A Kookum Has an Embarrassing Question

Housecall with Dr. Denise
urban NDN -July 2008 - issue 2

This month I'm sharing more health questions I've come across and my responses. If you have any health-related questions, please feel free to contact me at the information below.

My Kookum has been complaining of leaking pee when she coughs, laughs, or sneezes. She is too embarrassed to see the doctor. Why is this happening, and what can she do?

Stress incontinence (the loss of urine due to an increase in pressure in the tummy) is more common in women. Weakness in the pelvis muscles (eg due to childbirth, abdominal obesity--overweight in the tummy) and thinning of the bladder and vaginal muscles and tissues from the decrease in estrogen after menopause are often contributing factors. Urge incontinence is leakage due to inability to delay peeing when an urge is felt. Causes include bladder wall hyperactivity and neurological disorders such as Parkinson’s Disease and stroke. Overflow incontinence involves leakage due to an over-distended bladder usually from blocked urine outlet (eg. enlarged prostate) or neurological causes (eg. multiple sclerosis, diabetes affecting the nerves). Functional incontinence is caused by the inability to get to a toilet such as due to physical constraints (eg restricted mobility), mental factors (eg. dementia, depression), and environmental barriers (eg. distance to toilet, positioning).

Her doctor should rule out problems like a urinary tract infection or a problem with the nerves controlling the bladder muscles. Some things she can do include: decreasing caffeine intake; addressing any bowel problems like constipation; limiting fluid intake—1.5-2 L/d is considered appropriate; losing weight; quitting smoking; watching high-impact physical activities; avoiding some types of medications (check with her doctor) like diuretics, some blood pressure and depression drugs, and alcohol; and improving mobility & accessibility to toilets. When secondary causes have been ruled out or treated, she can try pelvic floor muscle training (aka Kegels): do a minimum of 30-45 pelvic floor muscle contractions (goal of 10 seconds for each contraction); done in 2 or 3 sets; may take 6-8 weeks to see results. To contract the pelvic floor muscle, instruct her to pee, and while she’s peeing, she should squeeze her pelvic muscles to stop the flow of pee. Biofeedback and/or electrical stimulation therapy can teach her to isolate and control these muscles if she is not having any luck. If the problem is severe, her doc might refer her to a gynecologist/urologist who could confirm the diagnosis and possibly book her for surgery. Another option is wearing pads/ “Depends” to catch the leak. Depending on the cause, there are some medications her doctor can prescribe to help manage her symptoms. There are different treatments available for men who have difficulty with stress incontinence after having prostate surgery—check with their urologist.

I have a new sexual partner who told me to get checked for STD’s, even though I feel fine. What is involved in an STD screen, and when should someone get checked?

A common misperception is that no symptoms, means no STI (sexually-transmitted infections). This is far from the truth, and is a huge reason for the continued spread of STIs. Get tested when: you have unprotected (no condom) sex, you have a new partner, you are worried about it, you are experiencing any symptoms such as discharge, pelvic pain/burning, lumps, bumps, sores, unusual vaginal bleeding, or fertility concerns. Many people choose to get tested regularly, such as every 6 months, or with their annual physical exam. A typical screen can include blood tests for HIV (anonymous and requires your consent), Hepatitis B, Syphilis, and Herpes Simplex (although some docs don’t check for herpes because it is so common, and can’t be cured—however there are medications that can decrease the duration and intensity of recurrences as well as the likelihood of spreading the infection). Gonorrhea and Chlamydia can be checked in two ways: 1) a pee test or 2) a swab. For women, this is a swab of the inside of the cervix (opening of the uterus) requiring the insertion of a speculum typically used in Pap tests. For men, this requires a swab of the urethra/inside the penis. If you are uncomfortable with the swab tests, you can get the pee test instead, keeping in mind that these tests are not as sensitive as the swabs. It’s way better to get tested than not—for treatment and relief from easily treatable infections, management with improved outcome of the non-curable ones, prevention of spread, and peace of mind. Tests for Genital Warts are more specialized and seldom performed (extremely common and difficult to treat), but often a doctor can recognize them on examination. Tests for vaginal infections (not necessarily sexually-transmitted) such as yeast, trichomonas, and bacterial vaginosis are usually reserved for women with symptoms.