Our Wet Secret

This month’s column is an interview with Meagan Matteson, MSN, CNP a specialist in female pelvic medicine-prolapse and incontinence. You might be surprised what your mom and aunties haven’t told you about bladder health.

Joy: I am so happy that we are getting the chance to talk about this important topic. I am even happier that I get to introduce you to our fabulous readers and have them get the benefit of your expertise in pelvic medicine. It has been said that 1 in 4 women over 18 years old experience incontinence and yet there are still so many misconceptions about prolapse and urinary incontinence. What have you found to be the biggest misconceptions women have about urinary problems including incontinence?

Meagan: There are 2 primary misconceptions about incontinence in women.  The biggest misconception is that it is NORMAL.  Urinary incontinence in females is COMMON but it is not NORMAL.  Because many women believe that leaking is an expected outcome of having children or getting older, they often postpone diagnosis and treatment.  Quality of life can suffer for years while women struggle.  This can include decreased sexual satisfaction, decreased work satisfaction, and decreased social interaction.  It can put a financial strain on individuals who need to pay for bladder protection.  The fact that a diagnosis is common as an outcome of time does not mean it is normal.

The second misconception is that most incontinence is treated surgically.  Most women understand that there is nothing inherently dangerous about urinary leaking.  Leaking is not going to kill you or cause significant health problems if left untreated the way high blood sugar or high blood pressure does.  Because of this, many people prefer to live with the consequences of incontinence rather than deal with it surgically.  Surgery sometimes seems like a drastic response to what is, at baseline, an issue of bother.  Fortunately, there are usually non-surgical, medical options to decrease urinary incontinence in women.  Going under the knife is an option but not a requisite treatment.

Joy: I feel like people are aware of bladder issues thanks to commercials for medications, but I think many women think this is an issue of aging. I have a relative who started taking medication for urge incontinence in college because it was really disrupting her life especially during final exams. How do you see pelvic health impacting women across their life course?

Meagan: There are certainly different issues related to the pelvic floor for women across their life course.  First, a description: the female pelvic floor  is a complex hammock of several different muscles that gives support to the pelvic organs and acts to keep urine and stool inside until we consciously give permission for them to come out.  This “floor” is under constant stress, both from our body and what we chose to do with it, and gravity pulling down from the outside.  Earlier in life, women experience symptoms due to a pelvic floor that is too tight-this can cause pelvic pain, pain with intercourse or urinary frequency and urgency.  As women age and move into the childbearing years, the muscles of the pelvis can become weaker, sometimes leading to incontinence or prolapse of the vaginal walls.  Estrogen helps keep the lining of the vagina and urethra supple and toned. Incontinence and prolapse often worsen during and after menopause when estrogen levels fall. Frequency of urination-with or without incontinence-can be an issue for women of any age.

I think the most important thing for a woman to know about her pelvic floor is that it cannot and should not be a source of embarrassment.  Women’s bodies do amazing things every day.  We should talk about those things.  We should also talk about what can go wrong with our bodies.  So many patients I see are terrified about their situation.  They don’t realize how many of their relatives and friends are experiencing the same problems.  They don’t need to be terrified-they need to share.  Talk to your sister, your mom, your daughter.  Talk to your health care provider.  Give your bladder and pelvic floor the respect they deserve.  You could have a better life and help someone else in the process.

Joy: It is really important to talk to your health care provider. I was reading the other day that on average, women wait 6.5 years from the first time they experience urinary symptoms until they obtain a diagnosis for their bladder control problem! Don’t wait for over half a decade to get help ladies! So what should I do if I leak urine when I cough or sneeze, feel like my bladder and uterus are falling out or have other such pelvic problems?

Meagan: That is a very concerning statistic and I see it all the time.  The first step in treatment for incontinence and vaginal prolapse is talking to someone about it.  If you are comfortable with them, your primary care provider can be a good jumping-off point.  You see them often and they are usually a good source of initial information.  If the problem is treatable with medication, they can often initiate that.  Your women’s health provider is another great resource.  Women are often more comfortable talking with them about sensitive issues.  Sometimes, depending on their level of confidence and experience, they can also initiate treatment.  Finally, if you have tried other avenues, a specialist may be in order.  Specialists such as urogynecologists (gynecologists with specific training in treatments for incontinence and prolapse) and female urologists can often give a broader picture of all the options, surgical and non-surgical, for addressing your problems.  If you are considering surgical correction, do your homework about your surgeon!!  Find out specifics including how many and what types of procedures the surgeon performs and how comfortable the surgeon is with the surgery you have been offered.  Remember-you own your body-you need to be comfortable with the choices you make about treatment.

Women.  We are super busy.  Business women.   Moms.  Students.  We are often pulled in a thousand different directions in any given half hour.  Sometimes, our bladder loses the game of “attend to me!”  My advice for everyone-is DO NOT TAKE YOUR BLADDER FOR GRANTED.  I am and always will be amazed at what our bladder can do.  We tell it to hold. Hold. Hold. Hold. Not yet. Not yet. Not quite. Now-GO.  And it usually does.  If you and your bladder are no longer on good working terms, you should ask someone why.  This could mean voiding too often or not enough.  It could mean you have leaking with exercising or intercourse or getting out of bed in the morning.  It could mean every time you put your key in the door, you feel like you are going to urinate on your porch.  It might sound bizarre or crazy to you.  It might make you feel like you are no longer in control.  And there is probably something that can be done to fix it.  You just have to ask.

Joy: Truth. We could talk about this forever but before I forget, I want to share your instructional sheet on how to do Kegels from an expert. Thank you so much for sharing your expertise with us and thank you for all of your work helping women getting back to a normal life!

I want to remind our readers that one of the easiest ways you can start on a drier path is to do Kegels. What are Kegels you ask? Kegels are simple exercises you can do discreetly that help tone your pelvic muscles and for many women relieve their incontinence problems. You can download Meagan Matteson’s expert instructions on how to do Kegels here!

*Nothing in this article should be considered a replacement for personalized medical advice/treatment from a health care professional. MyCity4Her does not provide medical advice, diagnosis or treatment.

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