Pink Prescriptions - August 2023

August 2023 Issue — Pink Prescriptions
Get Back on Track
When it Comes to Your Urinary Tract Infections and Incontinence:
Help is on the Way

When it comes to your urinary tract, it is important to stay on the right track! Not only can urinary issues cause pain, infection, and the breakdown of tissue, they can also cause unwanted leaking and diminish your quality of life. Fortunately, there are ground-breaking, new and exciting treatments that can put incontinence and recurring infections in their place and put your urinary tract back on the right track! We asked two local physicians, who help patients resolve these issues every day, to share their knowledge with us. Be prepared to learn something new; we sure did. The best news, though, there is help…and it can work!

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By Katherine Coley, M.D. — Advanced Women’s Care of the Lowcountry 

I suffer from recurrent Urinary Tract Infections (UTIs). What can I do to lessen my chances of getting them?

Recurrent UTIs are typically caused by bacteria, which is already found in the urogenital/anal areas, getting into the urethra (where urine comes out) repeatedly. The most common cause of this is during sex, and more frequent sex can cause recurrent UTIs. Bacteria thrive in warm wet environments, so having urine sitting in the bladder for long periods of time can also be a cause of frequent UTIs. This happens when you get dehydrated and pass urine less often, or if you are not completely passing urine when you void, such as with a prolapsed bladder.  Here are the most effective ways to avoid recurrent UTIs:

• Voiding after having sex
• Wiping from front to back to avoid dragging bacteria from the anus and vagina toward the urethra
• Drinking lots of water to keep urine passing though
• Showering rather than taking baths
• Using products such as concentrated cranberry tablets (instead of cranberry juice, which is mostly sugar)

Is there a correlation between urinary tract infections (UTIs) and post-menopause? Should I change any of my habits post-menopause to avoid UTIs?

As women age and their estrogen levels drop, the vaginal tissue thins out and starts to retract. This can allow the urethra to become more exposed, thus causing post-menopausal women to become more prone to UTIs, even when they are no longer sexually active. Using an estrogen vaginal cream around the inner labia and vaginal opening a few times a week can give enough estrogen to the area to help prevent UTIs, while giving only minimal systemic estrogen exposure. If you are not able to, or do not want to, use any estrogen-containing products, then vaginal rejuvenation treatments can also help by improving the quality of the vaginal and vulvar tissue. If you have a prolapse, using either a pessary or having surgery can help to reduce the prolapse and prevent incomplete emptying of the bladder. If you are having to wear a pad or adult diaper due to bladder leakage, changing the pad often and cleaning the area (front to back) with each change can help avoid UTIs, as well.

Dr. Katherine Coley is a Board Certified Ob/GYN at Advanced Women’s Care with 13 years of experience. She graduated residency from New York Presbyterian Hospital/Weill-Cornell program. Call for more information: 843-301-0718.

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By Dr. Tracy Blusewicz | Advanced Women's Care of the Lowcountry

I suffer from urge incontinence. What is the best way to reduce, or stop, leaking? 

There are many new and emerging treatment options for overactive bladder (OAB) and urge incontinence, plus some old good ones that you can rely on, too.  The problems you are experiencing now will only get worse without intervention. So, wearing pads today leads to full Depends’ briefs in a few years. 

First, you have to figure out if you have OAB with urge incontinence, or if you have mixed incontinence. Mixed urinary incontinence is a blend of OAB, urge incontinence, and stress urinary incontinence. This means you experience urinary frequency, loss of urine when you feel the strong urge, and also loss of urine with effort like a cough, laugh or sneeze. A provider can help you identify which type of incontinence you are dealing with and help you best choose your treatment plan. It's important to know what you have in order to get the best treatment. (I often find that a woman who reports a failure with a treatment plan often has picked the wrong one or did not treat ALL her symptoms.) 

Kegel exercises, pelvic floor strengthening, and abdominal core strengthening are great ways to work on staying dry. Losing weight, even a few pounds, can make a difference in your bladder health. Choosing a bladder-friendly diet, low in acidic food choices, caffeine, and alcohol all help.

The next steps can include guided physical therapy, women's wellness machines like VTone, Morpheus 8V, and Votiva, which all work on optimizing vaginal strength and health.

There are prescribed medications like the Oxybutynin, Detrol, and Vesicare, but unfortunately, these all have side effects of dry eyes, dry mouth, and constipation, which can worsen OAB! Newer medicines like Gemtesa and Myrbetriq do not have any of these annoying side effects and are more effective in treating OAB symptoms. Until recently, the insurance coverage was not the best for these effective medicines, but every year the coverage improves. So even if in the past your insurance did not cover these medicines, you should check again because coverage improves the longer a medicine is out on the market.

If you tried all of these medicines and are still experiencing symptoms, you could look into Botox for your bladder!  Yes, the same Botox used on faces can help your urge incontinence. The injections are performed by a urologist and work by relaxing the bladder muscles which spasm during OAB symptoms. Botox unfortunately does not last forever, so this is a continued treatment plan that you follow up with about twice per year.

There are other surgical options like InterStim, which is like a pacemaker for your bladder. An implantable device sends electrical pulses to the sacral nerves to decrease the bladder "chatter" that leads to OAB. This would be performed by a urologist and is usually considered after a woman has failed other options.

I hope this information leads to an awareness that a woman does not have to suffer with OAB symptoms! Ladies, talk to your providers, or find one that asks you the right questions which will lead to a dry life for you.  We don't let our babies sit in wet diapers, and you shouldn’t have to, either! Work on freeing yourself from the burden of OAB. It may take a combination of treatments, but you can have success.

 

I’m so nervous I’ll suffer from urge incontinence or an overactive bladder as I age.
What are some things I can do now for prevention?

Overactive bladder (OAB) is a real problem for many women! In the United States, it is estimated that 40 percent of women end up dealing with overactive bladder complaints at some point in their lives. Why are so many women affected by OAB? Pregnancy, childbirth, obesity, diet choices, lifestyle, hormone changes, and constipation are just some of the reasons. 

OAB is the frequent and sudden urge to urinate that you cannot control; it can cause the loss of urine or leaking. OAB can happen many times throughout the day, and unfortunately, can even cause women to wake up many times during the night. Some women report getting up two to three times per night, but I have had patients report getting up 10 times per night! That's not only annoying, it affects a woman's ability to get a good night's sleep, leaving her tired, frustrated, and embarrassed.

The good news is there are ways to decrease your chance of being affected by OAB. First of all, maintaining a healthy weight is key. Pressure on the bladder and pelvic floor from extra weight increases bladder dysfunction. Also, choosing a healthy diet with limited caffeine, alcohol, and "junk food" packed with chemicals is best for the bladder lining, decreasing the chance of irritation of the bladder. Not smoking or vaping also decreases the risk of OAB, again it is all about decreasing the irritation to the bladder. 

The pelvic floor is key to supporting the bladder and urethra, and a strong pelvic floor leads to the best bladder health. Unfortunately, the pelvic floor gets traumatized by pregnancy and childbirth, especially over time with multiple pregnancies and deliveries. Having a C-section doesn't spare a woman the risk of OAB because she carried the pregnancy and the surgery itself weakens the abdominal core, which also plays a role in urinary continence. Women who don't experience pregnancy or childbirth are not in the clear either, because menopause and the lack of hormones happens to all women! Constipation, jobs or hobbies that involve heavy lifting also weaken the pelvic floor muscles, so those heavy bags of soil you are moving while gardening is even a risk.

Since some of these risks are unavoidable in life, you can do pelvic floor exercises like Kegel's to strengthen your pelvic floor and help decrease the risk of OAB. Kegel exercises are a MUST do! The earlier you start these in your life the better. Optimally, women can do these while they are pregnant (they will help with delivery) and six weeks postpartum to rehab the pelvic floor. Starting them before menopause, while you still have your own hormones, is good too, but it is never too late to start doing Kegel’s.

What is a Kegel exercise and how do you do it ? First, start by identifying the pelvic floor muscles. You can stop your flow of urine midstream to figure out these muscles. Then, work on technique. Slowly squeeze your muscles, imagine you have a marble in your vagina and you are trying not to drop it. Slow, steady squeezes are the best while maintaining your focus. Often, women are moving their thighs or buttocks and not even moving their pelvic floor. You can buy Kegel weights online and watch a YouTube video to get the action down. You have to practice these at least three times per day every day to get your strongest.

As easy as it sounds, some women just don't want to practice Kegel’s, or can't feel their muscles enough to do them due to the extent of weakness. There is help!  You can go to physical therapy with a provider referral. There are Kegel weights, Kegel educational sites, daily home toning machines. There is also the game changing VTone machine, which is part of the Empower platform for women's wellness. This revolutionary device does the work for you and is stronger than you can do yourself.  One VTone session works your pelvic floor the equivalent of a years worth of Kegel exercises. Often women start these in their 30s or 40s, but VTone can help ladies up into their 80s, and we have even treated a woman that was 100 years old, proving no one likes to leak no matter how old or how young.

So, don't take OAB as an unavoidable reality. You can work on prevention, no matter what age!

Tracy Blusewicz, M.D., F.A.C.O.G., compassionate, genuine bedside manner has earned her the trust of many women for their health care needs. She can be contacted at Advanced Women’s Care of the Lowcountry | The Medical Spa 843-341-9700; www.awclc.com