#53: Urinary Incontinence: Tips and strategies to stay dry.

The Curbsiders Internal Medicine Podcast

Health & Fitness, Medicine, Science, Higher Education, Education

4.8 • 3.1K Ratings

🗓️ 21 August 2017

⏱️ 59 minutes

🔗️ Recording | iTunes | RSS

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Summary

Get control of urinary incontinence with tips from Internist and Women’s Health Specialist, Dr. Molly Heublein, Assistant Clinical Professor of Medicine at UCSF. This is a must listen if you’re still uncomfortable managing urinary incontinence. We learn nonpharmacologic strategies like pelvic floor muscle therapy, bladder training, timed voiding, foods to avoid, and run through the available medical therapies, their efficacy and side effects. Plus, a brief review of next line therapies like percutaneous tibial nerve stimulation, and botox injections for overactive bladder.

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Case: 79 yo F with at least 10 years of urinary urgency with occasional loss of small amounts of urine and rare full bladder emptying. She drinks 1 cup of coffee every morning and about 2-3 glasses of water per day. She tries to minimize liquids due to her incontinence. She has HTN and takes HCTZ. Has been on oxybutynin for 10 years and wants to try something else.

Time Stamps

00:00 Intro

01:06 Listener feedback

02:43 Announcements

03:43 Picks of the week

09:07 Getting to know our guest

14:27 Case of urinary incontinence (UI)

15:30 Epidemiology of UI

16:34 Screening for UI

17:30 The 3IQ Questionnaire

18:44 Additional testing in UI

21:23 Classifying UI

24:00 Nonpharmacologic therapy for UI

32:42 Effectiveness of pharmacologic versus nonpharmacologic therapy

34:50 Case continued. Changing medications

37:42 Mirabegron as an alternative to anticholinergics

40:18 More options for stress UI management

41:40 Next line therapies for urge UI, overactive bladder

44:38 Surgery for stress urinary incontinence

45:50 Botox therapy for urge UI, overactive bladder

48:30 Do we need any more fancy diagnostic tests?

50:30 Take home points

55:05 Stuart schools us on urinary incontinence in men and timing of BPH meds

56:40 Outro

Tags: urinary, urine, incontinence, urge, stress, mixed, bladder, training, kegels, pelvic, floor, muscle, therapy, anticholinergic, botox, assistant, care, educ

Transcript

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0:00.0	I was going to segue for you. Go ahead. I think you're capable of a segue. I'm not so sure.
0:07.2	I think you wanted to continue on your case there, Matt. Okay. Yes, Dr. Hori-Line.
0:18.4	Gosh, Stewart. Yeah. I'm glad we keep you around. You keep it very interesting.
0:30.0	Welcome back to the Curve Siders, the internal medicine podcast that uses expert interviews to
0:39.3	bring you clinical perils. Hello, Matt. And practice changing knowledge. I'm Dr. Matthew Wato,
0:44.1	here with my co-host, Dr. Stewart Brigham. You totally ignored me when I interrupted you just now.
0:49.7	And Dr. Paul Williams. Hi, here you go. Hi, Stewart. Hi, Paul. That's the fourth time.
0:57.0	I'm just still counting. Okay. Stewart, how about some listener feedback?
1:06.2	How about some listener feedback? It says, well, we've got one here. It's from an unidentified
1:11.4	listener. I assume they want to make an anonymous because it was from, oh, well, I don't know. We'll
1:16.0	find out. It says, fantastic interview. I would recommend announcing topics in advance so listeners
1:22.3	can submit questions for experts. The hosts can pick the most interesting questions to be answered
1:28.4	on air. And I have to admit, actually, after reading this, I just realized that I posted that
1:33.4	on my Facebook feed and forgot to look and see what questions they had for tonight.
1:37.8	Perfect. I forgot to remind you as well. We're terrible at this. Yeah. But I did, I think that's
1:45.9	a great suggestion. So we, we're going to try to make an effort, probably 24 to 48 hours ahead
1:52.5	of time to kind of say which topics we have coming up. And people can, people can leave them. So
2:00.5	just go to our Facebook page, the curbsiders, internal medicine podcast. We have a Facebook page,
2:06.8	and you can leave your questions there, or you can look for Stewart's post, which comes out
2:10.6	usually with, you know, sporadically within 24 hours of the recording. And we'll cheerfully ignore
2:16.5	those questions 24 hours. I just looked at the questions that are posted on Facebook. Were they
2:22.0	any of the questions we answered? No, it's ridiculous. It says, I pee a little on my underwear every
	...

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