An overactive bladder isn't just part of getting older. Dr. Andrew Sokol, a female pelvic medicine and reconstructive surgeon, discusses the symptoms and causes of overactive bladder, as well as what we can do to treat it.
TRANSCRIPT
Intro: MedStar Washington Hospital Center presents Medical Intel, where our healthcare team shares health and wellness insights, and gives you the inside story on advances in medicine. In today's episode, we talk to Dr. Andrew Sokol, a female pelvic medicine and reconstructive surgeon at MedStar Washington Hospital Center, about overactive bladder. Dr. Sokol discusses why this very common condition is not a normal part of aging and how it can be treated with both lifestyle changes and more advanced treatments. He also talks about why that 8 glasses of water you've been told to drink may be doing more harm than good.
Host: Thanks for joining us.
Dr. Sokol: Thanks so much for having me.
Host: Why is this topic top-of-mind today? What's important to know?
Dr. Sokol: Right, so, overactive bladder is this constellation of symptoms that is incredibly common. The term really refers to the urge, the need to run to the bathroom, urgency, frequency, which is going to the bathroom more than normal, with or without leakage, and it's the type of leakage where you can't get your key in the door or get your pants down fast enough. So, the prevalence or the amount of people who have this in the community is incredibly high. Actually, incontinence or leakage of urine is the second most common reason for admissions to nursing home facilities, but a lot of younger people also experience these symptoms.
Host: So, when we say younger people, in this case, how young can this happen?
Dr. Sokol: Yeah, I mean the, the, symptoms can occur even in children, of course, but oftentimes they're looking for different sources, so I'd say when we're talking about younger women, it tends to be women ages 18 through menopause, and then women who are after the age of menopause being the older women.
Host: And how many, how many, people have overactive bladder symptoms?
Dr. Sokol: So, I mean the absolute numbers are very high. I think that we can't come up with an absolute number because it's underreported. People think it's a part of, normal part of aging, but I can tell you that by the time a woman turns 80, there is a 20 percent chance that she'll have surgery for a pelvic floor disorder. So pelvic floor disorders, of which overactive bladder is one, are more prevalent than breast cancer. So, it's incredibly common and the, the, amount of people who get them increases as age increases, so there's a prediction that there will be a doubling of these types of issues by 2050 and that surgeries for pelvic floor disorders will double by 2050 as well, so it's very, very common.
Host: And the increase would be? What's the reason for the increase?
Dr. Sokol: Mostly due to aging. So, we do, we do, also know that the symptoms of urgency and frequency in overactive bladder are more common in women who are postmenopausal or whose ovaries have stopped producing the female hormone estrogen because the skin that's around the opening of the urethra, the tube that you urinate through, is estrogen responsive, and so that dryness and irritation and the shift of the flora make women more prone to those symptoms.
Host: Can you share some of the most common causes?
Dr. Sokol: Right, so unfortunately the most common cause is over-consumption of fluid. There's a broad misconception that one needs to drink a certain amount of water and it is typically quoted at 8 glasses of water, which is based on absolutely no research, but has become almost dogma. And then the second most common would be the over-consumption of bladder irritants and diuretics like coffee, tea and soda. Really, eliminating those things, cutting down on the fluids and having good toileting habits can take care of a lot of the symptoms of urgency and frequency, sometimes decrease leakage or the need to wake up at night, which is called nocturia. And, so I'd say those are the most common causes of overactive bladder. Actually, 90 percent of overactive bladder is called idiopathic, meaning that there's no underlying anatomical or neurological cause, 10 percent as an underlying cause.
Host: So, in those 90 percent of cases, what are some tips?
Dr. Sokol: So, yeah, so it turns out that there's a lot of good tips for this area. And so, because so much of this is behavioral, the first step is always behavioral. That's actually what's recommended by the guidelines of the groups that treat these disorders. So, the first step, I would always tell someone to cut the fluids down and I really say there is no magic number for the amount you drink, just drink when you are thirsty. I always would advocate for people who are having urgency to run to the bathroom, timed urination, so just go to the bathroom regularly, 6 to 8 times a day. Stopping fluid intake within three hours of going to bed is a very effective way of decreasing the need to wake up to go to the bathroom, and then pelvic floor squeezing exercises, which are called kegels, which have been around forever because they actually work. That's a great way to defer the urge. In other words, someone who's trying to get into the door, get the key in the door and is having the overwhelming urge oftentimes can squeeze those pelvic floor muscles and the urge will pass and it'll give them time to calmly walk to the bathroom. So that's really – those are the first steps that we always take.
Host: And then, how about the other 10 percent?
Dr. Sokol: Yeah, so 10 percent of women who, who have symptoms may have an underlying problem. The most common is, of course, urinary tract infections or bladder infections. So, as a provider or physician, when someone comes to me, my job is to, of course, rule out the uncommon things that can cause it; they're generally easy to rule out. The first thing that we'd always make sure is that there is no infection, not only urinary tract infections, but often sometimes making, make sure there are no vaginal infections which can cause these symptoms. Another area that we have to rule out is voiding dysfunction, the inability to empty the bladder completely, which in women is, of course, more uncommon than in men because women don't have prostates, but it can happen when there's vaginal relaxation or prolapse, which is something that I treat for a living. It can happen in women who have underlying disk disease, like lower disk disease in their spine. It can happen in women who have had strokes. It can happen in multiple sclerosis. It can happen if there's something obstructing the urinary system, like prior surgery for urinary leakage. And so these are the less common things that a specialist would rule out in someone who's got persistent symptoms that didn't get better with the behavioral stuff and some of the other simpler things we do.
Host: What are the most common ways to treat overactive bladder?
Dr. Sokol: Right, so, the recommendations, the guideline recommendations, start with behavioral therapy. That's everything that I just said. That's the fluid management, the toileting and the kegels. The second step is often female pelvic floor physical therapy. We have a whole network, particularly in this greater Washington region, of physical therapists who help defer the urge, train the pelvic floor muscles so that the muscles are strong, and help someone have time to get to the bathroom. And, then the third step is, there is a whole class of medication that's used to treat the symptoms of urgency, frequency or urgency incontinence. And these medications have been around for a long time, so this class of medications for overactive bladder is called anticholinergics. They're reasonably effective, but they're most effective when they're done with the other treatments. And, then there's a newer medication that was recently released over the past 5 to 7 years that gets around some of the annoying side effects of some of these medications. The medications used to relax the bladder can also cause dry mouth and dry eyes and constipation, and so that's sometimes sort of a stumbling block for people using these medications. I'd say most people do not start medications right away. We would always start the conservative things first, and then, if those things fail, then we would institute an evaluation of the urinary tract or other causes. And, if there was nothing found, there's lots of newer things available as well, so that includes acupuncture of the ankle, which has been shown to work as well as the medicines, and then Botox, which is very effective. It is done right in the office. It's a medicine that's put right in the bladder to relax the bladder wall. And, then finally, there's something called an InterStim. Which is, basically, it's an outpatient placement of a bladder pacemaker, which can be used for people who have failed other therapies as well. So, lots of things we can do for overactive bladder symptoms nowadays.
Host: So, how do you help women get around some of the emotional issues, right? I mean if you have to run to the restroom all the time, at some point.
Dr. Sokol: Right. So, yeah, women with overactive bladder sometimes feel really socially isolated. They don't – try not to go out so much because they find themselves being the person that has to get up from dinner three times. So, I mean, I think the most, the best way of sort of allaying their fears is, first of all, just letting them know how common this problem is. I think if people talk to their friends they'll—It's unbelievably common. The second is letting them know that there are things that can be done to treat the symptoms—there are effective treatments. And so, one of the, I think, most common things that we battle with, as urogynecologists, is this thought that it's a normal part of aging, which is completely untrue, not only for overactive bladder, like we're discussing, but also for leakage of urine with physical activity, which is called stress urinary incontinence. And there are very effective treatments. It's not a normal part of aging and someone who's experiencing these symptoms should/can see someone who can help them with their symptoms. That's really reassuring to people because a lot of people, and even primary care providers, sometimes don't understand that there are very effective treatments for a lot of these symptoms. I think the, sort of the takeaway point, maybe, would be that, that these symptoms of urgency, frequency and sometimes urgency incontinence, can't make it to the bathroom, are incredibly common, but simple behavioral things are sometimes effective in treating those symptoms. If those symptoms persist despite moderation, then seeking care can be very fruitful because there are a lot of things that are available nowadays that can treat these symptoms and really decrease suffering, decrease the need to use pads, and really help people with these symptoms.
Host: Thank you for joining us.
Dr. Sokol: Thanks for having me.
Conclusion: Thanks for listening to Medical Intel with MedStar Washington Hospital Center. Find more podcasts from our healthcare team by visiting medstarwashington.org/podcast or subscribing in iTunes or iHeartRadio.
