Patient and OBGYN Discuss Incontinence | Pelvis Party After Clinic Hours

We are back again this week with our new mini series After Clinic Hours where we meet with physicians (you guessed it) after clinic hours. 

Heidi Gaston, DO is back for part two! Dr. Gaston is an OBGYN who helps patients from every age and stage. This week's episode is very special because we are joined with Amy, a patient at OMC who shares her story dealing with incontinence and the treatment plans she went through! 

Check out our last episode with Dr. Gaston here ➡️ https://youtu.be/fxavsGVW7Cc?si=JaK829-3to6wfPOi 

Check her out here! ⬇️
https://www.olmmed.org/find-a-provider/profile/?id=658 

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See you next week! 💞

If you have questions, please leave a comment below or submit to hello@pelvisparty.com or send us a DM! Questions will always be anonymous 💞

Follow us on social media and wherever you stream your podcasts: ➡️ https://linktr.ee/pelvisparty  

Transcript

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And you don't have to live with it. It's not just a normal part of aging. Welcome back to After Clinic Hours, where the conversations get a little more honest, a little less filtered, and we talk about the things you probably wouldn't bring up at a dinner party, but absolutely should be talking about. So let me ask you something. Have you ever crossed your legs before sneeze or scoped out where the bathroom is the second you walk into a place, just in case? Yeah, you're not alone. Today we're talking about bladder leaks, why they happen, why so many people just deal with it, and what you can actually do about it. And this one's a good one because we're not just talking about it from a medical perspective. We've got real experience in the room. Today I'm joined by Dr. Heidi Gaston, who's seen this in everyday practice, and a patient who has actually had a sling procedure and is here to share what that was really like before, during, and after. Amy, welcome to the show. Thank you. Thank you for having me. We're so glad you're here to share a real life experience. And Dr. Gaston, welcome back. Happy to be here. Amy, tell us a little bit about yourself, uh, where you're from, where you live, children, uh, what kind of lifestyle you live. I work in a clinic setting and I have three daughters. My last two babies were born 15 months apart. So that was kind of interesting being pregnant for like two years in a row. Now my children are 24, 19, and 18. I'm very active. I've been a very active sports mom for my children, but also very active myself. I've always liked to rock, doing some half marathons and two full marathons, and have been very active and CrossFit over the last few years. So just very busy. You're an avid rider. Yeah. Like Dr. Gaston. You guys have that guy in common as much recently. Yeah. I kind of scaled back a little, but I do like to do that too. That's awesome. And you were saying you live in Alden. I live in Alden, Minnesota. Yep. Small town. What first brought you in to see Dr. Gaston? So I had just struggled with incumbents, especially with stress. So, like with my running and with CrossFit, you know, we have to do jump rope and heavy lifting, and it was just about impossible to do those things. And I just wasn't enjoying doing them anymore because of it. So I was frustrated. And a few years back, I had tried pelvic floor therapy, and that helped some. I had tried some different over-the-counter things like the impressive products. I had even some like spandex shorts that had the electrical stimulation, and nothing did enough to make those activities fun again. When did you first start to notice those type of symptoms? Oh golly. You know, it was probably five to eight years ago. I can't even remember when I did the pelvic floor therapy. It was a long time ago. And was there like an event that had happened where you had a moment that you're an aha that you really need to get in and seek care? No, I think it was just cumulative. Like, you know, especially going with the kids to things or being at their activities. It was that fear of, oh gosh, if I run too fast or if I have to move quick, what's gonna happen? And always being prepared for that. And I just got really sick of that. On a scale of one to ten, how severe would you say your symptoms were? I would say probably uh seven to eight. Pretty significant where it was affecting some of your daily activities. Yeah, I would say so. I would say I really cut back on running and we actually, and partly just because of being super busy and then COVID hit, we didn't go to CrossFit any longer, but I think that was also a piece of it. Like I just didn't enjoy trying to do jump rope anymore. Yeah, I know at my gym we we have jump ropes as part of our warm-up, and I just thought I tell them sometimes I'm not gonna do that because I don't want something. I've had babies and just you know, gravity starts to pull down. Yeah. Yeah, definitely. Completely natural, right? Um, but not something you have to live with. Right, right. And I guess, you know, that's probably it. Over the years, you kind of think, oh, this is normal, and you just keep tolerating it until finally you're like, no, I don't want this to be my life. I don't want to not be able to laugh without running to the bathroom first. Switching over to Dr. Gaston for a moment, how common is this, Dr. Gaston? I actually love hearing Amy's story now in hindsight because it's so reminiscent of many, many other women where they have been struggling with these symptoms for years and to some extent don't realize how normal it is. And by normal, I mean common, not something that has to be tolerated or something that can't be fixed or improved, but it does impact daily activity. It does steer women away from certain things and interactions with their kids or exercise. There is a marketed sign that says, I laughed so hard I cried down my leg. And it's meant to make fun of stress urinary incontinence, but it's not funny. It's real and it's a problem. And women shouldn't have to think ahead before they enjoy themselves. Amy, you mentioned that this is stress incontinence, and that is just one type. Is that right, Dr. Yastin? Yes. So stress urinary incontinence is the type of incontinence when you lose urine when the intra-abdominal stress on your bladder increases. So we're not talking about psychological stress like I had a stressful day at work. We're not we're not talking about that kind of stress when we're using the term stress urinary incontinence. We're talking about increased pressure from the abdomen on the bladder. So that's when you cough, laugh, sneeze, run, jump. And as that pressure on the bladder increases, for a lot of women, the urethra, the little baby sphincter that is supposed to keep the urine in the bladder until you say, relax, open, let me void, let me pee into the toilet. That urethra isn't fast enough or strong enough to stop that increased pressure from causing some leaking. So it eventually tightens and stops the rest of your bladder from emptying into your clothes, but a little bit gets out, or a lot of it, depending on how full your bladder is, when that activity happens. So there are other types of incontinence. The other most common type of urinary incontinence is urge urinary incontinence. And that's the I've gotta go and I've gotta go now. So when your brain sends your, or when your bladder sends your brain the signal, I'm full, it's time to go. You gotta beeline it to the bathroom. And so a lot of women will experience that when they put their key in the door when they're coming home or when their hands are submerged in the water while they're washing dishes. All of a sudden, they've got that message to their brain that they've got to go to the bathroom and they need to hustle to get to the bathroom or they're gonna empty their whole bladder. Amy, did you have any lifestyle changes that you implemented as you were noticing symptoms in the beginning? I had those shorts that I tried and probably just cutting back on some activities that I knew that were gonna be problematic. What about like fluids before bedtime? Did you No, I didn't have so much trouble with that. Nighttime wasn't ever really the issue for me. It was really just with activities. Okay. And then how long did you participate in pelvic floor therapy? Oh, God. It wasn't very long. I just did a few different sessions because it was not covered very well by my insurance. And then I just tried to do the things at home. Were there any other medications or anything? Was Amy a candidate for that, Dr. Gaster? So typically, stress incontinence isn't going to be addressed well with medicine. Sometimes women will come in and say that they have stress urinary incontinence, or more frequently, they'll come in and describe the symptoms of stress urinary incontinence, and they will also have some element of urge urinary incontinence. Sometimes in that setting where they have both, or what we call mixed incontinence, we can use a medicine to address the urge incontinence, and arguably their stress incontinence improves a little bit. But in general, the stress incontinence is a muscle or a architectural problem, whereas urge incontinence is more nerve, so more better addressed with medication. And so that led you both eventually to make the decision and Amy, ultimately your decision to have a procedure called the sling. Yeah. What was that like for you going into that decision? You know, I it was how I was gone with my daughter at a college visit, and we were doing the elliptical that morning in the fitness center, and I'm like, gosh, I'm leaking even doing the elliptical. This is ridiculous. So I think I texted Dr. Gaston right at that time and said, I need something done. What can you do? And she had an opening like that. I think it was maybe it was a Friday, and you had an opening on Monday for me to do the surgery. So I didn't even really have to think about it. I just said, Yes, let's do it. Yeah, you finally had enough, it sounds like. Yep. I happened to have Monday, Tuesday, Wednesday off of work. And I said, Do you think that's enough recovery? And she said, Yep, probably. Sounds like her. Scheduled it on Monday. And it was such an easy procedure. Such an easy procedure. I think I took Tylenol twice, maybe the day of the surgery, and didn't have to take anything hardly after that. A little bit of a heating pad, and I was back to work within three days. Wow, that quickly. Dr. Gaston, tell us what exactly a sling is in plain terms. Yeah. So the sling that I typically place for stress urinary incontinence is called the transobturator sling. The way that we do that is in the operating room, women will have, as long as they're a good candidate for it, the anesthesia that we call monitored anesthesia care. So they're not even receiving general anesthesia. They're receiving just enough anesthesia that they don't feel or remember the procedure, but they're still breathing on their own. So it's actually a really easy wake up as well. They don't have a lot of residual somnolence or sleepiness, and they don't experience a lot of the nausea and vomiting that can be associated with general anesthesia. So we make a small incision within the vagina on the anterior part, the top part of the vagina, and then two small incisions within the groin, and we thread a small mesh in through that those three incisions to change the angle of the urethra. So at baseline, the urethra is a sphincter, a small muscle, and it is impacted by gravity and then the stress that those activities can create on the bladder. So what we do with that sling is change the angle, add a little extra impact from the gravity perspective, so that the urine has to, if you will, take a turn before it gets to the sphincter, giving it enough time, slowing the urine down, giving the urethral sphincter enough time to tighten to prevent that loss of urine with the increased stress. So then there is some dissolvable suture that goes inside the vagina. And we typically use derma bond on those groin incisions. They're less than a centimeter long each, so very small incisions. And after the fact, there is a weight limit restriction and pelvic rest, so nothing in the vagina, for four to six weeks to make sure that the vaginal epithelium has healed well and doesn't create any mesh exposure, which could lead to pain or bleeding after the fact. What made Amy a good candidate for this? And in general, what makes a good candidate? The best candidates for this procedure are women who have true stress urinary incontinence. We've been able to define that they're leaking due to that increased intra-abdominal pressure. Women who have previously tried other interventions and failed those interventions or not had the optimal desired improvement. So they sometimes do have some improvement after those interventions, but they usually take continued work. And even with continued work, you don't always get complete resolution of your symptoms. Having tried something else and failed is is usually an important thing, both because insurance coverage matters, because surgery is expensive, but also because surgery has risks and you shouldn't undertake those risks if you can solve your problem with a less risky intervention. So Amy was a great candidate from both of those perspectives. She's also medically a very safe candidate to undergo anesthesia, to undergo surgery. So we didn't have to worry about other medical conditions impacting her healing. But people with diabetes need to have their diabetes fairly well controlled before they can have surgery, for example. So knowing what your personal risks are from your other medical comorbidities is going to be important before you proceed with a surgical intervention. And for you, Amy, what surprised you most about the process of this? I guess honestly, how easy it was. I have not had hardly any procedures and so hadn't really experienced healing, and it was so easy. Like I said, I didn't need pain medications and was back to work in no time. I think even the day after the procedure, I was at my daughter's basketball game. So I think just the ease and then the success of how my symptoms have improved. Amy, how quickly after the procedure did you know that it had improved symptoms for you? Oh gosh. When did I text you? Was it the day after or two days after? Where I had text and said, I sneeze and it was fine. Wow, that quick. Yeah. So this is gonna be one of those interventions that's essentially immediate improvement. What else have you noticed, Amy, since what other kinds of things are you able to do that were hard to do before? Yeah, we're back to CrossFit every morning, and I can walk and run and not have issues with having to wear pads or underwear that prevent leaking. Back to really normal activity and no no pain with anything. I do use vaginal estrogen just because I think that helps the scar part of it, but I haven't had any pain at all. Okay, so say more about that, a scar, and it could be from medical perspective, Dr. Gaston or Amy, if you want to elaborate. So there's an incision in the anterior vaginal epithelium that's gonna be similar to a superficial obstetric laceration. So it's not all the way into the muscle of the vagina like a more advanced obstetric laceration would be, but there is an incision and suture within the vagina. So it's going to have some healing and some that area in and of itself is going to not have the same stretch as native tissue. So having a little bit of vaginal estrogen is going to help that kind of return to its baseline. If you will, Amy, she's also perimenopausal age. So it has some potential other benefits from a long-term perspective for her. Did you experience any discomfort with the scar? No, nothing. Nothing. Wow. The other thing that I think is really important to know about stress incontinence is that this isn't necessarily a problem of age. We can see women of relatively young age who have stressed urinary incontinence. And I'll just say a fair number of pregnant women will experience stress urinary incontinence while they're pregnant. And part of that is that they are holding chronic increased stress on their bladder because of their growing uterus and growing baby. So for a lot of women during late stages of pregnancy, they might have stress incontinence, cough, laugh, sneeze, pee. For a lot of those women, it improves somewhat after pregnancy. But ultimately, pregnancy might be the first time that they experience that symptom and it could be something that continues on through their life. I typically counsel women that this procedure is something that we should wait to do until after they are done with childbearing, because this isn't something that can be done many times over. So it's kind of a one and done as far as you get one sling. So you don't want to do it and then have your anatomy architecture change with increased stress, increased weight many times again after the intervention, increasing the risk that you would have recurrence of symptoms, but then no longer be a good candidate for surgical intervention for your long-term management. That's helpful to know. And I think it's important for the audience to know too that, like you said, it's not just a part of aging or that you're going through menopause or perimenopause or anything else. It could happen at any stage. Amy, I'm curious, having gone through urinary leakage, incontinence, and then having this procedure, has that impacted uh you at all and how you talk with your children or talk with others about any kind of health concern, but particularly this issue? I would say absolutely, just because I work in women's health too. So, you know, I think just letting women know they don't have to be afraid of having a surgical procedure done. And that I think for too long we have told women it's normal, just live with it. You know, it'll be fine. And you don't have to live with it. It's not just a normal part of aging. That's what this podcast is all about is normalizing these conversations and the decisions that we make around our healthcare choices. And I think so many people are embarrassed and don't want to talk about it. And I guess if they're not asked, they probably don't ever bring it up. Yes, or they don't know what it is. You know, I think there is something to if you're not talking about it with other people who have it in common with you, something about not understanding what's going on with your body. Right. And finding a provider you feel comfortable with in sharing that information, you know, and and they ask the right questions to get you to explain what you're going through. And taking the time, something that we don't go in depth about, but we should, is the time and care that each patient receives when they're in the room with like someone like Dr. Gaston. It matters, you know, that they're not just treated like a number and pushed through the door. Would you say anything to that? Exactly. I think that's very important. Dr. Gaston always has time and asks the right questions and makes you feel comfortable with any concern you have. Thanks for that, Amy. I know that I've had women who have apologized to me. I'm sorry I'm taking so long. I'm sorry that this was a this was a long appointment or that we talked about all of these things. And I've I've told them, this is why you're here. This is while I'm with you, it is about you. And we're gonna address the things that need to be discussed with me. But just remember this in case you ever have to wait for me. If I'm running late for your appointment, it's because somebody else needed a little extra time today. Or you're delivering a baby. This whole procedure, what can a patient expect for longevity of it and what do success rates look like? You know, I actually just talked to a rep of the company, and he said that they that the company quotes a 10 to 15 year success as far as long-term improvement, and I would say almost complete, almost complete resolution of stress urinary incontinence. With that being said, I have not been in practice in southern Minnesota for greater than that amount of time. I've been here for um nearly nearing 11 years, but I have not seen a woman who has had a sling for stress urinary incontinence who has come back in and said it's not working anymore. So I would argue that the 10 to 15 years that is advertised is lowballing it. So something you have to look forward to, right, Amy? For you know, you don't have to worry about this for some time, if at all. Yeah. Well, before we wrap up this episode, is there any last piece of advice that you'd have, Amy, to someone considering this who has experienced urinary incontinence? Any uh tip that you might have along the way? What would you share? I would just say talk to your provider. Don't be embarrassed by it. Tell them what's going on so they can offer you the best treatment options. And don't be afraid of the procedure. If you need it, it's so simple and the recovery is so easy. That's great advice. And I am so glad that that was your experience and that you had an expert like Dr. Gaston. Two. That's a wrap for this episode of After Clinic Hours. If you take one thing away, this is common, but it's not something you have to just live with. A huge thank you to Dr. Gaston and our guest Amy for being willing to have a conversation that so many people need, but don't always hear. And we're not done yet. Next episode, we're bringing in three phenomenal women, plus our expert, who are willing to go there to talk about the uncomfortable, the things we usually don't say out loud, and the realities behind what so many are quietly dealing with. You're not gonna want to miss it. Until next time, take care of yourself and don't be afraid to start the conversation.