Who should you see for your bladder leaking

Lots of women are confused about who to see for their bladder leaking.  Should you talk to your PCP or your Gynecologist?  Or do you need to see a Urogynecologist, Urologist, or Pelvic Floor Physical Therapist?  The truth is that any of these practitioners should be able to help you get started.  If they aren’t sure of the next step, they should be able to refer you.  I think healthcare works best when you have a trusted relationship with your provider.  If you do, starting this conversation should be easy.  Just remember how common bladder leaking is, and don’t be embarrassed.  In my community, the PCP or gynecologist usually starts the evaluation and management of bladder leaking and then sends the patient to me if the basics don’t help.  But if you are starting from scratch, I have a few rules for you to follow when looking for help.

Don’t see a provider who offers just one thing.

Bladder leaking is complex, and women leak for different reasons.  It is important to know why you leak and what treatments will help.  (check out this post if you need help figuring out why you leak).  There isn’t one treatment that will fix everything.  It is important for your provider to have lots of tools in their toolbelt.  This doesn’t mean you don’t see a physical therapist.  While physical therapy always focuses on the muscles, they offer different things for different conditions.  You might be taught urge suppression for an overactive bladder.  You could learn pelvic floor bracing for stress urinary incontinence.  And relaxation techniques are always taught for a tight pelvic floor.  Physical therapy is always a reasonable choice.  Offering only one procedure to fix all leaking is not a reasonable choice.

Lots of practitioners own and offer only one treatment.  I see this, especially with the emsella chair, vaginal LASERING, and radiofrequency procedures.  These clinics tend to do many procedures offered by one company.  For example, the company that makes the emsella chair also makes the emsculpt and emtone.  Clinics that offer LASER often LASER different parts of the body.  This is true for radiofrequency as well.  You can think of this type of clinic as more of a LASER clinic than an incontinence clinic.  They have a relationship with the company and use their devices.  They aren’t there to assess your leaking.

Why does this matter?  Well, they don’t assess you thoroughly to make sure the treatment is correct for you.  And if the treatment fails, they don’t have any other options for you.  And in this scenario, the treatments are almost never covered by insurance and are expensive- usually in the 1-5 thousand dollar range.

Don’t see a provider who only offers the most aggressive thing.

In general, I think it always makes the most sense to start with conservative treatments and then slowly move towards more aggressive treatments if you need to.  There are lots of exercises, and behavioral changes that can make a huge difference in your bladder leaking (want more info? Check out this post! https://thewomensbladderdoctor.com/lifestylechanges/

).  Think pelvic floor strengthening and weight loss.  Or eliminating your bladder triggers.  These small changes can impact lasting change.  And there aren’t really any risks or side effects.  The worst thing that can happen is the treatment doesn’t work, and you’ve wasted a little time.

Surgeries for stress urinary incontinence are very effective, but they also have more risk than conservative treatments like exercising.  And while most women do well with surgery, some will have complications.  This is always a good thing to keep in mind.  Surgery should be avoided until it is the only option left.

Don’t believe only the marketing.

Marketing is expensive.  Some companies that provide procedures will help with marketing and advertising.  This means that new procedures are often heavily marketed, but older procedures and surgeries are not.  This marketing creates a skewed view of the available treatments and how well they work.  I know that all of those people who create marketing and advertising are really good at their jobs.  They impact how we view the world and create bias.  So be a little skeptical.  Look for information in other places.  See if you can find an article with data.  Look on the Mayo Clinic website or the NIH website.  Or ask your provider.  Or ask me.

I’m not trying to imply that marketing is bad.  But the goal of marketing is to make you desire that one thing.  And it works.  Ideally, everything would be equally marketed, and you could make an objective choice.  But that isn’t really how our world works unless you do a lot of digging and research.

Ask your friends

It is hard to rate providers.  There are reviews, but it is common for only really happy or unhappy people to write reviews, and they may not really reflect the practice.  It is hard to figure out where you really will get quality care.  The best way (although it is not a very scientific way) is to ask your friends.  Lots of women have bladder leaking and have already sought treatment. If you know someone, bonus!  They’ve already done some of the vetting work, and you will be halfway there!

Don’t be afraid to get a second opinion.

There are lots of doctors in the world.  And lots of patients.  Sometimes you meet someone, and it is not a match.  That doesn’t mean that person is not a good doctor. It just means they aren’t the right doctor for you.  So, if it doesn’t feel right, or you don’t like the answer you got, try again.  It is ok, and you won’t hurt anyone’s feelings.  Second opinions are always a good idea.

Use a provider finder.

Different organizations offer provider finders for bladder leaking.  These tools will help you find the right physical therapist, urogynecologist, or urologist.  You feel out some basic info, like your zip code, and you get a list of available providers.  You should make sure that your insurance covers your provider of choice.  I like the finders offered by AUGS

https://www.voicesforpfd.org/find-a-provider/

and NAFC

https://www.nafc.org/find-a-doctor

These are my thoughts on finding a provider.  The most important thing for you to remember, though, is to take that first step!  You can do this!