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Dr. Jones: What is the problem when your bladder seems to tell you that you need a bathroom frequently, urgently? What's that all about? Is it common, and what can you do about it?
So what can be the problem when you feel like your bladder controls your life, having to find a bathroom frequently? Today, in the virtual Scope studio, we'll be talking to Dr. Whitney Hendrickson, and she is a urogynecologist at the University of Utah Health. And a urogynecologist is a subspecialist who has completed training, extra training in both gynecology and urology. And since urogynecologists have training in both, they are particularly trained to help women with conditions like incontinence and pelvic organ prolapse. Welcome, Dr. Hendrickson.
Dr. Hendrickson: Thank you for having me. I appreciate it.
How Common Is Overactive Bladder and Who's Most Affected?
Dr. Jones: Well, we started the introduction about ladies who have to go all the time. And so what's an overactive bladder, and how common is it? Well, ladies may talk about how long their labors were and how big their kids were, but they don't talk about their bladders, at least not to me. So what is it?
Dr. Hendrickson: Yes, that's very true. Women don't talk about these problems that often. So happy to bring light on the topic. So overactive bladder, or OAB for short, is basically a constellation of symptoms, and those symptoms can include urinary urgency, so feeling like you have to go, have a strong urge to go to the bathroom. It can include urinary frequency, so feeling like you have to go to the bathroom, you know, more than six to eight times in a day, and then nocturia, which is when you wake up more than two times at night to go to the bathroom, and then can also include women who leak urine due to urgency incontinence. So women who have overactive bladder don't necessarily have to leak urine, but for the most part, women, unfortunately, are at higher risk of leaking than are men, our male colleagues.
What Else Could Be Causing Your Bladder Issues?
Dr. Jones: No, it's not fair. It's not fair. Well, what makes ladies feel like they have to go all the time that isn't really an overactive bladder? What other things can cause this? I mean, when I was pregnant, I had to go all the time, but I don't think I had an overactive bladder.
Urinary Tract Infection
Dr. Hendrickson: Yes, yep. So in pregnancy, yeah, often, in pregnancy, those symptoms can increase for a variety of reasons, and typically that resolves after pregnancy. Certainly, there are some risk factors in terms of the damage to your pelvic floor that can increase your risk. So there are some risk factors at the time of vaginal delivery that can increase your risk of having overactive bladder afterwards. But in terms of the things that we typically rule out or things that can cause these symptoms and aren't overactive bladder, that can include urinary tract infections. So UTI can cause these symptoms.
We always like to rule out and make sure that there's no blood in the urine. So sometimes you can see blood in the urine. Sometimes you can't see it. If you can't see it, that's called microscopic hematuria. And we like to make sure that there's none of that to rule out any sort of cancer. In women, that risk is actually quite low. It's less than 1% or less than 1%.
Pelvic Floor Issues
We also like to rule out and make sure that women are able to empty their bladder. So some women who can't empty their bladder might have these symptoms. We also like to look at their pelvic floor because some women who have a really tight pelvic floor will actually have these symptoms.
Prolapse
And then prolapse. So prolapse can cause some of these symptoms, and prolapse is just where the vaginal tissue can get stretched out and kind of come out through the opening of the vagina. And then other, you know, more rare things, like something that could be compressing the bladder or interstitial cystitis or painful bladder syndrome, which typically has a pain component. So a lot of things we're actually ruling out.
Does Overactive Bladder Always Lead to Incontinence?
Dr. Jones: Well, does overactive bladder cause incontinence? I mean, are pads a big business? They seem to be advertised to me all the time, but the internet probably knows how old I am. Maybe that's why I get all these advertisements.
Dr. Hendrickson: Yes. So overactive bladder definitely increases with age, including a component of overactive bladder, which is incontinence. So 30% of women, less than 30% have this, but almost 50% to 60% of women over the age of 65 have this problem. So overactive bladder includes incontinence. So a part of overactive bladder is urge incontinence, which is very different from stress incontinence. Stress incontinence, yeah, is a completely different issue.
Simple Steps to Manage Your Bladder
Dr. Jones: Well, so what are the first steps in helping women to get a little control over their bladder? Really, for some women, it's the auntie or the mom or whoever has got to stop at every gas station all the way down the road. How do they get some control over their life?
Dr. Hendrickson: Yeah, sure. So there's a whole handful of things that people can do at home. Those are just simple behavioral modifications. So typically, for an average-weight person, we recommend aiming to drink about 64 ounces of fluid in a day. Anything more than that, typically, is just going to come right out as free water. So you're going to make more urine than you really need to, and that's going to make you go to the bathroom more frequently.
Dr. Jones: So 64 ounces is how many glasses? That would be about eight glasses, six glasses?
Dr. Hendrickson: Yeah, eight 8-ounce glasses. Yeah, eight of the eight ounces.
Dr. Jones: Okay.
Dr. Hendrickson: And then, if you're a liter person, you know, the range of one and a half to two liters is often what we recommend.
Dr. Jones: Yeah.
Dr. Hendrickson: And then in terms of the volume, we also talk about reducing specific types of fluid. So the research has been a little varied, but the most consistent research shows that carbonated beverages or acidic or citrus beverages or caffeinated beverages, those can all lead to some irritation of the bladder or just make you make urine faster, which then leads to feeling like you have to go. So any way that you can cut those out of your diet completely, if not, you know, significantly decrease is certainly beneficial.
Dr. Jones: Right. So do Kegels work? Those squeeze exercises for your pelvic floor, do those work?
Dr. Hendrickson: Yeah, that's a great question. So it's a little bit more complicated than perhaps a yes-and-no answer. So Kegels are exercises where you can increase the strength of your pelvic floor, which it's important to have a strong pelvic floor, but you can very easily have a too strong pelvic floor and have kind of an increased pelvic floor tone or actually get a muscle spasm in your pelvic floor. So we want to strengthen our pelvic floor but also allow it to be kind of flexible. And so I typically tell people, you know, Kegels in moderation, but also making sure you're focusing on other areas of your core, so your abdominal muscles. Yeah, we've got to do more than that.
Dr. Jones: No, no. I'm just laughing at, you know, you see women who are bodybuilders, and they're all bulked up. And the thought of having my pelvic floor all bulked up makes me smile.
Dr. Hendrickson: Yes, yes. Not bulked up too much, just the right amount.
Dr. Jones: Not too much. Yeah.
Dr. Hendrickson: But, yeah.
Treating Overactive Bladder
Dr. Jones: Well, let's say, you know, you've figured that your pelvic floor is pretty strong and you cut out your caffeine and you don't drink water out of that water bottle all day long. So what's next? What's next?
Medications and Minimally Invasive Therapies
Dr. Hendrickson: Yeah. So the next things we typically talk about are medications or what we're now calling our minimally invasive therapies. So the AUA just put out new guidelines and kind of allows us to do any of those things at any time. We're more or less just restricted now by insurance companies. So the next therapies are meds and then, like I said, are minimally invasive therapy. And I can get into those in more detail.
Dr. Jones: Well, let's get into a couple of them. So what are the latest, greatest things? So what are the things that maybe ladies didn't hear about that would say, "Wow, I didn't try that. I didn't want surgery. Is surgery helpful?"
Dr. Hendrickson: First, I'll start . . . so after medications, then the minimally invasive therapies include Botox. So we can actually give Botox into the bladder, which most people haven't heard about.
Sacral Neuromodulation
And then we can also do a couple of different ways we can modulate the nerves. So neuromodulation is what it's called. And some of those involve surgery, and some of them don't. So things that have been around, you know, since the '80s and '90s are sacral neuromodulation where we implant a lead into the back, and that typically requires a trip to the OR or to a procedural room.
Implantable Tibial Nerve Stimulation
And then our latest and greatest thing, so about a year ago now, October of 2023, our implantable tibial nerve stimulation got approved by the FDA. And what that is, is just a little kind of three-centimeter rod that we implant into or close to the ankle, and then people can actually deliver therapy or stimulation to a nerve around the ankle at home.
Dr. Jones: Wow. That is brand new.
Dr. Hendrickson: Yeah. Yep, yep. And that, you know, doesn't require anesthesia. It's a procedure visit, people head home, and then, you know, can do everything else at home, which is nice.
When to See a Specialist for Your Overactive Bladder
Dr. Jones: That's great. That's great. Well, any tips and tricks you can suggest for women who have this problem? You suggested watching out for acidic drinks and caffeine and making sure you're not drinking too much fluids. Do putting things in the vagina? I mean, I know that sometimes a diaphragm or something, a tampon, does anything in the vagina help just, you know, make everything a little bit tighter, or what works?
Dr. Hendrickson: Yeah. Unfortunately, the intravaginal products aren't helpful for this condition. There is some data that vaginal estrogen cream, so basically replacing estrogen once you've gone through menopause, we could put that in the vagina and help to make the urethra close and potentially improve some of that urgency and frequency. But generally, what I would just tell everyone, and this, you know, goes for keeping a healthy bladder by just being healthy, is, you know, making sure you're going to your regular health maintenance. If you have diabetes, keeping your diabetes under control. If you have cardiovascular disease, making sure that that's treated and you're appropriately preventing progression, because interestingly enough, all of those things put you at increased risk of developing overactive bladder. So really the best thing we can do is prevent it from happening.
Dr. Jones: Right, right, right. Well, now, many healthcare providers don't do that much of a physical exam. So if women have a problem, they can bring it to their primary care provider, but they may really want to see a specialist who's going to take a look and take more history and make you pee in a bucket and things like that so you really know how much you're peeing and, you know, how much you're leaking. So you may need a specialist for that.
Dr. Hendrickson: Yes. Yep, definitely, yeah. First place to go to, primary care doctor, and if they don't feel comfortable, then, you know, your friendly urogynecologist is always happy to see you.
Dr. Jones: Well, now we have some answers and maybe some solutions to this common, you said it was common. So that's good news and sad news. But good news, your bladder doesn't have to rule your life. Thank you, Dr. Hendrickson, very much, and thanks for listening to the "7 Domains of Women's Health."