Nurse Maureen‘s Health Show
Welcome to Nurse Maureen's Health Show Podcast where we dive deep into all things health, sex, menopause, relationships, parenting, communication and more! Hosted by a passionate nurse with years of frontline experience, we bring you expert interviews, real-life stories, and the latest insights on staying healthy aging. Nothing is off limits as we delve into overall health, sexual health, mental health, and sexual health. Whether we’re breaking down medical myths, discussing cutting-edge treatments, or chatting with top health professionals, this show is your go-to for practical advice and inspiring conversations.
Nurse Maureen‘s Health Show
Beyond Kegels: Pessary for Stress Incontinence and Prolapse
Do you leak urine when you cough, sneeze or do you feel a bulge down there, afraid to mention it to anyone or think it's normal? I'm here to tell you that leaking urine is never normal, nor is feeling a bulge down there. Ladies, good evening. I'm Maureen McGrath, registered nurse, nurse, continence advisor, sexual health educator, and I want to talk to you about two conditions that are very common in women and often occur after childbirth or during perimenopause or postmenopause. First of all, I want to talk to you about leaking urine and the one message. If you learn nothing else from me, understand this leaking urine is never normal. No, when you cough and leak a little bit, or when you run and leak a bit, it's not normal. You're not supposed to do that. Or even when you have this urgency, you come home, you've got the bundles and you're at the door and you're trying to get in. You've got this urgency and then you leak on the way. We call that key in the door syndrome and it's not normal either. It's not normal when your bladder is really full and then you lose the entire bladder. So leaking urine is never normal, and one of the most common types of urinary incontinence is stress urinary incontinence. It's the involuntary leakage of urine that occurs during activities that increase intra-abdominal pressure, such as coughing, sneezing, laughing, exercising or even moving in bed or going from a lying to a standing position or going from a sitting in a chair to a standing position, and it happens because of weakened pelvic floor muscles or lack of mid-urethral support. There's a weakness in the mid-urethra and some of the causes of stress urinary incontinence include pregnancy, vaginal deliveries, childbirth, menopause, perimenopause. Estrogen loss leads to weaker tissues. Obesity, chronic coughing, smoking, asthma you might get, or you might get a, have had a COVID infection and have had two months of coughing and high impact activities over time can also cause stress urinary incontinence. And it can also be genetic, and you don't have to have had a baby in order to leak urine, and sometimes women just have particular genetic predisposition in their tissues that causes them to leak urine. So I want to talk to you about some of the common treatments for stress urinary incontinence.
Speaker 1:You've probably heard that Kegels work, or you've probably been told to do Kegels. Well, you know, to be quite honest with you, I have a pessary and urinary incontinence clinic in North Vancouver, british Columbia, and oftentimes I see women who are at the end of the road. They've tried everything and one thing is true Kegels have never worked. For I mean honestly, they work when it's quick Kegels for a different type, for urgency or urge incontinence or overactive bladder, but it does not work for stress, urinary incontinence. The other thing is hypopressives. You've probably seen a lot of that on social media. You know women are trying it and they're confused. It's difficult to do. A lot of these women are older, they can't get down on the ground, they can't coordinate it and you know, to be honest with you, a few years ago a pelvic floor physiotherapist came into our office and wanted to talk about hyper-opressive exercises and it wasn't a great pitch because she had just had a baby and one of the gynecologists that I work with said to her they were explaining the hyper oppressive and we were all kind of, you know, just baffled and and there's not a lot of evidence to support that they work.
Speaker 1:And the gynecologist said to her you've just had a baby and she said I leak urine. The pelvic floor physiotherapist. And she said because she said she just had a baby and that she said I leak urine. The pelvic floor physiotherapist. And she said cause? She said she just had a baby. And that doctor said to her do the hypopressives work for you? And she said no, and it's like what, anyway? Um, and so I I've seen a few women come in after having tried hypopressive exercises because the Kegels didn't work and the hypopressive exercises didn't work either. And they've also been told by a lot of influencers and people that don't have medical training or don't examine patients, so have never actually been taught how to assess a pelvic organ prolapse or how to assess stress, urinary incontinence, how to diagnose it properly. So they've never seen any women, they just claim this online and so and quite often they're not healthcare practitioners, so they're pushing this and so it's kind of getting a little bit of airtime, if you will, a little bit of traction, and but you know what that's just my, that just might be. What you need is traction for your and I'll be talking about that and how you can get some traction for your stress, urinary incontinence. I also want to talk about pelvic organ prolapse.
Speaker 1:That occurs when the muscles and the tissue supporting the pelvic organs, like the bladder, the uterus and the rectum, weaken and that causes one or more of these organs to drop or press into the vaginal wall, and it commonly affects women who've experienced childbirth, vaginal deliveries, vaginal labor and then even go on to a C-section. But sometimes women who have C-sections can have this as well. It can be caused by menopause, chronic constipation, heavy lifting. I remember a patient said to me my mother yelled out the window and said do not move that trampoline from one. You know, don't lift that trampoline from one end of the yard to the other. And and she's like that's my mother. I'm like your mother is absolutely correct, because you know that heavy lifting, you know it can snap.
Speaker 1:Sometimes the hormones decrease in the urogenital tract, in that which estrogen is the hormone regulator of the urogenital tract and that is what allows for the elasticity, the moisturization. You know the vagina is dynamic. As you're walking along, it's moving as well, but it's got to be elastic and if it's not elastic, if it's dry, you know it's more likely to actually prolapse. So the symptoms of a pelvic organ prolapse are a bulging sensation in the vagina, pelvic pressure or heaviness feeling a bulge for women who feel themselves down there. You could have incomplete emptying of your bladder, and nobody empties their bladder entirely. I do want to say that I have so many women they're like I'm pushing it out, trying to empty it and it's like no, there's always about 100 cc's left in after you void. But if you have a prolapse you may actually have two, three, four, 500 cc's left in and you're going constantly. That can be a sign. You can also have frequent urinary tract infections as well, or difficulty with bowel movements or discomfort or pain during intercourse.
Speaker 1:Now a lot of women will have a grade one, even a grade two. Prolapse is four stages or grades, and we do the POPQ to actually assess a patient. But only about 40% of healthcare practitioners utilize the POPQ or the pelvic organ prolapse quantification system. It's a very detailed and complex mode of measurement but it gives a pretty accurate degree or stage of prolapse, and so that's important. But oftentimes there's some general rules as well as to where the organ is, as it relates to the introitus to determine the stage or the grade. So that's important, but sometimes women will have a grade one. Grade two doesn't bother them, they don't even know about it. More likely grade one to 1.5, but grade two less so. But you could still have a grade two and it may not be bothersome for you. And so if you're told you have a pelvic organ prolapse, but it's not bothering you.
Speaker 1:It's just a good idea to make sure that you're using a personal moisturizer, because it's just as important to moisturize the vagina as it is the face. In fact, it's more important and it's also more effective. But use something like Repagyn, which is a vaginal suppository it has hyaluronic acid, vitamin E or Femme, which is another product as well to moisturize your vagina. You can use coconut oil as well, but I like things that go inside. It's not just on the vulva that you need moisturization. You need vaginal and urethral and that rectal wall moisturization as well. So it's important to use at least a personal moisturizer, if not low dose localized estrogen therapy in the form of a cream or a ring, because I think the tablet that's available it's too dry for a dry vagina and oftentimes, with a pelvic organ prolapse, you will see a dry vagina as well. So just remember that it's just as important to moisturize your vagina as it is your face.
Speaker 1:Ladies, let's talk about something we don't often talk about pelvic floor health. Whether it's postpartum changes, aging or just the demands of everyday life, many women struggle with bladder leaks and a lack of self-confidence. But what if I told you there's an effortless solution. Meet the Emcella Chair, just 30 minutes, fully dressed, and it will do thousands of Kegels for you, strengthen your pelvic floor, improve intimacy and feel confident again. So say no to incontinence and start to enjoy life again leak-free. Ask your doctor about the Emcella chair. For more information, go to wwwemcellacom. That's wwwemcellacom, so I want to talk about there's, you know, lots of treatment for stress, urinary incontinence and pelvic organ prolapse.
Speaker 1:Like you know, for stress, urinary incontinence, cut down on the bladder irritants like alcohol and coffee or caffeine, drinks and chocolate and citrus fruits and spicy foods and those kinds of things that will irritate the bladder. Also, it's important to treat the constipation, because constipation can increase stress, urinary incontinence or even cause it. And then you could do for pelvic organ prolapse, for example, you might do double voiding, where you change position, you void initially and then you either stand up on the toilet or you move your position forward or backward, depending on your prolapse, and you empty it a bit more. But I want to talk about a pessary, which is a little known device. It's a medical device. It's a medical grade silicone device. It's inserted into the vagina to provide structural support to the pelvic organs and also to the mid urethra because some of them are rings with a knob and that will help to manage symptoms of prolapse or incontinence. And so I fit women with these all the time and I've been doing it for the past 17 years and they are a godsend for some women.
Speaker 1:I had a patient one time who the doctor texted me and said can you see, so-and-so? She has procidentia. So it was grade four, everything was out, her bladder was entirely out of her vagina, it had descended entirely. And he said she has a $100,000 catering contract over Christmas. And you know she's not able to walk, she's uncomfortable, it's painful and it's embarrassing and everything. And I said you know I happen to be leaving town in about three hours. But I was in my clinic. I said if she can get here in the next hour I can fit her. And I fit her with a particular type of pess, uh, a Gellhorn. And within like five minutes that was how long the visit was and it she walked out of there, prolapse, put back in place and felt amazing and carried on and did her catering contract, the con contract, over the Christmas holidays. And I didn't get 10%.
Speaker 1:There is a cost for pessaries. They're not that expensive, a hundred $150 for the pessary and then the consult as well. But you know what? Completely worth it. They last two to five years and it's also important that a healthcare provider look at your vaginal tissues to decide whether you need a personal moisturizer or low-dose localized estrogen therapy, which you need a prescription for. So that's important to know as well.
Speaker 1:So the benefits of pessaries they can be used for stress, urinary incontinence. A lot of runners will just pop it in when they run because that's the only time that they leak and you can take it out at night. If you self-manage it, you take it out every two weeks. I show you how to do that. Wash it, insert it back in, make sure you have a vaginal inspection by a healthcare provider annually. If you want me to service it for you or your doctor, then you just come every three months to the healthcare provider. We take it out, wash it, take a look at your vaginal tissues just to make sure that there's no laceration or no area of irritation or if you're having vaginal bleeding, we'll assess that as well, just to make sure everything is going along as planned. But you know they're a non-surgical option for prolapse and urinary incontinence.
Speaker 1:Pessaries. They're awesome. They can improve bladder and bowel function. And lately I've fitted a few pessaries for some women who've had a rectocele and I always say you know the pessary typically won't help the rectocele but and you know I don't expect it to and then I put it in and a couple of different times lately it has actually helped with the rectocele and they were pretty significant rectocele as well. It can help to relieve that pressure and discomfort that you feel. And here's the great news you can still be sexually active. You can have penetrative sex with a pessary in place.
Speaker 1:Not all of them, most of them. So I want to quantify that they're custom fitted for your individual needs. There's a whole bunch of different types and you know I often say to patients this is an art, not a science. They're very easily managed, easy to remove for cleaning and adjustment. And you know if I had a patient, she came in, she was fitted somewhere else.
Speaker 1:She came in they didn't give her the pessary, they just told her the size and the type and it was a very strange, you know, not your first rodeo kind of pessary that you would use. A very common one is a ring with support, but this was a Schatz and it was a number three and I said, you know this isn't going to work for you. But I said, but I don't really want to be the naysayer here, so you know I'll insert it for you. But I could tell, because, comparing the vaginal vault to the pessary, I said, but I'll put it in, you know, see how you go, I could be wrong. I put it in, she didn't get to the door before the thing fell out. But then she, pessary I said let's flip it over flipped it over and it did work for her for, like you know, the better part of a week. But you know it kept falling out. I had shown her how to put it back in and it kept falling out. And at the end of the day, you know, then I had her come to my clinic and fitted her properly and she actually needed a size six ring. So the sizes are like two, three, four, five, six, seven and she went from a three to a six ring with support. So you know what?
Speaker 1:It's very important that you go to somebody who actually has experience fitting pessaries and they're typically nurse, continence advisors, the occasional pelvic floor physiotherapist not a lot. I get a lot of patients from pelvic floor physiotherapists who send me the patients who will have a prolapse. They're not suggesting that Kegels or hypopressives are going to help with the prolapse, they're suggesting that the woman needs a pessary. And also gynecologists, urogynecologists, obgyns, so obstetrician gynecologists and I imagine, occasionally a nurse practitioner or a general practitioner, but they don't commonly, they don't commonly fit pessaries. So it's very important that you have somebody who knows what they're doing.
Speaker 1:Many women find pessaries to be such an effective, low risk solution. You know a lot of women are afraid about infection but you know you rarely see an infection I mean no more commonly than a woman who doesn't have a pessary. It's low risk, especially when surgery is not an option or desired. You know people have their lives and they're planning. Or the other thing is there's an 18 month to 24 month wait in some places for to see an OBGYN and that's just to get the phone call and then it's another two or three months to wait to have the pest refitted. So it can take a long time and in two years a prolapse can worsen. And you know, especially if you have vaginal dryness nobody's looked at your vagina it can be drier and drier as the estrogen decreases in the urogenital tract.
Speaker 1:So so important to have it fitted by a healthcare provider. There are some that are sold online, one in particular, but why I hesitate with that is that many women will have post-coital bleeding, vaginal dryness, painful sex, burning, itching, and they won't be diagnosed with GSM or genitourinary syndrome of menopause. Therefore, they won't be treated with a personal moisturizer or low dose localized estrogen therapy, and so they're just putting this in. It's kind of hard, this particular device, and they're inserting it themselves. Nobody's examining them. So I mean, I think that's really for younger women who have confirmed stress urinary incontinence. They are a bit more expensive and they come with three different sizes. So you, you know you don't really you're not sized for it. It's a little bit of a guess, but I do think that the company does. You know, not none of those three fit you, which I think they fit 80% of patients with stress urinary incontinence. But you know, a lot of people think they're for prolapse and they're not. That particular one is only for stress urinary incontinence. But if one of those three doesn't fit, I do believe that the company will send you a bigger one or a smaller one, a different size, without having to pay more. So that's good.
Speaker 1:It's so important that you care for your vagina. We can't just forget our vaginas and that's why that assessment is so important. When a when a nurse contents advisor assesses you, they will assess your symptoms, your pelvic floor strength and your vaginal anatomy. They'll do an examination and they'll provide you with the right size and shape of pessary based on your prolapse severity. And you know, and quite honestly, what I do with my patients is I they can trial it, so they'll come in, I'll fit them, I'll make sure they can void because it can be obstructive, it's if it's the wrong size, if it's too big, and I make sure that they can go outside and they can run up and down the block, or they can, you know, take a good brisk walk and it doesn't fall out, especially if they bear down. So I'll have them squat as well.
Speaker 1:So, and I teach them how to remove it, clean it and reinsert the pessary if it's a type that's designed for self-management, as I mentioned, there are a few that are not designed for self-management, and you know. Then they come back in a week or two, they let me know if that works or not, and then you know we either try another one or go with that one. So you want to regularly clean it, every couple of weeks, just wash it with warm water and a mild soap, or you can go to your healthcare provider every you know three to four months, but really it's three months and they will take it out and put it back in for you and you also want to monitor for any symptoms. So if you experience any increased vaginal discharge, odor, irritation, difficulty urinating, bleeding, you want to contact your healthcare provider and, as I mentioned, a personal moisturizer or vaginal estrogen may be recommended to prevent dryness and irritation, especially for postmenopausal women.
Speaker 1:But a pessary can be an awesome device and it can last for, honestly, up to five years with proper care. When it oxidizes you know it's not effective anymore or if it just stops working and sometimes women need a larger size. Maybe six months, a couple of years down the road and the odd time a pessary has actually reversed the prolapse. But you know what you may need to replace it if it becomes damaged or doesn't fit well or if there's any changes in the vaginal tone or the prolapse severity. But you know, I typically see it supporting the prolapse and just being very effective in terms of not advancing the prolapse. So a lot of women will wear them while they're waiting for surgery or just decide to forego surgery and they'll just keep the pessary in. And you know, I had a woman, I think she was like 45, and she's like do some women leave this in for life? And I said, yes, they do. So I have women in every decade of life that has a pessary, anyway. So it's very important that you know about this, because this is a common healthcare issue for women and it's one that we don't talk about. We don't talk about below the belt for women. I was thinking, you know, so many doctors are uncomfortable with assessing vaginas and diagnosing genitourinary syndrome and menopause or even just vaginal dryness, yet they're so comfortable with prescribing Viagra. I mean we have to make a shift. We need to turn this around because women's intimate health is so important.
Speaker 1:If you have any questions or comments, feel free to text the show or you can email me nursetalk atotmailcom. Thanks so much for tuning in. I am Maureen McGrath and you are listening to Nurse Maureen's Health Show Podcast. Thanks so much for tuning in. I'm Maureen McGrath and you have been listening to the Sunday Night Health Show Podcast. If you want to hear this podcast or any other segment. Again, feel free to go to iTunes, spotify or Google Play or wherever you listen to your favorite podcasts. You can always email me nursetalk at hotmailcom or text the show 604-765-9287. That's 604-765-9287. Or head on over to my website for more information, maureenmcgrathcom. It's been my pleasure to spend this time with you.
Speaker 1:Ladies, let's talk about something we don't often talk about pelvic floor health. Whether it's postpartum changes, aging or just the demands of everyday life, many women struggle with bladder leaks and a lack of self-confidence. But what if I told you there's an effortless solution? Meet the Emcella chair Just 30 minutes, fully dressed, and it will do thousands of Kegels for you Strengthen your pelvic floor, improve intimacy and feel confident again. So say no to incontinence and start to enjoy life again leak-free. Ask your doctor about the Emcella chair. For more information, go to wwwemcellacom. That's wwwemcellacom.