The Incontinence Solution: Answers for Women of All Ages

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Barbara Nesbitt: Good morning, I’m Barbara Nesbitt, I’m the editor of OBGYN.net and we’re here this morning at the AAGL and I have the pleasure of being with a good friend and editorial advisory board member of OBGYN, Dr. William Parker.

William Parker, MD: Hi, Barbara.

Barbara Nesbitt: Dr. Parker is in private practice in Santa Monica and he has his second book out, which is The Incontinence Solution: Answers for Women of All Ages. His first book that we have on the website which is . . .

William Parker, MD: The Gynecologist’s Second Opinion.

Barbara Nesbitt: And this morning we’re going to talk about incontinence and the all age part and this book is written, as both of them are, for patients. Good morning, Dr. Parker.

William Parker, MD: Good morning, Barbara, thanks for having me. We felt there was a real need for a book about incontinence that, if you go to the bookstore which I often do, my wife and I do on Saturday nights often, there are no books for women talking about incontinence and we felt there was a real need to explain the problems, explain the solutions, to women that had incontinence problems, so we decided to write a book about it.

Barbara Nesbitt: All right. For those out there when, the subtitle is For All Ages. I don’t think, I think most women my age think that incontinence is probably something that would come as you age, after menopause. Explain to the audience why it is also a young woman’s problem.

William Parker, MD: It is extremely common in young women; it’s a really interesting issue. Any woman that’s had a child has the risk, vaginal delivery, has the risk of having incontinence and many women don’t talk about it. They don’t talk about it to their best friends, their husbands, partners, they certainly don’t tell their doctors and interestingly, doctors don’t often ask about it because they’re not very well trained to deal with the problems, at least historically. But young women have this problem, women who are teenagers sometimes even have this problem and don’t discuss it, but certainly women who’ve had a vaginal delivery, it’s not uncommon and there are many, many non-surgical solutions to these problems. Another thing we found is that women don’t want to talk to their doctors about it because they think they’re going to have to have an operation and they don’t want an operation and I understand that, but 70% of women with incontinence can be treated without any surgery.

Barbara Nesbitt: Tell us a couple of things that you would suggest to them first before you ever do surgery for them to try.

William Parker, MD: Well, the simplest things are, there are Kegel exercises, which many women have heard about, but many women do them improperly, they actually contract the wrong muscles and there are simple ways now that we can sense what muscles you are contracting and teach you how to contract the proper muscles to strengthen the muscles under the bladder and that works extremely well, it usually takes two or three visits, we have a nurse practitioner who teaches people how to do that and it’s called biofeedback and it’s very simple, fifteen minutes at a time, two or three times, once a week for three weeks and that seems to work for the majority. 

There are new medications that are now available that work extremely well for certain problems. Simple things like women who have to get up six or seven times a night to urinate and if they stop drinking liquids after dinner, especially alcohol, caffeine, things like that, that they can decrease their need to get up in the middle of the night and it’s simply something simple just like a lifestyle change can make a big difference. 

There are certain foods, spicy food, citrus, caffeine, alcohol, that irritate the bladder lining and they can feel the urge to go kind of frequently so sometimes dietary changes. But when we talk to patients, we go through a complete history and physical exam, see if we can identify the problem and then deal with the simplest thing first.

Barbara Nesbitt: Okay. Now say they try all those things or say on examination you see that there is a problem and it needs to have a surgical procedure done. What are some of those options and, say, what would be the simplest and . . .

William Parker, MD: Yeah, the nice thing now is that this field, in the last five years, has exploded in terms of research and we’re seeing now new procedures that are invented, the simplest and newest one is TVT and spark procedures that can be done through a small incision in the vagina as an outpatient, go home the same day without a catheter, virtually no pain, the incisions are about this big and the success rate is 90% success rate after five years, which is comparable to every other procedure that’s ever been invented through big incisions. So there’s a lot of new things happening in this area surgically.

Barbara Nesbitt: So if I’m correct, in this book, it will explain things, signs to look for, identify them and hopefully help women to say, ‘I could get this corrected.’

William Parker, MD: Yes. There’s a chapter on what’s normal, and there are chapters about incontinence, what that means, the different kinds of incontinence, there’s a chapter about how you get incontinence in terms of childbirth, some of the risk factors, forceps deliveries for long labor, pushing for four or five hours, really large babies, babies that have turned the wrong way and those are things that could be discussed with the obstetrician even before you have to say, hey, if this happens, I’d rather have a caesarean section. Now most people don’t want a caesarean section, but most people don’t want to have incontinence when they’re 70, 60, 70 or later.

Barbara Nesbitt: Okay now, obviously, I’m not having a baby but say I . . .

William Parker, MD: That would be interesting.

Barbara Nesbitt: That would be, I would make a lot of money. Say I were to have a child, could, if I was to say I had forceps delivery, would I then be able to start some of the things you talked about like Kegels to hopefully not or prevent a problem?

William Parker, MD: We think that that is probably likely but nobody has proved that it does make a difference. So we’re not sure that that works or not.

Barbara Nesbitt: Okay. Well, we’re going to have the book on the website and as in your other book, we’ll have some chapters here and there that they, you can read and I read the book, I think it’s written very well.

William Parker, MD: Well, my wife is an English teacher so we wrote it together and she doesn’t understand the science and she’s a good writer and she helped and so it’s very easy to read and . . .

Barbara Nesbitt: It is easy and so is your other book.

William Parker, MD: That’s what we tried to do, thank you very much.

Barbara Nesbitt: Thank you.