Join us for our 2017 Healthy Living series!
(upbeat music)
Hi, I'm Kelly Carlstein
with Blake Medical Center
and this is Healthy Living,
a show that brings you
the information you need
to live a healthier, happier life.
In today's episode we'll be
talking about incontinence.
I'm very happy to have
a special guest today,
gynecologist, Dr Veronica
Socas from Manatee Gynecology
and Blake Medical Center.
Thanks so much for joining us.
Thank you so much for inviting me.
Let's start by talking about why you chose
to become a physician.
I've aways been very
interested in helping people
and I found myself very fortunate
through my medical career
to have found a passion
in working with women.
And why specifically do you
like working with women?
You know, it's difficult
to put that in words,
but there is something
that I found very special
in women helping women,
and if there is a way through
my work I can help women
improve their quality of
life in a small or big ways,
I mean I find myself very
blessed and very fortunate.
Something not a lot of women like
to talk about is incontinence.
Can you give us an overview as to
what exactly incontinence is.
Yes, so basically incontinence
includes what we consider
to be a pelvic floor disorder in women
that includes potentially
urinary incontinence,
bowel incontinence, or
pelvic floor prolapse.
So any involuntary of loss
of urine or bowel contents
is considered to be incontinent.
And how common is it?
It is very common and we
are estimating that it's
gonna be in about one in every four women
in their lifetime they're gonna
have a problem with incontinence.
And this is not something that
only happens as we get older
or we are in menopause.
We know that in younger women,
and we're talking about a range
between 20 to 39 years old,
it's gonna be one in every four.
So usually that's in times
even can start as soon as
we have our first pregnancy.
And that's regarding very
specific urinary incontinence.
For bowel incontinence as well,
it's a very common problem.
We are estimating that it's
gonna be about 18 million
people in the United States
are having fecal incontinence.
That is about one in every 12 persons
here in the United States.
And what do you attribute that to?
There are several factors.
Specifically for urinary incontinence,
we know pregnancy is a risk factor,
smoking, overweight, and
as we increase our age
we increase our possibility of
having urinary incontinence problem.
For bowel incontinence, as well,
the problem increases as we get older.
There can be muscular or muscle
or a nerve related problem
associated with this.
And it seems like this is something
we didn't use to talk about.
Why do you think that people
are talking about it now?
I think there has been now
more awareness of this problem,
and I will tell you, I still think
that the numbers that we
know is underestimated
because people feel embarrassed,
ashamed of talking about this problem.
And I believe that a lot of people believe
that urinary incontinence
or bowel incontinence
is a normal part as we get older,
and this is never normal at any age,
and the other thing is that
there's treatment options
available for these people
and because they don't believe
that there's a solution
for their problem, they don't
bring it to their doctor
or their healthcare provider.
We know that it's about
30 to 35% of patients
that are having this
problem with incontinence
will wait more than
five years to seek help.
So I still think it's underestimated
and I'm so glad that we're
bringing this awareness,
that there's a condition,
that you're not alone,
and that there's treatment
options available for it.
Great, we're gonna take a short break
and then we'll be back
with more on incontinence.
Hi, my name is Barbara Shulla,
and on December 18, 2011,
my husband and I were in a car accident.
My husband had a paper
route and on Sunday mornings
I would help him to deliver the papers.
We had one more paper to deliver,
and we were coming down Proctor Rd,
and we were hit by a drunk driver
and we never delivered that last paper.
The impact of the vehicle was
at over 100 miles an hour.
My husband and the other
driver both passed away,
and I was Bayflited to Blake Medical.
Due to my extensive injuries,
I would have never made it
Bayflite to Tampa Hospital
or St. Pete Hospital.
I was lucky to have Blake
Hospital trauma unit
available for me.
The injuries I incurred
were two broken legs,
a broken hip, C2 fracture in
the neck, two broken hands,
a ruptured spleen, and a little
bit of surgery on the liver.
Not only did they save my
life, but they saved my foot
because on my left foot I had
a serious compound fracture,
and I'm lucky to be alive
and I'm lucky to be walking.
This has been such an
incredible experience for me.
It's brought me closer to God,
it's brought me closer
to the realization that
you're only given one day at a time,
make the most of it.
My thoughts about the medical
staff at Blake trauma unit,
they're wonderful people, they're
excellent at what they do.
They're out there to save
lives, and they saved mine.
And I know I'm just one person,
thank God that they did because I really,
I really appreciate everybody,
from the person that checks you in,
to the surgeon that says
goodbye, you're doing well.
Everybody is so wonderful.
(upbeat music)
Welcome back to Healthy Living,
I'm Kelly Carlstein and
joining me now is Dr Socas.
In the last segment we spoke
briefly about incontinence.
Let's talk specifically
about urinary incontinence.
What are the common causes?
Let's start with how we have
a normal bladder function.
So that organ, that specific organ,
has to have a communication
with the brain.
When there's a miscommunication
problems of incontinence can happen.
The other potential reason that
it can happen for a patient
is weakening of the
support of the bladder.
In the muscles, the ligaments
that support that organ,
if they become weakened, then
there can be a risk factor
to start developing this problem.
Let's talk about stress incontinence
versus overactive bladder.
Urinary incontinence is the
loss of involuntary urine
that is associated with
coughing, sneezing,
laughing, lifting, changing in positions.
So this is associated with a specific
activity that the patient
or women are having.
And an overactive bladder?
Overactive bladder is what we are consider
that "I gotta go, I gotta go."
So these patients have to
go often or more frequent
or have a sudden strong urge to urinate.
For some patients some will be able
to make it to the bathroom,
but there are others that
they have this strong urge,
and on their way to the
bathroom they're actually having
an incontinence of urine.
That's what we call urge incontinence.
As well, this includes when
patients have to wake up
more than one time at nighttime.
That is called nocturia.
So these become, all these
symptoms encompass the syndrome
of what we consider overactive bladder.
And what can we do, if anything,
to prevent this from happening?
One of the things that we
always recommend our patients,
and even they can start doing
during their first pregnancy,
because that's when some
of that weakening of
that pelvic floor muscle
or ligaments are happening,
is to do what we call Kegel exercise.
So these are pelvic floor muscle exercises
that the patients can do
to strengthen that muscle
and ligament that are
supporting the bladder.
And if you already have overactive bladder
or stress incontinence, is
there anything you can do
to stop it from worsening?
Obviously continuing
with this Kegel exercise.
It's when we work on these muscles.
So it's something that I expect to be done
on a regular basis for patients
to be able to work for them.
The other things that they can do
in a very conservative
approach is diet modification.
If you're having the sensation
of I gotta go, I gotta go,
I'm going more frequent, these
overactive bladder symptoms,
patients need to pay
attention on their diet.
There's bladder irritants that we know
that is gonna aggravate the
problem for these patients.
One of the most common ones
can be caffeine, alcohol,
anything that is citric is
going to irritate the bladder.
So the patient needs to be
aware that that's happening
so they can control their
symptoms a little bit better.
And at what point should someone seek help
from their physician?
I would recommend to seek
help when you start noticing
that this problem is effecting
your quality of life.
This is not a life-threatening situation,
but definitely can improve
your quality of life.
And let's talk about the treatment options
for both stress incontinence
and overactive bladder.
Let's start first with
stress incontinence.
So usually we always start with
the most conservative
approach for patients,
and this is lifestyle modifications.
That includes the diet
that I mentioned to you
and the Kegel exercise.
When these do not work
there's no medication
for stress urinary incontinence.
But what we usually do is a
minimally invasive surgery
that is an outpatient surgery
that can help significant
the patients that are having this problem,
up to 90% we can improve
their baseline symptoms.
Can you talk more about that procedure?
Yes, absolutely.
So it's an outpatient surgery
that can be done under local,
regional, or general anesthesia.
So the patient will be
going home the same day
and the recovery time is
about one to two weeks,
and then they will have
a normal function life.
And what are the treatment options
for an overactive bladder?
For overactive bladder, once again,
we always start with a
conservative approach
on diet changes, the
Kegel exercise as well.
This is very important when
I discuss with my patients
about Kegel exercise and why they work.
So basically, when somebody
is having this strong urge,
the bladder is having a
spasm or a contraction.
When you do this Kegel exercise,
you automatically send
a reflex to the bladder
to relax this muscle.
So we teach patients several
techniques on utilizing
this Kegel exercise, diet.
When these do not help the patient
or we don't see a significant change
in their quality of life,
then we can proceed with what
we call physical therapy.
Doing physical therapy, they
are working with a specialist
on a one-on-one which can
be a physical therapist
or a nurse practitioner that
can be working these patients
through their diet, the exercise,
strengthen that pelvic floor muscle.
One of the things that we're doing
on physical therapy as well
is we're stimulating the nerve
that is in control of
your bladder function
to regain that function back.
If that fails, then we
continue our next step,
which will be medication.
So the medication, usually
the way that they work,
is like a bladder muscle relaxant.
And most of them work very similar.
There are associated
side effects obviously
with any medication that we prescribe,
so we always have to
balance between the benefits
and the possible risk associated
with the medication for patients.
That's interesting,
tell me more about that.
Yes, I'm actually very excited
because now more and
more we're bringing these
innovative therapies for patients.
So that's the conservative approach,
the diet, the physical
therapy, the medication.
But when these are not working,
we don't see that significant
change in patients,
then one of the things
that we're doing now
is what we call a bladder
pacemaker for patients.
So basically the same idea
of the heart pacemaker
and how it actually regulates your heart,
now we have a pacemaker for the bladder.
So it actually regulates this function
and it's very specific,
more towards the symptom
of overactive bladder.
As well it will help for
patients that are having problems
with incomplete emptying of their bladder
to be able to have this.
For patients that are
having urinary retention,
this therapy will help
the patients as well.
This is one of the options.
The other option that we have for patients
that are not available
to have this pacemaker
because of surgery for
their medical conditions,
now we're utilizing Botox
injected in the bladder as well.
We can see the results starting to improve
in about two weeks.
The effect will go away
because it's Botox.
But, on average patients will improve
about six to nine months
and then we just need to
repeat that treatment.
So potentially a patient would
just need to come once a year
and have the Botox done in our
office under local anesthetic
and improve their symptoms,
and there's one more option, actually,
and that's why I'm so
happy that we're bringing
this awareness to our patients.
For patients that are
not interested in surgery
or having to go through surgery
or not able to have that,
in our office as well,
which is office space,
this therapy targets on the nerve
that is in control of
the bladder function.
Very similar to the bladder pacemaker,
but the difference in here
is that the bladder pacemaker
is acting directly on the nerve.
And with this in office therapy,
we're working on a branch of that nerve
and basically it's on
your lower extremity,
very close to your ankle,
which is through an
acupuncture needle in the skin,
which is very painless, but
what we do through this needle,
we actually are connected to a stimulator
that actually is stimulating that nerve
through that branch.
So plenty of options for patients
that are having this problem
with excellent results.
We're gonna take a short break
and then we'll be back
with more on incontinence.
(upbeat music)
I'm Stephanie Lanham, I'm 22 years old.
My name's Rhonda, my daughter Stephanie
was in a car accident
on December 13, 2012.
Two friends and I were going out to eat.
They estimated between
90 and 140 miles an hour,
the driver lost control of the car.
We hit a telephone pole, a tree, spun,
flipped, hit a parked car.
The driver passed away.
The other passenger was
supposed to be paralyzed
and I have a brain injury.
I have an adult version
of shaken baby syndrome.
I received the phone call
from my youngest daughter, Jessica,
that Stephanie was in the accident
at 3 o'clock in the morning,
and we talked to the hospital.
We found out by her
tattoos that it was her.
And they told us about
her arm and her finger
and then they announced that
she had a serious brain injury.
I was in a coma for 26 days
and in the hospital for 66.
All the staff there, they were
all fighting for Stephanie.
We would have people walk
up to us, nurses, doctors,
therapists, praying for
Stephanie every night
and making us feel like
they're our family, too.
They comforted me, they
comforted my daughter.
They made us feel at home.
They put me right in the
room with my daughter
so she would feel safe through
her journey of waking up.
The doctors fought very
hard to save my life.
My family is extremely grateful for Blake.
They treated my family as
if it was their family.
Stephanie has made a 100% recovery.
My future looks promising.
I'm here, I'm alive, and
it's all thanks to Blake.
(upbeat music)
Welcome back to Healthy Living,
I'm Kelly Carlstein and I'm
joined once again by Dr Socas.
In our last segment we talked
about urinary incontinence.
Let's switch subjects.
Let's talk about bowel incontinence.
Can you give us an overview?
Yes, bowel incontinence
is a very common problem.
We are estimating that it's
gonna be one in every 12 adults
in the United States
are having this problem.
And I believe those
numbers are underestimated.
When you're having this problem,
something that you feel
ashamed, frustrated,
that you don't want to talk about.
One of the things that I'm excited
is to bring this awareness
to patients that there's treatment options
available for them.
Is there anything we can do
to prevent bowel incontinence?
Once again, very similar
to urinary incontinence,
is working with that pelvic floor muscle
to strengthen that pelvic floor muscle.
So the same
exercise that patients will be doing
will be helpful for
patients of bowel problem.
One of the other things
that patients can do
is modification with their diet.
If you're having problems
with bowel incontinence
you want to avoid spicy food in general.
Patients, as well, they're
using over-the-counter
antidiarrheal or through
prescription medication
to help them.
And if you already have
bowel incontinence,
is there anything you can do
to stop it from getting worse?
Well you can improve it by
doing the pelvic floor
exercise, your diet as well.
You're not gonna be able to prevent it,
but you're gonna be able to
manage your symptoms better.
But if this is something that is affecting
your quality of life my
recommendation is to seek help
through your physician
because a lot of times
there's an underlying medical condition
that can as well be contributing
for you to have this problem.
And what are the treatment
options for bowel incontinence?
The treatment options for bowel
incontinence that we have,
the same idea that I described to you,
that bladder pacemaker,
we're utilizing for bowel incontinence.
And the reason that this
therapy works for the bladder
and the bowel is because the
same nerve that is in control
of your bladder function is
in control of your bowel.
And actually it's very important
because patient that is having problems
with urinary incontinence
is about 20% are gonna start
having problems as well
with bowel incontinence
because it's the same nerve
that has been compromised.
So one of the interesting,
not interesting,
but very important things that we're doing
when we're considering a
patient for InterStim therapy,
which is the pacemaker therapy
that I was mentioning to you,
is that we're able to test
in the office for patients
if this therapy is going to
be the right one for them
and that their symptoms
are going to get improved.
In addition to InterStim therapy,
are there any other options.
Yes, there are surgical options,
but I will tell you,
now with these innovative
therapies available to us,
we're doing less and less
surgical procedure for patients
because the risk associated
with these type of surgeries
and the results that we were obtaining
were about 50% improvement,
but now with InterStim on average patients
are getting 70, 80% improvement
on their baseline symptoms.
So now it has become to be
the standard care initially
once the conservative approach
has failed for these patients.
Is there a certain population that's
more at risk for bowel incontinence?
I will say that it
increases as we get older.
But there's no specific age.
It is not just associated
with menopause either.
And obviously, if there's an
underlying medical condition,
the problem can be on younger patients.
Previously you mentioned
pelvic floor prolapse,
can you give us an overview of that?
Yes, a pelvic floor prolapse
is when there's a weakening
on the pelvic muscle or
ligaments or connective tissue
that are supporting our pelvic organs
like the uterus, the bladder, the rectum.
When there's a weakening in their support,
these organs are going to start protruding
or coming down through
the vaginal opening.
Patients usually will
experience some pelvic pressure,
a filling sensation right
at the vaginal area.
The prolapse can come out as far out
that patients are actually
able to see that bulge
protruding through the vaginal opening.
And what are some of the
treatment options for that?
Yes, well let me go back a little bit
in regards to the prolapse.
So basically, if the weakening
is happening in the bladder,
that's something that we call a cystocele.
If it's happening on the uterus,
it's something that we can
all a uterine prolapse,
or procidentia if it
actually comes completely out
from the vaginal opening.
Or if the problem is on the rectum,
then we're gonna call this rectocele.
In my experience, what I usually see
is not one specific organ
is actually prolapsing,
usually it's a combination
because these muscles, ligaments,
and connective tissue are
correlated one another.
So usually there's a
descent on these organs.
One of the things that we
know is a very common problem,
and as we're living
longer, we're estimated
that about 11% of women by the age of 40
are gonna have a pelvic floor
surgery related to a prolapse.
And what are those surgery options?
We always want to start with
a conservative approach.
So once again, strengthening
that pelvic floor muscle
is very important,
but once the prolapse has happened,
obviously the muscles
are not gonna go back up,
but what patients are gonna
notice if they are doing these
pelvic floor muscles and they are affected
and working for them is that this prolapse
is not gonna be coming further down.
Because what happened,
we're going against gravity.
We're in standing
position most of the time,
so by gravity, these organs are always
gonna try to tend to fall down.
So usually it's a progressive problem
that we see with patients.
This is not a life-threatening condition.
If the patient we know
that they have a prolapse
and it is not bothersome for them,
they're able to do their daily
activities, we just watch.
Now when it becomes to be a problem
that is affecting their daily activities,
their quality of life,
besides doing those exercises
or working with a physical therapy
to strengthen that pelvic floor muscle,
one of the things that we can
do in the office is a pessary.
So this is a rubber vaginal insert
that we place inside of the vagina
to support that organ back
to its anatomic position.
Patient's usually have relief of symptoms.
And I will tell you, the
ideal pessary for patients
that we found is the one
that is actually inserted
inside of the patient and the patient
not even know that this
insert is in there.
So that is the most conservative approach,
and that is something that
we can approach in office.
Now when this fails, then we
will be talking about surgery.
But surgery there is no
one specific surgery.
Really is about their medical conditions,
if they've had previous surgeries,
are they a surgical
candidate or not obviously
or if they want to maintain
their sexual health,
then we are going to
actually be discussing
different type of surgeries for patients.
So there is not one specific surgery,
really it is specific to the patient
depending on the condition
that she's having.
And what's the one thing that you want
all of your patients to know?
That you are not alone.
That this problem is very common.
And if you're having this problem
that is affecting your quality of life,
seek help through your
healthcare provider.
Don't wait these five years
to be able to talk to them,
because there's treatment options.
This is not a normal part of aging, bowel,
urinary incontinence, pelvic prolapse,
that you have to live with this.
Great, well thanks so
much for joining us today.
Thank you so much for having me.
That's all the time we have for today.
If you would like more
information on today's guests,
please visit us at
and click on the Healthy Living talk show.
While you're there you can
also send me your comments
or suggest a topic for
one of our upcoming shows.
I'd love to hear from you.
I'm Kelly Carlstein,
wishing you healthy living.
(upbeat music)

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