Speaking of Women's Health
The Speaking of Women's Health Podcast is excited to bring you credible women's health information from host and Executive Director, Dr. Holly L. Thacker. Dr. Thacker will interview guest clinicians discussing relevant women's health topics and the latest news and tips.
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Speaking of Women's Health
Your Bladder Matters: Common Urinary Issues in Women
Have you ever wondered why urinary issues seem to affect women differently than men? The answer lies in our unique anatomy and hormonal makeup — factors that make female urinary health both fascinating and complex.
Dr. Holly Thacker takes listeners on a comprehensive journey through the most common urologic conditions affecting women during Urology Awareness Month. From the annoying but potentially dangerous urinary tract infections to the embarrassing reality of pelvic organ prolapse that affects up to one in eight women, this episode breaks down what's happening and why.
"Everyone needs a bladder that works," Dr. Thacker emphasizes as she explores how bladder health connects to overall wellness and quality of life. She tackles taboo topics with medical precision while offering practical advice for prevention and management. You'll learn why maintaining pelvic floor strength matters even if you've never been pregnant, how hormonal changes dramatically affect urologic health, and why sexual function is inextricably linked to bladder health.
Subscribe to the Speaking of Women's Health Podcast wherever you listen to podcasts and visit speakingofwomenshealth.com for more resources on taking charge of your health.
welcome to the speaking of women's health podcast. I'm your host, dr holly thacker, and I am back in our sunflower house for a new edition of our speaking of women's health podcast and on this new podcast for the month of September, which is Urology Awareness Month, we're going to specifically talk about female urology conditions. Certainly there's a lot that we could talk about for male urology and there are some overlaps, but they are quite different and we do have some urologists that specialize in what's called female urology. So they're not necessarily females, they could be male physicians or female physicians, but they specialize in problems that women and females have in the urologic system. And some of the more common issues in women include the common and annoying and sometimes dreaded urinary tract infections.
Speaker 1:Overactive bladder is another vexing and sometimes annoying problem. Interstitial cystitis, which kind of overlaps with chronic pelvic pain, can be challenging sometimes to diagnose and manage. Pelvic organ prolapse because women have a vagina, that's a hole in the pelvic floor. It can lead to the uterus kind of coming down if there's not adequate support, and even coming out of the vagina. In fact, up to one in eight women can experience the need for hysterectomy and pelvic surgery because of prolapse and certainly if you have a family member that's a blood relative with pelvic prolapse, that's important information to give to your healthcare team. Urinary incontinence or uncontrolled bladder leakage, whether it's stress, incontinence from coughing or urge incontinence or postpartum because of all the major changes that have happened in the pelvis and also kidney stones, they affect both men and women. So the reason women are more prevalent to some of these types of conditions is in part because of the female anatomy of the pelvis, as well as hormones.
Speaker 1:Now, in terms of urinary tract infections, in June, as you may recall, I did a podcast on urinary tract infections called From Solutions to Symptoms. That went in a lot of depth on everything that you need to know about bladder infections and urinary tract infections. So if you haven't listened to that one, I think that's a good one to go back to listen to. And if you don't already subscribe to our free podcast, just hit follow or subscribe, so every time there's a new podcast, you'll get notified.
Speaker 1:So a urinary tract infection is when the bladder or the urethra, or even all the way up ascending to the kidneys, can be infected, usually with bacteria, and this can progress to pyelonephritis, sepsis and even death. So it's more than just a minor annoyance. It's more than just a minor annoyance, and women get urinary tract infections easier than men because the urethra is so much smaller in women and it's obviously in close proximity to the skin of the vulva, the perianal area, and normal bacteria from the skin or from the perianal area can enter into the urethra, which is a sterile area where there's not supposed to be bacteria. Some of the symptoms can include burning, frequent urination, feeling the need to urinate even when there's an empty bladder, pain in the pelvic area or even the lower back or upper back. If it's spreading. There can be blood in the urine, fever, chills, even fatigue or confusion or nausea or vomiting, and sometimes, in older persons, they may not have a fever. Their mental status may just change.
Speaker 1:So in order to help prevent bladder infections and more serious urinary tract infections, it's important to stay hydrated. Avoid dehydration. Drink enough water so that the urine is lighter in color, not a dark yellow, so that you're flushing out any bacteria that might be trying to creep up into the bladder, and don't hold your urine. Try to urinate every four to six hours. Always wipe from front to back, especially urinating before and after any pelvic exams. Sexual activity, any kind of vulva manipulation is important. We also recommend that women avoid douching. Avoid any feminine hygiene sprays. These can be irritating and they can change the pH of the vagina when you're menstruating. If you're still menstruating, it's important to regularly change pads and tampons and not leave them in or on your body too long. Your body too long. Wearing cotton white underwear, loose-fitting clothes anything that's super tight creates more of a moist environment which can promote bacterial growth. It's also important to keep your nutrition up, your vitamin D up, getting enough rest.
Speaker 1:Now, in terms of minor urinary tract infections, sometimes they can go away on their own. Some women might start on like a cranberry extract or a D-mannose which inhibits E coli, but most of the time they do need to be treated with an antibiotic and you may need to get a clean catch urine. And that's when you wipe the vulva clean with a special wipe and you urinate a little bit into the toilet. Then you open up a sterile container and get the middle part of the stream in to get enough of a specimen and close the lid and then you can sit down and finish urinating and emptying your bladder, because then that isn't contaminated with vaginal secretions or skin bacteria and your express care or urgent care or doctor's office can usually accomplish this.
Speaker 1:Now, overactive bladder is when you have that strong urge to pass urine, even when your bladder is not very full, and it can be frequent. If you feel the need to have to urinate more than eight times a day, you may have overactive bladder and you should see your health care team. You don't necessarily have to start with a female urologist or a urogynecologist. That's a gynecologist that's gone on to specialize more intensely in the urinary system and pelvic prolapse. So there's a lot of different potential causes of overactive bladder. When the bladder muscles start to contract without warning, and sometimes not only does that lead to the urge to urinate, but it can actually lead to involuntary urine leakage or so-called urinary incontinence.
Speaker 1:Now, overactive bladder can be a symptom of other neurologic problems, such as diabetes, multiple sclerosis, parkinson's disease, or it can be the first sign of a bladder infection, urinary tract infection. Some medicines like diuretics, which are sometimes prescribed to get extra fluid off the body, can worsen symptoms. Excessive caffeine intake is very irritating to the bladder. So is alcohol, any kind of nicotine products and constipation, which is relatively common in women. All can contribute to overactive bladder. And my very first podcast that wasn't my book or was not medical CME that I did in season one in 2023 was about constipation, and constipation is definitely more common in women. Women tend to have a more sluggish colon and it is really imperative for good bladder function and good pelvic tone to not have constipation. So some of the symptoms of overactive bladder or that irritating sensation of an urge to urinate going too often or if you get up more than twice a night to urinate, it is important to get enough fluid intake, but not excessive fluid intake.
Speaker 1:And in order to help prevent overactive bladder, it's important to do appropriate pelvic floor strengthening. They've been dubbed the Kegel exercise and when you go in for your pelvic exam with your women's health care nurse practitioner or physician, that clinician can check for your pelvic tone and see if you know how to contract the pelvic floor, the levator ani muscles. Getting regular daily physical activity is helpful. Limiting bladder irritants, especially caffeine and alcohol, helpful. Limiting bladder irritants, especially caffeine and alcohol. Maintaining a healthy weight, because obesity pressure in the abdomen is not good for the bladder or the whole pelvic floor, and managing chronic conditions such as diabetes may help, and also avoiding caffeine.
Speaker 1:Now there are other treatments besides those general hygienic measures that I mentioned. Behavioral therapies like biofeedback and bladder retraining can be very helpful. Sometimes people need more intensive therapies, like intermittent catheterization, or they may need medications to treat overactive bladder. But it's always best to start generally with lifestyle and with pelvic physical therapy, and there are specialized physical therapists some of them are doctors of physical therapy that specialize in pelvic PT, which could be a whole other topic which hopefully we'll be able to get to in the future. I mean up to 20% of women experience pelvic pain in their life after delivery, after bladder infections, after vaginal infections, after any kind of surgery or trauma.
Speaker 1:Endometriosis can lead to pelvic pain and chronic pelvic pain and it's always better to treat this comprehensively and holistically and earlier rather than later. And if you didn't hear my prior podcast this season on endometriosis, that is a good one to go back to. That is a good one to go back to and listen to, and you have been listening to the Speaking of Women's Health podcast and I'm your host, dr Holly Thacker, in the Sunflower House, and we are talking about Female Urology and Urology Awareness Month. We all need a working bladder. In fact, when I will treat women for genitourinary syndrome of menopause, vaginal atrophy, hormonal thinning of the vulva, the urethra, the vagina, the base of the bladder.
Speaker 1:I always ask the woman if they're seeing me because they're concerned about being able to comfortably be sexually active. And a lot of women say yes, absolutely. And I say, well, if you weren't sexually active and you were a nun, would you be here to see me? And they kind of think, and most of them say no, they wouldn't have come to see me. And that's when I say to them wouldn't have come to see me. And that's when I say to them um, well, we don't really medically care what, uh, an adult consenting does with their genitals, um, in the privacy of their own home, or if they do anything at all, or if they're a nun or not. But everyone needs a bladder that works and that's healthy and needs a healthy vulva.
Speaker 1:So it's important not to just separate sex from the health of the whole pelvic floor and the whole urinary tract system and the sexual functioning, bowel and bladder. They're all very intertwined the nerves that supply the pelvic floor, the muscles that support them, the bony structure, the connective tissue, the bladder, the uterus. If you still have a uterus, or even if you have had surgery and don't have a uterus, you're still a female and you need a comprehensive exam. There's nothing that annoys me more is when a woman tells me that her physician or gynecologist has sent her away saying you don't have a uterus, you don't need pap smears or gynecologic exams. That is not true. It's important, when you're a woman and you're not sure if it's a bladder problem or a pelvic problem or a gynecologic problem or a nerve revolver problem, to generally start with your women's health clinician first.
Speaker 1:Now, if it's suspected that you have interstitial cystitis, which has also been dubbed painful bladder syndrome, this is another common and many times under-recognized condition of chronic pelvic pain, and the longer someone has pain and those pain circuits reverberate, there can be central pain with the brain, peripheral pain from the nerves or some local problem, and even after sometimes the original problem is treated, whether it's endometriosis or whether it's a bladder infection or a vaginal infection or post-birth trauma, sometimes that pain reverberates. In terms of interstitial cystitis, which is this very painful bladder condition, there's not really been one single underlying cause that's been identified. We do know that it is more common in women than in men, and some of the factors that are associated with the higher risk of interstitial cystitis is one being a female. Yes, your sex. Women are diagnosed with interstitial cystitis more frequently than men. In fact, women generally have more pelvic pain than men, but kind of like how osteoporosis is sometimes ignored in men and they can have osteoporosis and they need evaluation and treatment, but it's so much more common in women that it's more focused in women. That's kind of the same thing with pelvic pain as well. Generally, when men have painful bladder syndrome it's more likely associated that they have inflammation of their prostate gland.
Speaker 1:Prostatitis from perhaps a bacterial infection, sometimes a bacterial prostatitis is a catch-all term for pelvic pain, which many times is neuromuscular in origin. In men. Now, your age is also a factor. Most people with interstitial cystitis are diagnosed during their 30s or older. And if you already have a chronic pain disorder, interstitial cystitis can be associated with other pain conditions like irritable bowel syndrome, fibromyalgia. So sometimes irritable bowel fibromyalgia, chronic pelvic pain, kind of like a low serotonin syndrome. Migraine headaches can sometimes cluster in certain individuals that are predisposed, luster in certain individuals that are predisposed.
Speaker 1:Now, some of the symptoms of icy interstitial cystitis is a constant need to urinate, pain with urination, unexplained painful intercourse, a tender suprapubic area where the bladder is and of course, these are very similar to a bladder infection. So of course, the urine needs to be dipped, either by your primary care physician or gynecologist or a urogynecologist. If there is the concern that you have interstitial cystitis, then you generally need to see a specialist like a urogynecologist or a female urologist, and not all of those physicians even specialize in interstitial cystitis. A lot of times you need a complete team a medical physician, a bladder specialist, a pelvic physical therapist, sometimes even a pain management physician, and it can seem overwhelming to people who have pain. And while interstitial cystitis itself cannot be simply prevented, it can definitely be managed and flare-ups can be managed. You need a kind of comprehensive, holistic approach Through lifestyle changes, potential dietary modifications.
Speaker 1:It's always important to help reduce stress, because some people, when they're stressed, they get a tension, headache or pain in their neck. Other people hold it in their pelvis, and the strategies of reducing stress exercise deep breathing, yoga. We have a lot of good information on yoga on our website Tai Chi massage, aromatherapy just having time for yourself. A lot of my patients are so pressed to the wire they don't even have five or 10 minutes just to themselves a day, and I can sometimes identify with some of those days 12 plus hour work days, rushing here, helping take care of my grandchildren, running my fellowship, supervising and directing and leading this non nonprofit Speaking of Women's Health. It can be a very, very full life and many people are volunteering or they're taking care of elderly relatives or sick relatives or friends or doing a lot of community work and sometimes there's just so much excitement in life to want to pack so much in that you really do have to plan for adequate sleep time, adequate relaxation and, if you haven't heard our podcast where I've interviewed sleep experts and talked extensively about sleep, that is important, I think.
Speaker 1:Keeping a diary when you have chronic pain, whether it's pelvic pain or interstitial cystitis or migraine headaches, fibromyalgia. Keeping a journal and paying attention to triggers, changes in your physical activity or sexual activity, diet, reminding yourself to maintain adequate hydration. Different foods and beverages can definitely aggravate the bladder and some of the more common bladder irritants include caffeine, alcohol, spicy foods, citrus fruits, artificial sweeteners and also um, there can be certain uh, tropical fruits that can irritate people that have a high histamine content. Also, I found that certain vitamins and b-complex vitamins, which are excreted in the urine and concentrated in the bladder, and if you have, like your b complex vitamin and you wash it down with a lot of caffeine and then a swig of orange juice, you might not only get heart burn, but you may your bladder may burn as well. So it is important to be your own little detective and sleuth.
Speaker 1:Now, in terms of interstitial cystitis treatments, medications such as Elmiron have been prescribed. They're taken three times a day. There have been some retinal side effects and some doctors don't like to prescribe this. I usually always recommend first that calcium citrate supplements be considered. The citrate salt is soothing to the bladder. Now you don't want to overdose on calcium and usually we recommend that you get your calcium in your diet, but sometimes cutting back on some dairy products and using calcium citrate can soothe the bladder.
Speaker 1:There can be bladder installations of DMSO, which is a very potent solvent, and that's one of the medicinal uses of DMSO. That's, like you know, an official medical practice. Many people have used DMSO topically for musculoskeletal problems, but since it is so well absorbed, you have to make sure there's not other things on your skin that you don't want to penetrate into your body deeply. Sometimes implantable electrical stimulation devices are used. This is more invasive and a less common option and a less common option. Sometimes low doses of tricyclic antidepressants are used not for depression but to try to rework the nerve irritation.
Speaker 1:I have found that in postmenopausal women who have interstitial cystitis or vulvodynia or chronic pelvic pain that they usually need higher doses of estrogen than the average woman. So many times we can use low doses of estrogen for menopausal hormones to stop hot flashes and help the bone, but it's not enough for a highly sensitive genitourinary system and embryologically the vagina and the base of the bladder and the vulva and the urethra, which is the tube that carries out the urine from your bladder, have a very high concentration of estrogen receptors, and so the standard menopausal hormone therapy is not enough. So I usually have pretty good doses of vaginal estrogen as well as systemic, and sometimes I'll use vaginal DHEA which will boost not just estrogen but testosterone which can help the muscles in the pelvic floor.
Speaker 1:Pelvic organ prolapse POP you don't really want to be popping out your organs down through the vagina and unfortunately it's a pretty common condition and half of women who've had children by a vaginal delivery may notice things coming down. I had my first two children 18 months apart, and I remember going for my postpartum visit and I was like mortified to find out that there was some slight droppage of the pelvic organs and I was instructed by the nurse practitioner on how to appropriately do Kegel exercises and avoid heavy lifting, which was kind of hard to do because I would be carrying these two babies of mine, which are now pretty big men, and then a third one came after that, so that pelvic floor with pregnancy and delivery and carrying young children around can really affect the pelvic floor. So you must treat it with care. You must have adequate strength, not too much strength. We don't want the pelvic floor to be in spasm which can cause a lot of pain. But I was happy after you know, getting adequate hormones back, because when you breastfeed hormone levels are low and that can make the tissue thinner.
Speaker 1:The combination of that and good nutrition and physical therapy doing Kegels kind of snapped everything back in place. Doing kegels kind of snapped everything back in place. But we can't change gravity and age. You can change the activities that you do and how healthy your pelvic floor is and your bowel and bladder function. You can work on that and all of that really helps if you're light-eyed and thin, pale skin and you've got a family history of prolapse, your connective tissue may not be quite as sturdy as other people's and even without childbearing, I have seen women who've never been pregnant, who are normal body weight, have prolapse. And if you're someone who really likes to do a lot of jumping and spiking with your physical activity you're a gymnast, you're a long distance runner, hitting that hard concrete and pavement for miles and miles on end that causes a fair bit of trauma to your pelvic floor and may make the prolapse worse, and it can be the bladder that drops down the rectum, the uterus, the cervix, and it can be complete, which is very distressing.
Speaker 1:I can do an exam on a woman and eight months later she's calling me, telling me something's hanging down there, and so it's very good to get an assessment, even if you don't need a pap smear, that you still need a pelvic exam at least every one to two years for sure, whether or not you have a cervix or not. And if you didn't hear our podcast and our reprisal podcast on cervical cancer screening, that's really important. I'm seeing women every single day who are past the three-year mark and many even past the five-year mark, after age 30, of getting their pap smears and it's concerning to me because since we stopped obsessively having to do them every year, once we started to do HPV testing, I've just seen there just be more of a lackadaisical approach and really we can prevent deaths from cervical cancer if you're getting screened early, screened early. So make sure that you know if you've had a pap smear and that you have the results and you don't just think, oh, I had a pelvic exam. I mean, putting a speculum in or doing a palpation or a bimanual exam is important, but that's not scraping the cervix and doing a pap smear.
Speaker 1:So the cause of pelvic organ prolapse? Certainly childbirth and pregnancy has a lot to do with it, especially vaginal delivery. But advancing age, obesity, hysterectomy, chronic straining and just abnormalities of the connective tissue and abnormalities of the repair of connective tissue can predispose some women and just disruption and stretching of the connective tissue, which is usually due to pregnancy and childbirth but also can be from surgery or any other kind of traumas. The symptoms can vary depending on which organs are involved. Urinary incontinence frequency, a weak or prolonged urinary stream, feeling like incomplete emptying or needing to change positions to fully empty the bladder can be another symptom. Having trouble defecating or needing to put support on the perineum or even put fingers in the vagina to push the rectocele or rectum to support it so that stool can be evacuated through the rectum. There can be a feeling of a bulge or even a protrusion, sexual activity can become painful or more difficult.
Speaker 1:So, in order to prevent this, you definitely want to have a good pelvic floor and strong muscles, certainly long before pregnancy and delivery, and certainly rehab afterwards, and it's important to manage your weight. It's normal to gain 25 to 30 pounds. Of course, with pregnancy that's expected, but unfortunately, most women gain that much weight after they're done childbearing, at the time of perimenopause, and so it's important to weigh yourself once a week and realize the older you get, the less calories that you generally need and the more you need to focus on muscle building activities as opposed to just aerobic activities. Managing the weight is very important. Sometimes five or ten pounds of weight loss and correcting constipation can dramatically improve urinary and urinary function, and if you haven't listened to our prior podcast on weight management, weight loss that is like the number one concern women have, and we have a lot of really great resources on our website, speakingwomenshealthcom, on our podcast, and it's important to monitor your physical activity and avoid activities that put a lot of extra strain on the pelvic area jumping, spiking any kind of Valsalva maneuver, bearing down, avoiding heavy lifting and not transmitting all that pressure to the pelvic floor down through the vagina.
Speaker 1:Quit smoking if you smoke and listen to our podcast on quitting smoking, because tobacco damages the collagen and that's why smokers look a lot older than non-smokers, because they lose a lot of collagen in their face. It's why smokers don't heal as well after surgeries and even a cigarette or two a week is still damaging. Taking care of chronic coughing I mean many women are not incontinent, but if they get an infection or reactive airways or a flare of their asthma and they start coughing, that can trigger pelvic prolapse symptoms and or incontinence. So how do we treat pelvic prolapse? Well, if it doesn't bother you, your doctor may not say anything needs to be done other than Kegels, avoiding constipation and coming back for yearly exams. But surgery is an option when your quality of life is being affected.
Speaker 1:In terms of medications, we want to treat vaginal thinness, dryness, genitourinary syndrome of menopause. Vaginal estrogen can be helpful and I find that vaginal DHEA, which boosts estrogen and testosterone, that the testosterone can help the muscles. There's only five bands of muscle that support your bladder neck, so women tend to start to lose muscle mass after age 45. Pessaries, which are a silicon type device that can be put up in the vagina to push things up, can be used in women who want to avoid surgery. Many times find this very helpful and then surgery is more definitive. In season two of our podcast, I did do a podcast on urinary incontinence, talking about making bladder leakage a thing of the past, and so if you're having trouble with bladder leakage, that is an important one to go back to. So at the time of this podcast taping, we don't have the pelvic stimulating devices that I previously used to recommend to women the ATTAIN device, which was like biofeedback and stimulation of the pelvic floor to strengthen the pelvic floor, which was not a treatment for prolapse but an excellent treatment for stress incontinence and urge incontinence and urge incontinence and mixed incontinence. And if we can get through this microchip shortage and get these devices, if they're back on the market by the company, I will be sure to let women know and that's why I always say bookmark my website and periodically check our news and listen to our podcast.
Speaker 1:So involuntary leakage of urine is not normal. It's not a part of aging, even though maybe half of your friends have this problem Childbirth, age, hormonal changes, family history certain medications can make it worse, like some of the medicines given to men who have a big prostate, bph. There are some medicines that kind of relax the internal urethral sphincter and that might be great for an older man with a big prostate but not for a woman. And some of those times those medicines might be used for high blood pressure or post-traumatic stress disorder and that can make incontinence worse. I've also seen women develop cough from ACE inhibitors, which are more likely to cause cough in women. They're a blood pressure medicine and so if you're coughing more that can make incontinence worse. So of course any cough should be evaluated worse. So of course any cough should be evaluated.
Speaker 1:Minor, occasional leaks of urine generally can be just treated with better bladder hygiene and Kegel exercises. But if it's more common you need further evaluation. And please go back and listen to that Urinary incontinence podcast on stress incontinence, urge and mixed. But it's always a good idea to avoid bladder irritants like caffeine and alcohol. A little bit of caffeine is good. It may be good for the brain, for fatty liver, for energy for pain control, but excessive caffeine is not, and alcohol is also an irritant and a toxin and maintaining a healthy body weight goes a long way at reducing a lot of medical conditions and ideally prior to pregnancy, it's good to have your health care clinician check to see if you know how to do a Kegel correctly, because about 10 to 20 percent of women, even women who are physicians and nurses or who know pelvic anatomy and physiology, can't do the Kegel.
Speaker 1:Sometimes you need instruction and biofeedback. Biofeedback and there are lots of treatments for incontinence medical, physical, pessary surgery. Biofeedback can be very effective and that's why I love those Attain devices because it was like self-biofeedback. But pelvic floor, female physical therapists for women and there are males who specialize in the pelvic floor and can treat men and women as well, although many times a woman might feel more comfortable with a woman, male might feel more comfortable with a male physical therapist. Really what's most important is having someone who's specially trained and who you can feel comfortable talking about bowel and bladder and sexual issues, because all of that stuff is involved with your whole pelvic floor and sexual dysfunction can occur at any age and there are treatments. We have a sex therapist at the Cleveland Clinic who we've interviewed on our podcast, and she talks about being able to talk comfortably about sexual function and some of the causes of sexual dysfunction.
Speaker 1:Medications can affect hormones, like oral contraceptives, chemotherapy, blood pressure medications, hormonal changes with lack of sex hormones, like in menopause. It always amazes me how, when women move past childbearing and they lose their sex hormones and they're just shocked that they've lost their sex drive, which you know the purpose of the sex drive is to reproduce. And so when you've lost your reproductive hormones and you're on no hormones and you have less hormones then you know you have had for decades it's not surprising to lose that sex drive. But there are evaluations and treatments and being sexually active well into advanced age is a sign of good health, because diseases like diabetes and high blood pressure, excessive alcohol, can really ruin the sex life and vaginal infections and untreated depression can affect the sex life and then, sadly, some antidepressant medicines can further cause trouble with climax or sexual desire. So it's important to kind of keep track of what's going on in your diet, your medication, your physical lifestyle, your relationship with your partner, and to keep track of this and be honest and share this information with your healthcare clinician. We have had podcasts on sexual dysfunction and treating low libido. I think it's important to make an appointment specifically to talk about that problem, as opposed to adding it on at the end of a visit that you're there for an annual exam or another problem visit and treating this problem involves a comprehensive evaluation, a look at your medications many times. Hormone therapy, vaginal DHEA can be very helpful. Pelvic physical therapy can be extremely helpful if there's chronic pain and sometimes an evaluation and counseling with a sexual health specialist is needed.
Speaker 1:And lastly, we're going to talk just briefly about kidney stones. I already did a podcast in season two on kidney stones and, as an osteoporosis specialist, I'm very interested in calcium metabolism and many types of kidney stones are because someone has a disorder in their calcium balance and they have calcium oxalate stones. But dehydration, a family history, elevated uric acid, a diet that's too high in salt and sodium and protein can increase uric acid oxalate levels. Obesity increases kidney, certain medications, some blood pressure medicines, as well as type 2 diabetes and gout. I did do a podcast on uric acid and gout. It's always good to come in when you see your physician with all your medications and your supplements Not just a list or pictures, but bring them in Now.
Speaker 1:Symptoms of a kidney stone can be intense pain in the lower back or the abdomen, nausea or vomiting, seeing blood in the urine, although it might just be microscopic pain when urinating, being unable to urinate, having fever or chills, which might indicate infection. Drinking at least 64 ounces of water a day is very helpful, along with reducing sodium and salt content. Getting enough citrus and citrate in your diet is very important if you've had calcium oxalate stones, managing your blood pressure and your medical conditions. Occasionally, kidney stones can be painless. It's unusual because usually they're very painful, but they can just collect in the kidney and cause kidney damage. Many times small stones can pass without the need for specific treatment. If you pass a stone and you're able to catch it, keep it because we can chemically analyze it in the lab.
Speaker 1:There are minimally invasive procedures that urologists do, where they can remove the kidney stone or do lithotripsy, trypsy. So, in conclusion, urologic problems in women as well as men, but especially in women, are pretty common and they can cause pain and discomfort and they can affect the quality of your life and even, occasionally, your longevity, depending on what the problem is, as acute infections can lead to sepsis and death, but the good news is, most of these conditions are treatable and your urologist, female urologist or urogynecologist, along with your main principal primary physician, are important it's important to work as a team are important it's important to work as a team. So thank you so much for listening to our Speaking of Women's Health podcast. Don't miss a future episode. So please subscribe wherever you listen to podcasts Apple Podcasts, spotify, tunein wherever you listen to podcasts and give us a five-star rating or share our podcast, and you can go on our website speakingofwomenshealthcom and donate to our nonprofit. Remember be strong, be healthy and be in charge. Thanks again and I'll see you next time in the Sunflower House.
