Discussing the aging process for women with Jane Harrison-Hohner R.N., R.N.P.

By Jane Harrison-Hohner
WebMD Live Events Transcript

Jane Harrison-Hohner R.N., R.N.P. joins us for a discussion on what to expect as your body and mind age. The process, the pitfalls and the peaks.

The opinions expressed herein are the guests' alone and have not been reviewed by a WebMD physician. If you have questions about your health, you should consult your personal physician. This event is meant for informational purposes only.

Moderator: Welcome to WebMD Live. Today's discussion is on the Aging Process for Women, with Jane Harrison-Hohner. Harrison-Hohner, RN, RNP, is a nurse practitioner who has worked as a women's health care specialist for 15 years. Today she will discuss what occurs as the body and mind age -- both pitfalls and peaks. 

The advice provided by Jane Harrison-Hohner is hers and hers alone and does not necessarily reflect that of WebMD. If you have any medical questions about your health, you should consult with your personal physician. This event is meant for informational purposes only.

Moderator: Hello and welcome, Jane, to the program it's a pleasure having you here with us

Harrison-Hohner: Good day, everyone. 

While we are waiting for other questions to be asked, let's begin with some questions already received about treatment options for female urinary incontinence. One woman has asked about Detrol, the heavily advertised treatment for incontinence. As the sufferer of urinary incontinence, perhaps the most important thing you can do is to get a correct diagnosis. We know 15 to 30 percent of older women who are not in nursing homes or other facilities have incontinence. But did you know that incontinence is a problem for 9.5 percnet of younger women aged 15-35?! This is a common problem for many women and, too often, they delay getting a correct diagnosis. 

The most common type of incontinence is stress incontinence (SI). The symptoms of SI are a loss of urine with coughing, laughing, sneezing, lifting a heavy object, anything that increases pressure waves transmitted down through the abdomen. Causes for SI can be things like having a number of vaginal births, being post partum, having a prolonged second stage of labor ("pushing"). Some women who have never had these common risk factors get SI, often with the hormonal changes that cause a lower estrogen level (e.g., menopause, breastfeeding). SI can be treated by the woman herself using the Kegel exercises to strengthen the muscles around the bladder neck. 

Moderator: What about for the younger women who haven't experienced births and have urinary incontinence (sudden feeling of having to urinate)?

Harrison-Hohner: Moderator, what you are describing is the second most common type of incontinence -- called detrussor instability (DI). While SI is an anatomical or structural problem -- the neck of the bladder loses it's angle so the urine runs out easily, DI is more of a neurological problem, like overactive bladder, or spastic bladder, as some women describe it. Instead of being triggered by cough/laugh/sneeze, DI happens when the bladder starts to contract inappropriately, for example, when you start to wet yourself while you are trying to get to the bathroom or are trying to get your pants down.. Some women report this sudden urge to void as soon as they are at the front door of their house trying to get the key into the lock! In some ways, DI is worse to have because you may not have a warning like knowing when you are going to sneeze, so you cross your legs! DI can be treated by a trial of "freeze and squeeze." Stop. Pull up tightly on the vaginal opening muscles. While this technique helps SI by trying to re-establish a less open exit for the urine, for DI, this technique stops errant bladder contractions, too.

DebbieDavis_WebMD: I am 32 and I think I have DI. It happens randomly, like if I'm in a movie and I worry about having to get up and go, sure enough, within a little while, I'll feel like I have to. It seems like it's psychological.

Harrison-Hohner: Debbie, you have made an important discovery! Yes, DI does have more of a neuro-psychological cause than the structural problem with SI. That's why for some women, self treatment of DI involves some retraining of the urges. Freeze and squeeze doesn't change the amount of urine in your bladder (which often isn't that much!) Additionally, some foods and drinks are noted to worsen DI.. A partial list might include caffeine, carbonated drinks, artificial sweeteners (oh no - diet pop), alcohol, fruit juices or things with high acid content, and more. Debbie, you could start with lifestyle stuff and if that didn't work, then you could be a candidate for the anti-spasm medications -- of which Detrol is just one of the most recent. By contrast, if SI isn't helped with muscle strengthening (and you can get a physical therapist who is trained in this specialty who can prescribe a machine with a vaginal wand that stimulates your muscles while you watch TV). Then your best bet is evaluation for surgery. DI is not to be treated surgically!!!

DebbieDavis_WebMD: (For DI) Is there any prescription or non drug remedies that help? Or should I do Kegels, too, and if so how many / how often?

Harrison-Hohner: Great questions. Kegels are the most helpful if you do three sets of 10 "long strongs" per day. Some researchers recommend that you should do them in a variety of positions, some standing up, some sitting, and some lying down. Other researchers say you should mix them with "quick flicks." The most important thing is to do them. Lets talk about herbs, prescription meds, etc., for DI. As far as I know, there are no herbs that have been tested for DI in a medical type study. However, a common OTC drug (Sudafed) can be used by healthy women for brief treatment of SI. More often DI women, if they have failed diet and freeze/squeeze will be tried on an antispasmodic, like Detrol.

DebbieDavis_WebMD: What is Detrol and what form does it come in?

Harrison-Hohner: Detrol, Deb, (2 mg 2x per day) stops bladder urgency and frequency, assuming you don't have a concurrent bladder infection too, but dampening down the bladder nerve hyper-reactivity. Side effects can include dry mouth, constipation, dry eyes, headache or upset stomach. If you're thinking to yourself, "That sounds like some of the older antidepressants side effects," you have made a correct assumption. While Detrol is NOT an antidepressant,  many of the older antidepressants like Elavil (amytriptyline) or Imipramine can be used at bedtime for DI control through the day.

A question was asked about the bladder's nervous system in DI. Amazingly, men and women have somewhat different nerve patterns in their urethras! The nerves that stimulate the bladder to contract usually only fire off when the bladder stretch receptors are sending the message that the bladder is as full as a large water balloon.. With DI it's different. Even if there is only a minimal amount of urine in the bladder, either a bladder irritant like a diet soda or the sound of water running, or your brain thinking I wonder if there is a bathroom near, can cause the bladder nerves to start to contract so that you feel that you have to go right now!

Another question has been raised; any more about incontinence?

cab501_MSN: I just had a hysterectomy and am in menopause what can I expect? There was some problem with my urethras during surgery. I had an IVP. It was ok. Could this be the reason I want to go so often?

Harrison-Hohner: What a terrific question. You have a number of factors at work. The first is hysterectomy (hyst). When the uterus is removed, some of the support for the bladder can be lost. Often the surgeon may do a "repair" to try to "re-angle' the bladder neck to avoid SI.. Sometimes this is not judged to be necessary. If your ovaries were removed with your uterus, you are definitely menopausal (as compared when the uterus alone is removed and the ovaries remain --  your period stops, but your ovaries are still working for the present.) If you are truly menopausal by age or ovary removal, then lack of estrogen to feed the cells of the urethra and bladder neck are gone. In addition, if there was a "problem with your ureters during surgery," then you may have had a catheter after surgery, which could predispose you to a post-op bladder infection or slight delay in return to your normal voiding pattern. If this continues, return to your GYN person or seek evaluation with a "urogynecologist."

cab501_MSN: Comments on HRT (Hormone Replacement Therapy) - my mother has breast cancer I did for only three days.

Harrison-Hohner: Question on HRT from a woman who's mom had breast cancer. This is a dilemma for many of us. What data is available suggests is that there may be an increased risk for your own breast cancer, even if you don't take HRT. One of the main problems is that most of the big, good studies we have to answer your question are based on women who chose to take HRT -- and many women with moms/sisters with breast cancer want to avoid HRT as there might be an additive risk. I believe that all women need to be informed that there is a modest risk of breast cancer in current users, but that the risk begins to rise with greater than 3 to 4 years of HRT use and 4 to 5 years of ERT (Estrogen Replacement Therapy) use. Let's plan to talk more about the newest breast cancer data with HRT and how that should direct our own decisions..

Moderator: We are almost out of time. Do you have any closing comments?

Harrison-Hohner: Thanks to all for their contributions; please continue to bring your important questions for all of us the learn and share. Yours, Jane

Moderator: Unfortunately we are out of time. It's time to wrap up today's discussion with Jane Harrison-Hohner. Thank you to Ms. Harrison-Hohner for being a guest speaker. You were wonderful as always. It was a pleasure having you back on again. 

The advice provided by Jane Harrison-Hohner is hers and hers alone and does not necessarily reflect that of WebMD. If you have any medical questions about your health, you should consult with your personal physician. This event is meant for informational purposes only.

Take care everyone and have a great day.

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