Bonnie Blair
Biography

Dennis Miller, MD
Biography

	What is a urogynecologist? Can your partner feel the mesh when you are having sex? Isn't leaking just an inevitable part of getting older?

U.S. speed skater Bonnie Blair was one of the fastest women on ice. But after giving birth, she was slowed down by a common post-childbirth condition -- stress urinary incontinence (SUI), the leaking of urine during day-to-day activities. Blair and her doctor, urogynecologist Dennis P. Miller, MD, joined us on Jan. 13, 2005, to chat about Bonnie's experience and discuss treatment options for SUI.

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, Bonnie and Dr. Miller.

MILLER:
Thanks for having us.

BONNIE:
Ditto.

MODERATOR:
Bonnie, please tell us how you discovered that you had stress urinary incontinence (SUI)?

BONNIE:
About two months after I had my first child I wanted to get back to my active lifestyle. I went for a run and got about a half a block and my shorts were soaked. It was embarrassing; it was disheartening; it was frustrating. And I thought, is this something normal that happens after you have a child? It took me a couple of months before I discussed the situation with my husband and about a year before I brought it up with a doctor.

MILLER:
Bonnie's story is so typical, which is why we're happy to have someone people respect so much come forward and tell her story. Women, on average, will suffer the condition three to ten years before talking to their doctor or even their husband about it, and they end up suffering in silence.

Bonnie: "I thought, is this something normal that happens after you have a child?"

MEMBER QUESTION:
Bonnie, I understand your reluctance to talk about this problem. What finally changed your mind about talking to the doctor?

BONNIE:
When I went to my doctor's visit I believe it was more her asking me, do you have a problem, and with leaking of urine. She had known that I had had a difficult delivery with my first child and that's why I had switched doctors to begin with. It was really something more she brought up to me and then I kind of let it all out, and was then freer to talk about it.

MEMBER QUESTION:
What is a urogynecologist? Do I have to see one or can I see my gynecologist or should I see my family doctor for leaking?

MILLER:
That's a good question, and it depends on whether you ever discussed it with a physician before. A urogynecologist is a physician who specializes in problems that fall between gynecology and urology, notably, incontinence and prolapse, problems specific to women. It never hurts to first discuss it with your primary care provider; however, it is often treated by a specialist.

BONNIE:
My normal OB doctor sent me to Dr. Miller who then performed the surgery on me.

MODERATOR:
Bonnie, what did your doctor recommend as a first treatment?

BONNIE:
I think first you have to realize that you need to make the decision you're done having children before having the surgery. Since I had only had one child, even though my doctor discussed surgery with me at that visit, the year after I had my child, I knew I still wanted more children. So at that time I tried doing what they call pelvic floor exercises; I tried weights and electrical stimulation, and really gained little or no ground. Then we decided, because now I had had my two children, and my husband and I knew we were done having kids, that it was time for surgery. I had the surgery a year ago December. And I have been symptom free ever since.

MODERATOR:
Doctor Miller, can you please explain "weights" and "electrical stimulation?"

MILLER:
There are several conservative options, particularly for people with mild problems or who cannot currently have surgical treatment. Electrical stimulation is a small device placed in the vagina to assist at the exercise. Cone weights are less commonly used but are tampon-shaped weighted devices placed in the vagina that reflexively cause the pelvic floor muscles to contract. Used 15 to 30 minutes per day, they are just another way of improving the success of the pelvic floor exercise.

MEMBER QUESTION:
Is the Kegel method effective alone or do you have to use it with biofeedback?

MILLER:
That's another good question. Kegel exercises have been widely used since 1949. They're not harmful and may be of small benefit. My experience has been that for people with significant bladder problems they are very unlikely to be successful as a sole treatment. We are much more likely to recommend a biofeedback program or a highly successful, minimally invasive surgical procedure, known as TVT. TVT stands for tension-free vaginal tape (by GYNACARE).

MEMBER QUESTION:
What other pelvic floor exercises are there?

MILLER:
In addition to simple Kegel exercises, there is a physical therapy program that can go by the name biofeedback or pelvic floor rehab (all of which mean the same thing). That involves exercising multiple groups of the pelvic floor muscles, and is taught and reinforced by a specially trained bladder therapist. The exercises in a pelvic floor rehab program work better because you're using modern principles of exercise physiology: sets, reps, targeted exercises by a specially trained therapist.

You can find these programs through most hospitals or most independent therapy centers. However, it will ultimately require a physician's order for you to participate in the program.

MODERATOR:
Bonnie, it's great that you were able to have the surgery and that it went so well. But you said you couldn't have it until you were done having children. What did you do between your first and second child?

BONNIE:
Between my first and second child and after my second child was when I was doing the biofeedback, the weights, the electrical stimulation and gaining little to no ground and discussing with my husband that we were done having children, we realized it was time to have surgery.

The opinions expressed herein are the guests' alone and have not been reviewed by a WebMD physician.