Things You're Too Embarrassed to Ask a Doctor Season 1, Episode 1: Female Pelvic Health with Dr. Dianne Glass

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You're listening to Things You're Too Embarrassed to Ask a Doctor, a production of UChicago Medicine. Each week, we'll feature one physician and ask them your most searched questions in their areas of expertise. 

For more information on our episodes, visit us at www.UChicagoMedicine.org/Podcast. Have something you're too afraid to ask your doctor? Tweet us @tytepodcast. I'm your host Kat Carlton. 

Have you ever had a burning medical question but you weren't sure whether you really wanted to call your doctor about it? Maybe it's not even that burning, but it's something like, so as a guy, I'm wondering, should everyone be doing kegels? 

Well, you're in luck. Over at the University of Chicago Medicine, we've created a show just for you. Our show is called Things You're Too Embarrassed to Ask a Doctor. On every episode, we'll feature one doctor and ask them stuff related to their area of expertise. We'll take some questions, some from colleagues, people on the street, maybe even you, along with some of the most searched questions on the internet. 

Our line of thinking there is, people are turning to Dr. Google when they might be better off talking to their physician. On today's show, we'll cover a few things related to female pelvic health. So, let's get to it. From the University of Chicago Medicine Hyde Park campus, I'm your host Kat Carlton. 

Welcome to this episode of Things You're Too Embarrassed to Ask a Doctor. Today, we have Dr. Dianne Glass. Welcome. 

Thank you very much for having me. 

Dr. Glass, can you tell everyone listening what kind of doctor you are? 

Absolutely. I am a urogynecologist. 

And what does a urogynecologist do? 

A urogynecologist is a doctor who sees sort of the overlap between urology and gynecology. So they see patients that have all types of issues with the vagina as well as the bladder. 

Hey again. When I was doing research for this episode, one of the big areas of curiosity focused around something called pelvic organ prolapse. Back to Dr. Glass for more on that. 

So whenever I talk to my patients about pelvic organ prolapse, I tell them to think of the vagina like a house with four walls and a roof. And pelvic organ prolapse is kind of a relaxation of the support of the vagina. And it causes a caving in live some of those walls. 

So the uterus sits in the roof of the vagina. And if the support of the uterus relaxes, uterus can kind of descend into the vagina a little bit. Similarly, that wall between the bladder and the vagina can relax into the vagina a little bit, causing a bulge in the vaginal area or even coming out of the opening of the vagina. 

That means some of your organs can both descend into other parts of your body but also come out all the way, is that correct? 

So, the organs themselves don't come out. They're always covered by the skin of the vagina, but the vagina can descend and even kind of turn inside out a little bit like a sock. So the bladder that sits just behind the vagina or the uterus can come down through the opening of the vagina. 

OK, so that actually leads me to my next question. Can my uterus fall out? 

So, sort of. The uterus sits inside the body. The cervix, which is the very bottom part of the uterus, pokes into the vagina. So as prolapse gets worse, the uterus can descend lower in the pelvis, kind of into the vagina. And eventually, the vagina can actually flip sort of inside out. And so the uterus is inside the vagina and but outside of the body, if that makes sense. 

So as we mentioned before Dr. Glass treats a lot of things besides pelvic organ prolapse. So we're going to move on to another thing she's familiar with, which is incontinence. So why do people see you for incontinence? 

They come to see me because it's something that has a huge impact on quality of life. It is something that people don't like to talk about, it will cause people not to leave their homes, it will cause people to avoid activities and really not engage in their life the way they used to. And so it's important that they come to see somebody to help reduce the amount of impact it's having on their life. 

And how common is it, because it's something that's searched a lot? It is incredibly common. 50% of women have some form of urinary incontinence. And that percentage grows as patients get older. 

So we'll jump into some of our questions. The first one, which you just talked about a little bit, is how incontinence affects life. 

It affects how much fluids people drink. There are people who will try and dehydrate themselves because they're afraid that they're going to leak. It's also expensive. So people who use a lot of pads wind up having a big cost of having to buy those pads and having to deal with them all the time. And it has an effect on kind of what you do in your relationships as well. 

When does incontinence occur? 

There's two major kinds of incontinence. So there's stress incontinence, and then there's also overactive bladder, which if you think of your bladder like a balloon, stress incontinence would be not squeezing the balloon shut tightly enough at the end. And it occurs when you laugh, cough, sneeze, jump up and down. 

This is something that is incredibly common in younger women, particularly after they've had a baby. It is something that progresses over the course of your life. 

There is also overactive bladder, which is the bladder squeezing when it's not supposed to. So people get that sense of like, oh, got to go the bathroom and have to rush to the bathroom to get there and will sometimes leak on the way. 

What causes overactive bladder? 

The exact causes of overactive bladder are varied. Some of them aren't really very well known. So some people can have neurologic problems that will cause overactive bladder. People who have spinal injuries can have overactive bladder. 

But the most common causes of overactive bladder are really just it just develops. As you get a little bit older, your bladder can become more sensitive to certain kinds of foods. And your control over your bladder gets a little bit less. 

Another question is, what type of pad is best for people who are experiencing incontinence? The most common thing for people to do when they start having urinary incontinence is to start using menstrual pads, that's something that we're all very familiar with. 

But actually, the best kinds of pads are incontinence pads. They're a little bit different, they're meant to absorb a thinner liquid. And so when you go to the store and you're looking for pads, definitely look in the aisle for what for the incontinence pads versus menstrual. 

Will incontinence ever go away, or is there a way to cure it? 

So as we talked about before, there's kind of two different types of urinary incontinence. So with stress incontinence, doing pelvic floor exercises or kegel exercises can help with decreasing stress incontinence and then some women can help make it go away. 

There are other treatments for stress incontinence. There's some surgical options. You can put something in the vagina to help support the urethra. For overactive bladder, changing your diet, so avoiding things that will irritate your bladder-- coffee, tea, soda, carbonation, spicy foods, and citrus, all those things that are really good and life will help relax the bladder. 

They just kind of irritate the lining of the bladder and will cause it to be a little bit more overactive. Pelvic floor exercises are also helpful. But then there are medications that can be used. Botox actually is something that can be used to help relax the bladder as well. 

Sorry, back up one second, what is a pelvic floor exercise? 

Pelvic floor exercises are squeezing the muscles that you would squeeze to try and stop your flow of urine. And so it's a muscle that most people don't really spend much time thinking about. But when you sit down to urinate, if you try to slow down the stream of urine you have the right muscles. Those are the muscles to do a kegel exercise with. 

So then away from the toilet, not when you're urinating, you squeeze those muscles and hold it for 10 seconds, relax for 10 seconds, hold for 10 seconds. And you need to do 50 or 60 of those a day. 

Cutting back in with this question we heard earlier from one of my male colleagues who I think would appreciate staying anonymous. Guys, don't think we forgot about you for this episode. 

So as a guy I'm wondering, should everyone be doing kegels? 

It's definitely something that can be helpful. In patients who have issues with pelvic pain, I would not recommend that they do it. But in patients who are having a little bit of leakage when they cough and sneeze, absolutely, I'd recommend doing that. 

If you're having issues with making it to the bathroom on time, I absolutely recommend it. If you do a quick kegel when you have that urgency, sometimes it'll make the bladder be quiet and calm down. So on the whole, pelvic floor exercises are great for most people to do. 

Also good to know. Anything else related to incontinence that you think people might like to know? 

Really just that it's incredibly common, and it's not something you should be embarrassed to talk to your physician, about because we hear about it all the time. So never be embarrassed on our account. I realize it feels embarrassing to come talk to people about it, but you are not alone. 

So we'll move on to another really commonly searched area, which is UTIs. Now, what does UTI stand for, and what does it mean? 

So UTI stands for a urinary tract infection. And it just means that there is an infection somewhere and either the kidneys or the bladder. Most people think of a UTI is really cystitis, which is a bladder infection. And they're is something that is very common in women. 

What causes them? 

They are caused by bacteria getting into the bladder and multiplying. The bacteria come from the vagina and the opening of the urethra, which is the tube from the bladder to the outside world is just right there next to vagina. So it's always exposed to this bacteria that is normally living there. And so when that bacteria climbs up the urethra, you can get a urinary tract infection. 

So there are probably a lot of different ways you can get one. It's not just from sex, because that's something that searched a lot. 

Absolutely. That's usually when women will start getting urinary tract infections is with the onset of sexual activity. But no, it's something that you can get without having intercourse. You can just get them. 

It's something that becomes more common in postmenopausal women. The estrogen protects you a little bit, it helps make the urethra a little bit less likely to have infections. It also changes the bacteria that live in the bladder. 

The super powers of estrogen, I never knew. 

Absolutely, the super powers of estrogen. Vaginal estrogen is something we use a lot in our postmenopausal patients to help avoid urinary tract infections. 

If it's not treated with estrogen or another type of medication, will UTIs go away on their own? 

They can. So if you start having symptoms of a urinary tract infection, sometimes they will go away in a couple of days if you're drinking a lot of fluids and helping flush things out. But if they're not going away, going and having it treated with an antibiotic is something that I would recommend. 

And the last thing I have on my list is vaginal atrophy. Now what is that? 

Vaginal atrophy is a thinning of the tissue of the vagina that occurs after menopause. And so it's just from a decrease in the exposure to estrogen. It actually can happen a little bit in women who are postpartum as well when they're breastfeeding, because you also have a decreased amount of estrogen. 

So it is something that causes a lot of discomfort in women. They can have a dry sensation the vaginal area, itching, just general discomfort. Sometimes that can cause pain with intercourse. 

But the good news about it is that there is a lot to do about it. So sometimes just using a vaginal moisturizer that you can get over the counter is something that can be helpful, using something like Vaseline or an Aquaphor or coconut oil to moisturize the area can be helpful. 

The biggest thing that we use to help reverse it is vaginal estrogen, so using an estrogen cream that's placed in the vagina. And that actually does reverse it. 

It gives the estrogen back to those tissues and helps reverse the thinning. So it thickens up the tissues, it increases the vascularity of the tissues, and makes them a little bit more elastic as well. 

That is all the questions I have here. Is there anything else that you wanted to talk about or maybe encourage patients to know to help them be comfortable to ask these types of questions? 

I think the biggest thing to help encourage people is that you really should bring these up with your primary care physician, bring this up with your gynecologist when you're at your annual visit. If there's anything that you're uncomfortable with, have questions about or something which is making your life difficult, talk to us. It's what we do, we talk about this area all day long. 

And so I always tell my patients, never be embarrassed on my account. I promise whatever you're telling me I've heard 15 times and I've heard exponentially more bizarre. So don't worry, don't be embarrassed, come talk to us. 

So you just mentioned people come in and ask these questions all the time. What's an example? What's something that people ask you about? 

People come in and they are just very embarrassed to say, you know, I leak, I can't make it to the bathroom. And people always feel alone with that. They don't talk with — it's not something that you talk with your friends about. And so I think people don't really realize just how common it is. 

People will also come in and they will tell me, oh my gosh, there is a bulge. There is something very weird that they don't want to tell you that they looked down there. And don't worry, everybody looks with a the mirror, it's fine. But just don't be embarrassed, it's important to come ask. 

Is there anything people should be looking for, because you said people look with the mirror, that's normal? Is there anything people should be looking for in terms of the different areas we've talked about that are other signs they might want to talk to their doctor that they might not think would be worth talking to a doctor about? 

If you ever feel that there's a bump, a lump, something that just looks strange and as you kind of looked like you're like, oh, this looks like it's changing a little bit, always worth asking a physician because better safe than sorry. 

Sometimes you can have little things that either maybe the bump bothers you and it can be removed. But in really rare cases, it could be a cancer or something that really could be taken care of. So I would say anytime you see something that looks like, ah, that's a change, that hasn't been there, I would ask about it. 

All right. Well, that's all the time we have. Thank you, Dr. Glass, for being on the show. Any last words to our listeners? 

Happy bladder health. 

Happy bladder health, that's a good one. All right. Until next time, this has been Things You're Too Embarrassed to Ask a Doctor. Once again, I'm Kat Carlton and you've been Listening to Things You're Too Embarrassed to Ask a Doctor. Music from today's episode is by Blue Dot Sessions. For more information on our show or to submit a question, visit us at www.UChicagoMedicine.org/Podcast, or tweet us @tytepodcast. That's tytepodcast. 

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