The "Vagina Whisperer" - Is It Time To Go? | Urinary Incontinence 101

A super important topic on the Menu today! We're talking Urinary Incontinence. Approximately 30-50% of women over the age of 50 experience some form of urinary incontinence, a condition that tends to become more prevalent with age. Our guest, Dr. Briana Walton, aka - the "Vagina Whisperer" brings the facts on this condition. This podcast provides crucial information and can help all, whether you are experiencing this or someone you know - your mother, grandmother, favorite auntie, or whomever. Do kegels still help at our age? And did you know that there are apps to help you locate the nearest bathrooms on-the-go? 'So glad you're here! 

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BIO: Briana Walton MD. I have been a specialist in Female Medicine and Pelvic Reconstructive Surgery for nearly 20 years.

One thing I have learned, being on the giving and receiving end of medicine, is that we are continually changing. I chose this specialty because I enjoyed the spectrum of care provided over a woman’s life time. And as I have seen my patients change and have changed myself, it has given me an appreciation for the mind, heart, and soul of a woman. As life evolves; having a baby, going through a divorce or surviving menopause, we begin to make choices about our care and appearance that we would never have considered in the past. Some of these choices are emotional and based on fear or concern about our medical health. However, many decisions we make are due to the natural phenomena that occur in a woman’s body. These events push us to consider creating a new version of ourselves to address our intimate wellness. I would be happy and honored to help you ask critical questions, and begin to explore areas where you may not have had the courage to speak up. I have learned that women are hard on themselves and don’t take time to take care of ourselves because we are always caring for others. I want to give women an opportunity to address their needs and their desires. At the Center for Feminine Wellness and Surgery, we will take the time to discover what’s right for you and how to move forward in your renewal process. It’s time for you to take the best care of YOU!

https://briwaltonmd.com | https://www.instagram.com/briwaltonmd/ | https://www.instagram.com/thecfws/

RESOURCES:

https://www.hopkinsmedicine.org/health/conditions-and-diseases/urinary-incontinence/urinary-incontinence-in-women. https://www.webmd.com/a-to-z-guides/what-is-a-urogynecologist
https://nafc.org/bhealth-blog/the-best-bathroom-locator-apps/  http://toiletfinder.net

Transcript

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SPEAKER_00 0:00

Does this sound familiar? You're out and about, and all of a sudden, that urge it's there. You have to look for a restroom immediately. Or you're out with your friends or family, or you're at home and you're laughing, and all of a sudden it happens. Or you're at the gym, getting your workout in, and it happens. Or you cough or you sneeze. We're talking urinary incontinence. And it can impact the quality of your life and it can be a serious matter.

SPEAKER_02 0:29

Overactive bladder actually falls under the urge incontinence, where you are, I gotta go. I gotta go right now. Get out of my way. I'm gonna knock you over to get to the bathroom.

SPEAKER_00 0:41

We'll be back in a flash. A hot flash. Hello, everybody, and welcome to another episode of the Ageless Glamour Girls podcast, where we talk all things aging on this beautiful and sometimes challenging, okay, often challenging but liberating journey, and nothing is off limits. I'm your host, Marquita Curtis Haynes, CEO and founder of the lifestyle brand Ageless Glamour Girls, which celebrates, embraces, empowers, motivates, and sometimes entertains women aged 50 plus. We're so glad you're here. I hope you're ready to learn more about intimate wellness. That's a very, very important topic. Now, I've never met today's guest in person, but a friend introduced us and she referred to her as the vagina whisperer. I'm like, oh my goodness, I have to have her on the show. That is, oh I just love that title. Meet Dr. Brianna Walton. She's a specialist in female medicine and pelvic reconstructive surgery. She's owner of the Center for Feminine Wellness and Surgery in White Plains, Maryland. Welcome to the show, Dr. Walton.

SPEAKER_02 1:53

Thank you so much for having me. And I'm so glad she introduced us. This is going to be a lot of fun. I can't wait to talk to you. Oh, good, good.

SPEAKER_00 2:02

Yes, yes, yes. Thank you. All right. We want to start with the big question, of course. What exactly is urinary incontinence, also known as overactive bladder?

SPEAKER_02 2:12

So you actually bring up a good point because incontinence is an accidental loss of urine. Okay. Uh it could also, you could have incontinence that's also bowel related, but we'll save that for later. Uh, but when you're specifically talking about urinary incontinence, there's different so like flavors. Okay. Overactive bladder actually falls under the urge incontinence, where you are, I gotta go. I gotta go right now, get out of my way. I'm gonna knock you over to get to the bathroom. Exactly. Versus stress incontinence, which you mentioned in your introduction, like you're coughing, you're laughing, you're doing a squat in the in the gym and something comes out, or you're dropping it like it's hot, right? Like those are the things that make you leak. You could even have a combination, it's a it's the gift that keeps on giving. You could have both. Um, and then there are women who actually have more and more as we get older functional incontinence, meaning that you don't walk fast, you have mobility issues, you can't get to the bathroom quick enough because your body won't allow you to. So there are a lot of different varieties, but the most common uh two types that I deal with on a regular basis are stress and urge.

SPEAKER_00 3:29

Okay. Yeah, that that that pretty much covers it a lot of information here. Yes. Now, um, I did read an article about the structure of our bodies. How do the structures of our bodies, you know, play into this incontinence, urinary incontinence?

SPEAKER_02 3:49

Another good question because I, you know, a lot of people come to me and they're like, you know, uh, you're the vagina whisperer, you just, you know, all things below the belt. But quite frankly, when I see people, I am doing not just uh a look at your vagina and let me see or feel, but I want to know about uh do you have any hip or back issues? Do you have any knee issues? Because being off kilter will affect the pelvic floor. And the floor is not just, you know, the muscles, it's everything that connects the muscles to the bones. So it's the ligaments, it's the tissues, it's all of those things that support the pelvic organs and keep them stabilized, whether you're jumping or bending or whatever activity you're doing. So women who have lower back problems, who have hip issues, who broke their knee, they can be off-kilter and shift pressures to affect the pelvic floor. Or just think about every woman who has had a baby has altered their posture, their bellies are out, their back is different, so they have more of the curvature related to it, and that can have some long-term effects, especially when things start to loosen up.

SPEAKER_00 5:00

Wow. You raise a great point because you know, with the hip and knee surgeries, you know, you might you're you're you're off balance to begin with, right? Right, yes, right.

SPEAKER_02 5:10

Especially most women are are counseled that they should wait until the pain is so bad before they have a hip or a knee replacement, right? They say, wait, wait, wait. But over time, you are constantly bearing weight differently. And who's who's accommodating for that? Who's compensating for it? Your hip, your back, your abdomen, and your pelvic floor. Everything is trying to adjust in relationship to being off. I didn't even think about that.

SPEAKER_00 5:42

Yes, okay, those are excellent points. Excellent points. Now I know that you talk just talked about the common types of incontinence, uh, stress and urge. Um, and then we'll get back to the pelvic floor in a minute because that's very important. But I want to know how does in general, and you mentioned this a little bit, but I just want to talk about a little bit more. How does urinary incontinence impact one's life?

SPEAKER_02 6:05

Yeah. I, you know, when I first started practicing, most, and that was, you know, in the 90s actually, um, most of the patients would say, Oh, I can just deal with it. I'm not gonna, I'm not gonna have this surgery. And everybody was concerned about having surgery. But when you look at the data and you know that about one out of three women will change their practice patterns in terms of sexual function, two out of three women will stop doing the things that they love doing because they're afraid of leaking. They won't go to church, they won't go to the gym, they stop participating in social activities, and so that has a future impact on anxiety. I'm scared, I'm worried, I'm nervous, I'm gonna pee on myself, and depression. I'm not socializing like I was before. So it has a lot of sort of mental health impact. But then if you look at even further, we know that women who are rushing to get to the bathroom are increased risk for falls. Falls hip fractures, right? Um fractures can result in a couple things, surgery, institutionalization. So if you can't toilet yourself, you're much more likely that for your family, if they can't take care of you, if you're getting to the point where you're all on your own, but you're not quite sure if you can stay on your own, you start having problems with toileting, that's your admission straight to somewhere else to have someone else to help you. And that that's the thing that we want to encourage. If you want to stay independent, if you want to continue to do the things that you want to do, if you want to have a aging well, right? You've got to take care of these things that may seem like not that important.

SPEAKER_00 7:58

Wow, that all excellent point. So much great information. And you reminded me of uh someone recently told me when I told them I was gonna do this podcast. And um, and she was like, on the job, there's one restroom right by everybody's office, right? And she says sometimes she has to go so badly when she and when she gets there, it's occupied. And so I just thought about what you said the anxiety, the anxiety sets in. It's like, what am I gonna do? I have to go back to my job, I have to go back to the desk. So, yeah, it's tricky. Um, so the question beg uh this makes the question is this fixable? How do we manage urinary incontinence? For example, should we cut back on our alcohol, cut back on caffeine? And of course, once you hit 50 and 60, are pelvic floor exercises or cago exercises still relevant? Let's talk treatments. And I want to start with self-treatments, such as some of the ones I just mentioned.

SPEAKER_02 8:54

Sure. Well, I I think the key is figuring out first of all what flavor you have. And so if you're talking to your primary care, you know, whether that's a physician or a physician extender, like a nurse practitioner or PA, you're gonna talk to them about your symptoms so they can make the right diagnosis and then potentially even send you to somebody like me, right? But even before you get there, there are reversible causes of incontinence. So if you are you have infections, you want to make sure you don't have recurrent infections all the time, even menopausal changes like um the thinning of the tissue can reflect or cause issues in the urethra and the bladder. So you end up going to the bathroom too many times at night. You have more urgency. So those are things that we can pretty easily treat with just like minimal interventions. Um, a lot of women unfortunately put things into their diet that are bladder irritants, things like caffeine. We know about caffeine. We usually say, Oh, I gotta cut back on my caffeine. What a lot of women don't know and understand is that a lot of the dietary supplements like phenylalamine, the stuff we use to cut down on our calories, diet coke, diet products, that irritates the bladder too. So you've got to be careful about your balance and make sure you're just getting water in your diet as opposed to just putting crystal light in everything, right?

SPEAKER_00 10:25

Right. That makes sense. That makes sense now. Um, and and what about the pelvic floor?

SPEAKER_02 10:32

You know, how okay, I'm gonna ask you a personal question, Marquita. Come on now, let's talk personal. You said all things, so we're going there. Right. Uh, have you ever been instructed in your years of going to see the provider? How many times have they taught you how to do keegels?

SPEAKER_00 10:55

Oh my goodness, you you you have jokes. Never, everyone serious, but never, ever. You know what I learned, I you know, learn from friends or in books or whatever. You know, my mother certainly didn't tell me about that, right? You know, and and and then it worked back then, but does it work now?

SPEAKER_02 11:12

So there are little hints that you're doing them correctly, but it's really good for us as a provider to teach people how to do them when they're doing their pelvic exam. Okay. Because you grade the the ability of somebody to do a Kegel. If they're really good at them, then they could potentially be very effective for incontinence. If a patient has had a birth injury, because one of the main risk factors is a vaginal delivery. Okay. You had a big-headed baby come through your pelvis, right? And you had a long labor or you had forceps or a vacuum, and it changed your pelvic floor and the muscular ability to contract those muscles, right? Then sometimes kegels are not going to help you because you don't have the ability to contract those muscles. So, why would I tell someone who's in a wheelchair who's paralyzed to practice walking, right? Right. So that's the the analogy I would use. If those muscles are damaged, sometimes it's not helpful for you to actually go do Kegels on your own. And if I've assessed that somebody is you're you're okay, but you're not great, then we can add a physical therapist, like your own personal trainer for the Pellet Floor. They'll teach you, they'll teach you how to do them better.

SPEAKER_00 12:39

Okay, and and here all along I thought that you know Kego was, you know, a Kego is a Kego's for the sex, for the sex, when it can better, yes, yes, yes. You know, you're sitting at a red light, you're doing it, right?

SPEAKER_02 12:50

Yeah, I mean, I don't know what you want to talk about today, so I'll go there, but you know, you're talking about this so much.

SPEAKER_00 12:58

Okay, but um, but yes, cagles. Okay, now are they how are they related to pelvic floor exercises? How are how are the muscles? Yeah, the cagles are they connected at all? And going back to something I was about to ask earlier, I don't know if I asked, it's like, do they still work if you're over 60? Yeah, and the pelvic floor exercises.

SPEAKER_02 13:23

Yes, I've been very impressed with some people. I'm like, oh, don't show you know, I'm sometimes I'm doing an exam on a patient and I have my fingers in. I'm doing, I'm saying, okay, I want to check your pelvic floor muscles, so I want you to pretend like you're picking up a penny with your butt. That's the best analogy. I'm doing it right now. That helps you to sort of guide the muscles into the right position where you can assess how strong, how long, and what direction are they going because there's a there's not just one component, there's multiple components to strength. Okay, and so when I'm doing that, sometimes I'll say, Well, don't brag. I mean, I know you get this, you you're good, but you don't have to show off.

SPEAKER_00 14:07

Right. Oh my goodness. Uh-huh. But yeah, okay. So, all right. So you're telling me that it still matters, that I could still practice.

SPEAKER_02 14:18

Okay, you want to know a secret? You could check on yourself, you could check your ability to do those contractions on your own. You take your dominant hand, you take your thumb, you insert it inside of your vagina, okay, and you do a kegel. And if it's thumbs up, if the thumb comes up and it stays up for a good four seconds, you've got good kegel muscles. If you feel nothing, you are not doing them right, or you don't have the ability to do the exercises. Okay, that's a quick and easy way, down and dirty, to figure it out for yourself. We used to say when you're in the restroom, stop the flow. But the drunk of the bladder like that, the bladder is either supposed to store or it's supposed to empty. Don't confuse it, don't go back and forth saying stop, start, stop, start. Let it either flow or let it hold.

SPEAKER_00 15:16

Oh, wow. Cause yeah, because that, yeah, because yeah, because I've been, yeah, yeah. Okay, let's let's stop this flow right now, please. Let's let's practice while we're in the bathroom. Okay, good to know. Good to know.

SPEAKER_02 15:30

Commercial break to test your keyboard.

SPEAKER_01 15:36

Okay, everybody, we're gonna take a little break. We'll be back in a flash, a hot flash.

SPEAKER_00 15:46

And we're back. Okay, so we got the kegels, we got the pelvic floor exercises, and the pelvic floor physical therapist, your physical therapist.

SPEAKER_02 15:57

So they are really very helpful because they can empower you to really learn more about your body. There are women who really don't understand from an even sexual function standpoint, the ability to use those muscles during uh intercourse uh to really enhance or change their satisfaction. And so just understanding and knowing that sometimes is like really gratifying for a patient to really say, I know my body, I own this body, my body does what I want it to do instead of it doing what it does. That makes sense, and I also want to point out not I don't have I have never given birth to children, to any babies, unfortunately, but that doesn't matter, you still have issues, yep, especially if you've had any changes in posture or or uh structure, so lower back issues. Um, I've gained weight and lost weight, and that has affected me uh in terms of my ability. The more weight, it's just like the the um analogy we use on the knees. The more weight loss you have, the less pressure it is on the knees. The same for the pelvic floor. So sometimes losing significant amounts of weight can affect your urinary incontinence pattern. Um shoot, yeah, yeah. It just but think about you as a strong woman, right? Like a lot of us, like, oh, I can do that, I can lift that, you know, refrigerator. And we do things that put ourselves at risk. We're doing heavy lifting, or let's say you have problems with chronic constipation, you're straining, you're pushing. That straining can damage the pelvic floor muscles, it can change damage the nerves, and so you can end up not just with valve dysfunction, but you can end up with bladder dysfunction because you're straining all the time.

SPEAKER_00 18:01

Oh my god, okay. I'm not, I'm not, I'm serious. Who knew? So constipation is related to urinary incontinence. Now we're talking about urinary incontinence, yes.

SPEAKER_02 18:14

Yes, ma'am. You can be constipated to the point that it causes incontinence, but the chronic straining related to constipation can have a long-term effect on incontinence too.

SPEAKER_00 18:29

Wow, wow. I know that when you're if you're if you get really, really constipated sometimes, you can't urinate, you can't even pee. Right. It's like so you have to handle that. And I've I just thought about all the people who are in the um, you know, the zippy, you know, the constipation is one of the main problems with that.

SPEAKER_02 18:46

And um yeah, yeah, I think you know, we we don't and haven't really appreciated the sort of interrelatedness of the pelvic floor. Um, you know, when when I when I introduce myself as sort of a urogynecologist or pelvic floor specialist, I say, it's like, you know, a gynecologist and a urologist got together and they had a baby. That's me. Um, but quite frankly, we are also doing a lot with colorectal work, and everything we do is sort of below the belt. So any compartment that's below BBB, bladder, bowel, or bulges, we are taking care of those issues as a urogynecologist.

SPEAKER_00 19:32

Okay, you later on you have to let me know if you know anyone in my area where I live that I can go see. Otherwise, I'm gonna have to meet. You're on a plane, airplane come to see you in Maryland. I'm just saying. You could be um, I was talking to a couple of women and somebody also mentioned um, since we're still talking about self-treatment, um, Pilates. Oh, yoga, does that help? Do those do they help?

SPEAKER_02 19:59

Yeah, absolutely. In fact, if if a lot of my patients are too busy, like you know, if you told me in my life where I had to go uh to see a pelvic floor physical therapist, I couldn't do it. Like I don't have time. Uh so doing Pilates and yoga is almost the equivalent of some pelvic floor exercises because you are working on your core, core floor, back door that really is learning how to strengthen that sort of trifecta to keep things supported and helping maintain your balance and posture, I think is even equally as important when you're talking about getting older and trying to make sure you're navigating to the bathroom without a fall or a trip.

SPEAKER_00 20:44

Yes, yes, poor us. My mother once said, you know, I told I said years ago, and the dementia was coming on, and I said, Mom, because she had a you know a a toward, you know, upbringing, she grew up growing up in Mississippi. And I'm like, mom, you have to write a book. And she's like, You think so? I said, Yeah, mom, but by this time she was like um 88 or somewhere, 89. And I said, Okay, I said, What? I said, we need a title. What are we gonna call it? What are we gonna call it? She's like, and she had still gray eyes. She looked at me, she's like, Aging is hell. I'm like, mom, well, you know, she used to also tell me, just keep on when I would ask her questions, she would she would always say, just keep on living, just keep on living. And mom, now you can yeah, okay, all right, we could be here all day. We could go live. Okay, now now we talked about you know the self-uh help kind of stuff you could do, you know, the um the cagles, the you know, Pilates and stuff like that. Right. I want to talk about medications. What's on the market today? How do they work? I'm I'm here in suppositories, types of creams you rub it in, and uh tell us what's up with that.

SPEAKER_02 21:55

So it depends on the type of incontinence, generally speaking, for stress and The first sort of way to address it is the exercises. Um, but medications really don't have a role in stress incontinence. Uh, it it is to it tends to be more for overactive bladder, okay? And I I I like to joke with patients, I like to say things that make them remember. So overactive bladder is a lot of fun. Frequency, urgency, and nighttime urination. If you have that frequency, urgency, and nighttime urination, and are you dry fun or are you wet fun? You leak on yourself or not? That's overactive bladder. That is a category where medications really probably has the best impact. And we're talking about OAB drugs, drugs like Detrol, Ditropan, um, the some of the new ones on TV that you'll see, Myrbetric, uh, Gem Tessa, though there are a lot of different varieties, and most of them really focus on making the bladder either relax or decrease the spasms to give you a lot more time to get to the restroom. Those medications can be fairly effective, but some have side effects, right? Some categories will cause dry mouth, dry eyes, and unfortunately, constipation. Others can affect your blood pressure. So we we try to find the right one, but you know it ain't up to me, right? It's up to your insurance company. That's a sad, sad reality.

SPEAKER_00 23:30

Don't get me started on that. Unless you get on Medicare. Oh, sorry.

SPEAKER_02 23:36

Right. Well, what a lot of people don't know is that if the medications are either um not as effective or or they have side effects, you can actually start looking at Botox. So Botox that was my next question. Yay, Botox.

SPEAKER_00 23:52

Okay, let's talk about Botox in the Vijay J.

SPEAKER_02 23:55

All right. So Botox can be in the vagina for pain, but we use it in the bladder to calm it down. So think about it. When you inject it in your face, you're doing it to relax the wrinkles, to kind of soften things. It does the same thing in the muscle of the bladder, it relaxes it, so it gives you a lot more time and more storage capacity. The beauty of Botox is that there aren't a lot of systemic side effects. You're not going to get dry mouth, dry eyes, or constipation related to it. The key is we use a set amount so that we don't overdo it because you don't the worst thing than leaking on yourself is not being able to pee. Okay. You're either having to catheterize yourself, and that that's not something that we want to run to. So we keep our doses really low. Now, usually most people will have one to two doses per year, and that can be in the office now. It doesn't have to be under anesthesia.

SPEAKER_00 24:57

Okay, that here again, your chock full of information. Oh my goodness, Miss Vagina Whisperer. Okay, now I know this is serious. Now, can you also get surgery for this? And what does that entail? And you know, I know I think you can get surgery for you know, fixing, you know, tighten up the Vijay J, you know, and show like that.

SPEAKER_02 25:21

So let's let's differentiate because there are a couple different types of procedures. I'm gonna share some information. I hope it's okay with your listeners to tell the truth about myself because I'm over 50 now. Um, one of the things that I, you know, went into urogynecology was my appreciation and love for surgery and anatomy and that sort of thing. And when we first started, we were doing very large incisions on the abdomen, like a C-section. Then I went to training and we did laparoscopic procedures. So I was my the first fellow in my my uh um training in uh Boston at Harvard. And when we first started, we were doing laparoscopic procedures, little belly button procedures. But now, and what we've done in the last 20 years is go through the vagina and make a small incision, only big enough for my finger, to put a little strap of material under the urethra, like a little hammock, and that can support the urethra and keep you from leaking when you laugh, cough, or sneeze. And they're very reliable, fairly quick to do, limited recovery time. So we like them because it's much more even um cost effective. You know, if you think about how many pads do you go through, how much, how many dry cleanings do you have? What do you have to do in terms of paying for your incontinence? If you add that up over time, sometimes even just doing surgery earlier, especially when most women wait years and years and years before they do anything, that's the key. Um, but uh uh I'm gonna throw in the other area where incontinence may not be detrimental but bothersome, just like annoying. You know, you're you occasionally will leak, you're occasionally having problems. There are some newer techniques with uh energy-based therapies using using a laser or radio frequency to help treat the tissue. Now, what it does is if the equivalent is think about when you fry an egg, you don't change the egg, but you denature the protein. You change it from a liquid form to a firm form. When you heat tissue, you tighten collagen, but you also send a signal to the body that I've been injured. So I'm gonna send in more collagen, I'm gonna send in more blood vessels, I'm gonna send in growth factors to help you recover from this injury that you cause. And so that's sort of the thought process around early stage leakage that you could potentially have some impact with some of these newer therapies. And there's a lot of newer studies that are gonna happen over the next few years to really document this. Okay.

SPEAKER_00 28:08

Now, when you say early stage, you mean like all of a sudden you're doing it now, and it's like, what the hell? So that's an early stage.

SPEAKER_02 28:16

Well, I would say early stage is, you know, I've got um a lot of young moms who they've got toddlers at home and they occasionally, like maybe once a week, twice a month. You know, they're it's not detrimental that they have to wear a pad every time, but it's not predictable. And that's that that's a problem that I think a lot of people have is that when they can't predict when it's gonna happen, so they can either prepare with a pad, that makes it really challenging. You know, nobody wants to be in the middle of sex and all of a sudden they start leaking, right? Oh my gosh, that happens. Yes, it can happen. When sex, oh my gosh. But I would say just blame your partner, they won't know. That that there you go. Blame the book, blame it on the boogie. And and going back to the surgery, what's the name of that surgery? So there is uh the general category is a sling, a mid-urethral sling. Okay. Um, what I talked about with our mutual friend or or the altistling, A-L-T-I-S, um, which is basically a mini sling. So it goes in through one incision, and instead of having exit points, it gets anchored into tissue or structures to help hold it in place. And it's adjustable so that you, you know, it's not one size fits all. You try to tighten it in response to how bad the leakage is, and you stop when you're when you corrected the leakage. So you can do that as an outpatient procedure, meaning you don't have to stay overnight in the hospital, and most patients can go back to their normal activities pretty quickly.

SPEAKER_00 29:53

Oh, okay. Here again, that is good to know. Um let's see the surgery, that, that, that. All right.

SPEAKER_02 30:02

I want to the other thing that I was gonna just say is that you know, there's there's um the the one thing that we didn't talk about are pessaries and and um it so pessaries are a device, right? Like you remember diaphragms back in the day? Yes, I never have one, but I remember them, yes. Okay, so a a pessary is like an industrial strength diaphragm, it's thicker, they come in different shapes and sizes, they basically fold and are placed inside of the vagina and essentially lift up parts of the vagina that are either falling or leaking. And so if somebody doesn't have time, not a good candidate, or doesn't want surgery, a pessary is a really good. So I I kind of explain it like a vaginal tampon. It's a good way for you, you insert it, you remove it. I don't have to do it, but if you can't do it, we leave them in for a length of time. Okay, who knew? So let's say if your mom is and I don't know if she's still is she still alive? No, I wish four or five years now, yes. All right, but she was having incontinence. She said, I just don't want to go under anesthesia. I'm nervous about not waking up if I have it. A pestery is a really great intervention because that way it would cut down on some of the leakage. We could leave that device in there, they would come in four times a year to be checked just to make sure it's in the right place and space, and it has a very low risk of side effects.

SPEAKER_00 31:41

Okay, I like that. Here again, you better get some insurance, everybody. Keep your insurance. Oh my god, just yes. Um, you know what? But and before we go on to my next question, I want to um read something to you. Um, because I asked a couple of a couple of women about uh urinary incontinence, and this one lady was saying she doesn't have it anymore. And she says, Um, I'm not sure what happened to make that issue go away from me, but I think overall black better kidney bladder health definitely must have helped. She says, I took a lot of supplements for kidney and bladder. Um, I'm not sure if it was connected to several UTIs, but when those cleared up, she didn't have urinary incontinence anymore.

SPEAKER_02 32:26

What's up with that? So, again, just trying to clarify what kind of incontinence she had, because that's an important distinction. Um, but it just in terms relative to the supplements, one of the things that happens is that if you start to correct the what we refer to as the microbiome, that's those are the bacteria, those are the community of bacteria that live in your bladder, vagina, and valve. If you change the pH and make it unfriendly for certain bacteria, you can change the stability of the bladder. There's newer studies that are coming out about that. I think the other question is did the did the the the young lady start to lose weight in response to be taking care of herself a little bit better, you know. When we start doing supplements, are we also doing other things in terms of lifestyle that might be helpful? Um, is she doing more exercises? Is she walking more? Is she becoming more active? You know, I don't think it's one answer. Oftentimes it's the collective. As a you know, I also say for risk factors, it's not usually one thing that has caused the incontinence, it's one hit, then two hits, then three hits, and then you're down, right? And it's not usually you're all of a sudden bad, it's progressive over time.

SPEAKER_00 33:49

And then the medications, as you get older, you know, a lot of women will get high blood pressure, and then one of the prescribed prescribed medicines is a water pill. Yep, you got it.

SPEAKER_02 33:58

You got it, and so I often will hear the primary cares have told their patients to take their water pills at night, right? But you know, you want to wake up how many times, you know, in order to empty your bladder. So it it becomes sometimes a struggle, and that's why a good relationship between your providers is really important. I I think one of the things that has been beneficial with um electronic records is that I can talk to my colleagues a lot easier when I'm we have the same patient patient. Like I want to be able to say to my colleague who's taking care of my patient, hey, I would like to switch your water pill to daytime. What do you think about that? You know, I don't want to have to make a phone call and wait for it. I want to just send an email or a text.

SPEAKER_00 34:50

Yes. And and that's the beauty of being in the same system where with all your doctors, because they do, they share the records. And I love that. Love that. Now, and speaking of um providers, when is it time to see your doctor about this? And does it matter what kind of doctor we see? I know we've talked about that earlier.

SPEAKER_02 35:08

I think anytime you're bothered, they should be told. Anytime you have a problem that you're um changing your life and lifestyle, you need to talk to somebody about it. And it doesn't matter if it's a physician, a nurse practitioner, or a PA, talk to them. It doesn't matter what specialty, talk to them. Because the key is they can initially start some things that don't require a specialist. I think seeing a specialist comes becomes much more important when you're thinking about surgical intervention or when you're complicated, right? Like you've already had a lot of different things done, you've got not one problem, but more than one, like prolapse and incontinence. And I know we can talk about that, but those are things that come together very commonly.

SPEAKER_00 36:00

Yeah, that that that sounds for me. I think I ran across that prolapse. Um, when you mention that. Um, now that's pretty common.

SPEAKER_02 36:09

One in three women will have some, one in three women will have some form of a pelvic floor disorder, which is either urinary incontinence, bowel issues, constipation or fecal incontinence, or prolapse. The pelvic organs are bulging or dropping into places.

SPEAKER_00 36:28

Right, that's what it we, yes. I ran across that, yeah. In in my research, uh, because I love I love doing research. Um, okay, wow, so much good information. Now, you know how you know the deal. Um, I want to talk about when you're out and about, you know, you're at the mall or whatever. You know, it helps to know before you go, right? You you want to pinpoint those things. And there was a quote out it's like you know you're getting old when you're going out, and the first thing you do is you look around to see where the nearest bathroom is.

SPEAKER_02 37:00

There's a term for it, it's called bathroom mapping. Oh, bathroom mapping. I like that. Yep. It's just like when you are that person where you're like, okay, where are all the bathrooms located? And or you're going to the same route and you know the bathrooms along that location. That that that tells you there's a little issue, there's an issue.

SPEAKER_00 37:23

And and and on the sidebar, if you're on a road, you know, on vacation or your road trip, of course, men could just pull over and just yeah, and that's it, and uh keep on rolling. That's right. Literally, not us blessed women. All right, now uh who told me uh there's an app, right? So that was the next question. Yeah, when you mentioned the bathroom mapping, yeah. Um, I I just I ran across that so my research that there are bathroom locator apps, there's more than one. I think there are like five or six out there. This sounds like a good plan to me.

SPEAKER_02 37:57

I think it's a great idea just to find out, like, and I, you know, I wonder if some of the apps tell you how you know, if you rate the bathrooms, because you know, I I used to do a lot of medical mission work, and so I and now say it I've peed and pooped in the most interesting places in you in the world. But but it would be nice to know the cleanliness, you know, the accessibility. It's like a Tesla station. How many are available? You know, is it one?

SPEAKER_00 38:31

Exactly. Exactly. Because when you gotta go, you know, you gotta go.

SPEAKER_02 38:36

You don't want to have to keep looking around. I you know, I've suffered that I made the Uber driver pull over once and say, I gotta go. I can't say you won't have to stop. Unless you want me to bring you your car, you will stop.

SPEAKER_00 38:50

See, that makes sense to me. That makes sense to me. And going back to what you said about raiding bathrooms, I started, I guess like two or three years ago, I started taking pictures and stuff in inside the stalls. I'm like, now now how does this look? We're in our bathroom, you know, for women, we're squatting, and then we have to try to maneuver this big thing with the toilet tissue. That's why I have to get my tissue in advance, you know. It's like, and I'm always like, and can we have every bathroom just push the door out instead of coming in?

SPEAKER_02 39:17

Right, it's not asking for too much, just it's not asking for too much, and you know, so the the one of the the things that I find interesting for women is um, and you you made a point that uh there almost needs to be a green book for bathrooms, totally, totally, but um when you sit down, your sort of hygiene and posture allow the labia to separate and you to change relax your pelvic floor optimally when you're standing. Sometimes our tissue gets in the way, right? Our labia, you know, are covering it up, and so the stream deviates, it can run down your leg and the toilet. Yes, that's women we catch it, we catch it, but I'm sorry, go ahead. Right, so you're really trying to use like um and having a good strong pelvic floor so that you can separate your legs wide enough to get the labia apart, right? And then be able to squat far enough to allow the urine to flow so it doesn't hit your legs. Because imagine if you have back or hip issues, right? You can't do that very well. You can't get low enough.

SPEAKER_00 40:43

That does yeah, yeah. That's why I said more women need to be in the field of designing the bathrooms and you know the stalls and all of that, because yeah, it is what it is. And I have a group, the Ages Cafe, which is a field that's our chat, the chat room for Ages Clamber Girls. And and we did a squats challenge once. It's like, and I'm always stressing it's like you gotta squat if you can. I mean, because because we have to squat constantly. Yes, we have to squat, so you better try to keep all of that in check. But now, when you talked about the bathroom, um, you know, finding a bathroom, and I want to know is there something psychologically about this? When you're at home or it doesn't matter if you're at home or you know, out and about, and you have to go, and then because I'm looking at right now, I'm looking at the the room where the closest bathroom is, and you know, and and sometimes you jump up and the closer you get, it's like a science fiction movie, the closer you get, it seems like the further away the bathroom moves, and and the closer you get to the bathroom, the harder it gets to hold it.

SPEAKER_02 41:48

Yes, is that psychological or combination of events? So, you know, I hear people as and we call it key in the door incontinence. As soon as you get that key in the door, ah, you know, you start that dance. And so some some people will call home, get the door open for me, and don't let anybody be in the bathroom because I'm on my way and I'm gonna have I'm coming in hot.

SPEAKER_00 42:11

I'm right, right, right, right, and and you know what, and and that reminds me, if you see if you're out at the airport and you see someone in um the ladies' room in the stall and they're standing really close to this to the door in their stall and their feet are facing the door. That's me because it's like I've gotten in the bathroom and then I have to just stand there before I can do, you know, yeah, okay, I'm here, I'm here, and I have to calm myself down and take deep breaths.

SPEAKER_02 42:37

Perfect, perfect segue because those that's one of the things that our pelvic floor physical therapists do a really good job of teaching patients relaxation techniques to distract that bladder, to retrain it. The bladder is trainable, it just starts to act up as we get older due to menopause and hormone changes, to chronic issues with again um either orthopedic or neurological problems. And so by learning to relax the pelvic floor, take deep breaths, sometimes even just um uh doing a kegel will suppress the urge. Oh, okay. Yeah, so that's why physical therapy can be extremely helpful to just learn some techniques. It may not take your incontinence away, but if it brings it down to the level where it is uh functional, where you can actually do the things you need to do and get into the bathroom without it running down your leg, it's worthwhile.

SPEAKER_00 43:38

You know what? That's an excellent point. I've never thought of that. I don't know anyone who's thought about that. To go to physical therapy to learn some of the moves, some of the things you can do. That is a great point.

SPEAKER_02 43:49

And it's usually covered by your insurance, regardless of what you have. Most people, even if they're on um Medicare, will have up to 20 sessions. A year. So you don't need 20 sessions of pelvic floor physical therapy. If you do the exercises well and they can teach you some techniques, you probably go three, four, five times, and you're good. At least you learn some habits and some techniques to help mitigate some of the symptoms that you described.

SPEAKER_00 44:17

Okay. I love that. And also when you're out and about, it helps to just you know, carry some extra pads around, uh, just in case. And one of a friend of mine told me she keeps extra clothes in her car.

SPEAKER_02 44:29

It's the unfortunate reality that I think some people do that because that they've I'm gonna say this, no judgment. I think as a woman, we have a tendency to be more kind to the people we care for than kind to ourselves. And so most women will neglect their own symptoms for years and ignore them to the point where they get fairly severe symptoms, right? And then it makes it harder to fix. So my encouragement is you're the guardian of your galaxy. Own it. If you're starting to have symptoms, complain about them. Don't wait until they get so bad that you have to do something.

SPEAKER_00 45:22

That's right. That's an excellent point. Excellent point. And um, yeah, and I want to just touch on one more thing. Well, twice. Um, the paths. We talked about the paths and stuff, but you know, with the surge of the older population comes a surge in the sales of pads, disposable incontinence uh products. Um, but then they were I read where a lot of people are relying on paths, and instead of getting treatment, they just wear the pads, wear the paths, wear the pads. And and so that connects to what you just said. Take care of yourself, find out what's happening.

SPEAKER_02 45:57

So, how many people do you know who've had a hip replacement? A ton. Quite a few. How many people you know had a knee replacement? A ton. How many people you know had cataract surgery? A ton. The rate of people having surgery for incontinence is about one percent. It's significantly underutilized when the ease and the ability to do it with limited side effects by the right doc is so much easier than getting your hip or knee replaced. So I'm I'm I'm just trying to encourage us. Stop thinking of these problems as just little minor issues that you have to live with. Ask the questions early so you can figure out you don't have to do anything right away, but start figuring out what the options are so that you can plan it and format it at the right time for you. Right, right.

SPEAKER_00 46:56

That that is so true. Because at least we we're armed with information today. Within my mother's time, I would go visit her and she she took the water pill and we would hit the streets whenever you know. I go to town, and she would take her water pill, and then and then as soon as we hit the house, as soon as we hit the door, she would stand up by the door and she would squeeze her knees together really tightly, and then she would start walking to the bathroom. And I used to call it the Tinkle Dance, aka mom's dance. And it's now I get it. As you get older, you got to do whatever you have to do, but to your point, get in, get in to see what's going on. And um, and and that reminds me all of all this. I used to love wearing jumpsuits back in the day. Are you kidding me? That's an extra 20 minutes. And who's gonna hold up that that public bathroom? Who's gonna hold it up for me?

SPEAKER_02 47:47

No, you got it. Like you got a choice. You either wear a jumpsuit and don't drink anything, or you wear regular clothes and then you can you you can have what you want, but that that combination of drinking and jumpsuits, mm-mm.

SPEAKER_00 48:04

I tell you, um, Dr. Watson, this has been so good. I uh I learned so much, even though with my research, I learned so much just hearing it from a doctor.

SPEAKER_02 48:14

Thank you.

SPEAKER_00 48:14

You're amazing, you're amazing.

SPEAKER_02 48:17

Well, I love what I do. I I joke and I say, you know, I wasn't uh this is not not necessarily something that I felt like Jesus said, go be a Euro gynecologist, but it's my ministry.

SPEAKER_00 48:28

I love that. And it shows and it shows that you love what you do. It really, really does. Um, thank you so so much for coming on the podcast. We really appreciate that.

SPEAKER_02 48:39

Thank you for having me. This has been great. Uh, this I love that you're talking to women over 50. I think we have finally started uh opening it up to say that you know you don't have to age in silence, uh, that you can still be glamorous and age, right? So it's just a beautiful thing that you're doing. So thank you for helping one vagina at a time.

SPEAKER_00 49:03

Okay, I was about to get serious, but I love that. I love that. Okay, this is why she's called the vagina whisperer. Uh, we've been talking with Dr. Brianna Walton. She's a specialist in female medicine and pelvic reconstructive surgery. She's owner of the Center for Feminine Wellness and Surgery in White Plains, Maryland. I'm booking, booking a ticket. Um, thanks so much for coming on the show. And I'm gonna include all of her contact information, her social media, you know, all of that in the podcast description. Oh my goodness, thank you. Thank you.

SPEAKER_02 49:40

Thank you. It was a great time. I look forward to talking to you again.

SPEAKER_00 49:43

Yeah, maybe next time we'll have to um, you know, break and win in in public.

SPEAKER_02 49:48

Oh, yeah. I got a funny story about that. Okay.

SPEAKER_00 49:55

Okay. All right. You've been listening to the Ageless Glamour Girls podcast where we talk all things aging on this wonderful, transformative journey. Please don't forget to subscribe to um our show, and we're available wherever you get your podcasts. Um, we we got we house the video versions on the Ageless Glamour Girls YouTube channel. And um, you can subscribe to us there as well. Now, if you want to join the conversation, be a guest on our show, email us at info at ageless glamourgirls.com. Again, that's info at ageless glamourgirls.com. And we recently started rolling out our ageless Arthur's book series. So if you write your first book over 50, come on the show. We want to talk about it. We want to talk about it. And um, also check our private Facebook group. It's called the Ageless Cafe. I mentioned it earlier. Uh, we call that uh the chat arm for Ageless Glamour Girls. We're also on Instagram and other social media um platforms, and don't forget to grab a copy of our new book and anthology, Ageless Glamour Girls Reflections on Aging. These women are aging age from the 50s to the 80s. Um, let us know what you think about it. And you can leave a review on Amazon, um, on the books um you know page. And by the way, we're now collecting names for our second volume, volume two. So if you want to be a part of volume two, email us at info at agelessglamourgirls.com. Again, I'm Marquita Curtis Haynes, founder and CEO of the lifestyle brand, Ageless Glamour Girls, and I'm also the podcast host of the same name. Thanks so much for being with us, everybody. Keep sharing your stories, preferably with us. But you know, just keep sharing it. There's so and we have so much to share, as you know. Here's the healthy aging and joyful living. We'll see you again real soon. Bye bye for now.