Here are five things I would never do as a urogynecologist.

There’s a trend right now on TicTok of medical professionals listing the five things they would never do, given their education, knowledge, and experience.  I’m jumping on the bandwagon!  Here are the five things I would never do as a urogynecologist:

1. Smoke-

Smoking increases your risk of bladder leaking and bladder cancer.  This means that smokers leak more than women who don’t smoke.  And if you need surgery, smokers are more likely to have complications and heal poorly.  This means that women who smoke are more likely to leak and less likely to have good results from surgery.

This may not seem fair, but the data is very clear.  So clear, in fact, that we recommend women stop smoking at least four weeks before surgery- this improves the results.  Some insurances even require that a woman quits smoking before they will approve surgery.  This is all because the increased risk of complications results in more expensive treatment.

But most women aren’t aware of these additional risks of smoking.  We really aren’t just nagging you about a bad habit- smoking is bad for your body.  Smoking makes for an unhappy bladder. (read more here about smoking and the bladder: https://www.nafc.org/bhealth-blog/how-smoking-contributes-to-incontinence and here about smoking and surgical complications https://apps.who.int/iris/bitstream/handle/10665/330485/9789240000360-eng.pdf

2. Assume your symptoms are because of a bladder infection

Bladder infections often cause pain with peeing, needing to go all the time, needing to go urgently, or just emptying small amounts.  But many other conditions can cause these same symptoms (or at least some of the same symptoms)- pelvic floor muscle pain, interstitial cystitis, or even overactive bladder, to name a few.  You may know your bladder is irritated, but you may not know why.  A bacteria could be causing it, or it could be something else altogether.

This is why checking the urine with a urinalysis or culture is important.  Otherwise, you may be treated with lots of antibiotics which won’t fix the problem.  So, while it is a hassle to get to the office to check your urine, it is important to get the right diagnosis!  This is especially true if you seem to be getting lots of infections and antibiotics aren’t helping- it may be something else!

3. Shame you

You can pretty much tell me anything.  I totally know that no one wants to be in my office talking about the things we talk about.  My whole practice centers on health concerns that no one wants to talk about- prolapse, bladder leaking, vaginal issues, stool leaking.  I’ve heard it before.  I won’t make you feel badly about it.  I know you would rather not be discussing an issue you wish you didn’t have and never thought you would get.  I’m glad you are talking about it.  I want to help you fix it.  I’m definitely not going to make you feel badly about bringing it up.  And I know that talking about these things can be emotional, and I always have tissues on hand.

I want you to feel comfortable when you are talking about your symptoms and what bothers you.  I also want you to be comfortable talking about treatments.  It’s ok if you find the anatomy confusing.  Or if you need me to explain the surgery again.  Or if you aren’t comfortable with surgery.  Medicine can feel complicated.  And you should be confident that your treatment choice is right for you.  I’m looking to help you live your best life and need you to help me figure out how to do it.

4. Ignore lifestyle and diet

We are what we eat.  Lifestyle and diet can have a huge impact on the bladder.  Artificial sweeteners, carbonation, preservatives, spices, caffeine, as well as citrus and tomatoes, can all cause bladder urgency and frequency- that needing to go! feeling.  And these aren’t the only bladder irritants.  Being aware of your personal triggers can solve your bladder issues.  We also know that women who are active, exercise, and have a normal weight are less likely to leak, which is one more reason to eat a little less and exercise a little more.

It is important to take the time to look at your lifestyle and your diet.  This often means keeping a food diary or exercise diary.  While this may seem like a tedious exercise, most of us don’t really think about the little things we do every day and how they impact our bodies.  So this exercise can provide a wealth of information. (ES Lucasz JAMA 2017)

5. Tell you bladder leaking is a normal part of aging

Leaking is common.  We estimate that 46% of adult women have stress incontinence.  As we age, leaking is more common.  But that does not mean that you have to accept it.  Just because it is common does not mean it is normal.  When it interferes with your life, it is time to do something about it.  Bladder leaking can be managed, controlled, and cured.  You need to know what the options are and pick what works for you. (https://thewomensbladderdoctor.com/)

JM Wu NEJM 2021