Breaking the Silence: Understanding and Conquering Stress Urinary Incontinence
Enhanced Wellness Living, Ridgeland, Mississippi, Functional Medicine Clinic
Kelly Engelmann, Founder, Family Nurse Practitioner, Lead Functional Medicine Nurse Practitioner
It might surprise you to learn that a primary driver for women to enter assisted living is something most of us, and our patients, are facing on a daily basis but are not comfortable talking about…
That’s right, a completely normal condition, which according to Mayo Clinic, impacts 50% adult women, increasing to up to 75% of women over age 65, is something many women still consider taboo to discuss.
So, what is this mysterious, yet all-to-common condition?
Urinary Incontinence, or more prominently, Stress Urinary Incontinence (SUI).
SUI is the inability to control bladder function or the involuntary leakage of urine, particularly during times of physical activity. When pressure is applied to the bladder and urethra, be it from laughing, walking, jumping, sneezing, having sex, or any other regular daily activity, the sphincter muscle will open and a person will unintentionally release urine due to lack of bladder control.
Have you ever debated doing a favorite activity such as going on a road trip, watching a funny movie, playing with your children or grandchildren, participating in an outdoors event, or having sexual intercourse with your spouse because you have to consider things like will there be a restroom nearby? Will I have to wear a diaper or pad? Do I need to bring a change of underwear and pants? Will I wet myself and be embarrassed?
If the answer is yes, you are one of millions of women who, have done nothing wrong, but are likely dealing with Stress Urinary Incontinence.
As common as SUI is, it’s reported that only about 25-61% of women have discussed their SUI symptoms with their healthcare provider even though the condition leads to a less active and less fulfilling life for many women.
According to Jody Joyner, Physical Therapist of over 30 years, focusing on pelvic floor and urinary incontinence at Specialized Physical Therapy, (Flowood, MS + Ridgeland, MS) 90% of patients are unaware of how their pelvic bowl functions and the importance of their pelvic floor.
The pelvic floor, or bowl, is literally a bowl full of muscles, tissues, and organs. Containing the bladder, urethra, genitalia, anus, rectum, uterus, fallopian tubes, and ovaries, our pelvic bowl supports bladder and bowel function, reproductive health, sexual function, core muscle stabilization, and internal organ structures.
Like all other muscles, the pelvic floor must be strong, it needs to stretch, to have full length, and to know how to correct properly.
Throughout our lives women transition through various hormonal and structural shifts, which impact every aspect of our pelvic floor function and ability to control our bladder.
Hormonal transitions, particularly times of lower estrogen, such as breastfeeding, perimenopause, and menopause, may seem more subtle on the surface, as many women are taught that Vasomotor symptoms, aka hot flashes or night sweats are the only signs of hormone imbalance. These symptoms are viewed as something to “deal with”,…your mom dealt with it, so did your grandmother, now it’s your turn.
This is simply not true, hormonal imbalances can present at any time in a women’s life as anxiety, fatigue, insomnia, constipation, unexplained weight gain or loss, chronic stress, hair loss, infertility, lack of libido, vaginal dryness, and/or, the overall feeling “off”.
When our hormones are off, particularly, when our estrogen is low, our vaginal tissue suffers and our pelvic floor muscles weaken, contributing to SUI, vaginal dryness/a lack of natural lubrication, painful intercourse, and changes in libido, all of which can be challenging on our mental and emotional health and marital relationships.
We also face a variety of structural shifts throughout lives including, pregnancy, childbirth, aging and gravity, which lead to a loss of collagen and elasticity, and, often, the development of Stress Urinary Incontinence and painful intercourse. Childbirth is a primary driver of SUI, with an estimated 24% of women in the US reporting postpartum pelvic floor dysfunction, according to the National Library of Medicine.
Many women do not acknowledge that they have been miserable for years, dealing with SUI by wearing pads or diapers, avoiding sex, and watching their health and relationships deteriorate due to these completely natural shifts.
According to Dr. Jenn Owen, GYN and Chief Medical Officer of the Owen Health Group, the biggest challenge we face as medical providers in supporting our patients is that many women simply do not feel comfortable talking about these topics.
Dr. Owen has found that the most common complaints women have but don’t want to discuss are…
#1=Urinary Incontinence, which affects every aspect of life yet is considered embarrassing. Women do not want surgery but are unaware that there are non-surgical treatment options
#2=Vaginal Dryness, which leads to painful sex, decreased desire for sex, and impacts self-confidence. Women are going years without sex, dramatically impacting their overall health and health of their relationship
#3=Lack of Sensitivity/Sensation/Pleasure, which leads to the inability to achieve orgasm
As healthcare providers we can help women navigate this conversation in helping determine what is lacking….arousal, desire, or orgasm? Having patients consider questions such as…
–Is sex so painful you can’t bear it? Potentially structural and hormonal challenges
-Are you unable to achieve orgasm? Potentially a hormonal challenge but also a clear sign that tissue needs improvement
–Is it a lack of desire or libido? A clear sign of hormonal imbalance
-Are you concerned you may leak urine during sex? A clear sign of structural challenges
So, how does this land us in assisted living, often times unnecessarily or prematurely?
Urinary Incontinence drives UTI’s, which, at a more mature age impacts psychological function, leaving many women unable to fully focus or concentrate as we are in a constant state of worry. This leads to the unnecessary prescribing of medications when, really, the bladder and overall bladder function is the root cause of challenges.
Many of us have seen patients, or even family members, walk into the doctor or hospital with unexplained neurological symptoms-frequent falls, drowsiness, confusion, or hallucinations, only to learn that these are actually, often missed and diagnosed too late signs of a UTI, which can lead to kidney failure or sepsis.
Well then, what can we do to prevent these larger health scares and address SUI, hormonal imbalances, and structural challenges?
By addressing the signs our bodies are sending us in our 30’s, 40’s, and 50’s with the functional approaches and regenerative technologies we have today there is no reason for suffering or progression of SUI.
A multifactorial treatment plan is essential to achieving optimal health. This can mean….
-Understanding the root causes of hormonal imbalances through working with an appropriately trained healthcare provider
-Using in-depth lab testing, test don’t guess
-Following a food-first approach-consuming whole foods to reduce inflammation, balance blood sugar, address gut health challenges, achieve hormone balance, and promote healing
-Discussing and considering appropriate Bioidentical Hormone Replacement Therapy treatment options
-Researching pharmaceutical options
-Working with a Pelvic Floor Physical Therapist
-Embracing non-surgical, all-natural regenerative health treatments such as Votiva, the O-Shot, FemiWave, and CO2Lift Carboxy Therapy, all of which are offered at Enhanced Wellness Living, to promote the body’s natural ability to heal
-Addressing common myths such as…
*SUI is a normal part of aging
*Surgery is the only treatment option for SUI
*Prescriptive medicine is the only option overactive bladder symptoms
*Pelvic PT is only about Kegels
*Women are interested in “vaginal rejuvenation” for improved aesthetics rather than addressing health challenges
Let’s look at some of our SUI treatment options a bit more in-depth.
We will start with pharmaceutical and conventional medicine management. These treatments have historically been the only option women are educated on, though are often off-label, anecdotal, and do not address the root-cause of the condition.
Mostly commonly, Duloxetine, a prescription medication developed for patients with depression and anxiety, is prescribed off-table for the management of SUI. The rationale being that the medication may work to increase the activity of the nerve that stimulates the urethral sphincter, therefore improving control. There is little evidence to support the efficacy of usage of this SNRI, which may have short and long-term side effects and does not address the root-cause or reverse symptoms of Stress Urinary Incontinence.
Other common conventional treatment options may include…
-bulking agents-gel compounds which are injected into the urethra and aim to increase resistance to the outflow of urine by reducing the size of the urethra opening. This is not a long-term solution and does not address the structural or hormonal causes of SUI.
-surgical procedures such as a sling being placed under the urethra or the highly invasive bladder neck suspension surgery, which involves lifting the bladder neck and stitching it to the front of the vagina. According to Mercy Health, complications from these treatment options may include bleeding, UTI, difficulty urinating, painful intercourse, vaginal prolapse, and the recurrence of SUI.
Now let’s talk about regenerative health treatment options which promote the body’s natural ability to heal. Again, a multifactorial approach, often combining 2 or more these treatments can lead to life-changing results.
Nutritional and Lifestyle Medicine:
Using food as medicine to maintain a healthy body composition/avoid obesity, balancing blood sugar/preventing diabetes, reducing inflammation, and addressing hormone imbalances by eating whole foods, avoiding endocrine disruptors-plastics, tap water, pesticides, cigarette smoke, cosmetics, flame retardants, processed foods, etc, may help prevent and/or reduce the severity of SUI symptoms.
Pelvic Floor Physical Therapy: Studies show that only 50% of women know how to properly do a Kegel, to which there are 3 parts-pinch, squeeze, lift. Pelvic PT is about way more than Kegels though! Many women hold stress and trauma in their pelvic floor and actually need to relax and release, rather than tighten, to see improvements in pelvic health.
The goal of pelvic PT is to create full flexibility and range of motion of the pelvic floor.
Combining both internal and external manual therapies to palpate the muscles of the pelvic floor and determine and improve levels of strength and range of motion.
“In pelvic PT we create individualized treatment plans, teaching functional exercises, and focusing on education, such as proper position for bowel movements, lifting, breastfeeding, positions for intercourse, and breathing techniques for Vagal nerve toning to help eliminate problems”, Jody Joyner.
Hormone Management: using customized hormone management based on in-depth lab testing during the times of hormonal shifts, particularly those times of lower estrogen, is proven to minimize symptoms of hormonal imbalance which can drive SUI.
It is important that hormone treatments be overseen by a medical professional who understands the importance of regular reevaluation of hormone levels to ensure proper dosages and prevention of possible health risks.
Votiva: this safe, effective, gentle, non-invasive wand therapy treatment, which is an FDA Cleared technology, uses bipolar radiofrequency to stimulate the body’s natural healing process. Votiva combines gentle volumetric heating with fractional treatment for a therapeutic experience and immediate results by regenerating cellular health and vaginal tissue both internally and externally.
This regenerative technology strengthens and tones the pelvic floor muscles, while promoting the production of new collagen, new blood vessels, and new nerves to address the root causes of SUI, sexual discomfort, vaginal dryness, laxity, sensitivity, and has also been shown to treat hemorrhoids as an added benefit.
Votiva does not require the use of medications, hormone therapy, or creams, and often provides immediate results, though 3 treatment sessions are recommended for optimal results. The wand treatment allows medical providers to cater treatment to the specific areas of concern for each individual patient.
A 2017-2018 peer-reviewed study by PRS Global Open showed “radiofrequency is safe for the treatment of pelvic floor dysfunction. This study showed no changes in resting pelvic muscle tone but an improvement in maximal pelvic floor contraction. There were no adverse events from the radiofrequency treatment.”
Dr. Owens, a Votiva provider for over 6 years says, “you are not putting a band aid on the problem, you are truly changing the tissue back to a healthier state”.
The O-Shot: a non-surgical, non-invasive, completely natural treatment which aims to support the body’s ability to repair, produce collagen, heal at a cellular level, and improve vaginal sensation.
The O-Shot, which uses platelet-rich plasma, is a completely safe, non-pharmaceutical treatment option which involves using a small amount of the patients own blood, from which PRP, also known as “liquid gold”, extracted. PRP is then injected into the top of the vaginal wall near the urethra and bladder neck, as well as the clitoris, to improve bladder control, stimulate the production of natural lubrication, and intensify sexual sensation.
PRP has been proven to aid in the treatment various conditions including both sexual and structural challenges in women, erectile dysfunction and Peyronie’s disease in men, hair loss, and loss of laxity in the face, by promoting collagen and elastin, improving blood flow, and promoting tissue regeneration.
Studies reviewed by the National Library of Medicine show PRP to be a considerable treatment option for addressing mild to moderate SUI and improvements in female sexual health were reported with “high satisfaction”.
FemiWave Acoustic Wave Therapy: often used in conjunction with Votiva and/or the O-Shot, this all-natural wand therapy improves blood flow to the pelvic floor. A non-invasive, long-lasting therapy, acoustic wave wand treatments are performed on the inner and outer labia to increase blood flow to the vagina by repairing blood vessels and damaged tissue.
With this procedure you can expect to have increased lubrication and sensation, as well as strengthening, tightening and improved physical appearance. FemiWave allows for safe and effective, hormone-free, pain-free women’s health procedures based on FDA Cleared technologies using bipolar radiofrequency.
CO2Lift Therapy: a medical-grade home-based, non-hormonal treatment, proven to be “phenomenal for vaginal dryness”, Dr. Owen. Also known as “carboxytherapy”, CO2Lift therapy is a gel masks which releases carbon dioxide, which the body recognizes as an injury and rushes oxygen-rich blood to the area, promoting healing.
This treatment option can be used to prep tissue, expedite the healing process, and maintain and accentuate the results of Votiva, FemiWave, and O-Shot. CO2Lift therapy is also available for facial rejuvenation.
These all natural, non-invasive, regenerative treatment options aim to address the root cause of common female health challenges while leveraging the body’s natural ability to heal and repaid. These treatments have little to no downtime or side effects and offer life-changing results.
In summary, when we address root-cases of both hormonal and structural health challenges, particularly through eradicating SUI and healing the bladder, we are not only improving overall health, we are supporting a better connection for the patient with their body, regenerating sexual function, reigniting the desire for intimate relationships, empowering our patients to take ownership of their health, and enhancing and extending quality of life.
–National Library of Medicine, ClinicTrials.gov-Votiva, Efficacy and Safety of
–National Library of Medicine, PubMed Central-Votiva, InMode
–National Library of Medicine, PubMed-Duloxetine
–National Library of Medicine, StatPearls-Pelvic Floor
–National Library of Medicine, Turkish Journal of Obstetrics & Gynecology, PRP
–National Library of Medicine, Pilot Study, PRP for SUI
-Find a Votiva Provider using InModeMD