Incontinence Part 1

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Incontinence in women who have had vaginal deliveries.

This podcast discusses what incontinence is and how it effects women who have had vaginal deliveries. Brett Newcomb and I talk about how by getting your hormones replaced you can avoid some of the very embarrassing symptoms of incontinence and get back to living your life worry free.


Incontinence Part 1, BioBalance Healthcast 77 with Dr. Kathy Maupin and Brett Newcomb
Recorded on April 18, 2012 | Podcast published to the internet on May 4, 2012

Kathy Maupin: Welcome to Biobalance health cast. I’m Dr. Kathy Maupin.

Brett Newcomb: And I’m Brett Newcomb and today we’re going to be talking about a topic that effects a lot of women who are post menopausal who have had vaginal deliveries in their lifetime. And it’s a problem that most of them encounter they don’t seem to talk to a lot of people about it. They don’t necessarily know to anticipate that it’s going to be a problem and when it happens they feel ashamed, embarrassed. And they are concerned what’s wrong with me? There are lots of possible interpretations about, well why is this happening? So today we want to talk about it, we want to talk about what the interpretations are and what you can do about it. And the problem is incontinence in women over 40 who have had vaginal births.

KM: And incontinence can happen at any age for various reasons. But we’re limiting what we’re going to talk about today to women who have vaginal births or to women who have carried large babies because that also affects the supporting structure. Large babies or twins and not have a vaginal birth does the same thing to the bladder. But there are two kinds of incontinence. One is the incontinence that is most likely to happen to women and that is stress incontinence. And the other kind is irritable bladder where the bladder spasm’s and every time it spasm’s you lose urine.

BN: So incontinence really means a urine leakage as opposed to be not being able to urinate.

KM: Yes that’s true, that’s true.

BN: So there are unexpected urine leakage concerns that these women begin to have?

KM: Oh we feel like babies. We don’t want to wear diapers. That’s ridiculous. Women will talk to each other about bleeding and babies but they won’t talk about urine loss. Because that means that “that’s what like what grandma did and had to wear diapers.”

BN: And I think that’s why grandma wears so much perfume. You go to these places and you can’t breathe because all these women have all these conflicting perfume.

KM: Yea but they can’t smell either. They lose their sense of smell.

BN: They can’t. I know that sense is gone. But I also think they are trying to covering up.

KM: Well they very well may be but our babies smell good because we have good diapers now. So I assume we have good diapers for adults. But I’m trying to talk to you about how not to wear diapers, how not to have to change your life because of this. Because, if you have incontinence of any kind then you’re also going to have insentience when you have sex. Now that is something that is going to stop you from having sex. So the last thing women want is “oh I feel so sexy” and then lose urine during sex and then they’re mortified. They’re not going to have sex again for a long time. Until they absolutely have to because it’s an embarrassing thing.

BN: And if they don’t know they assume something is really wrong.

KM: And it’s very hard to tell doctors that you’re losing urine. However your doctors know that if you’ve had a vaginal birth or more than one vaginal birth. They know very well that if you’ve had a vaginal birth your bladder is not going to work later, because in general that’s one of those things. It’s like they don’t talk to you about your breast sagging after breast feeding. We know that but why tell them something that’s going to make them not breast feed.

BN: If it aint broke, don’t fix it.

KM: That’s right. But one of the risks of having a vaginal birth is incontinence. So we should be informed of that while we’re pregnant.

BN: Yes.

KM: So now my soap box is down, I’ll put it away. So stress urinary incontinence has to do with, that particular incontinence has to do with the tearing out or stretching of all the supporting structures in the pelvis. Because women have round pelvises to have babies, most women have round pelvis to have babies, and men have flat pelvises. So because you have a round pelvis that is as big as babies head on the inside, then you have a lot of area that has to be supported. Your bladder is part of what is being supported. Your uterus or my uterus is part of what’s being supported it has muscles and tendons and it’s like hammock and it’s holding everything up. So that‘s what we need intact to keep our bladder continent. So this type of bladder incontinence has to do with the angel of the urethra. And women have very short urethra. Men don’t have incontinence because of this reason.

BN: And the urethra is the tube that.

KM: The tube that you can see the opening of right above the vagina. So you can see that little opening but it’s only about that long at the very most. And you have to have an angle with the bladder. The bladder is here and the urethra is here the bladder usually sits right on top. And your uterus is right underneath this. So when your bladder fill sup it gets big like this so when you urinate you straighten that angle. So then it all comes out. And that’s a neurologic function. Yes you need your nerves for that.

BN: So you need a kink in your urethra to be what you want.

KM: To be continent. You have to have that angle. So that is what you lose when the baby is sitting on your bladder and then when you push the baby out the bladder starts coming out with the baby. And it tears out the supporting section.

BN: Because you’re pushing all that.

KM: Yes, you’re pushing a watermelon out through your vagina. So it tears all those little fibers and all of that connective tissue. So that is what happens. It’s a weakness.

BN: So the more babies you have vaginally, then the more guaranteed it is that you’re going to have these problems.

KM: Right and a lot people have it after one baby, and they have another and it gets worse and they have another and doctors or your surgeons, urologists don’t want to fix it if you’re going to have more babies because you’re going to tear it out.

BN: And so what happens is when they cough or when they laugh or when they sneeze they squirt a little bit of urine.

KM: Or when they lift something. You can just lift your child. Lean down, lift your child, pick it up. Especially if you squat to pick up, which is good for your back. If you squat, you open up the pelvis more and loosen up those muscles more and the bladder falls and you pee. It’s a horrible thing to have happen to a young woman. Now what mostly happens is you get better after each baby. You don’t have a constant problem with incontinence. You have just intermittent it doesn’t change your life, you can put up with it. You know if you have old you’re going to have to wear a pad or something because you’re going to cough and lose urine. Now most of my patients ask me “why did I have just little bits of incontinence and then I turned 40 and now I have incontinence all the time?” And those that didn’t get it at 40 get it after menopause. And so those reasons with stress incontinence have to do with the damaged tissue that you were able to still tolerate and still keep you continent. Everything gets thinner when the testosterone leaves after you’re 40. So all of those tissues, the muscles, the connective tissues, the fascia and the tendons all stretches out and get lax, the bladder falls more and then you’re incontinent more often. But then when estrogen leaves it gets worse. When estrogen leaves, the bladder is an estrogen sensitive organ. So when you lose estrogen, the opening to the vagina and urethra gets very thin and so the bladder itself loses integrity.

BN: So the cell walls get thinner because they’re stretched or elongated?

KM: The tissue of the bladder itself, not the cells but the cells may get farther apart. The tissues itself that make up the bladder get lax and get thin. The tissue maybe gets this thick, we’re multiplying the microscopic image but if the wall is that thick before menopause and then it becomes thin then the whole bladder loses integrity and you lose the angle all the time.

BN: So women are just doomed to have this happen or is there something they can do about it?

KM: No you’re not doomed. Not it’s terrible to talk about a problem that you don’t have an answer to. There are multiple things that you can do. I mean obviously we talked about surgery.

BN: C section.

KM: Yes you can have c section instead of vaginal birth.

BN: Don’t have fat babies.

KM: Then you can have surgery after birth. Yea, when our mother had us they smoked.

So they all have little babies. So we don’t smoke anymore or do anything bad so our babies are really big in general. In any case, that’s preventive. But afterwards you can go to the urologist and have a surgery where they support, they pull up the area around the neck of the bladder so it makes that angle.

BN: Kind of like a face lift. You just have a bladder lift.

KM: Yea it is. So that’s one thing you can do. But before you do that I think it’s wise to get your hormones checked because that’s non invasive. You can get a blood test to see if you have any estrogen, if you have any testosterone. And if you’re low on those, most of my patients come to me for other reasons and they go “and by the way, I don’t have incontinence anymore.” And that’s because all their muscles, their muscles around and underneath the bladder are thicker and tighter than the estrogen that I give them makes the lining thicker, so in the bladder itself, so the bladder has more integrity and that little opening that is your urethra it thickens up so It’s not so easy to let urine out.

BN: So that’s the estrogen is testosterone involved in that as well.

KM: Testosterone does the muscle part. Testosterone holds up the bladder better and the uterus by making better muscles in that sling that we were talking about.

BN: So estrogen protects the gland or the organ and testosterone protects the muscles that complimentary benefit of restoring the strength so you don’t have incontinence problem.

KM: Around it. Right and for some people it is so damaged that they start out with such thin connective tissues that this is something that they still have to have surgery for but your surgery then works better because it’s going to heal better and you have the basis of what you needed to begin with to have a continent bladder.

BN: So you’ve been talking about incontinence in the bladder and you started by saying there are two difference kinds. One was stressed induced and the other was irritable.

KM: Right well stress is like lifting or coughing. And irritable bladder but we’re going to have to talk about that next time. But the stress incontinence is the most common and the thing I see the most and I fix the most. And you also have to remember not to get the lowest dose of estrogen, because that doesn’t work. Lowest is not best in the world of bladder. You have to have enough estrogen to actually be like a 35 year old so your bladder things you’re a 35 year old. So normal levels like 60-250 is a normal level of estrogen. That’s what you should have and then you’ll heal.

BN: 60-250 is a wide range.

KM: Well that’s because we cycle so we go between 60-250.

BN: So if you stay in the range.

KM: If you stay in the range. Most women are better when they are between 90-115. That’s adequate. But those low dose hormone replacement therapies, those bring you up to about 10 or 30.

BN: So do you recommend the different methodologies, is it cream, or pellet or pill.

KM: You can get a high enough dose of oral if you take oral. You can bring it up to a higher dose and that will get you to the right level. You can also get the right dose with a patch. You just have to have a high enough dose patch. Doctors are always trying to give you lower dose. We don’t do that with any medicine. Oh yea you have diabetes. Let me give you the lowest level of insulin I can possibly give you. Your blood sugar will still be high. But that’s ok, we’re just going to give you a low dose. We don’t do that.

BN: You’ll just go into a small coma.

KM: Right and you know you’re just going to have all kinds of neurologic deficits because we just gave you a little insulin. We don’t do that with anything but hormones. But of course we’re women. They don’t do that with men’s hormones. They give men enough to be 35 again. And so once again we hit that impasse of doctors are trained to give the least amount of drug to women and then they’re trained, because most of them are men still, to give them adequate doses.

BN: So we have enough information to do an additional podcast on this and hopeful you’re interested and you want to hear what works for you and what your situation might be. And if we haven’t touched on it in this conversation, please watch for the next podcast if you have specific questions that you want to ask us or share with us you can always contact us.

KM: You can contact me at that’s the website or [email protected] or you can contact my office at 314-993-0963.

BN: And you can reach me at

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