1 in 3 Women Live With Incontinence and Most Never Ask for Help | Dr. Rena Malik

0:01This is a Be Well Moment, the most replayed moments from my latest conversation. It's a glimpse into the wider episode, which you can find linked in the show notes below. Because sometimes one small moment is enough to reconnect to living well and being well.

0:22What is urology and what do you think that we need to be paying more attention to in this area? I mean, urology is a great specialty. We're essentially medical and surgical doctors of the genitourinary tract. So anything from the kidneys all the way down to the genitals, we cover it. And so that can be things like kidney stones, tumors, urinary issues, infertility issues, kids with urinary issues. And me, I specialize, as you mentioned earlier, in female pelvic medicine, reconstructive surgery, and sexual medicine. And so those fields essentially encompass things like urinary leakage, prolapse, issues with bladder that's associated with prostate, with nerve conditions, and also any sort of reconstruction of those areas.

1:11And then in sexual medicine, we're talking about ejaculation, arousal, orgasm, those sorts of issues, any issues surrounding that area essentially. And pelvic pain, interstitial cystitis, there's just a whole host of things that we take care of. And I think that, you know, it's a field that people delay seeking care in, right? Like whether it's even a urinary issue, which is embarrassing, right? If you're wetting your pants, you're kind of embarrassed about it, right? They don't come. They delay care for a variety of reasons for a long period of time, which ultimately builds shame, may worsen their condition over time because they're not getting care early when it's easier to treat.

1:56And so, and ultimately, like if you have blood in the urine, that's one thing I will say, people still will delay, but that needs to be evaluated to like rule out cancers. So I think those sorts of things, like, again, people will be like, I'm okay. I see a lot of like young men with lumps in their testicles. I don't see a lot of it, but there are, you know, in the history of my career, I've seen a lot, a few a year where they've delayed seeking care because they have a testicular mass that turns out to be, might be testicular cancer or a penile mass that might be penile cancer. Right. So like those sorts of things, because they're in, you know, very private areas and we're scared about what it could be.

2:33And like my favorite thing is someone comes in for something that's completely benign and I get to tell them like, I'm so glad you came and you don't have anything wrong with you. Right. Because I get to give them that like reassurance. And you might be like, oh, what a waste of a visit. But I just gave them like their life back, right? The anxiety they had about this little thing that's completely benign, not cancerous, not going to hurt them. Now they know that and they can go live their life without anxiety and stress. So like you might think like, oh, that's a waste of time. It's not. It is super important for you to be comfortable living your life and feeling comfortable that nothing's wrong with you.

3:09Completely. And I think I've heard a lot about this. You mentioned kind of like the prostate as well around like men going to get their prostate checked regularly and is that something that you think should be more talked about because I was just googling the stats and what an eight men will be diagnosed with prostate cancer in their lifetime I mean it's a huge thing and I don't think I know many of my male friends in their 30s or 40s are going to get their prostate checked and actually it's something that's really important. So in their 30s and 40s you don't need to unless they have a family history so if you have a family history of prostate cancer or you're African-American or you have other genetic like conditions that are so and you would know that because you had multiple family members with cancer you can get screened early but usually at about 55 is when we start screening for prostate cancer and so that includes usually a blood test like a PSA which is a screening test so you can have a high PSA for a variety of reasons but it sort of tells us okay should we look further into this and rule out cancer and then also a digital rectal exam, which is essentially a finger in the butt where we feel the prostate, make sure we don't feel any nodules.

4:15And it inspires a lot of anxiety in young men, but I would say like, we're used, this is like our job and we do this all day and we make it as comfortable as possible for you. And if you're uncomfortable, we stop, right? We don't have to do it, but it's important to get done because sometimes you can get higher grade, more aggressive prostate cancers. And I think there's a ton of misinformation around like prostate cancer doesn't kill you and you don't need to get checked. And yes, there are low grade cancers that will probably never become a problem and can be watched or observed for some period of time or, you know, getting recurring biopsies.

4:49But then there are higher grade cancers that will get worse and create problems and metastasize. And those are the ones we want to catch. And so I think if you're between the ages of 55 and 69 and of good health absolutely get screened. After about the age of 70, we usually have a discussion with you saying, if you think you're going to live longer than 10 years, and that's a hard discussion to have, then you should continue screening. But if you don't, then you're probably going to die of something else, right? And so it's a kind of assessment of your other healthcare problems, because usually prostate cancer is very slow growing.

5:23Well, okay, so that's interesting. So over the ages of 55, so actually, I've just kind of told off my friends for no reason in this conversation so apologies to anyone in the sessions and quarters that I said that to for me it was something that was really on the kind of topical conversation this year I keep seeing it a lot in the media about men needing to get their prostate checked and I kind of thought it's probably quite important to go and get your MOT but good to know that that's from 55 and within this like is there anything that you really find is important to kind of mention that people should be paying more attention to because obviously, you know, for me getting the most out of this was banishing the shame around sex, sexual health, you know, understanding more about our pelvic floor.

6:02I think it was so isolated to women. I only heard about it in Pilates and from my friends that had babies, but men, I think I asked my partner and he didn't, you know, he didn't really even know how to answer that question. So I think kind of like covering these areas are really important. But for you as a urologist, is there anything else that you think that we really need to be paying more attention to in this area? I would just say that if you feel like there is an issue in any of the areas I talked about, don't delay. But I would say that for women, the one thing I do notice a lot is that people start to think that leakage after having a baby is normal, right?

6:38Like, oh, of course I leaked a little bit when I jumped on the trampoline with my kid. And it is common. It is about one in three women that will experience incontinence, but there are options to treat it. And so if it's bothering you, you can get help. And then in terms of men, I will say, and women too, if you're having issues in the bedroom, we know this better for men because again, there's more studies, but I think it's probably the same for women is if you're having issues with erectile function, or in women's case, like clitoral engorgement and sensation, it can be like a canary in the coal mine we call.

7:13So a sign that there may be heart disease or other cardiovascular conditions because the blood vessels to the genitals are much smaller than the blood vessels to the heart. So if they become blocked for whatever reason, if you have some blockage in your heart, right, the first place you're going to see it is your genitals. And so if you're having issues in the bedroom, see your primary care doctor, get a cardiovascular evaluation. So whatever that may be for you depending on your other risk factors. It can be blood work, it can be an EKG, it can be a stress test. Again, that's all kind of decided by your doctor, but get that evaluation because it can be very important.

7:50It could save your life. Thank you for listening to this Be Well Moment. If it resonated, the full conversation is linked in the show notes. And I hope it gave you a small pause to take a moment for you and to reconnect to living well and being well. If you loved it, please do leave a review follow the show or share this maybe with someone you love