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I was recently interviewed by Emily Barclay, Founder of the Perimenopause Hub.
The following is the transcript of this interview where we discuss how perimenopause and menopause affects both bladder and pelvic health in women going through these transitions.
I recently chatted with Susan Farrell, about how a woman’s bladder and pelvic health are affected during perimenopause, menopause and beyond.
Welcome Susan to the Perimenopause Hub. Would you kindly introduce yourself to our audience?
Hi Emily, and thank you for having me on the Perimenopause Hub to address women’s issues which are near and dear to my heart.
I’m a board-certified nurse practitioner, a continence specialist and a certified health coach.
I’ve also had additional training on biofeedback evaluation and treatment for bladder and bowel disorders, as well as pelvic floor disorders with a focus on complex pelvic floor cases.
And I’ve been honored to serve on the Project Advisory Council for the National Association for Continence here in the USA.
In my clinical practice I focused on common bladder control problems in women.
I’ve transitioned my clinical practice to essentially a virtual nurse health coaching practice where by using my evidence-based holistic health coaching method, I guide women with embarrassing bladder control problems to empower themselves to take back control of their bladder and life by helping them to create their own Your Healthy Bladder Solutions ProgramTM .
Since the Perimenopause Hub has an international audience, would you tell us what is a nurse practitioner?
Yes, of course. Here in the USA, I have a Master of Science degree in Nursing and I am licensed as an Advanced Practice Registered Nurse.
I have advanced clinical training beyond my initial professional registered nurse (RN) preparation. I'm also board-certified as a Gerontological Nurse Practitioner.
What sets nurse practitioners apart from other health care providers is our unique emphasis on the health and well-being of the whole person.
With a focus on health promotion, disease prevention, health education and counseling, nurse practitioners guide patients in making smarter health and lifestyle choices, which in turn can lower patients' out-of-pocket costs.
As far as the actual practice, this may vary from state to state, but overall a nurse practitioner may practice autonomously and in collaboration with health care professionals.
Nurse practitioners provide a full range of primary, acute and specialty health care services, including:
Ordering, performing and interpreting diagnostic tests such as lab work and x-rays.
Diagnosing and treating acute and chronic conditions such as diabetes, high blood pressure, infections and injuries.
Prescribing medications and other treatments.
Managing patients' overall care.
Educating patients on disease prevention and positive health and lifestyle choices.
How common are bladder control problems in women?
Great question Emily and I’d like to paint the picture of magnitude of this common women’s health problem.
There is a stigma surrounding bladder control problems in women. And it creates a silence among both women and health care professionals.
If urinary incontinence were a country, it would be the third largest in the world behind India and China.
This is a huge health problem that is severely under-reported.
Many women don’t ask for help from health professionals and many health professionals don’t ask women if they are having bladder control problems.
Wow, that's a lot of people. I never would've imagined this many.
Yes, and women are three times more likely to suffer from urinary incontinence than men.
Worldwide estimates are that urinary incontinence affects about 423 million people over the age of 20. This affects women about 303 million women and 121 million men
Of the 25 -30 million adult Americans suffering from some form of urinary incontinence, almost 75% of those are women.
One in four women over the age of 18 experience episodes of leaking urine involuntarily. This number increases for women in their 40s, 50s and 60s
Between the ages of 18 and 44, approximately 24% of women experience incontinence.
Some estimates report that 43% of 50- to 64-year-old women suffer from incontinence. And for women 65 and older, this number is estimated to be over 50%.
And these numbers are likely to be even higher than reported.
On average, women wait about seven years before they seek professional help for their bladder control problems. But over 50% and possibly up to 75% never seek professional help.
Many women simply rely on coping strategies like using pads, wearing special underwear, limiting fluid consumption and wearing dark clothing to disguise signs of leakage.
Then they start a cycle of withdrawing from social interactions. And once a woman stops socializing, it's easy to see how the withdrawal can lead to depression.
Her bladder control problems start to control her life now.
Urinary incontinence leads to lower self-esteem, impaired well-being, and reduced sexuality compared to women without incontinence.
This affects relationships with their partner, family and friends, work.
Urinary incontinence affects all aspects of a woman’s life. In many ways this is a disability.
Why is it that women don’t seek help for this common problem?
Embarrassment, shame, denial and fear are probably the main drivers. Loss of control.
The stigma of bladder control problems in women results in silence. This runs so deep.
Women hide this from their closest friends.
The denial is that women often think of urinary incontinence associated with older, frail women.
But many women are still very active in their lives with work and families and friends, so they don’t relate to this.
It’s very difficult for women to accept that this is happening to them.
And many believe that the bladder control problems won’t get worse. But it will and it does, it won’t just go away.
Women begin to develop their own coping mechanisms and will actually change their lifestyle to compensate living with embarrassing bladder control problems.
Women keep moving their personal goalposts on how much they are willing to accept living with their bladder control problems.
As I mentioned before, many women do not even bring this up with their health professional.
Many women are afraid that medications or surgery are only option. Many are misinformed about the causes and the treatments available.
And way too many women are losing the freedom to live life on their terms because of common, and often reversible, bladder control problems.
If the bladder control problems are not reversible, they can definitely be managed better.
How does perimenopause and menopause contribute to bladder control and urinary incontinence problems?
Let’s look at the changes that happen as we age.
Our bladder muscle ages and this decreases the bladder's capacity to store urine, as well as the inability to completely empty.
There’s a decrease in urethral resistance pressure. The urethra is not staying closed like it’s supposed to, and this is what we see with stress incontinence, in addition to a relaxed pelvic floor.
And involuntary bladder contractions are more frequent as we get older.
Pregnancy and vaginal childbirth also contribute to bladder control problems that begin to appear during perimenopause and menopause.
Fluctuating hormone levels occur during perimenopause and menopause, especially a decline in estrogen levels.
There’s not a defined start to perimenopause or a smooth transition into menopause.
We use a term in menopause called Genitourinary Syndrome of Menopause (GSM).
Genitourinary refers to a woman’s genital and urinary systems.
Declining estrogen levels play a critical role in both bladder and pelvic health.
The bladder and urethra (tissues) are highly responsive to the presence of estrogen.
Estrogen helps keep the lining of the bladder and urethra healthy.
As shown in this illustration, the darker the color, the more estrogen responsive.
(Diagram courtesy of Chronic UTI Info)
As women produce less estrogen, this causes deterioration of these tissues, and this can lead to urinary incontinence or bladder control problems.
The same goes for the vagina being estrogen responsive.
Declining estrogen levels contribute to vaginal dryness, burning, irritation and decreased lubrication with sexual activity.
The common urinary symptoms that women experience are frequency and dysuria which is pain or discomfort when urinating.
This is also the time when women are at increased risk for urinary tract infections.
We often see women starting to develop bladder control symptoms such as urge, with and without urine leaks, and leaking urine when they do activities such as coughing, sneezing, lifting something or laughing during perimenopause and menopause.
It’s a sad day when women feel they need to control their laughing for fear of bladder leaks. Deep belly laughs, either by yourself or with friends, are very healthy.
Think about how good you feel after a deep belly laugh.
Women don’t need to live like this. There are so many options available to help them with their bladder control problems.
Wow, this all sounds overwhelming, never knew this was such a serious and overlooked problem. How difficult is it to treat or manage bladder control problems?
Yes, I know this looks overwhelming to many and you’re probably thinking that your perimenopause, menopause and beyond years are going to be pretty bleak.
But it’s really not once you break this down into small steps. It’s like figuring out a puzzle.
And there are many things you can do to be proactive and address your bladder control problems early on.
I’ll share with you some resources where women can get information and start developing their own healthy bladder program.
Depending your situation, you may be able to start with some self-care management.
If you have pain, bleeding, a urinary tract or vaginal infection, or any other medical concerns, please see an appropriate licensed health professional first.
A good place to start for yourself and to help give a clearer picture of your situation if you should ever seek the help of a licensed health professional is to start a journal or what is sometimes called a bladder diary.
This can be done across three to seven days. Mix it up to include days where your activities vary such as the weekend. Three days is a good number to start with.
Write down the times you eat or drink, what you consumed, and then also note when you have your bladder control problems.
Then look for patterns and triggers. You can eliminate certain foods or drinks that you suspect may be contributing to your problems.
You can learn behavioral techniques such as “quick flicks” to resist the urges like when you’re putting the key into the door lock and you feel that intense urge to get to the bathroom right away, or when you hear or put your hands in running water.
You can learn how to support your pelvic floor when you need to sneeze, cough or lift something if you have stress incontinence. This is commonly known as “The Knack” where you squeeze up and hold.
This one is important to know in general for all women when you’re doing any movement exercises that increases abdominal pressure and puts pressure on the pelvic floor.
Such as?
Movements that involves jumping, squatting, lifting.
This includes typical exercises as well as some yoga poses. You want to brace and protect your pelvic floor. This is important for all women, not just perimenopausal or menopausal women.
There are even strategies for runners.
You can develop your own voiding strategies using bladder retraining techniques.
And you can also start doing pelvic floor muscle exercises commonly known as Kegels.
Pelvic floor muscle exercises are helpful for stress incontinence and urge with and without bladder leaks (overactive bladder) or a mix of any of these.
I’ve heard women say they often don’t know if they are doing these exercises correctly, or they’re difficult to do or they just can’t or don’t want to go to a pelvic floor therapist just yet. Is this a common concern from women?
Yes, definitely. This is something I often hear in my nurse health coaching practice.
I’m a proponent of pelvic floor muscle exercises for stress and urge incontinence and overactive bladder, when appropriate.
Pelvic floor muscle exercises are considered a first-line treatment option meaning this is what is suggested to women to try first. This is a non-invasive treatment as opposed to taking medications or surgery or getting Botox injections into the bladder.
You can try to do them on your own but many women cannot do the exercises correctly or consistently. It can be difficult isolating the correct muscles to squeeze or relax.
Even when a woman does go to a pelvic floor physical therapist to learn how to do these exercises, the appointments are usually spaced a week apart so she often forgets how to do them when she gets home.
Or she just cannot take time off to go to these appointments once a week for 6, 8 or even 12 weeks.
Even when biofeedback is offered, this is where the woman is given visual feedback of how well she is or isn’t contracting and relaxing her pelvic floor muscles, this does not always solve this issue.
Even with clinical guidance, women have difficulty performing the Kegels correctly.
So, then women do not return to the pelvic floor therapist or their physician because they feel frustrated and defeated because they think that "the Kegels don't work for me."
So, these pelvic floor muscles exercises are recommended to women, yet they seem to be difficult to do correctly, even when they go to a pelvic floor physical therapist, so what are women supposed to do then?
Yes, this a big problem. And many women are desperate to get their bladder control problems back under control and yet because of these issues, they feel like they’ve “failed.”
This is very demotivating and contributes even more to the feelings of depression, low self-image and self-worth that she may already be experiencing.
I’ve created a Facebook group specifically for women wanting to focus on how to get their best possible healthy bladder, pelvic floor and self.
And while Kegels are important part of pelvic floor health, getting a healthy bladder and pelvic floor is more than just doing Kegels!
One of the solutions we discuss is the use of an FDA approved medical device that you can purchase from a company. It comes with a 60-day money back guarantee.**
And in the USA, it’s Health Savings Account (HSA) eligible. It’s also available for international shipping.
It’s an electrical stimulation and neuromuscular re-education medical device that rehabilitates weak pelvic floor muscles and it’s used for the treatment of stress, urge and mixed incontinence.
It’s also used to maintain urinary incontinence in women.
It takes the guesswork out of doing pelvic floor muscle exercises correctly and consistently.
Seriously? This medical device does the pelvic floor muscle exercises for you?
Yes seriously. Your pelvic floor muscle exercises are done for you correctly and consistently. You can use this device when you’re sitting on the sofa watching TV or reading a book. It’s that’s simple and discreet.
I’m trained in pelvic floor therapy, and I did this in my clinical practice, but I personally use this device.
There are six programs that you can select from and they go through a series of contractions and rest times.
This is an FDA approved medical device with clinically proven results. This is not a cheap, imported sex toy. For many women this means no more pads, drugs or pills.
This sounds exciting!
It is Emily. Having a device like this helps women to empower themselves to take back control of their bladder and life.
This device can be used on your own, in between visits with your pelvic floor physical therapist and as part of your long-term maintenance plan.
There’s information posted about this device, the discount coupon and how to join my Facebook group on my Healthy Bladder Solutions for Women website.
I need to mention that it’s a woman’s personal decision as to whether to start pelvic floor muscle exercises on her own or to see an appropriate licensed health professional first.
It’s important to know that you have options. Many options.
Wait, you need to do these exercises forever?
Well, yes.
As we age, our muscles change, our muscle strength decreases and this happens to our pelvic floor muscles.
Doing the pelvic floor muscle exercises helps to combat the effects of our aging pelvic floor muscles.
I know, I know, many women don’t want to hear or think about this. But this is a reality that will catch up with many women sooner or later.
Because having your best possible healthy bladder and pelvic floor involves continuing these exercises to maintain as much function as possible for as many years as possible.
So yes, this does require a commitment but think of the consequences if you don’t make this commitment to yourself.
We already make space in our lives for our what we consider our important commitments.
We use creams on our face daily, we get our hair cut and sometimes colored, we brush our teeth with toothpaste every day, wash our hair, all practices that require a commitment. And many of these are long-term commitments.
Healthy bladder and pelvic floor practices should be part of our daily routine and a long-term commitment.
Would you tell us about the Your Healthy Bladder Solutions Program that you mentioned earlier?
My private nurse health coaching is a holistic practice meaning I take a mind – body - spirit approach to healing.
I help guide women to empower themselves to take back control of their bladder and life from embarrassing bladder control problems.
As a holistic nurse health coach, I meet the woman wherever she, that’s our starting point, we address the woman’s ambivalence to change first and then together we create a plan.
What is ambivalence to change?
Women are being pulled in two opposite directions. They have a wish to change and fear of changing.
During perimenopause and menopause, it’s a wild ride with all of the fluctuating hormones, hot flushes, mood swings, and the physical, mental, social changes that women go through.
The ability to seek out and take in the necessary knowledge and the power to translate that into self-care behaviors gets altered. There’s a loss of control.
They want to change, they know they need to change, but something is stopping them from taking the necessary actions to change.
I saw this in my own clinical practice and it’s one of the reasons I transitioned to health coaching.
There are many women, who for whatever their reasons, just could not make the necessary changes to get back their best possible healthy bladder and self.
Was it their lack of motivation? Did they not have the knowledge to understand the importance of making changes? Why wouldn’t they want to do everything possible to stop their bladder control problems?
I began to realize that as a healer that in order to help women heal and makes changes, I needed to meet them where they are, and understand them within their social context.
As a nurse health coach, I act as a change agent.
I help women recognize their ambivalence to change and guide them to make space for their transformation, but the power to make these changes lies solely within them.
Guiding women to empower themselves, would you expand on this a bit?
I find that women with chronic health conditions, and bladder control problems are considered a chronic health condition, have been disempowered not only because they feel a loss of control over their body, their bladder and life, but also from their encounters with health professionals and the healthcare system.
When it comes to bladder control problems, I deep dive into the possible factors causing or contributing to the problems.
Women are genuinely surprised at how much power they actually have in initiating actions to start taking back control of their bladder, life and health.
This has been a real eye-opener Susan, thanks for being here on the Perimenopause Hub. Do you have any final comments or suggestions for our audience?
Yes, and thank you Emily for talking with me today on this important women’s health issue.
Know that you don’t need to suffer in silence from bladder control problems.
Bladder control problems are common but they are not normal.
Many common bladder control problems can be reversed or properly managed.
Early interventions are key.
And the earlier you start taking care of your bladder and pelvic floor, the better your success in preventing, reversing and stopping bladder control problems.
Empower yourself with knowledge.
Knowledge is power and the Perimenopause Hub is a testimony to this. Emily you provide such valuable information from the many experts you’ve gathered together.
Take an active role in decision making with your healthcare provider. Seek out another if you’re not satisfied with the care.
Believe in yourself. Believe in your strength. Be your own advocate. Don’t give up hope.
I’ll be posting the contact info and resources Susan mentioned below.
Healthy Bladder Solutions for Women website
Information about the pelvic floor muscle exerciser device YARLAP ** can be found HERE
