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MedStar Health DocTalk
Breaking the Silence on Women's Urinary Incontinence
In this episode of MedStar Health DocTalk, host Debra Schindler tackles a topic that many women face but few discuss: urinary incontinence. With an estimated 25 million American women affected, it's time to break the silence. Joined by MedStar Health urogynecologist Dr. Abigail Davenport, they delve into the myths surrounding incontinence, the different types, and the various treatment options available. From urgency incontinence to stress urinary incontinence, Dr. Davenport provides invaluable insights into how lifestyle changes, physical therapy, and advanced therapies can help women regain control over their lives. Tune in to learn why this common issue shouldn't be a source of shame and how empowering conversations can lead to effective solutions.
For more episodes of MedStar Health DocTalk, go to medstarhealth.org/doctalk.
For more episodes of MedStar Health DocTalk, go to medstarhealth.org/doctalk.
Comprehensive, relevant and insightful conversations about health and medicine happen here when MedStar Health doc talk. These are real conversations with physician experts from around the largest healthcare system in the Maryland D.C. region. Maybe you have a friend like mine, one who laughs so hard she cries all the way down her leg. My friend has warned me through laughter many times not to make her laugh because she was about to peer pants that was really funny in high school. But if its still a problem today, we dont talk about it. In fact, most women dont want to talk about it. Urinary incontinence. It affects 25 million American women, with estimates indicating nearly half the population of adult females in the United States will experience some form of urinary incontinence at some point in their lives. It is not uncommon. So why is it still a taboo subject? And what are the treatment options? We are breaking the silence on it today with MedStar Health euogynecologist Dr. Abigail Davenport. So hit the pause button, take a quick bathroom break, and let's get to it. I'm, your host, Debah schindler. Welcome to DocTalk. Dr. Davenport.
>> Dr. Abigail Davenport:Hi. How are you?
>> Debra Schindler:Good. I don't think in high school, when my circle of friends and I were all aware of this friend who would laugh and pee herself that she was experiencing in continents, we just didnt call it that because she was a teenager maybe and she didnt have any kids yet. There really are myths about what causes someone to lose their bladder, isnt there?
>> Dr. Abigail Davenport:Yeah, you know, theres a lot of myths around what contributes to incontinence. And we do see it more commonly as women age, as we have menopausal changes that affect the vagina and the bladder and the urethra, thats the tub we urinate through. But certainly in younger women, we can see this problem as well for various reasons. there are certain disorders related to the strength of tissues and muscles and ligaments that can contribute to it at a younger age. And other things, like that cause chronic coughing or bearing down. But we do tend to see it more in women as they go through the menopause transition 50 years and older. That's when it becomes much more prevalent.
>> Debra Schindler:There are different kinds of incontinence. Let's go through what they are.
>> Dr. Abigail Davenport:So incontinence, just to start out with the definition is involuntary loss of urine. And it can also involve involuntary loss of stool. If we'talking about fecal incontinence, the two biggest types of urinary incontinence that I deal with on the daily are going to be urgency incontinence and stress urinary incontinence. So I usually say the urgency incontinence is the gotta go, gotta go key in the door, you're doing the PP dance, you'trying to make it there. Urgency and frequency. And then there's something called stress urinary incontinence. And that's going to be the leakage with coughing, sneezing, laughing. Some women will have it when they jump on a trampoline or they stand up too quickly, maybe they're lifting something heavy. And then there's a mix of the two, which is called mixed urinary incontinence. And that's a very common type of incontinence that I see. It's probably the most common having both. And then in some women who have difficulty emptying the bladder, we have something called overflow incontinence. And the way I explain that to women, it's almost like having a cup that's very full of water. Eventually, when you keep filling that very full cup, a little bit will flow over the top. So if the bladder isn't emptying well, it can't hold anymore, it overflows and more comes out.
>> Debra Schindler:Are there different kinds of treatment for these different kinds of incontinence?
>> Dr. Abigail Davenport:There are. So the causes of these different types of incontinence are different. So if we talk about urgency incontinence that, gotta go, got to go. Urinary urgency frequency, or overactive bladder as a term, some women may have heard that's caused by spasticity of the bladder. Because the bladder is a muscle. That's actually how the bladder empties. It squeezes. And almost as if you're holding a water balloon and you're squeezing at the top to push the water down, the bladder empties in the same way. So when we have overactivity of that squeezing, it's going to push the urine down and out more and cause that sensation of urgency and frequency. There are things in our lifestyle that can contribute to making the symptoms worse. And the biggest thing I see is different substances that women drink that are irritating to the bladder. So caffeine, things that are very acidic, carbonated beverages, things with artificial sweeteners. So if you think, you know, Diet Coke, your coffees, things like that, the more you drink of that, the more the bladder will be irritated, the more frequently you'll have to go. So we look at behavioral things. There's also special physical therapy for this, there are pelvic floor physical therapists who are trained in the support of the pelvic organs and how to reinforce the muscles and gain bladder control by working on those muscles. There's also medications by mouth that can be given that stop that spasming of the bladder. And if these things are ineffective, we have more advanced therapies. Those are going to be things like Botox for the bladder. We have an acupuncture for the bladder, and then there's even a neuromodulator for the bladder that is kind of like a pacemaker that is inserted under the skin and helps restore the bladder's function and can last for many years.
>> Debra Schindler:How does that work? It affects the muscles of the bladder in some way. Electrically.
>> Dr. Abigail Davenport:Yeah. So there is a tiny electrode that's placed near the nerves that work on the bladder. And this electrode basically modulates the signals from the brain and the spinal cord that are causing the bladder to contract too frequently. So it filters out and restores the normal function of the bladder. It's a really nice therapy. It's been around for more than 20 years. Very, effective and very safe.
>> Debra Schindler:Is it surgically implanted?
>> Dr. Abigail Davenport:It is. So that's a therapy that can be tested in the office with something called a peripheral nerve evaluation, where tiny wires are placed in the lower back. And women can try the therapy out for a week with a waterproof dressing applied to the area and write down their symptoms to see if it works for them. And if it does, and they're very satisfied with the results, then they would go on to have the modulator implanted in the or. And it's a short procedure. We use a special X ray and it involves about, a 2 inch incision in the buttock area to put a battery under the skin, just like a pacemaker has a battery and then they're good to go.
>> Debra Schindler:Is it the same implant that is used for the opposite problem where some women who cannot release their bladder, they can't let go of urine?
>> Dr. Abigail Davenport:That's a great question. Yes, it is. So that is one of the primary treatments for urinary retention. That's the term for the inability to empty as well.
>> Debra Schindler:I know someone who has that, and she had that the procedure. And you can recharge the battery without having to remove it?
>> Dr. Abigail Davenport:Correct. So there have been newer devices released in the last few years that have an external charger, just like one of the diss you can place your cell phone on. It's the same concept the you place against the skin and you can recharge the device every six to 12 months.
>> Debra Schindler:And she has a remote control for it.
>> Dr. Abigail Davenport:Yep. Yep.
>> Debra Schindler:Before we get any further, I did want to ask, what is a urognnecologist, and where does that fit in with the GYN and the OB gyn?
>> Dr. Abigail Davenport:Yeah, I kind of joke and I say urogynecology is like having a urologist and a gynecologist who had a baby. And m. That's what I do. So I do a little bit of both. But the track for urogynecology is one of two ways, either through an OB GYN residency or through a urology residency. So you complete a residency in one of those two and then go on to do additional fellowships training. So for me, I went to residency for general OB GYN for four years, and then I completed a three year fellowship in urog gynecology and reconstructive pelvic surgery. And there's a similar program for urologists who want to go into this. And the, analogous term for that would be female urology. They may have done a female urology fellowship.
>> Debra Schindler:Did you start medical school to be an OB gyn? Maybe you were interested in delivering babies and then you.
>> Dr. Abigail Davenport:Oh, interestingly, I was not. I was actually interested more in breast reconstruction or burn. and then I realized that I was very interested in continuity of care. And then I wanted to have relationships with patients, which for a lot of surgeons, if you have a long history of a relationship with a patient, that's usually a problem. Right. You don't want to be seeing people come back that mean something went wrong. So I realized that wasn't for me. And ob gyn was only one of the only surgical subspecialties where you could have that long term relationship with women. And I really loved that. And then when I was in medical school, I happened upon a rotation in urogynecology at Vanderbilt. Actually, I did a visiting rotation. And I worked with one of the forefathers of ureoynecology, and he had me sit and do all of the exams. We did cystoscopy, which is looking in the bladder together. And I listened to these women's stories and saw the distress, the incontinence and other pelvic issues caused them. And I just found that I had a heart for those patients and I really wanted to be involved more in their care. And then when I went to residency, I knew from day one that that was what I was going to pursue.
>> Debra Schindler:Interesting. What was the most distressing thing that you found? These women would talk about when they would share with you, you their experience of incontinence.
>> Dr. Abigail Davenport:I think incontinence prevents women from living the lives that they want. It's a major quality of life issue. I've heard stories of patients who don't want to get in anyones'car because they're afraid of wrecking the seat. I've heard stories of women who don't want to sit on their own furniture because they'afraid of ruining their furniture. People who can't go out anywhere because they don't know where the bathrooms are going to be. So they cant go to the fair or to the mall. They cant do things with their grandchildren because they cant pick them up. And so it has a huge impact on the social relationships in our lives. And so these women will have depression, anxiety, theyll be at higher risk for admission to nursing homes and things like that. And it is a fixable issue, but women don't talk about it. And there is a huge need for more information about urogynecology and urology and the solution to this problem so we can empower women again to take back their lives, especially as they get older.
>> Debra Schindler:What's the reaction to adult diapers? Or is there a name for that? Is there a better name for adult diapers?
>> Dr. Abigail Davenport:Unfortunately, no.
>> Debra Schindler:That's probably part of the shame and embarrassment that you, you're at a point where you may need that or It's suggested even.
>> Dr. Abigail Davenport:Yeah, it's a really shame filled diagnosis for a lot of women. And that makes me sad. It is common. You know, we don't talk enough about what happens when we have children. We don't talk about the stress that's put on the pelvis and the muscles, the bladder, everything inside the pelvis that lives there. All these organs that are affected when we have a baby. And those are risks that I think women need to be informed about and they need to be given resources early. For example, pelvic floor physical therapy in the postpartum period can help mitigate a lot of these things in the long term and help women recover more quickly from childbirth. But for some reason in the United States, that's not standard of care.
>> Debra Schindler:Do you mean Kegel muscle exercises?
>> Dr. Abigail Davenport:Kegel muscle exercises are contractions of the pelvic floor and that is part of pelvic floor physical therapy. But attending pelvic floor physical therapy involves evaluation of all the muscles that support the pelvis as well. The hips, the buttocks, the abdominals. There's many muscles that support the pelvis and Help stabilize it. In addition to that, Kegel exercises are very challenging to perform by oneself. I would say greater than 90% of the women that I see in the office, because I will have them attempt at Kegel, are unable to perform it on their own. So they require instruction on how to do it correctly in order to have the benefit of the therapy.
>> Debra Schindler:What do you tell them to do?
>> Dr. Abigail Davenport:I tell them to squeeze their muscles like they're trying to hold in their urine. That front door key in the lock. How am I, am I squeezing it? But most women cannot actively contract those muscles on their own.
>> Debra Schindler:Wow. Okay. Would that be considered a more severe case of incontinence?
>> Dr. Abigail Davenport:No, that's just the average woman out there thinking she's doing it right.
>> Debra Schindler:Wow. Okay. Now, you said in this country, does that, is that to say that in other countries they are more progressive in that area?
>> Dr. Abigail Davenport:Yeah. And Europe attending pelvic floor physical therapy after having a baby as standard of care, while women are set up with that.
>> Debra Schindler:So, and what does that look like?
>> Dr. Abigail Davenport:It involves a referral to see a professional, a physical therapist who specializes in the pelvic floor. So usually they'll do some sort of internal evaluation of the muscles of the pelvis and also as I mentioned before, the legs, the back, the buttocks, to evaluate what muscles may need strengthening to help increase continents. But it's not just for continents. It's also to restore the function of those muscles before the continnce occurs.
>> Debra Schindler:That's so interesting. Are there any studies that show less prolapse or other pelvic issues that may come about later in life as a result of that postnatal care?
>> Dr. Abigail Davenport:It depends on the severity of whatever problem there is in the pelvis, but it can help prevent advancing problems worse, and it can certainly improve and ``inence.
>> Debra Schindler:I mentioned my friend. I don't think when I was in high school, my circle of friends and I were all aware of this friend of ours who would laugh so hard she would pee herself that we equated that to incontinence. And maybe that was because we were just teenagers. We didn't have kids yet, we didn't think about it. But that really is a myth, isn't it, about incontinence that it. It can't happen in younger people or it can't happen if you don't have children?
>> Dr. Abigail Davenport:Yes, incontinence can happen in anyone of any age. Although it is more common as we age and go through menopauseis.
>> Debra Schindler:What are some of the other misconceptions about urinary incontinence.
>> Dr. Abigail Davenport:I think the biggest thing that I see is women saying this is just a natural part of aging and I have to live with it. That'sort of the mentality that a lot of women have. They feel relegated to having this as part of their lives. And I like to tell patients that while incontinence is common, it is treatable as well. Common doesn't mean that it's normal to have to wear pads or to wear diapers all the time. And so I like to have a goal of getting them as dry as possible within six months of seeing me. And that may be a combination of the physical therapy, medications. There's some other procedures for stress urinary incontinence. But very rapidly, I like to progress them along so we can get them as dry as possible.
>> Debra Schindler:A woman comes to see you for urinary incontinence the first time, what's the first step that you'take in treating her?
>> Dr. Abigail Davenport:We want to talk to her. I want to know how long the symptoms have been going on. I want to know what type of symptoms she's having, is at the urgency frequency, the coughing, sneezing, laughing. I want to know what she's drinking throughout the day, how many times is she leaking, how many times is she going to the bathroom during the day and at night, is she having a lot of urinary tract infections? Has she gotten treatment for this before? And then I also ask about bowel symptoms and symptoms of prolapse, other things that can be associated with incontinence. After that, we perform a bladder ultrasound where we look to see how well the bladder empties. And then I do a pelvic exam where I look at the skin of the vagina, look at the urethra again, that tube urinate through. I feel the muscles of the pelvis. I look to see if anything has dropped and try to identify any obvious causes of the leakage that's going on.
>> Debra Schindler:What would you see if you saw a problem there?
>> Dr. Abigail Davenport:So, oftentimes I'll see skin changes related to menopause. So thinning of the skin, some irritation. I can see that the bladder has droppedon occasion. Sometimes I'll even see the leakage happening. A lot of times we'll have patients cough to intentionally try to provoke the leakage to understand why it's going on.
>> Debra Schindler:Should a woman know if she has a prolapse, a bladder prolapse?
>> Dr. Abigail Davenport:The only time we treat prolapse is when it is bothersome to a woman. Or if it making it difficult for the bladder to empty. And usually that doesnt t happen until a prolapse is very severe, meaning its coming all the way out. So for most women they can have prolapse and have no idea and its not affecting their lives and no treatment is necessary whatsoever.
>> Debra Schindler:Oh, how would you know that there is a prolapse? You see it in a pelvic exam?
>> Dr. Abigail Davenport:Correct. If it's mild. If it's severe, a woman could feel that it was coming down.
>> Debra Schindler:And there are surgical treatments for that?
>> Dr. Abigail Davenport:There are non surgical treatments as well.
>> Debra Schindler:Is that usually the cause for urinary incontinence?
>> Dr. Abigail Davenport:No, they're two separate entities, but they commonly co occur.
>> Debra Schindler:Who then would you prescribe medication for and how does medication help? If the problem is because of weakened muscle and tissues and tendons and age, how does the medication help?
>> Dr. Abigail Davenport:So the medication does not help with women who have incontinence from the weakened muscles and age. It actually helps with women who have spasticity of the bladder, which contributes to the urgency frequency things that we see with overactivity of the bladder based on the type of incontinence that they have. I will kind of put them down that treatment algorithm. So if it's overactivity of the bladder, we talk about behavioral things that can be changed. I'll usually refer them to pelvic floor physical therapy, discuss starting and medication if they're interested in that. If they have stress urinary incontinence, the coughing, sneezing, laughing, related leakage. I still talk about behavioral changes in pelvic floor physical therapy, but I may have them come in for something like a pessary insertion, which is a vaginal insert that puts a little pressure on the bladder as a next step as well.
>> Debra Schindler:What about lifestyle changes?
>> Dr. Abigail Davenport:It's mostly related to looking at the things we eat and drink that can cause irritation of the bladder and then also looking at the frequency of how often we urinate. So for example, if a woman is holding her urine for six hours, the bladder is going to be very full and then it's going to be more difficult to keep the urine in. If she does something that causes leakage. So she pushes down really hard, her coughs really hard and the bladder is very full, shes more likely to have leakage. So I may tell a woman, I want you to urinate every two hours to keep your bladder more on the empty side to prevent that.
>> Debra Schindler:For example, lets talk about the different therapy options.
>> Dr. Abigail Davenport:O so for women who have urinary urgency Frequency and leakage associated with that, commonly referred to as overactive bladder. I typically start with looking at the things that they're behaviorally doing that could be contributing. And that's going to go back to what in the diet could be irritating the bladder. Is she going so often that she's training her bladder to have to go more often? She's training the nerves to need to go every time there's even a little bit of urine in the bladder. And so then we talk about gradually spacing out the frequency of urination. That's called bladder retraining. I may send her to a pelvic floor physical therapist to teach her some strategies to Kegel and to have a relaxation when she feels that contraction so she regains control of her bladder. There's medications that affect the spasticity of the bladder and decrease that sensation of urgency and frequency. And then when those things don't work, sometimes we perform a specialized bladder test called urynamics to help understand what's going on a little bit better. So we're moving away from the one size fits all to catering treatments more to what's going on with the woman's body. Once we have the results of that, we may talk about percutaneous tibial nerve stimulation, which is essentially an acupuncture for the bladder. And then there's bladder Botox. So similar to the Botox being injected in the face, which women are very familiar with, that for cosmetic purposes, where it stops the muscles from moving and it stops the wrinkles. Botox in the bladder stops the spasming of the strong bladder muscle. It paralyzes that muscle to stop the urgency and frequency.
>> Debra Schindler:Do you do that in the office? Are they sedated for it? It sounds like it might be painful.
>> Dr. Abigail Davenport:The Botox is injected through a telescope. It's called cystoscopy. That can be done in the office. And frequently we will use a topical anesthetic, a gel in the bladder, and then we'll also instill a numbing agent inside the bladder itself. And the whole procedure takes about five minutes. It can be a little uncomfortable, but it's not horribly painful, and most women tolerate it just fine. And then after that, we have that other neuromodulator that I'd mentioned before, which is like a pacemaker for the bladder that filters out the abnormal signals from the brain that make the bladder go more often. So that's the overactive bladder care pathway's what we call that.
>> Debra Schindler:Getting back to the Botox, I think I'd be afraid that I would not be able to freeze up the muscles and not enable me to use the muscles in the same way. Like it would have a counter effect. How does it help?
>> Dr. Abigail Davenport:Well, that's why we use a, very low dose when we start with the Botox. So we titrate it up if we need to. So we start with a lower dosage and we increase slowly. The woman doesn't have a response. We know from big studies looking at this that the risk of having the urinary retention or having the bladder overcompensate like you just described by not being able to empty, is low, less than 10%. Probably about more on the 5% side. So overall the risk of that happening is low. So talking about stress incontinence as well, that's the leakage with coughing, sneezing, laughing, standing, quickly, trampolines, all of that. But the treatments for that also start with looking at things behaviorally that could be contributing. So is it excessively drinking fluids and not going frequently enough so the bladder is very full? Is it related to, pushing down too much? Things we call Valsalva activities. So when you're really increasing the pressure in the abdomen, heavy weight lifters, things like that. We'll also send a patient to pelvic floor physical therapy to strengthen the muscles of the pelvis. Because with this problem it can be more of a support issue. And there is also pessaries for this, which are vaginal inserts that put a little bit of pressure on the urethra. That's the tube we urinate through to have some resistance for when we do the activities that would cause the leakage to occur. There's also fillers for the urethra to go with the Botox. Right. But basically it's a gel that's injected through a tiny scope that causes the whole of the urethra to be a little bit smaller. So there's more resistance when a woman coughs, sneezes or left. And that's a simple outpatient procedure that can be performed under lite sedation or some people even do it with, an anesthetic injection in the office. And then finally there's other procedures that are slightly more invasive, but still are outpatient procedures. Things like mid urethral slings that women may have heard about as well.
>> Debra Schindler:What is that exactly?
>> Dr. Abigail Davenport:A, midurethhral sling is a small piece of mesh that is placed through about a half inch sized incision in the vagina. It's not the mesh of all of the lawsuits that we see on tv, we don't use that mesh anymore. And it's a very safe and effective procedure. It's considered the standard of care in the United States for stress urinary incontinence.
>> Debra Schindler:can you feel that from the outside of your body?
>> Dr. Abigail Davenport:No. Once its there, you dont know its there at all.
>> Debra Schindler:Okay, how long is that procedure and whats the recovery line?
>> Dr. Abigail Davenport:Well, on my end the procedure only takes about 20 minutes to do. The recovery is a six week recovery, but that's mostly weightlifting restrictions so that everything heals very well and after that.
>> Debra Schindler:They shouldn't have any Urinary incontinence. Is it a cure?
>> Dr. Abigail Davenport:It's the most effective procedure we have for stress urinary incontinence. There's always going to be some women who will still have some leakage, but we're looking at greater than 80% improve.
>> Debra Schindler:Do you have to try the other options first to suggest that one or do some patients just go right to the mesh?
>> Dr. Abigail Davenport:Some patients go right to it. It really depends on a woman's goals. And also insurance issues, of course.
>> Debra Schindler:So with this problem being so common, when is the right time for a woman to come to see a doctor?
>> Dr. Abigail Davenport:If it's impacting a woman's quality of life or her self esteem or it's something that's come on out of the blue, it's never going to hurt to bring it up to your doctor and seek treatment.
>> Debra Schindler:Who's usually your patient? What's the average age say?
>> Dr. Abigail Davenport:My typical patient is a 60 year old active woman looking to get back her life.
>> Debra Schindler:And she comes in and she goes through the course of treatment, maybe she gets the sling, maybe she'using medications. Do they usually go on and pretty happy? I mean, is the problem truly solvable?
>> Dr. Abigail Davenport:It's solvable. That's kind of the tragedy of women waiting so long to seek care. Most of my patients come to me, get treatment and say I wish I did this 10 years ago.
>> Debra Schindler:It's life changing then because now they can travel again and yes. Or whatever they've given up as a result of this problem.
>> Dr. Abigail Davenport:Yes, it is. It's absolutely life changing.
>> Debra Schindler:We talked about the difficulty in talking about this problem and the embarrassment for many women, understandably. When did it first occur to you that that was part of the problem?
>> Dr. Abigail Davenport:I think the time that I heard about it the most and I really understood the tremendous impact was when I was in residency and I was working on a research project called qualitative research, which is Basically where you just look at people who have a problem and you call them and you talk to them, you ask them what is your experience with them. And that led me down the road of talking to dozens of women, about their experiences with bladder control and bladder treatment and the stories of women who couldn't sit in a friend's car or were afraid of sitting on their own furniture and ruining it. And hearing these stories made me realize how devastating this was for women and also how hard it was for them going through treatment. Initially, because the treatment algorithm involves starting with medications which are often not tolerated well by most women because of side effects and things like that. But we are limited, of course, by insurance coverage and all of those things and we have to start there. But it can be really disheartening for a lot of women when they start with that early on and don't allow themselves to get to the treatments further in the algorithm, that are more effective. And so I've kind of made it my mission, using that research to inform women early on know we're going to start with these other things knowing that it may not be a great long term solution, but that there are really good ways to fix it long term once we check those boxes for their insurance and start more conservatively. So it's been really nice to see how just starting with those conversations early on in my training led me to this deeper understanding of what it's like for women to be in this position with incontinence and go through the treatment, over the course of, you know, six months to a year.
>> Debra Schindler:It's only by talking about it that women are going to find out that there are solutions to the problem and that they don't have to live a compromised lifestyle. And hope this podcast makes that clear today.
>> Dr. Abigail Davenport:Yes, it's a tragedy of women's healthare that we have not empowered women to talk about what happens with their bodies and that there is a lot of shame surrounding talking about these issues. You know, we talk about women's parts as, sort of this portal to having children. And we forget the other functions that are there. We forget about the bladder, we forget about having the bowel in that area. We forget about how sexual function is an important part of our social relationships with our partners and necessary for families to function. We've sanitized it in a way that takes women's power away from them. And I would love to see us build this future where we empower women to talk about what's happening with their bodies without any Shame.
>> Debra Schindler:What question do they have most often?
>> Dr. Abigail Davenport:I get asked a lot. Is it cancer? you mean not being able to.
>> Debra Schindler:Hold their bladder, they fear they have cancer?
>> Dr. Abigail Davenport:Yeah, they feel that something life threatening is going on. And so one of the first things I do after I do an exam is I say I didn't see anything dangerous. And this is very common to allay womens fears. But thats the biggest thing when I see women is they usually think something really terrible or dangerous is going on. And that thats a big part of, I believe, the delay in seeking care.
>> Debra Schindler:Is there a concern that urinary incontinence may be related to fecal incontinence?
>> Dr. Abigail Davenport:Yes, and we do commonly see them together because maintaining control of bladder and bowel function are so interrelated. If we see one, were very likely to see the other. So I have a standardized intake form for everybody that I see where I ask questions about urinary incontinence and also bowel incontinence and also pelvic organ prolapse because they so often co occur.
>> Debra Schindler:Do you treat the fecal incontinence as well?
>> Dr. Abigail Davenport:I do.
>> Debra Schindler:Okay.
>> Dr. Abigail Davenport:that's all part of that pelvic floor dysfunction.
>> Debra Schindler:We've covered a lot today, but the most important takeaway in this, as you said, is female incontinence is common, manageable, and nothing to be ashamed of. And if you're experiencing symptoms, don't hesitate to seek help.
>> Dr. Abigail Davenport:Put yourynecology into your Google search, go find a urog gynecologist and talk to them about what's going on with you. It can only improve your life, it can only make things better. And talk to your girlfriends about what's going on with you so that they don't feel alone and they don't feel like it's just, them. Because I guarantee you it's not great advice.
>> Debra Schindler:Dr. Dabenport, thank you so much for being here today and sharing your expertise with us. UN Talk. If you're in the Baltimore area and you would like to schedule an appointment with Dr. Davenport, call 443-777-7608-443777-77608. If you would like to provide feedback on this podcast or get more information on incontinence, send an email to doctalk medstar.net.
