Sep 26, 2019

Interview Transcript

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.

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