[Music] it's a condition that can negatively impact a person's quality of life and daily activities like work travel exercise and sleep in this episode of being well I'll talk with Horizon Health's Dr Michael Shanks about the signs of overactive bladder and what you can do to ease those symptoms when Sarah Bush Lincoln opened in 1977 it was with the promise to serve the community's healthc care needs it has grown into a two hospital system with nearly 60 clinics that provide trusted compassionate care for over 50 years Horizon Health has been keeping you and your family healthy and although some things have changed Horizon Health's commitment to meet the Ever Changing needs of our community has remained the same Horizon Health 50 years strong Carl is redefining Healthcare around you innovating new Solutions and offering all levels of care when and where you need it investing in technology and research to optimize Healthcare Carl with Health Alliance is always at the Forefront to help you thrive [Music] thank you for joining us for another episode of being well I'm your host Lacy Spence and today we are welcoming in a new guest to the show all the way from Horizon Health we are welcoming in Dr Michael Shanks welcome to being well thank you for being here today thank you for having me of course we like to let our viewers get to know who they're hearing from and so do you mind telling us a little bit about yourself and how you ended up uh doing what you're doing yeah sure I'm a a urologist that practices at Horizon Health and uh I started my journey uh depal University in Green Castle Indiana and then I went to Chicago uh and trained in Chicago and did my residency there I was raised by my grandfather who had bladder cancer so that always kind of got me interested in uh Urology and naturally um went to medical school and Urology was um where I decided to um specialize fair enough well uh I think a great place to start before we dive into our topic today which is incontinence and overactive bladder um but you mentioned urologist not a lot of people maybe know what that doctor specializes in so can you fill us in yeah a urologist treats disorders of the gendo urinary system um and um takes care of patients that have uh urinary disorders and today I think we'll be talking about urinary incontinence yes that's on the docket uh and so I think we're going to start with overactive bladder so kind of explain what that is yeah so overactive bladder is a sensation of urgency typically overactive bladder causes frequency urgency urinary frequency urgency um the reason that this happens is a um overactivity of this muscle it's a abnormal connection between the bladder and the brain and uh it causes frequency urgency and um a sense of urgency preceding the leakage so there's leakage always associated with this um overaction bladder um and urinary incontinence so I didn't even think about this being connected to the brain so this is kind of also a mental kind of brain game a bit there is some yes there is some uh brain games that happen with urinary incontinence but um it's more of a neurological um you know the the the um signals that are being sent from the bladder to the brain then being sent back down to the bladder are overactive and so that causes an overactive bladder uh which manifests itself with frequency and urgency and so how does this happen does this impact everyone or is there something that you know I'm doing bad bathroom habits no um men women and children actually can be um Afflicted with this however mostly uh we're seeing this in older men and older women uh as we age the bladder ages with us um there's multiple things that contribute to this such as um urinary surgeries um abdominal surgeries um there's some dietary things that can contribute to urinary incontinence um so it's multifactoral there's multiple things that typically contribute to overactive bladder okay so is there a difference um between what we've been talking about overactive bladder and then urinary incontinence there is so there's there's multiple types of urinary incontinence uh the four types of urinary incontinence are um urgency incontinence stress incontinence mix incontinence and then what we call overflow incontinence so overactive bladder and urgency incontinence um go hand inand which is again the sensation the difficult to defer sensations of urgency prior to the leakage and so that's called urgency incontinence uh stress incontinence typically manifests itself with leakage um after what we call Val Salva Maneuvers and Val Salva Maneuvers are anything that increases your intraabdominal pressure coughing laughing sneezing jumping Jacks physical activity going from a sitting to a standing position uh so that's stress incontinence and stress incontinence typically uh is due to uh sphincter deficiency or what we call hypermobile urethra um and third type of incontinence it's mix incontinence so some men and women have a predominance of one there's a predominance of urgency incontinence or a predominance of mix incontinence but there's both they have some urgency but also some stress incontinence and then lastly is um over flow Inc continence and that's typically where the bladder fills to a point where it has to go somewhere either goes up to the kidneys and causes kidney insufficiency or leaks out from below oh no that sounds problematic if it's coming back up is there any symptoms with that or would I know it's happening not always uh if there's a neurologic problem that's contributing to this many times men and women don't know that this is happening um but it can cause some pain some flank pain uh very similar to um kind of kidney stone pain okay so we know to look out for that kind of uh ailment that kind of feeling you had already mentioned that this can impact men women and children uh can you kind of walk us through what does it kind of present like in those different categories typically it's a progressive condition so all of these overactive bladder I deal typically with overactive bladder stress incontinence and mix Inc continents um and so it's usually a progressive condition that happens you know after child birth for a woman for example that causes uh stretching to the pelvic floor muscles and some uh dysfunctional voiding uh and so childbirth pelvic floor um any type of pelvic floor surgeries hysterectomies um any type of procedures that are going to affect the pelvic floor um can result can result in this and so multifactoral meaning multiple things contribute but surgeries aging um being overweight um different types of medications such as diuretics or water pills will cause some frequency in urgency um and then there's some congenital abnormalities that can also contribute I'm sorry that's for is that just for women or both men and women men and women both men and women the difference between men and women is that a man has a prostate and so that prostate results in for lack of better terms of Plumbing problem and uh women do not have that prostate so for women it's um it's we're not dealing with the prostate so there's there's less organs that may be contributing in a man the bladder can contribute the prostate can contribute the sphincter can contribute the ureth can contribute in a woman it's the urethra and the bladder okay gotcha so you're talking a lot about this you know kind of the the wear and tear the age of the body you know impacting older adults um but in children what are we looking for is gosh because if I'm somebody who's maybe potty training my child or something like that I'm not really thinking about oh is this a leakage problem right and in in children usually it's you know it's it's a pathology that's abnormal and so most children are able to after their potty trained are able to hold their urine at appropriate times and uh urinate or volitionally void at appropriate times typically in children it's secondary to urinate tract infections or some kind of anatomic defect um as an adult urologist I I don't deal with a lot of pediatric urinary incontinent so but I do see them initially and get the workup started and then would send them to a pediatric specialist so a lot of times it's it's an anatomic defect that's resulting in um urinary incontinence and a lot of times that's due to a urinary tract infection in in K in kiddos children okay so we're talking about um all of these different facets that you know things are presenting how they're presenting um at what point is it a problem when do I need to talk to my doctor really it becomes a problem when it causes a quality of life issue okay you know and so if that means that you're changing your garments on a regular basis or you have to know where every bathroom in your hometown is um due to this urgency sensation so really when it becomes a quality of life issue and many times that will manifest itself with with symptoms that are concerning and that's why am I going so much why am I urinating so much why am I leaking or why am I not emptying my bladder all the way okay so how do we fix it yeah you know we're talking it aw a lot about how it can be such a pain um as far as your everyday life but I mean I'm sure the folks home want to say okay that's me what do I do next absolutely yeah so as far as treatment for um urinary incontinence there's different treatments for the different types of urinary incontinence so okay starting with overactive bladder or urgency incontinence typically we I talk to patients about dietary and lifestyle modifications right avoid those things that contribute to urinary incontinent such as caffeine alcohol spicy acidic Foods or the bladder irritant so um many folks have urinary issues at night they're getting up frequently at night well if you're drinking coffee and or alcoholic beverages before nighttime or there's a large volume then what goes in must come out and those the caffeine and alcohol act like water pills and so it causes more frequent urgent urination so the first step is to try to uh determine what may be contributing to your urinary symptoms uh and and fix those things and many times it's it's things that we're consuming um and so dietary LIF cell modifications making sure that the the bowel is appropriate and appropriate working order constipation diarrhea can result in urinary symptoms um and uh so avoiding those things again some kind of medication sometimes medications can cause this so dietary and lifestyle modifications if that isn't improving um the urinary incontinence and overactive bladder then we can talk about further conservative options that would be like pelvic floor physical therapy is a very nice option that can uh pelvic floor physical therapist is someone who works with the pelvic floor and uh determines what muscles need to be used to control the bladder and so there's biof feedback that happens there and so that's usually used as an adjunctive therapy alongside dietary and lifestyle modifications then if we're still having quality of life issues we talk about medications and so there are medications for overactive bladder no specific medications for stress incontinence because it's more of an anatomic defect than um than a this is overactive bladder is a muscle defect the bladder muscle which is called the D truser muscle so there are muscle there are um medications that slow that down that decrease frequency decrease urgency decrease leakage many times folks fail medications or they they don't want to take medications so they're too expensive to take these medications they're new medications and insurance won't cover them so in that situation we talk about Advanced therapies for uh overactive bladder Advanced therapies for overactive bladder uh after we failed the dietary lifestyle modifications uh medications are um Botox is an option for men and women that have overactive bladder and it decreases the muscle spasticity um there is uh a procedure that I um provide called um neuromodulation and neuromodulation is uh a small implant that acts like a pacemaker for the bladder so it regulates very similar to a pacemaker for the heart that regulates the heart rate um this is a pacemaker that stimulates the nerves that feed the bladder um to regulate that signal between the bladder bladder and the Brain brain and so it regulates that such that there's some normaly in bladder symptoms this um implant there's the there's a trial period for this implant so we are able to trial the period for a week to ensure that these men and women are going to get 50% Improvement in their urinary symptoms as long as they do then insurance will cover the actual implantation which is a second outpatient both these are outpatient procedures that are done in about 30 to 45 minutes ooo that's a lot to take in lot to take in that is for overactive bladder for stressing stressing continence as we said earlier is usually due to a sphincter deficiency or urethra hypermobility so that urethra is moving within the pelvic floor um and there are traditionally we used to do slings for those women and still slings are um a very nice option in the gold standard um a new kit on the Block is uh a medication that bulks the urethra so the tube is basically coapted so that tube is brought together with a bulking agent that's what we call hydrogel and the hydrogel is a biologic so it's 98% water and it stays in the body for about 7 years and the body resorbs that and they may need to have that that treatment repeated and I'm sorry I've I've not been around the block per se uh a sling what is a sling a sling is uh essentially a hammock for the urethra to uh decrease that urethal hypermobility so it's implanted um in the par urethal tissues which is a fancy way of saying right around the urethra underneath the tissue and it holds the Ure thr okay so if we're feeling that urgency to go can we train our body like in a bad way like by going so much holding the bladder is something that I see on a regular basis especially for us working folks that um you know may not be able to get to the bathroom holding the bladder is something that I always you know recommend to my patients to try to avoid once your bladder tells your brain that you have to urinate it's time to go urinate and holding that bladder causes a stretching of that muscle which is made out of a elastin it's elastin fibers like in our waistband and if that bladder is stretched too much or has an infection on a regular basis any kind of insult to the bladder it can cause the elastin to change the collagen and that bladder will not squeeze collagen's a scar so that bladder will not squeeze as well and so holding the bladder is something that I try to have my patients avoid uh but there is bladder training you can train your bladder to um to kind of mimic your normal bladder function and that would be initially we start with urinating every hour even if you have to even if you don't have to urinate go to the bathroom every hour and then you move that up to every hour and a half the next week every two hours you know and so getting some sense of normaly in our bladder many times that bladder training will be an adjunct of therapy too to help alongside with some of these other treatment options we talked about and I know it's going to be different for everyone you talk about it impacting your quality of life but um is there are you able to give it like a guesstimate of how often you're going um that is like worrisome ideally you know throughout the day every 2 to 3 hours is pretty normal depending on what you're taking in of course the volume what whatever volume you're taking in if there's you know those things that we talked about that cause bladder irritation then that will cause you you know to urinate more frequently medications right lots of folks are on diuretics and medications that cause you to urinate more frequently well we can't avoid that cuz many times that's for fluid in the body that they want to get out and so that needs to get out somehow and then you urinate it out so um as you're start as you're talking about starting at like training yourself starting at an hour so is it anything that's kind of like under that hour mark you should maybe be a little concerned if you're going every half hour absolutely yes that that's not normal physiologic voiding and so any anybody who's urinating you know um multiple times within an hour or multiple times within a few hours ideally you you're urin every 2 to 3 hours and then nighttime ideally we we do our best to get as much sleep as possible it's very important for our longevity it's very important for our overall health um and so ideally zero to zero to one time at night um is is what we prefer it doesn't always happen that way but and our goal is not to result in complete resolution of symptoms but do our best to get you back to a normal quality of life sure well what would you say to somebody who's maybe hesitant to seek help for this maybe it's a little a little embarrassing or they've always heard something like oh you're just getting older oh that's just part of you know you just had a baby something like that I hear that all the time and after we've taken care of these folks um they many times tell me I wish I would have sought you out earlier oh right because you know the the longer you wait the um the the the more concerns that can arise and especially in men with prostates that hold a lot of urine behind that constant um retention of urine can cause chronic bladder damage and that chronic bladder damage doesn't always come back and you know and so we we want to do our best to address whatever problem is causing the void and dysfunction for bladder preservation because we only have one bladder and that bladder muscle is um you know is is very um it can be injured due to Chronic damage yeah over time what other complications can come from putting off this visit putting it off you you know urinary retention is a big one that I see in men inability to urinate so there we have to place catheters and those catheters naturally are are not comfortable for men and um so in that patient population I do my best to counsel them on on really doing something sooner rather than later so that we can preserve this bladder health and we don't get in this situation again and typically that's addressing the prostate um and the bladder those are two organs in men that we address um and so in men and women urinary tract infections recurrent urinary tract infections stagnation of urine that inability to empty the bladder all the time we're having frequency urgency leakage urine is can cause skin breakdown so it can cause breakdown of cause ulcers and um can cause many problems down the line and so typically what I see is urinary retention uh in recurrent urinary tract infections that contribute to kind of overall quality of life and so addressing these symptoms optimizing the health of the bladder optimizing the health of the prostate urethra um are optimal um for the Optimal Health of of these organs and your overall health trying to stay out of the hospital no absolutely so if I'm somebody who um I'm having these issues and I need to I think seek a specialist am I able to directly seek your help do I need to go through a primary care physician first it everybody does a little bit differently but um a referral uh typ what happens is these folks will see their primaries their primary care physicians up front and talk to them about their problems and then from there they'll refer them to me but we do um see patients on a non-referral basis so if there's a problem and you can't get in to see your primary care physician or you just want to seek out a urologist upfront then um I'd be happy to take care of uh those patients but that's typically how it happens either referral or um somebody that that seeks me out without a referral and we're in our last several minutes here um as we are talking about getting these referrals as far as the um pelvic floor therapy are you able to refer for that as well yes okay gotcha so just keep passing on that baton to whoever they need to see that's right and we have a great pelv floor physical therapist at Horizon and she does a really good job and most of my patients that I'm doing these procedures for I'm also sending them to her why because it's we're optimizing bladder health and we're optimizing public floor Health we're optimizing voiding uh function and and men and women and in my experience the longer that we wait to do this the more chronic damage there is I gather this is not a one siiz fits all by any stretch but can you kind of walk me through if I'm somebody who is seeking your help and we're trying these various methods about how long is this process of trying you know trying on the Cinderella slipper to figure out which one fits most men and women have already gone through dietary and lifestyle modifications whether they've been prompted to do that by their primary care or they do it on their own uh and so um that's pretty much out of the way when I first see these patients and so the starting point usually you know is a is a medication um and and then that medication we do a trial of a medication the trial of medication is typically a month month to 6 weeks um if there's no significant Improvement there's multiple types of overactive bladder medication that as you said it's not a one siiz fits all and so we can you know attempt older medications um versus newer medications there's only a few that I try and if those uh in that four to 6 weeks they fail these medications then they're candidates for advanced therapies and so you know ideally we we would address these issues within a few months okay if they fail medications then we're moving on to Advanced therapies all minimally evasive that's by the by the way as well sure all outpatient the uh implant that you were talking about you said that was patient correct yes gotcha um if I'm somebody who has had that uh implanted and say it is working but then I run it into some sort of complications what is something that I would need to call you about and say hey something's something's up if if the leakage change changes in any way if it deteriorates um then typically we the we have it's a multidisiplinary team so we have some we have reps that um have a motherboard computer essentially that can control the settings on this and so we have them reach out to the to the Reps if there's any troubleshooting issues uh and they work through that with them and then if there's any surgical issues than they come to to us um but typically it's a to answer your question it's a deterioration of the symptoms and then we would change the setting on the device and either increase the the power therapeutic dosage to the nerves or decrease that therapeutic dosage that's so Hightech that's very neat it is all right so in our our last minute or so do you have any final thoughts thoughts for our viewers anything that you would like to say to them that um is important for them to know yeah I think it's important for uh you know all patients to know that addressing some of these urinary issues um in a timely manner is important so that we don't result in chronic damage to the bladder uh chronic damage to the other organs that um that make us void on a regular basis um and I'm happy to help uh in any way that I possibly can and to wrap us up any short success story that comes to mind lots of success stories with urinary Inc continents why because it's a pretty um you know it's a procedure these procedures are something that cause an immediate effect and so um multiple that come to mind are folks that have urinary incontinence and bow incontinence and the the neuros stimulator affects both of those so recently had a patient that had dual incontinence B and bladder and we had near resolution of her symptoms and she as happy as she could possibly be and a happy patient makes me happy so absolutely a total game changer for them I'm sure absolutely awesome well Dr Michael Shanks thank you so much for coming on being well we so appreciate your time and knowledge happy to be here thank you of course and we thank our viewers for joining us for this episode we hope you learned something uh we hope you go when you got to go and we hope that you'll join us for our next episode Carl is redefining Health Care around you innovating new Solutions and offering all levels of care when and where you need it investing in technology and research to optimize Healthcare Carl with Health Alliance is always at the Forefront to help you thrive for over 50 years Horizon Health has been keeping you and your family healthy and although some things have changed Horizon Health's commitment to meet the everchanging needs of our community has remained the same Horizon Health 50 years strong when Sarah Bush Lincoln opened in 1977 it was with the promise to serve the community's health care needs it has grown into a two hospital system with nearly 60 clinics that provide trusted Compassionate Care [Music]