Nurse Maureen‘s Health Show
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Nurse Maureen‘s Health Show
Breaking the Silence on Urinary Incontinence
Did you know that it is never normal to leak urine? Hi, I'm Maureen McGrath, registered nurse, nurse, continence advisor and sexual health educator, and tonight we are talking about urinary incontinence. It's a very common condition, particularly among women and older adults. Prevalence rates vary, but generally range from 25 to 45% in women and are higher in older age groups and in institutionalized settings. It's a multifactorial condition, with stress and urge incontinence being the most common types, and, may I say, diagnosis is key. It affects millions of Canadians, including new moms, women during and after menopause and women managing chronic conditions. Yet most people tend to suffer in silence because of stigma, shame or lack of information.
Speaker 1:With World Continence Week upon us, june 16th to 20th, this story I knew would resonate widely with so many of you, and it's a chance to bring visibility to something many women carry quietly along with a lot of other load in their life as well. I'm excited to have two incredible voices with valuable perspectives on stigma, mental health and the importance of community and also progress in the treatment arena. Katie Glab is a Guelph resident living with multiple cirrhosis and she is going to talk about the wide range of symptoms people with chronic conditions like MS may face and why conversations around issues like urinary incontinence matter and we don't really talk about it because there's so much shame and stigma associated with it. But I love that Katie is going to talk about it because she is so compassionate, she has a community-centered perspective on living with ms and advocating for visibility. My other guest is casey gardner, associate director of medical affairs at bd, canada, and she's going to provide expert insights into how innovation is changing the way urinary incontinence is treated and managed, making it more accessible and less isolating.
Speaker 1:Welcome to the podcast, ladies. Thank you, you are so welcome, katie. I want to ask you. First, I want to thank you so much for joining the program and talking about this, because it is an embarrassing condition and you know a lot of women don't talk about it. I often say you know we don't really share this. You're not going to go to a dinner party and say, hey, how are you? And while I'm leaking urine, things aren't so great. I'm losing sleep. I'm, you know, not able to exercise. It's really impacting my quality of life. Why do you think urinary incontinence remains such a taboo subject, even though it affects millions of Canadians?
Speaker 2:See, I find this so fascinating because I I don't know if it starts with potty training, like. I have no idea, but I feel like women inherently just keep this quietly to ourselves, whether or not it has to do with the embarrassment factor, like you pointed out earlier, whether it has to do with you know, we don't talk about it with our spouses because you know we want to remain desirable and that's not an easy topic to talk about with you know, your husband or your or your spouse, and it's so nuanced in. No, I'll just keep this quiet, I'll just manage this myself, I don't need to talk about it, and maybe talking about it makes it real. It makes it something that you actually have to deal with, which is not really how we perceive ourselves. Also, I don't know if there's an element of maybe being a burden that we don't want to. We don't want to feel like we're something that has to be taken care of.
Speaker 2:Women inherently are caregivers. So as soon as you know we're asking for support from other people about something as difficult to talk about, as stigmatized as urinary incontinence it becomes, we're asking for help. And I don't know about most women out there, but I struggle with doing the very same thing. So, and frankly, it's not something that our doctors are proactively speaking about with us either. I didn't know, as somebody with MS, that I am probably going to be impacted by urinary incontinence until Casey told me that it was something that I may have to tackle later in life.
Speaker 1:So I don't think that there's proactive conversations no-transcript years to see her doctor about urinary incontinence and oftentimes the response is because physicians haven't been trained in medical school about it. You know the response can be like can you live with it or do Kegels, neither of which can be all that effective for many women and women with neurological conditions like MS and Parkinson's. Yes, many don't realize that they may actually be affected by urinary incontinence. Casey, what are some of the emotional or psychological impacts of that silence?
Speaker 3:I think it's a lot of other similar to a of other things, like even infertility for females, where that impact of sort of suffering in silence and feeling like you're alone in this journey does make it harder to reach out and get help.
Speaker 3:I know there's, I think you just mentioned, like a lot of studies have shown, and on Canadian adults as well, that like 41% don't even know that help is available if they are urinary incontinent and if they are only 50%ontinent and if they are, only 50% of them will initiate a conversation with their healthcare provider. So that like sort of suffering and silence, I think is really strong. I think the misconception that it's like a natural part of aging or post-pregnancy and there's really nothing you can do about it probably just takes a toll on that sort of isolation and feeling like you're alone in this journey and, like Katie alluded to before, there's so many people going through this and also there's like a lot of studies out there that link kind of depression, social anxiety and isolation to urinary incontinence. So it's one of those things that's sort of well documented in literature but not still not well discussed.
Speaker 1:You couldn't be more correct on that and not to mention increased laundry, increased use of pads, because there's a lot of money poured into advertising on television about the only thing you can do about urinary incontinence is use pads, which can lead to skin infections and it can actually lead to that depression and loss of dignity. But we're going to be talking about some of the great treatment options today, which is why I'm so delighted to have both of you on the program. Katie, can you share a little bit about your journey with MS and how you felt when you learned that bladder health and leakage of urine may become a part of your experience?
Speaker 2:For sure I'd be happy to. I think that my journey to towards diagnosis was probably very similar to a lot of people out there. It started with eye pain and doctors telling me, ah, it's just dry eyes. Until I started losing my vision and realized that it wasn't really dry eyes at all.
Speaker 2:And then, just like again most people out there, it took years for me to be diagnosed and I was diagnosed right after the birth of my son, my second child, and it was terrifying. It was, you know. All of a sudden it's this journey of the unknown. You have no idea what's going to happen tomorrow and you just, it cripples you because you don't know how to even almost get out of bed when you know your eyes aren't working you. And then you don't know if it's going to get better. You don't know if you're going to get worse. And going back to my comment earlier, am I just going to become something that people have to take care of? And I had, I had a four month old at home and that was terrifying and just. And then the one ifs right, just the toll on your mental health. Luckily I'm so blessed with an amazing MS specialist who just really reassured me that this was going to be okay and that I was going to be able to to manage this.
Speaker 2:But to Casey's point earlier, and not talking about things, I'm not feeling, you know, being able to be open and honest. I did shelter myself and close myself off because it felt easier to pretend like everything was okay. It felt easier to admit that I was strong when I really wasn't. And what ended up happening was I ended up going to my first MS walk with my family and realized how much I had actually prevented them from showing up for me by telling them that I was strong and by telling them that I had it all. They didn't even really feel like that they could support me, despite how much they wanted to. And it was a really powerful moment for me to realize that I could, you know, drop that strength. I could be weak. I could open up to my mom, my dad, my husband, my brother to say my mom, my dad, my husband, my brother, to say, hey, I'm, I'm not okay and they would be strong for me.
Speaker 2:And what drove that was realizing that if I can own this and I can own that, I'm dealing with this. It led me to being open and probably committing what most people would say is a, you know, a career suicide, which is I opened up at work. I talked to my boss about my MS diagnosis, I talked with my team and and sort of opened up yeah, I live with MS and I live with it every day, and some days are better than others. Some days I feel incredibly fatigued. Sometimes I you know I struggle with motherhood and a husband with a demanding career, and they rallied around me.
Speaker 2:It was really powerful and it drove Casey getting involved in this conversation, and I don't know if other people out there have a Casey in their lives, but I highly recommend finding one. This woman goes dives into research and that it was this entire group of people who go. I bet we can do more. And then, sitting there with Casey and go, she says you know, did you know that this was going to be something? That urinary incontinence is not something that I may encounter, but it's something I probably will encounter.
Speaker 2:It's something I need to prepare for. And Casey sits back and goes encounter, it's something I need to prepare for. And Casey sits back and goes let's talk about all of the things that you can do to help prevent urinary incontinence in the future, or things that you can do to help mitigate it. And I'm sitting there with my jaw dropped and I'm going I'm sorry, pardon. Not only are you teaching me that there are things that I can do to help prepare for my future, but this isn't something that I knew as my part of my own diagnosis.
Speaker 2:I go in, I see my, you know, I see my MS specialist. He's amazing. He asks me Through every physical hey, do you have any bladder problems? But he's not telling me why. He doesn't. You know, and maybe that's my feeling, I'm not asking, I just go no, and I carry about my day. But then Casey opens up this door of conversations and now it's not something to be ashamed of, it's something that the people around me are saying hey, let's not only have this conversation, let's see if we can tackle this problem. It was really powerful.
Speaker 1:Absolutely. And you know a lot of women present with bladder problems as a first symptom of MS. And I see that in my clinical practice where they're having difficulty emptying or they're, you know, leaking or having tight kind of overactive bladder, kind of overstretched bladder symptoms as well, and so it's often and I'm often thinking, oh, could this be MS? You know, because there's so many nerves in the bladder. And so when women present with particular bladder symptoms, you know sometimes they need a referral to a neurologist. You know they may need to catheterize to fully effectively empty their bladder to prevent urinary tract infections. And so I'm so glad that we're having this conversation because I also have many patients with chronic neurological conditions, like Parkinson's disease for example, and then they have the diagnosis and they are dealing with, you know, pain and movement issues and balance issues and gait issues, and then all of a sudden bladder issues present for them and you know they're shocked and surprised and downright depressed. They, you know this also, you know, adds, you know, insult to injury, if you will. It just makes things much worse.
Speaker 1:And sometimes women will get urinary incontinence unrelated to a neurological condition. So you know it can be a double whammy. If you will, they may have it as a result of decreased estrogen in the urogenital tract and they may have it because of a chronic neurological condition. You've become an advocate, katie, for visibility and community. And what do you wish more people understood about living with chronic conditions like MS and those invisible symptoms?
Speaker 2:your find your people that'll rally around you and accept that. You know, if you can have these difficult conversations with your people your ride or dies, whether it's your, your partner, whether it's your best friend, whether it's whether it's your Casey and you find somebody and and and open up about it. All of a sudden it becomes now, it becomes real. And these symptoms you need to talk about it with your doctor because there's so many things that we don't know. And if you can open yourself up to the opportunity for treatments and to open up yourself to these, for these difficult conversations, you can start to to find a new way to deal with it. Start to to find a new way to deal with it which isn't just in silence, right, You're not just dealing with it in, you're opening yourself up to options.
Speaker 2:And that's the biggest thing, I think, is we don't know what we don't know. So I didn't realize that some of my symptoms were MS related until I asked my doctor. And if we I know so many women in my lives, in my life, that are experiencing urinary incontinence and they just assume it's a result of motherhood oh, I pushed out a couple of kids. This is just how I deal with it. No, talk to your doctor, see, if this is something that you have to live with or if there are things that you can be doing, this is it's so important for us to be able to connect with the people around us and because of this feeling oh, it's just something else that I need to deal with.
Speaker 2:There is sort of and, Maureen, I'm sure you see a lot of this, but you almost get to this point of just medical fatigue, like medical decision-making fatigue, like you just don't want to deal with something else and it's easier to pretend it's not happening and just deal with it in silence than opening up and talking about it, because you're already dealing with your I mean for MS, specifically your DMTs, your you know, you're going in for your injections or you're going in for blood work, you're going in for your MRIs, and you're just exhausted and just don't want to deal with something else.
Speaker 2:But if you can get over that hurdle, you can improve your quality of life and this doesn't become something that's. You know, this hidden thing you just have to deal with in silence.
Speaker 1:Exactly, and I think you made a great point earlier too like it's okay to say yes to help, and oftentimes, as women, we don't do that. Casey, from your perspective as the medical affairs expert at BD, how has innovation changed the landscape for people managing urinary incontinence? I'm so interested in this.
Speaker 3:Yeah, I think and I have to give kudos to Katie for coming out with her story and being so open with it, cause I think that ultimately, innovation thrives on a better understanding of the need and the patient population that can benefit from new products and sort of ways of thinking of how we care for these patients. So having Katie be so vocal and like under, like asking questions and like know can this be better, what options are available, I think ultimately that whole scenario of open dialogue just uh seeds innovation. But I think we kind of you know there's a breadth of new products that are on the the market from, and I think you know there's an awareness, obviously, as we talked about before, that incontinence is a real issue um, I think a heightened awareness too, around the complications of managing incontinence in inappropriately in terms of like CAUTI, urinary tract infections, incontinence associated dermatitis, like that sort of. Also, I think that awareness will facilitate future innovation. And then, obviously, our aging population. It's something that just really needs to be addressed.
Speaker 3:I'll give like a couple examples. Obviously, there's, you know, we talk about it sort of in our. My thought process goes you know, what can you do per prevent, what can you do to treat and what can you do?
Speaker 3:to management and there's so many different options in each category, very simple options. You talked about is Kegels. From a socioeconomic standpoint, anybody can do that, you know. Depending on the specifics of your incontinence it's more or less effective or effective. I can see percutaneous tibial nerve stimulation, or PTNS, is one that I hear more and more about and that can be exceptionally impactful for some urinary incontinence. So it's sort of an electrical stimulation that stimulates the tibial nerve kind of around your ankle which can help regulate bladder function and the nerves that control it. There's actually a couple different electrical stimulation sort of modalities that have done series of trials on them and that are all fairly effective. The PTNS is a little bit less non-invasive, it doesn't require an implant. So these types of sort of preventative approaches or early interventions are becoming more and more accessible, I think, as more companies sort of are investing in that technology to see better outcomes.
Speaker 3:And then I'll maybe pitch one of BD's products that I think is a really great one and it's an external catheter system. It's called PureWick and it was actually initially designed specifically for women. They have, prior to this, had no external options for other than diapers or briefs to manage urinary incontinence, and this is essentially? It's a non-invasive option. It's an absorbent wick that sort of, from a visual perspective, looks kind of like a tampon and it sits between your legs and it's connected to a wall suction and that wall suction sucks the urine away from that area to avoid wetness, which can really help to prevent incontinence-associated dermatitis and, because you don't have an indwelling catheter, it can prevent things like CAUTIs.
Speaker 3:So things like that can really give patients kind of their dignity back, avoid complications, and it's exceptional support to your also support system. Who say, if you suffered from nocturnal aneurysms at night, you would apply this PureWik device and then essentially your caregiver doesn't have to be up with you in the middle of night either changing sheets or helping you to the bathroom. And we've we've heard from a lot of customers that that is exceptionally helpful from just sort of a quality of life perspective for both the patient and the care provider. So that was just kind of a dabbling of it. Yeah, go ahead Right.
Speaker 1:I was just. I love the Pure Wick and I recommend it to my patients, and you've just reminded me I have another patient that I'm going to actually call her today because it has so many other benefits in addition to just the reduction of contact dermatitis. But it can actually reduce laundry and costs and you know, it can prevent exhaustion as well, especially for caregivers. So that's, that is an awesome product. I have to say I've used that or recommended it many times in my clinical practice.
Speaker 1:Yeah, and you know just some other simple ones like preventing chronic constipation, for can prevent urinary incontinence, and localized estrogen therapy, for women as well, can actually reduce urgency and nocturia getting up at night to avoid. So there's lots of things and I'm so happy that BD is innovating in this area because it's not the sexiest subject, let me tell you, it's not been easy being a sex educator talking about urinary incontinence in my career, but nonetheless, somebody's got to do it. So, casey, what are some of the most promising developments or products that help make continence care less isolating? Are there some things coming down the pipeline?
Speaker 3:And I also wanted to ask you if you wouldn't mind just defining what CAUTI is, c-a-u-t-i catheter-associated urinary tract infections, which pretty much defined it there, but if you could cast a little bit more light on that, yeah, so essentially what you said is if you have an indwelling catheter and that catheter sort of ultimately seeded an infection that you then get a UTI or urinary tract infection from, they're sort of bucketed in that category versus if you had a UTI and you didn't have a catheter in there's US versus Canada, there's some different sort of motives around awareness around CAUTI.
Speaker 3:As Canada, there's some different sort of motives around awareness around CAUTI. The US hospitals are penalized if they have, if they, if a patient gets a CAUTI or acquired in the hospital. So as a result, there's a heightened awareness around tracking them and around preventing them. Unfortunately, like that's not the case in Canada, there's definitely a lack of awareness of their prevalence and probably the economic impact that they have on the hospital, because they are very common and I think some hospitals do a decent job of tracking them but there's no penalties, I'd say, for them if a patient gets them in the hospital. So there's pros and cons of doing both, but obviously when you know more you can do better know more, you can do better, and that link helps a lot.
Speaker 1:I think the penalty is the cost associated with long-term hospitalizations and also you know many patients who are admitted with a UTI or urinary tract infections. You know they have a greater length of stay. They are at increased risk of falls and fractures. They can. It can of falls and fractures. It can lead to other chronic conditions. It can lead to them not being able to live independently anymore and having to go into long-term care. So I think it is very important that hospitals address urinary tract infections and I think it can be done really in the emergency department. But also a product like PureWeck could help as well to all those hospital administrators listening out there. Check out this device. Access is often a barrier, whether it's access to information, care or products. Is there anything being done to bridge that gap and what still needs to happen? I mean, besides opening up this conversation and opening up the floodgates to this conversation?
Speaker 3:Yeah, I full and Katie feel free to jump in. I think the connection, the higher prevalence in women for urinary incontinence, I think, tethered with everything else that seems to disproportionately affect women and the lack of awareness around it, bd is definitely really trying to focus our efforts on women's health and promote better women women's health and advocacy through sharing conversations like what Katie is doing, and just really advocating for better care and for women. I think you know it really feels like the time is now to have these conversations. It's becoming more open, more aware.
Speaker 3:Postpartum postpartum urinary incontinence, menopauseinary incontinence, like you mentioned before, there's so many um versions of this that disproportionately affect women. Even women are disproportionately affected by ms and so like it does, I think, layer on these conversations that we need to advocate for better solutions for women, um for companies to specifically develop products for women, not do sort of design and trials on men and then include women as like an afterthought or sort of will this work on them? I think that will really foster innovation. But also I think, especially as we are starting to shift care from the hospital to outside of the hospital and like having appropriate funding, sort of match, where that care is delivered, is like still a key barrier, especially in Canada. I don't think the funding at home or in long-term care really matches the need for that patient population right now.
Speaker 1:Right, I couldn't agree with you more. And, Katie, what would you say to somebody who's struggling with urinary incontinence but hasn't yet spoken to a healthcare provider about it, or is just suffering in silence and just carrying on with their lives leaking, wearing pads trying to hide it? You know, missing out on events. I had a patient the other day say to me, you know, if this, she was being fitted for a pessary, which is a small medical grade silicone device that's inserted into the vagina to support the mid urethra in her case, and she said if this doesn't help me, I'm not going to go to this birthday party that I've been invited to on Tuesday. And I said no, no, no, you must, you must. If it doesn't help, you call me back, We'll fit you with something else. You know, people really miss out on life when they are living with urinary incontinence. So what would you say to somebody?
Speaker 2:Oh, my goodness, All I want to say is that you feel so alone right now, but what's interesting is you're probably not and you're probably like. The people around you are probably either somebody near you that's probably going through maybe not necessarily with, with a chronic disease, like but we're all impacted by your incontinence in some way and I think that that I know you feel alone right now, but you're not. There's so many people out there that are going through the same thing. And I feel like to Casey's point earlier.
Speaker 2:The mental toll it takes on staying silent and dealing with this without talking to your healthcare provider is so heavy. But I also completely appreciate how hard it is to take that first step, to go and talk to your doctor about it, and I think the only real message I want to say is yes, you're struggling, but you don't need to struggle alone and if you're not ready to open up about it, you have to be the first person to take that step. I can understand that, but I just want to hope that you understand that most, that there are people out there that are going through the same thing and I don't want you to feel so completely alone. And when you're ready to talk to your doctor. That's it, yeah.
Speaker 1:And it's often the first step in a in a pathway of many care providers.
Speaker 2:The other thing that, going back to what Casey was saying about, you know, access to care. We are, we as women, need to really rally around one another as we, you know we're steps behind really changing the medical landscape and having either OBGYNs or even neurologists to sit there and proactively say, hey, you've just had a couple of babies or you've been, you know, diagnosed with MS. Have you heard about pelvic floor therapies? Have you heard about these different things? This is something that you may want to consider and because that's not quite happening yet, we as women need to really drive those conversations and rally around one another. We have the power to support and empower the women in our lives. My best friend had a baby and said, hey, have you heard about pelvic floor therapy? And I said, what are you talking about? And she helped educate me on what that's like postpartum. We need to be able to be better at supporting one another and opening these doors for conversation organically and educating each other as women.
Speaker 1:Absolutely, and sharing stories is so empowering. Casey, if you could make one bold change culturally, medically or policy wise to better support women living with urinary incontinence, what would that be?
Speaker 3:I don't know if I have one. I would say awareness and access is kind of the key that stand out for me, you know, awareness of conditions that specifically affect women and access for women to get those medically appropriate treatments for them.
Speaker 1:Awesome information Ladies. Thank you both so much for joining me on the podcast tonight. I really appreciated your voices and the information, and I'm going to share some of this information with my patients just today. So thanks for the reminder about the PureWik.
Speaker 3:Thank you for having us. Thank you so much.
Speaker 1:You are both so welcome. My guests were Katie Glab she's a Guelph resident living with MS, and she spoke about the wide range of symptoms for people who live with chronic conditions like MS and she's not only facing those symptoms but maybe possibly, quite honestly, probably looking at living with urinary incontinence at some point in her life. And my other guest was Casey Gardner, Associate Director of Medical Affairs at BD Canada, and she provided so eloquently expert insights into how innovation is changing the way urinary incontinence is treated and managed. If you feel that this episode could help somebody else, feel free to share it with your mothers, your friends, your daughters, your sisters. We've got to make this more accessible and less isolating for people. And thanks so much for tuning in. I'm Maureen McGrath, registered nurse, nurse, contents advisor and sexual health educator. You can get more information at my website, maureenmcgrathcom, or you can head on over to my YouTube channel or find me on Instagram, Facebook, wherever. And thanks so much for tuning in. Helping women's bladders one squeeze at a time here, ladies. Until next time, I'm Maureen McGrath.