear in the older population. And so sometimes they just need prompting to be reminded to go to the bathroom on a pretty regular basis.

Dr. Jones: Right.

Dr. Lenherr: The other thing that's really common in that older population is constipation that no one identifies. So, again, it just makes the bladder always feel like it's partially full.

Dr. Jones: Right. Well, I think that this is common.

Dr. Lenherr: Very common.

Dr. Jones: In fact, if you bring it up and I won't say you, I brought it up to my family, my sister and I found out that she was struggling with the same problems that my mother had struggled with it, that I had struggled with it, and then I talked to my friends and we're all occasionally struggling with it. And so this is a common problem and some people manage to putter along and do okay, but for people whom it really interferes with their life having to know every single potty in every single store and every single rest stop between here and your cabin, that can get old.

Dr. Lenherr: It's very exhausting. It definitely impacts quality of life. And that's one of the main things that I assess with my patients is, how much is this really running their lives? And if they're not that bothered by it and they can accommodate on the weekend or so, then they're okay. But sometimes people have special events that they want to go to, and so we come up with a tailored plan to help them when they want to go to a wedding or they have a road trip that they want to do with a friend and they have been avoiding doing such activities because they're afraid they're going to have to go and pee all the time.

Dr. Jones: Well, it's great that (a) you can talk like a grown-up to a grown-up, we can talk grown-up to grown-up about this kid's issue. And the takeaway here is that there are many causes of overactive bladder and many treatments, not just medication that you might see on the TV, and we're grateful to have Dr. Lenherr to help us hold it. And thanks for joining us on The Scope.

Dr. Lenherr: Thank you for having me.

Announcer: Have a question about a medical procedure? Want to learn more about a health condition? With over 2,000 interviews with our physicians and specialists, there's a pretty good chance you'll find what you want to know. Check it out at thescoperadio.com.

Interviewer: You're getting older and you're noticing that you're peeing more during the day, during the night. Is this normal? That's coming up next on The Scope.

Today, we're talking with Dr. Kirtly Parker Jones. She's the expert on all things woman. Dr. Jones, the scenario is you're 40, 50, you're getting up there in the numbers and for whatever reason, you're just starting to pee more. You're starting to wake up more in the night, you're starting to take a little more breaks during the day. What's going on? Are you normal?

Dr. Jones: Yeah, this is, well, remember we talked about normal . . .

Interviewer: Is she normal?

Dr. Jones: Is she normal? Welcome to the overactive bladder club. Welcome to the potty club. It turns out that urgency, meaning a bladder that contracts before it's really, really full is quite common. And the range in studies go from five percent to 30 percent of women by midlife have what they consider an overactive bladder and sometimes even leak a little.

Dr. Jones: So let's talk about medical or structural problems that might lead to this. We're not talking about stress incontinence, meaning you got to go when you cough or sneeze. This means you're just kind of walking around and then you got to go and then you just went and then it's an hour or two later and you've got to go and it's just going. First of all, the most common that causes urgency, meaning I've got to go is a urinary tract infection. But if this has happened over a long period of time, that's not going to be it. A UTI, a urinary tract infection, is actually an acute event.

Interviewer: And usually hurts, doesn't it?

Dr. Jones: It usually hurts. Now, there are women who have fibroids or something in their pelvis that's growing that's leaning on their bladder. So just as when a woman's pregnant and the baby's head is leaning on the bladder and they have to go all the time, if you have a big fibroid on your bladder or another pelvic mass, that can be a benign mass and it could have been growing slowly over years and you just know that you can't hold as much. So those are some reasons.

There are people with neurologic problems, multiple sclerosis, and other conditions that can make kind of an overactive bladder and that's what you see on the TV, it's called overactive bladder.

The most common reason is we don't know. So I call it idiot-pathic, instead of idiopathic, meaning it's unknown, I call it idiot-pathic. And it has to do with an aging brain. And that is the kind of ability to calm your bladder that you had to learn at two so that you could be continent and not pee in your pants all the time.

As you get older, you lose some of that so your brain can say, "Oh, I think I want to pee and I want to pee now." You can retrain your brain to say, "No, I really don't. I just went two hours ago and I haven't had anything to drink." So mindfulness training actually works very well.

So we have classes here at the University of Utah in mindfulness training specifically to help women with overactive bladder. As I said, it's common. Five to 30 percent of women complain of this. So they have to get up once or twice at night.

Now, another important reason before I get back to the overactive bladder is I see women walking around in their yoga pants with their water bottle. And they have water bottle with them everywhere because it's part of their drinking, drinking, drinking so that certainly can be part of it in women who are trying to watch their weight know that drinking water is good, and then they're drinking buckets of water and they have to go.

And those women, when you ask them are when they keep a diary, actually will let you know if you have them pee in a little thing we called the hat that sits in the potty so you can measure it. They are peeing a lot because they're drinking a lot.

There are other conditions like diabetes where you have a lot of sugar in your blood. Those people actually become dehydrated because when you have to get rid of the sugar, you have to get water out with it so those people pee a lot.

So there are a couple of things that are medical that caused frequent urination but those people are peeing in buckets and when you have to get up in the night and you get out of bed and you just pee a little bit, so that's urge incontinence or urgency we call it. There are ways to treat it.

Now, there's medicine to treat it but the medicines make a little difference. So they did some randomized studies where they looked at medicines that are actually, you see them advertised on the TV. They may decrease the number of urge episodes a day by one or two so you're still left with a moderate amount.

Interviewer: You're still pretty much going regularly.

Dr. Jones: You're still going. You are. And they have side effects of dry eyes and dry mouth, and what do you do when you have a dry mouth?

Interviewer: You drink more.

Dr. Jones: You drink more. So I think what we usually try to do is help people retrain their brain.

Interviewer: So mindfulness is the best solution.

Dr. Jones: Mindfulness is one of the best solutions and making sure that you don't have a lump in there, that you don't have diabetes, that you don't have other conditions that will make you go that are medical concerns. The most common is the brain just isn't as good at suppressing that bladder spasm as it was when you were 20, and now you need to retrain your brain.

Interviewer: So if you don't have a medical condition like diabetes, or urinary tract infection, and you're getting up there in the numbers . . .

Dr. Jones: Yeah, in the numbers.

Interviewer: In the numbers, right? We're just going to call them the numbers, and you're peeing a lot more than you used to, this is normal.

Dr. Jones: This is normal and I'm sorry.

updated: August 13, 2020
originally published: May 11, 2017

Dr. Jones: As human beings have evolved, our big brains evolved to be bigger than our pelvis has evolved to be bigger. So births have become a little harder with a few more long-term consequences for women. This is Dr. Kirtly Jones from Obstetrics and Gynecology at University of Utah Healthcare and this is the scope of the problem of getting the baby out.

Announcer: Covering all aspects of women's health, this is the Seven Domains of Women's Health with Dr. Kirtly Jones on The Scope.

Dr. Jones: It has clearly been an advantage for humans to have a big brain. So with the big brain comes a big head. Today in The Scope studio I'll be talking to an expert on the pelvic floor, Dr. Ingrid Nygaard. She is a professor at the University of Utah and a urogynecologist, a gynecologist who specializes in pelvic floor problems. So what is the pelvic floor really? Not something you scrub with Ajax or something but give it to us.

Dr. Nygaard: No, definitely not. It's one of those important structures that we appreciate only really when it's not functioning as well as we wish it would. The pelvic floor is made up of the muscles, ligaments, connective tissues and nerves that support our internal organs, like the bladder, the uterus, the vagina, rectum. The pelvic floor muscles run from your pubic bone at the front to the base of your spine at the back. They're shaped like a sling and they hold your pelvic organs in place.

Dr. Jones: So it's kind of like a sling or a hammock but you don't want it too sling-y. You don't want it too hammock-y. You want it to be strong. So all these muscles and connective tissues keep our insides in. What happens when a baby comes out that way?

Dr. Nygaard: Well, as you can probably imagine, to allow the baby to pass through, the structures in the pelvic floor all have to stretch quite a bit. Luckily our body starts preparing for this long before labor even starts. But the pelvic floor muscles sometimes weaken after childbirth and then they weaken further as we get older.

Dr. Jones: Well, women give birth vaginally all over the world but why do some women have problems after vaginal birth and some don't?

Dr. Nygaard: Well, we know that weakened or dysfunctional pelvic floor muscles can cause problems down the road, like bothersome leakage of urine or pelvic organ prolapse where one or more of the pelvic organs bulges into the vagina. But for most women these conditions don't happen until they're middle aged or older. We don't know very much about how young women experience changes in their pelvic floor function after childbirth. It's probably fair to say that most women notice some minor changes after giving birth but the fact that most women who deliver vaginally don't have long lasting problems speaks, I think, to how amazing our bodies really are.

Dr. Jones: So as young women they may have the original insult or the original maybe even damage but that really doesn't show up until ageing and gravity and time adds its little mix to the potion. Is that how it goes?

Dr. Nygaard: Right exactly.

Dr. Jones: Right. So if women have a problem after vaginal birth, could it get better on? And so you're suggesting that these they don't notice it or maybe it gets better on its own?

Dr. Nygaard: No, absolutely it could get better on its own. A lot of processes go on in our bodies that encourage healing and recovery after childbirth. Over the first couple of months for example, the uterus goes back down to normal size and the pelvic floor muscles start regaining their strength, and this means that symptoms that some women notice after childbirth often go away within a few months. If it doesn't get better, is there anything we can do to help? Well, we're lucky that time alone helps many women recover well after childbirth but we don't know very much about other factors that might help women recover well after vaginal delivery. But one thing women can do to help get the pelvic floor back in shape after delivery is pelvic muscle exercises. Some people call those Kegel exercises. I encourage women who notice some urinary leakage for example, to do these. It's a good idea to have someone give you some guidance to make sure you do these correctly and effectively, and a great resource for this is a women's health physical therapist and you can also ask your doctor or nurse for tips.

Dr. Jones: Oh and they're really easy to do. I just did them. I can do them while I'm even talking on The Scope radio right now and I don't have to hold my breath and my face isn't getting red.

Dr. Nygaard: It's not getting red.

Dr. Jones: But someone in the studio is kind of laughing. Oh, okay, well let's talk about does childbirth cause any problems over the long-term? We talked about that a little bit.

Dr. Nygaard: Well, over the course of her lifetime about one in five women undergoes treatment, often surgery, for pelvic floor disorders. Childbirth is one thing that can contribute to this but there are many other factors too from ageing to nerve problems like strokes to obesity and genetics plays a role as well.

Dr. Jones: I read somewhere that female paratroopers had a little more prolapse but that's just an aside. So what kind of research are you involved with regarding these problems in childbirth?

Dr. Nygaard: That's amazing to consider the fact that even though nearly four million women deliver baby in the US every year, most of them vaginally, there really hasn't been much research about how to maximize recovery after childbirth in terms of pelvic floor health. So we are conducting a study called the MAPH study, which is short for Motherhood And Pelvic Health, and the goal of the study is to find out what we can recommend to help women recover well after vaginal delivery. We're specifically looking at how things like physical activity, intra-abdominal pressure and muscular strength influence pelvic floor support and symptoms during that first postpartum year. We see this research as an important step in crafting prenatal and postnatal regimens that will promote better pelvic floor health. We're planning to enroll about 1,500 women across the Salt Lake Valley. Our participants are all first time new moms and we're so grateful to them for lending us their time and involvement to help us learn about pelvic floor health after childbirth.

Dr. Jones: So for those of you who are still having babies or about to have your first, the good news is that it goes mostly just fine and for you ladies who have some long-term consequences of getting those babies out, there's hope and there's help, and thanks for joining us on The Scope.

Announcer: TheScopeRadio.com is the University of Utah Health Sciences Radio. If you like what you heard, be sure to get our latest content by following us on Facebook. Just click on the Facebook icon at TheScopeRadio.com.

Dr. Jones: Multiple sclerosis is a disease that's more common in women than men. It's a complicated disease, it's a neurologic disease, but it affects many parts of the body and today we're going to talk about the bladder, and MS, and your health, on The Scope.

Announcer: Covering all aspects of women's health, this is the Seven Domains of Women's Health with Dr. Kirtly Jones, on The Scope.

Dr. Jones: Today in The Scope studio, we have Dr. Sara Lenherr, who is a specialist in neurology, she's trained as an urologist, but she's pretty clearly interested in the way the brain talks to the bladder. And today we're talking with her about MS, patients with MS, and problems they might have with their bladder, and what might be done. So talk a little about the brain talking to the bladder and multiple sclerosis.

Dr. Lenherr: In normal patients that don't have neurological problems, the brain is designed to tell the bladder to store urine for as long as is reasonable, and then when you're near a bathroom, then you volitionally go ahead and void out your urine. Unfortunately in multiple sclerosis and a lot of different types of neurological disorders, the communication between the brain and the bladder is disrupted by the nervous system problems that happen in MS.

And so specifically, sometimes that bladder becomes over-active and receives too many signals from the brain, and then it also, the sphincter that's supposed to keep you from leaking doesn't necessarily relax when you want to go ahead and pee.

Dr. Jones: So what happens? So a woman who has MS and has neurologic symptoms in her bladder, what would she experience?

Dr. Lenherr: So usually they'll present with urinary frequency and urgency, but sometimes they just don't empty their bladder at all, so they'll feel like they have to go, they try to go, and then they can't empty out their bladder completely. Either just a little bit comes out or none comes out at all, and interestingly, sometimes we catch these cases of multiple sclerosis before they're even diagnosed by a neurologist, because women will present when they're a little bit younger, and they have no reason to be in urinary retention to not empty their urine.

Dr. Jones: So let's back up, so urinary retention. You mean if they go a little bit, then their bladder gets fuller, and fuller? I see a balloon in my head.

Dr. Lenherr: Exactly.

Dr. Jones: How full is too full and what happens?

Dr. Lenherr: Well, if you have too much urine in your bladder, especially for women, usually when you have too much in your bladder and you're a female, you have what's called overflow incontinence, where the urine just comes out even though the sphincter is nice and tight. And so those women will notice that they just leak, and they can't empty out all the way. They feel full.

Dr. Jones: Well, so a lot of women leak, so how would you know that it's overflow? What test would you do?

Dr. Lenherr: So we can do either a catheterized volume to see if there's urine left over after you pee. Or we can just do a little bed side ultrasound to evaluate whether or not there's any urine leftover in your bladder.

Dr. Jones: So a urologist might actually pick up MS before the patient shows the other neurologic signs of MS.

Dr. Lenherr: That's correct.

Dr. Jones: And these are young women.

And young women being wet all the time is devastating, well it's what, it's devastating for any woman of any age, but for young women in particular, they don't want to be wearing pads, and Depends. So what kinds of things do you have to offer for women with MS?

Dr. Lenherr: So once we identify the problem, then we need to discuss with the patient what drives their quality of life, and what is a safety issue. So safety issues would be if your bladder doesn't empty all the way, and it ultimately causes the bladder to stretch out and cause damage, and sometimes could impact kidney function.

Dr. Jones: Oh, so it backs up and backs up?

Dr. Lenherr: It can back up all the way and it could cause the kidneys to have damage which is a bigger issue. The other thing that can happen with the urine sitting in the bladder for a long time, it can lead you to get urinary tract infections. So there's multiple things that we can address with a safety issue, and then we need to look at quality of life, so quality of life is impacted by leaking all the time, or having to go to the bathroom all the time.

Dr. Jones: So do women have to empty their own bladder with a tube? I mean do you give them medication to make their bladder squeeze a little harder?

Dr. Lenherr: So depending on how their bladder works when we evaluate it, we frequently have to have these patients go use a small catheter to empty their bladder on a timed basis. And that generally treats them very well because it empties the urine when they want to, and they're able to control risks of urinary tract infections and kidney damage, and then they also don't have the overflow incontinence that we discussed before.

That's one good strategy, sometimes if the over-activity is really bothersome, and they still have irritation even though there's a small amount of urine in their bladder, we put them on other types of medication and we also can offer them chemodenervation, which is called botox, which is similar to the botox that you put on your forehead for wrinkles, we can inject that in the bladder to relax it.

And we can also put in nerve stimulators that help act like a bladder pacemaker. So there are multiple different options we can offer women with multiple sclerosis to help them manage their bladders better.

Dr. Jones: Well that's great news, because for MS it's a condition that waxes and wanes through a life time. It often begins in women's early 20s, or 30s. So giving somebody the qualify of life so they can be the persons that they want to be, is a really important service that you guys can offer.

And I think for many women with MS, they feel like their life and their agency has been taken away, and empowering them to have a little more control.

Dr. Lenherr: Exactly, and also considering that we follow them for the rest of their lives, and sometimes their bladder conditions change, so we need to adjust the strategies that were working five years ago.

Dr. Jones: And here at the University of Utah, we have a medical record that helps our doctors talk to each other so you're not doing this just in the urology clinic. You talk to their other MS doctors.

Dr. Lenherr: Exactly.

Dr. Jones: Because often they're on a lot of meds.

Dr. Lenherr: We coordinate all their care and make sure that we're all working together to improve the quality of life and keep them safe.

Dr. Jones: That's great to know because I've had a lot of patients over the years with MS. It's very discouraging. Knowing that there's things that they can do is very helpful, and Sara thank you for joining us on The Scope.

Announcer: TheScopeRadio.com is University of Health Science's Radio. If you like what you heard, be sure to get our latest content by following us on Facebook. Just click on the Facebook icon at TheScopeRadio.com.

Dr. Jones: Diabetes and the bladder, you never think of these two things going hand in hand. You think of a cupcake and diabetes, not the bladder and diabetes, but today we're talking about diabetes, the bladder. This is Dr. Kirtly Jones and this is The Scope.

Here in The Scope studio, we have Dr. Sara Lenherr, who is a urologist by training, but subspecialty trained in neurology. Today we're talking about diabetes because diabetes is a complex disease. It affects every part of the body and the bladder is the final common pathway of both nerves and sugar and trouble. Welcome to The Scope, Sara.

Dr. Lenherr: Thank you for having me.

Dr. Jones: I think in my own practice sometimes I diagnose diabetes because of women's urinary frequency. So can you tell us a little bit about how the first signs of diabetes might affect the bladder?

Dr. Lenherr: Sometimes women with poorly controlled diabetes end up having a bladder that spasms too frequently, and that can be very bothersome. It makes them feel like they have to go more frequently and urgently.

Dr. Jones: Also, sometimes people who don't know they have diabetes yet, their sugars are high, the kidney is trying to dilute that sugar, and they just pee a lot.

Dr. Lenherr: Yes, frequently these patients make too much urine because their kidney function is affected, and so they just make more urine than the bladder can handle, and it makes them feel like they need to go more frequently, and they do.

Dr. Jones: So peeing a lot in large volumes, for me, I remember that from medical school, was you better make sure they don't have diabetes.

Dr. Lenherr: Exactly.

Dr. Jones: Over the long term, though, diabetes affects your nerves in your feet and affects other parts of your brain, but talk about the bladder in long-term diabetes.

Dr. Lenherr: Diabetes in patients that have had it for a long time can affect the fingers and toes, and all that sensation also affects all of the nerves that go to the bladder, and so the bladder doesn't necessarily contract at the right time. Either it's overactive, or it's underactive. It doesn't contract well enough, and so therefore it doesn't squeeze when you want it to and you don't empty your bladder completely.

Dr. Jones: So in terms of diabetes, we certainly want people to be in good control, because that might help early on a lot of their bladder symptoms, meaning if their sugars are in good shape, their bladder will probably be in good shape. But for people who have been diabetic for a long time and they weren't in such great control and now they have more permanent damage, how do you make that diagnosis?

Dr. Lenherr: Usually, we check and see whether or not the bladder empties completely, so once you go, we can then check and see if you have a residual left over in your bladder, and then we can also check bladder function tests where we measure the pressures inside the bladder and see how your bladder behaves with filling and then trying to empty your bladder.

Dr. Jones: Is that very comfortable? Reassure me that that's not going to be a painful test.

Dr. Lenherr: It's a very simple test that's done in the office. We put a very small catheter that's smaller than the mouse cord that goes to your computer, and we place that inside your bladder, and we place also a very similar small one inside the rectum. This helps us look at how the bladder behaves with filling and emptying to measure those pressures and see whether or not your bladder nerves are not working properly.

Dr. Jones: Okay, maybe I would have this test. Okay, I'll have this test. So, I had this test and my bladder isn't contracting very well. What are you going to do? What can you do to help me with this?

Dr. Lenherr: Depending on how much your bladder is injured, sometimes we have to have patients actually just pass a small catheter every four hours while they're awake to empty their bladder as opposed to trying to pee it out. But if you have a little bit of bladder function, then sometimes we can actually give you a bladder pacemaker that helps your bladder contract in a much more efficient manner, and therefore you're able to empty without having to use that catheter.

Dr. Jones: How about as people get older? I think of the elderly patient with what we call comorbidity, so they're older, they have diabetes, they have heart disease because it's affected their heart, maybe they had a stroke. Urinary incontinence is the number one reason to be admitted to a nursing home. So what do we do for older people? Can they do their own catheterizations, or is this something a family can help them with?

Dr. Lenherr: The complex patient with incontinence is definitely some of the more challenging cases that we have, and it's a balance between figuring out what the goals of care are. Some patients are very happy to have family help them catheterize if they need that to be done. Sometimes patients would rather not have their family members be going down there and helping them pass a catheter, and depending on how the bladder works, it can be a very good option to leave a chronic catheter in place.

Usually we try to place that in a suprapubic location, so right above the pubic bone below the belly button, and that helps drain the bladder and improves quality of life in a lot of patients. But these are really specialized conversations that we have with both the patients and their families to determine who is going to help out the patient and who is going to be able to help keep the patient safe and happy.

Some of the more rewarding conversations are having these discussions where you have patients understand these are my choices and this is what my goals of care are, and it's not always a quick fix, and it's not always the most complicated solution. Sometimes it just needs to be something simple that everyone agrees this is what I want to have my life be like, and I'm there to offer those solutions for them.

updated: November 24, 2021
originally published: December 23, 2015

Dr. Jones: Wait, can we stop at the next gas station? Yes, I know we stopped at the last one but this is your bladder speaking and maybe it's time to get some help. This is Dr. Kirtly Jones from Obstetrics and Gynecology at University of Utah Health Care and this is your bladder on The Scope.

Announcer: Covering all aspects of woman's health, this is The Seven Domains of Woman's Health with Dr. Kirtly Jones on The Scope.

Dr. Jones: Urinary incontinence is common in women, as many as 30% of women have incontinence for one reason or another. Babies moved your bladder around or you have an overactive bladder. Incontinence pads are a billion dollar business. But if your primary care provider can't help or you have more complicated medical issues maybe you need to see a urologist.

Today in The Scope Radio studio we'll be talking to Dr. Sara Lenherr. Dr. Lenherr is a urologist at the University of Utah and she's going to help us understand some of the more complicated reasons for bladder problems. She has a special interest in neurology, let's talk about how our brain and our bladder communicate.

Dr. Lenherr: The brain and the bladder have a really important communication process that needs to occur and basically the bladder is designed to store urine as a vessel until your brain tells it that it's okay to go to the bathroom, like when you're near a bathroom. And then the sphincter is designed to hold urine in place. Again, when you're able to get to the bathroom in time.

Sometimes in some medical conditions and other things that have happened with pelvic surgery or other types of vaginal deliveries with babies, that communication can get disrupted and so we need to pay special attention to that type of communication.

Dr. Jones: I always admired dogs who could put a little here and put a little there and do exactly what they wanted and when. But when that's not working I thought only men went to urologists. You know, for their prostate problems or those guy things. So urology for girls? For women?

Dr. Lenherr: So that is a really common perception and actually women have bladders too and they need to be pee too and urologists are specially trained to take care of the bladders pretty much exclusively and so we're here to help both men and women.

Dr. Jones: Great. So I'm an OBGYN and in our department we see a lot of women with urinary problems and we can fix a lot of them. But we're not very good for those women with complex medical problems. So can you talk a little bit about that?

Dr. Lenherr: So women have many different sorts of disorders that can disrupt the way the bladder works. The common ones are ones that disrupt the signals that go back and forth between the bladder and the brain. And also there are signals that make too much urine, so some women have heart disease which causes their kidneys to actually make urine and shift that around at the wrong time, and so they need to go more frequently and urgently because they're just making more urine.

There are many different types of conditions that affect the way the bladder works and really with an in-depth evaluation with a specialized urologist is really useful in order to figure out do we need to work on the bladder squeezing too much at the wrong time? Or is it a problem with the sphincter being too leaky, causing you to leak when you don't want to?

Dr. Jones: Well I can see that really takes some specialty training and you did a specialty fellowship in this area?

Dr. Lenherr: Yes, so there's a new specialty that came out a couple of years ago called, "Female Pelvic Medicine Reconstructive Urology" and we specialize in basically bladder function and how the bladder and the brain communicate. In order to evaluate how the bladder and the brain communicate frequently we perform what's called, "urodynamic evaluation" where we study the bladder pressures and the sphincter pressures, the urethral pressures, and figure out how they coordinate and communicate with different sensations.

Dr. Jones: Well we're really glad you're here at the University of Utah for all of us who are getting a little older, having a few more medical problems, and don't have the bladder that we want. Voluntary control of the bladder is a beautiful thing, but if it's not working for you, we and Dr. Lenherr can help.

Announcer: TheScopeRadio.com is University of Utah Health Sciences Radio. If you like what you heard be sure to get our latest content by following us on Facebook. Just click on the Facebook icon at TheScopeRadio.com.