Female pelvic health: Things You’re Too Embarrassed To Ask A Doctor

You’re listening
to Things You’re Too Embarrassed to Ask a
Doctor, a production of UChicago Medicine. Each week, we’ll
feature one physician and ask them your most
searched questions in their areas of expertise. For more information
on our episodes, visit us at www.UChicagoMedi
cine.org/Podcast. Have something you’re too
afraid to ask your doctor? Tweet us @tytepodcast. I’m your host Kat Carlton. Have you ever had a
burning medical question but you weren’t sure
whether you really wanted to call your doctor about it? Maybe it’s not
even that burning, but it’s something like– –So as a guy I’m
wondering, should everyone be doing kegels? Well, you’re in luck. Over at the University
of Chicago Medicine, we’ve created a
show just for you. Our show is called
Things You’re Too Embarrassed to Ask a Doctor. On every episode, we’ll
feature one doctor and ask them stuff related
to their area of expertise. We’ll take some questions,
some from colleagues, people on the street, maybe
even you, along with some of the most searched
questions on the internet. Our line of thinking
there is people are turning to Dr. Google
when they might be better off talking to their physician. On today’s show, we’ll
cover a few things related to female pelvic health. So, let’s get to it. From the University of Chicago
Medicine Hyde Park campus, I’m your host Kat Carlton. Welcome to this
episode of Things You’re Too Embarrassed
to Ask a Doctor. Today, we have Dr. Dianne Glass. Welcome. Thank you very
much for having me. Dr. Glass, can you tell everyone
listening what kind of doctor you are? Absolutely. I am a urogynecologist. And what does a
urogynecologist do? A urogynecologist
is a doctor who sees sort of the overlap
between urology and gynecology. So they see patients that
have all types of issues with the vagina as
well as the bladder. Hey again. When I was doing research
for this episode, one of the big
areas of curiosity focused around something
called pelvic organ prolapse. Back to Dr. Glass
for more on that. So whenever I talk
to my patients about pelvic organ
prolapse, I tell them to think of the
vagina like a house with four walls and a roof. And pelvic organ prolapse
is kind of a relaxation of the support of the vagina. And it causes a caving in
live some of those walls. So the uterus sits in
the roof of the vagina. And if the support of
the uterus relaxes, uterus can kind of descend
into the vagina a little bit. Similarly, that wall between
the bladder and the vagina can relax into the
vagina a little bit, causing a bulge in
the vaginal area or even coming out of the
opening of the vagina. That means some of your
organs can both descend into other parts of your body
but also come out all the way, is that correct? So, the organs themselves
don’t come out. They’re always covered by
the skin of the vagina, but the vagina can
descend and even kind of turn inside out a
little bit like a sock. So the bladder that sits just
behind the vagina or the uterus can come down through the
opening of the vagina. OK, so that actually leads
me to my next question. Can my uterus fall out? So, sort of. The uterus sits inside the body. The cervix, which is the very
bottom part of the uterus, pokes into the vagina. So as prolapse gets
worse, the uterus can descend lower in the
pelvis, kind of into the vagina. And eventually, the vagina can
actually flip sort of inside out. And so the uterus is inside
the vagina and but outside of the body, if
that makes sense. So as we mentioned
before Dr. Glass treats a lot of things
besides pelvic organ prolapse. So we’re going to move
on to another thing she’s familiar with, which
is incontinence. So why do people see
you for incontinence? They come to see me
because it’s something that has a huge impact
on quality of life. It is something that people
don’t like to talk about, it will cause people not
to leave their homes, it will cause people
to avoid activities and really not engage in their
life the way they used to. And so it’s important that
they come to see somebody to help reduce the
amount of impact it’s having on their life. And how common is it,
because it’s something that’s searched a lot? It is incredibly common. 50% of women have some form
of urinary incontinence. And that percentage grows
as patients get older. So we’ll jump into
some of our questions. The first one, which you just
talked about a little bit, is how incontinence
affects life. It affects how much
fluids people drink. There are people who will
try and dehydrate themselves because they’re afraid
that they’re going to leak. It’s also expensive. So people who use a
lot of pads wind up having a big cost of
having to buy those pads and having to deal
with them all the time. And it has an effect
on kind of what you do in your relationships as well. When does incontinence occur? There’s two major
kinds of incontinence. So there’s stress
incontinence, and then there’s also overactive
bladder, which if you think of your bladder
like a balloon, stress incontinence would be
not squeezing the balloon shut tightly enough at the end. And it occurs when you
laugh, cough, sneeze, jump up and down. This is something
that is incredibly common in younger women,
particularly after they’ve had a baby. It is something that progresses
over the course of your life. There is also
overactive bladder, which is the bladder squeezing
when it’s not supposed to. So people get that
sense of like, oh, got to go the bathroom and
have to rush to the bathroom to get there and will
sometimes leak on the way. What causes overactive bladder? The exact causes of
overactive bladder are varied. Some of them aren’t
really very well known. So some people can have
neurologic problems that will cause overactive bladder. People who have spinal injuries
can have overactive bladder. But the most common causes
of overactive bladder are really just
it just develops. As you get a little
bit older, your bladder can become more sensitive
to certain kinds of foods. And your control over your
bladder gets a little bit less. Another question
is, what type of pad is best for people who are
experiencing incontinence? The most common thing
for people to do when they start having
urinary incontinence is to start using
menstrual pads, that’s something that we’re
all very familiar with. But actually, the best kinds
of pads are incontinence pads. They’re a little bit
different, they’re meant to absorb
a thinner liquid. And so when you go to the store
and you’re looking for pads, definitely look in
the aisle for what for the incontinence
pads versus menstrual. Will incontinence ever go away,
or is there a way to cure it? So as we talked
about before, there’s kind of two different types
of urinary incontinence. So with stress incontinence,
doing pelvic floor exercises or kegel exercises can help with
decreasing stress incontinence and then some women can
help make it go away. There are other treatments
for stress incontinence. There’s some surgical options. You can put something
in the vagina to help support the urethra. For overactive bladder,
changing your diet, so avoiding things that
will irritate your bladder– coffee, tea, soda, carbonation,
spicy foods, and citrus, all those things
that are really good and life will help
relax the bladder. They just kind of irritate
the lining of the bladder and will cause it to be a
little bit more overactive. Pelvic floor exercises
are also helpful. But then there are
medications that can be used. Botox actually is
something that can be used to help relax
the bladder as well. Sorry, back up one second, what
is a pelvic floor exercise? Pelvic floor exercises
are squeezing the muscles that you would squeeze to try
and stop your flow of urine. And so it’s a muscle that
most people don’t really spend much time thinking about. But when you sit
down to urinate, if you try to slow down
the stream of urine you have the right muscles. Those are the muscles to
do a kegel exercise with. So then away from the toilet,
not when you’re urinating, you squeeze those muscles
and hold it for 10 seconds, relax for 10 seconds,
hold for 10 seconds. And you need to do 50
or 60 of those a day. Cutting back in
with this question we heard earlier from one of
my male colleagues who I think would appreciate
staying anonymous. Guys, don’t think we forgot
about you for this episode. So as a guy I’m
wondering, should everyone be doing kegels? It’s definitely something
that can be helpful. In patients who have
issues with pelvic pain, I would not recommend
that they do it. But in patients who are having
a little bit of leakage when they cough and
sneeze, absolutely, I’d recommend doing that. If you’re having issues with
making it to the bathroom on time, I absolutely
recommend it. If you do a quick kegel
when you have that urgency, sometimes it’ll make the
bladder be quiet and calm down. So on the whole,
pelvic floor exercises are great for most people to do. Also good to know. Anything else related to
incontinence that you think people might like to know? Really just that it’s incredibly
common, and it’s not something you should be embarrassed
to talk to your physician, about because we hear
about it all the time. So never be embarrassed
on our account. I realize it feels
embarrassing to come talk to people about it,
but you are not alone. So we’ll move on to another
really commonly searched area, which is UTIs. Now, what does UTI stand
for, and what does it mean? So UTI stands for a
urinary tract infection. And it just means that there
is an infection somewhere and either the kidneys
or the bladder. Most people think of a
UTI is really cystitis, which is a bladder infection. And they’re is something
that is very common in women. What causes them? They are caused by bacteria
getting into the bladder and multiplying. The bacteria come from
the vagina and the opening of the urethra, which is
the tube from the bladder to the outside world is just
right there next to vagina. So it’s always exposed
to this bacteria that is normally living there. And so when that bacteria
climbs up the urethra, you can get a urinary
tract infection. So there are probably a lot of
different ways you can get one. It’s not just from
sex, because that’s something that searched a lot. Absolutely. That’s usually when
women will start getting urinary
tract infections is with the onset of
sexual activity. But no, it’s
something that you can get without having intercourse. You can just get them. It’s something that becomes more
common in postmenopausal women. The estrogen protects
you a little bit, it helps make the
urethra a little bit less likely to have infections. It also changes the bacteria
that live in the bladder. The super powers of
estrogen, I never knew. Absolutely, the super
powers of estrogen. Vaginal estrogen
is something we use a lot in our
postmenopausal patients to help avoid urinary
tract infections. If it’s not treated
with estrogen or another type of medication,
will UTIs go away on their own? They can. So if you start having symptoms
of a urinary tract infection, sometimes they will go
away in a couple of days if you’re drinking
a lot of fluids and helping flush things out. But if they’re not
going away, going and having it treated
with an antibiotic is something that
I would recommend. And the last thing I have on
my list is vaginal atrophy. Now what is that? Vaginal atrophy is a thinning
of the tissue of the vagina that occurs after menopause. And so it’s just from a decrease
in the exposure to estrogen. It actually can happen a little
bit in women who are postpartum as well when they’re
breastfeeding, because you also have a decreased
amount of estrogen. So it is something that causes
a lot of discomfort in women. They can have a dry
sensation the vaginal area, itching, just
general discomfort. Sometimes that can cause
pain with intercourse. But the good news
about it is that there is a lot to do about it. So sometimes just using
a vaginal moisturizer that you can get
over the counter is something that can be
helpful, using something like Vaseline or an
Aquaphor or coconut oil to moisturize the
area can be helpful. The biggest thing that
we use to help reverse it is vaginal estrogen, so
using an estrogen cream that’s placed in the vagina. And that actually
does reverse it. It gives the estrogen
back to those tissues and helps reverse the thinning. So it thickens up the tissues,
it increases the vascularity of the tissues, and makes
them a little bit more elastic as well. That is all the
questions I have here. Is there anything
else that you wanted to talk about or maybe
encourage patients to know to help them
be comfortable to ask these types of questions? I think the biggest
thing to help encourage people is that you
really should bring these up with your primary
care physician, bring this up with
your gynecologist when you’re at
your annual visit. If there’s anything that
you’re uncomfortable with, have questions
about or something which is making your life
difficult, talk to us. It’s what we do, we talk
about this area all day long. And so I always
tell my patients, never be embarrassed
on my account. I promise whatever you’re
telling me I’ve heard 15 times and I’ve heard
exponentially more bizarre. So don’t worry, don’t be
embarrassed, come talk to us. So you just mentioned people
come in and ask these questions all the time. What’s an example? What’s something that
people ask you about? People come in and they are
just very embarrassed to say, you know, I leak, I can’t
make it to the bathroom. And people always
feel alone with that. They don’t talk with– it’s not something that you
talk with your friends about. And so I think
people don’t really realize just how common it is. People will also come in and
they will tell me, oh my gosh, there is a bulge. There is something
very weird that they don’t want to tell you that
they looked down there. And don’t worry, everybody looks
with a the mirror, it’s fine. But just don’t be embarrassed,
it’s important to come ask. Is there anything people
should be looking for, because you said people look
with the mirror, that’s normal? Is there anything people
should be looking for in terms of the different areas
we’ve talked about that are other signs they might
want to talk to their doctor that they might not think would
be worth talking to a doctor about? If you ever feel that
there’s a bump, a lump, something that
just looks strange and as you kind of
looked like you’re like, oh, this looks like it’s
changing a little bit, always worth asking a physician
because better safe than sorry. Sometimes you can
have little things that either maybe
the bump bothers you and it can be removed. But in really rare
cases, it could be a cancer or something that
really could be taken care of. So I would say anytime
you see something that looks like, ah, that’s a
change, that hasn’t been there, I would ask about it. All right. Well, that’s all
the time we have. Thank you, Dr. Glass,
for being on the show. Any last words to our listeners? Happy bladder health. Happy bladder health,
that’s a good one. All right. Until next time,
this has been Things You’re Too Embarrassed
to Ask a Doctor. Once again, I’m Kat Carlton and
you’ve been Listening to Things You’re Too Embarrassed
to Ask a Doctor. Music from today’s episode
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cine.org/Podcast, or tweet us @tytepodcast. That’s tytepodcast. [MUSIC PLAYING]