A Heart That Beats for Home

49. The Bladder Battle: Real Talk Around the Fear of a Cough or a Sneeze.

• Nikki Smith • Season 2

Share episode

We would love to hear from you! Text us any feedback.

Urinary incontinence is a challenge many women face but often shy away from discussing. As someone who has personally experienced the impact of this condition, I take you through my journey of trying various treatments to regain control over my life. From the initial frustration of leakage during everyday activities to discovering the role fascia plays in pelvic health, this episode shares my candid exploration of solutions—from Kegel exercises to pelvic floor therapy—that might resonate with many of you who are navigating similar paths.

Our conversation takes a deep dive into the decision-making process behind considering surgical options. With the guidance of Abraham R. Shashoua, M.D., a renowned urogynecologist, I faced the tough choice of undergoing a traditional bladder sling procedure. This segment delves into the emotional and practical considerations of opting for surgery after non-invasive methods proved insufficient. The aim is to provide insight and support for those weighing similar medical interventions, highlighting both the challenges and potential outcomes.

The journey to overcoming bladder incontinence does not end with surgery. As menopause introduced new factors into the equation, I share my transformative experience with a Bulkamid procedure. This episode underscores the importance of understanding hormonal changes and their impact on women's health. By recounting my positive results and the support I received, I hope to empower other women to seek solutions and foster a community where we can openly discuss and address these issues. Let’s work together to spread awareness and share knowledge, making the journey for others a bit easier.

You can find Dr. Shashoua here:
https://www.chicagourogynecologist.com/about-our-doctors/abraham-r-shashoua-m-d/

Learn more about Bulkamid:
https://www.bulkamid.com/




JOIN ME ON SOCIAL MEDIA:
Follow Along @ - https://www.instagram.com/nikkicronksmith/

Speaker 1:

Hey friends, I'm Nikki Smith, your host here at A Heart that Beats for Home, the podcast where we're ditching filters and diving headfirst into the raw beauty of all things home. Now, I am no expert when it comes to this whole parenting and marriage dance. I'm simply a gal who's been riding the mom roller coaster for 22 years and a wife still untangling the mystery of it all 25 years after saying I do. My goal is to bring you unapologetically messy and boldly genuine conversations about cultivating strong families. We're gonna laugh, possibly cry, and straight talk about the joy and chaos that comes within the four walls that we call home. No judgment and certainly no perfection, just real talk from my heart, a heart that beats for home. Let's dive in. Hello friends, welcome back to another week here at A Heart that Beats For Home, happy to have you here with us for another episode. Today I am just going to kind of be going off script and just sharing a personal story with you that I have talked a little bit about on social media and have gotten several comments, several people reaching out for more information, and I will tell you this is a weird space social media, the podcast trying to decide how much of personal life you put forward, how much of it you keep more as generalizations. No-transcript, exact same way, but nobody is really talking about it. And so I just feel really passionately that part of my mission is to be authentic and transparent, and this is one to me that seems like a no-brainer to chat about, and I know that, if you're listening, maybe this is so far out of realm for you, but you probably know somebody who struggles with this Maybe it's for your mom or your girlfriend. But just want to dive in and talk a little bit today about a recent procedure that I had back in November for some bladder issues, and I'm going to just kind of walk you through what that process was, what kind of led up to it, the different choices that I was presented with for treatment, and then the results that I have had and why I am just so excited and want to be able to share this with so many people. So I'm going to take you back.

Speaker 1:

You know, several years for a lot of us who have had children. We always, you know, we laugh and we joke that. You know your girlfriend who can't do the jumping jacks or who can't jump on the trampoline or who gets to laugh in too hard or sneezes and crosses her legs because of urine incontinence. And I know there's nothing beautiful about that, it's not a fun thing to have to admit to, but I think it's always just kind of been accepted as this is just part of what happens to our bodies as we have children and as we get older, and I know that there is a population that doesn't struggle with this at all. And to you I say you have been showered down from heaven with blessings on your bladder, and then there are all different extremes of those of us that do deal with some level of bladder leakage.

Speaker 1:

And so I started to notice this not too far after I was done having my children. It was the very basic what you would consider. You know, quick cross your legs if you get laughing super hard or if you sneeze. And I just watched it start to progress over the last 5 years into something that seemed to be interfering with my daily life way more than I wanted it to. It became a total annoyance. It became something that I was very aware of, that really was impacting a lot of my life, and started to dig into what were some of my options and so for, of course a lot of us right. You, you research on the internet and they're like here's what you do, you got to do your Kegel exercises. So I spent probably a decade on and off doing Kegel exercises, thinking that was going to strengthen my pelvic floor and it was going to take care of all of those issues. That did not help. Then I moved into going to pelvic floor therapy. After meeting with my gynecologist and urologist, kind of decided that you know, pelvic floor therapy was probably a good option for me and so went through a pretty intensive I think it was like 24 sessions an hour each of just trying to work through physical therapy to see if that would give me some relief and kind of a lot of the focus in that was just learning that, the way the body works and fascia.

Speaker 1:

If you're not familiar with fascia, I'm a big kind of geek on fascia right now, researching it a lot and using different tools to break down fascia on your body all over. Fascia wraps from the bottom of your feet all the way to the top of your head. It can create a lot of tension. It can create a lot of other issues and in pelvic floor therapy they were explaining to me that if you have really tight fascia and fascia, if you've ever taken a raw whole chicken and you've pulled that skin back from the chicken and there's kind of the fibers that are between the muscle and the skin that would be similar to the fascia in our bodies. And as that fascia gets really really tight, it impacts so many things and it pulls and it twists and it can get caught up. And one of the reasons that people can have an increase in urine incontinence is if your fascia is super tight, it actually how it crosses through your body, it kind of goes across your pelvic floor and can actually tilt your pelvic floor to not be in the correct position. And they are explaining to me that if we can really work on loosening up that fascia, that if your pelvic floor kind of drops back into where it's supposed to be, that hopefully some of this issue will go away.

Speaker 1:

And so I was super committed to about 24 sessions of pelvic floor therapy where they specifically, you know I had in my mind, I had an idea of what pelvic floor therapy would be and it was none of that. It was like breaking down fascia in my legs and my back and in my shoulders, trying just to get my whole body to loosen up, and then tons of stretching and mobility exercises, and really felt like, maybe for a short term, maybe for like two or three months, I did have a little bit of improvement. They walked me through cutting out caffeine, eliminating some different foods that can play into bladder or urine incontinence, and never really got any substantial difference enough that it eliminated, it being something that I thought about, had to plan for and prepare for on the daily. So I did that pelvic floor therapy probably two years ago, and just was not happy. And so then there was some conversation about maybe trying some different medications, some bladder relaxers, in case I was having bladder spasms, and none of it really felt like something I wanted to do as the thing I didn't want to be on medication for the rest of my life, and so I just I just hesitated to go that route, and so I just kept living with this annoying piece of my life and I remember just thinking to myself this is normal, this is just what happens to women as they get older, after we've had kids, and I was having a conversation with a girlfriend that's a little bit older than me and has also had three children. And she said, nikki, this is not normal. Like your degree of this is not normal. You do not have to keep telling yourself that this is just what everybody deals with. Like you have got to go see a urogynecologist for this. Well, I put that off and I put that off and I put that off and finally, this last summer, a lot of you listeners know that I've been working really, really diligently on my health and nutrition just the stage of life, balancing hormones and getting more protein and eliminating extra weight.

Speaker 1:

And as I was working on these things, one of the things that was top of my priorities was getting at least 10,000 steps in a day, working up to 15 to 18,000 steps a day. And as I was doing these walks, I was just becoming increasingly frustrated with this leakage that was happening, and it started to become, you know, a couple of years ago. If I tried to run or if I was running downhill, that seems to be something that would trigger it. But taking a walk, I could go 4 or 5 miles and have no issues until about a year ago, and some of just the simple things like taking a walk for 2, 3 miles would just get to be to the point that I would have leakage, and I think this is so crazy Like this doesn't make any sense. It was when I would carry a bag of groceries in, or I would lift up a heavy package, or I would be scared, somebody would scare me and I'd get startled. It just started to become more and more frequent, to the point that we're just being fully transparent here on the podcast. I was having to pretty much wear a pad every single day just to make sure that I was covered in case of a scare, a cough, a jump, maybe a walk, and I got to the point that I was like this is ridiculous. I am 47 years old, this is not how my life should be.

Speaker 1:

And so last summer called this girlfriend up that had been pestering me and I just said Okay, you got to help me, I want to listen to you, I want to do something about this. And she works in the drug world and has been in women's health for a long time. And I said ask all of your coworkers who the very best urogynecologists that they know in the greater Chicago land, illinois, indiana, ohio like I don't care if it's in the Midwest who is the very best urogynecologist that they would recommend. And within an hour this sweet friend came back to me and she said okay, it's a total unanimous decision, they've all said this specific doctor and you need to call him. And so again, and I'm going to link him I'm not 100% sure how to say his name, but I think it's Dr Shasha and I'll make sure to link everything here in the comments.

Speaker 1:

But they all said, for sure, this is the guy you need to go to. And so I pulled him up on a quick Google search and was thrilled to see that he had like 600 five-star reviews, which is very hard to find for a doctor. It's very, very hard to find a doctor that has amazing ratings. And so it was like OK, this is my guy. So they said give him a call, see if you can get in. One of his drug reps had made that call to him and said hey, this girl's calling you, get her in. And so I called and within the day God bless them they had snuck me into their calendar for just 3 weeks later when I came home from the lake.

Speaker 1:

And so I went there for my first initial consult, took a girlfriend with me, we did the Chicago thing for the day and went in there for my exam, was able to kind of lay out for him all of the different things that were going on, and at this point I had kind of resorted myself to like if I need to have surgery, I really don't want to do that, but at this point I think that it's probably something I need to be okay with moving forward with. So get in there, he does his exam and was only with me. First of all. He was just the coolest guy ever and he came into the room and just had a great bedside manner. Instead of sitting on the chair or the doctor's stool, he hopped up on the counter, put his feet on the stool, was just so laid back, so friendly, so just easy to talk to. So got all my history.

Speaker 1:

Then he did my exam, only probably spent 30 seconds in the exam and he patted me on the shoulder and said Okay, go ahead and get dressed and I'll meet you in the conference room. And he walked out the door and I texted my husband and I was like your girl's going to need some surgery. That was like a 30 second exam and he's meeting me in the conference room. So I knew at that point like he saw everything you needed to know. That's like this girl's going to need some medical intervention. So I meet him in the conference room, which, again, just the way the office worked, every single staff member was so great.

Speaker 1:

This doctor is so unbelievably attentive and met me in the conference room and he got out a bunch of papers and he basically said, knowing that you've done the pelvic floor therapy, that you've done all these other things the fascia, the kegels, all of the things that you could do preventatively to restore your bladder that they haven't worked, he said you're pretty extreme and I really do feel like you need surgical intervention. And so he laid out for me, gave me information for two different procedures, one I had never heard of and one I was very familiar with because I'd been doing research. The first one that he gave me the information for was a traditional bladder sling where there's a mesh sling that's used to kind of hold up the bladder to eliminate some of that leakage kind of the gold standard in the United States for what is used. And with that he gave me quite a few pamphlets with a lot of the risks that are associated. And again, I am not a medical professional, so this is only my story and sharing my research and my thoughts and my personal experiences with you. But going into that meeting, I had already done a ton of research on bladder slings and was super, super resistant to the idea because of the level of complications and I know a lot of it has to do with your surgeon but the risks seemed very high and he gave me all the information that I needed to be aware of there are a lot of complications that can happen, but he really felt like it was a good option for me. And then he slid across a pamphlet and he said and I always like to tell my patients about a second option which is actually the gold standard in European healthcare when it comes to bladder incontinence so immediately my little antennas went up when I heard that it was European gold standard. I thought this is interesting, that something that's gold standard in America would be very different than what's gold standard in Europe. And so he went on to explain a, a bulking procedure.

Speaker 1:

The actual brand name was Bulkamed. It's B-U-L-K-A-M-I-D. Bulkamed is the brand name and it's a procedure that is way less invasive. It can be done outpatient. It has a very quick recovery of a day or two at most. It can be done under local or general anesthetic, depending upon preference. It can be done in a doctor's office instead of having to be done inpatient because, well, his office was connected to a hospital so he had a small surgical room in his office that it could be done in Same day. You can go home Like very, very little complications. And essentially what it is and again I'll include some links in the show notes so that you can go and watch some different videos or look at the website.

Speaker 1:

But it is a procedure that's done. I did it under local anesthetic instead of general and it's a bulking of the urethra and so it is going into the urethra and adding an agent in four to six different areas around the urethra to kind of bulk it up so that there's less urge for leakage. It just kind of is strengthening back up that urethra. So it's not lifting your bladder, it's changing the opening of the urethra. Is kind of my understanding Again no Dr Lehman's terms from reading all the pamphlets. And so he just said I want you to go home, I want you to look at these two. I think you know the bladder sling is probably a guaranteed fix but comes with a handful of risks, and then the bulk of mid. It works for some and it doesn't for others.

Speaker 1:

And so, as I came home and I really started researching all of these things, the bladder sling when it's done, it's done. It's from what I can understand. It's not something that you can go in and just take out. There are a lot of complications of the actual mesh either migrating through the wall of the vagina or getting caught up and causing some pain. I started talking to a ton of people that had had bladder slings I actually put out on my social media pages if you've had one or you know somebody and I had a lot of personal conversations with people who had had the bladder slings and probably 50% were very happy, felt like their results were great, and 50% had had pretty serious complications. One gal, even having 10 different surgeries, had a catheter, now permanently because of some damage, and I just I could not come to peace with doing the bladder sling. And so ultimately, kind of how my husband and I broke it down was you know, the bladder sling, they say, could have a 10 to 15-year life where it should work really, really well for you pending you don't have complications.

Speaker 1:

When I was looking at my age, you know I'm like not quite 50. So if this bladder sling is going to get me 15 years and then I'm going to have to address the problem anyways, does that feel like it's something I want to do at this age? Really it's not. I wanted to see what can I do for the next 10 to 15 years to continue to get this problem not to be an issue or to get better so that if it does end up something that I need to do, like a bladder sling, I would rather be 65 at that stage, so that that bladder sling life is going to get me to 75 or 80 would be my hopes.

Speaker 1:

And so really started researching Bulk Amid and discovered that there is a chance that it might not work. And I also have to be very clear here to tell you I did not have a prolapsed bladder. So if somebody has a prolapsed bladder, I know every single medical situation is going to be a little bit different, but this is more for the person that just has leakage and doesn't have the prolapse. And so again, I know, not every single person is a candidate for this and it's different per every single situation, but it did seem like people in my position that this had a really good, a really good success and also had like minimal, tiny, tiny complications. So I think the biggest complication that I read about was you could potentially have to go home with a catheter for two to three days would be one complication. And then the other one was that it might not work and you would need to come back in for what they would call like an additional session where they would inject actually more of this agent into the urethra to create more bulking than the original procedure had done. So I think they called it like a top off. You might have to come in for a top off in a year or whatever.

Speaker 1:

So just looking at this information made the decision that 100% I wanted to start with the bulk amid procedure and so I was able to schedule that I had met my deductible for the year because I had been doing so much with my health over 2024. So I really wanted to get it done and I did make the decision 100% I wanted to do it under local anesthetic and not do general and do it outpatient in the doctor's office, and so I was able to schedule that, for I believe it was November 22nd is when I had that procedure. I was able to go in there, drove into the office in Chicago with my husband. The procedure was about 15 minutes. I was in the office for about an hour and a half and again, the office staff was phenomenal the nurses, the front desk, the doctor himself so fantastic.

Speaker 1:

So the procedure itself is awkward. It is again. You can watch all the videos online. As far as pain goes, it wasn't pleasant. There's local numbing and then internal numbing and I would say that there was probably about two or three minutes where some tears maybe fell from my face and ran down the side of my eyes where there was a little bit more intense pain. You can watch. The whole procedure is done with scope so you can see what they're doing on the screen. There was a couple of moments during the procedure where I just had to close my eyes and resort back to some of that Lamaze breathing from when I had my babies, but it was so short-lived. The whole procedure was literally 15 minutes from the time the doctor started until he was done.

Speaker 1:

When they are done doing the procedure of adding, they did it for me you can do between four and six injection sites kind of around the urethra. I did need six, he said, and when he's done he fills your bladder up full of water, removes the scope and ultimately the test is you immediately have to sit on a commode and they want to make sure that you are able to empty your bladder or at least pass I think it was 400 cc's of the fluids that he had put in there to make sure that it wasn't closed off too much, that there wasn't incredible pain, any issues, and so I was like, please Lord, please Lord, please Lord, and so procedure was over, was able to sit on the commode right there in the procedure room and immediately passed everything that I needed to pass, to be cleared, to go home, be cleared, to go home. And so literally 20, 30 minutes after the procedure, they rechecked my blood pressure, took my vitals and I was able to walk out the door with my husband. We got in the car it was a snowy, cold, freezing day in November and was well enough that on the way home from Chicago, we stopped and actually had breakfast at a little one of our favorite places, because I was feeling good enough to stop and actually have breakfast. So I was taking it easy came home that Thursday I think pretty sure it was on a Thursday and I kind of just laid low in bed on Thursday, friday and Saturday, just didn't do a whole lot You're not supposed to do a lot of lifting for those first couple of days.

Speaker 1:

Just gave myself the time to sit and heal and rest and sleep. Had no pain after the first four or five hours. Blood in the urine initially, but then after probably two, three hours after surgery. No other side effects A little bit of menstrual type cramping that went away with just a little bit of like Tylenol and a heat pad, nothing that kept me awake, no big issues. I have a hard time with anesthetic and so since I didn't have to do a general anesthetic, I didn't have any of that crazy nausea and just miserable feeling that I always get after a surgery or a procedure that needs general, and so was so thrilled the doctor called me the night of the procedure to check in with me.

Speaker 1:

I will tell you he also called me personally after I was there for the first visit. He also wanted to run some hormone panels on me, just because he felt like maybe this was associated with menopause. I didn't really know that I was in menopause at the time and had discovered that my periods had been really irregular and my blood work came back, that I was, my numbers were way into menopause and that can also be a contributing factor to increase urine incontinence. And so if you're even in this stage of life, know that this is also just something that happens with menopause in a handful, or I don't know if it's a majority, I don't know what percentages are know that this is also just something that happens with menopause in a handful, or I don't know if it's a majority, I don't know what percentages are, but that urine incontinence is one of the top things that is a negative implication of menopause. And so, never having anybody telling me that either, it made so much sense onto why maybe it had gotten so much worse in just the last couple of years, probably very highly tied to my hormone levels, that I wasn't paying attention to at that point that I am now very highly paying attention to.

Speaker 1:

And so he called me that night after my labs and gave me the results myself. He wanted to touch base with me. He wanted to see if I had questions on the two procedures as I was researching it. Just, I don't know, I physically don't know how he does as much as he does as the doctor, just the amount of time and attention and the phone calls to the house. He called another time to check in with me to see if I had questions deciding between the two and ultimately had agreed with me that the bulk of med would be a great place to start. So I had great interactions with him before. He called me the night of the procedure to check in on me and said you know, if you're having the level of success already that you are, you're probably a golden star patient and this is probably going to be just something that totally drastically changes your life.

Speaker 1:

So immediately noticed, immediately noticed that I could go for way longer periods of time without having to use the bathroom. I had gotten to the point that pretty much hourly I would look for a bathroom, kind of even more just preventatively, to make sure that my bladder was always empty. I would be very careful on how much I drank if I was going on a road trip or if I didn't know that I was going to. You know, if I was going to go take a hike with friends, I would just not drink for a couple hours before and notice, even just in the days of recovery, that I could drink a ton of liquids and go three, four, five hours and not need to use the bathroom, which was completely foreign to me. So I noticed that right away. Then, as I was able to start maintaining more activity, it was funny because I got to coughing like four or five days after the procedure and immediately in the kitchen I crossed my legs to cough and my kids were like, why are you crossing your legs? And I'm like I don't know. I think I'm scared, but could cough, could sneeze, could laugh, could lift things, could literally contract my muscles and actually be able to stop the flow of urine or to be able to just contract my muscles a little bit to lift something heavy and not have any leakage.

Speaker 1:

So I went for my one-month follow-up and they said that everything was fantastic. They looked for infection, they looked for anything that would be a warning sign, not a thing, and said, if you're having this kind of success at a month out, you really probably are someone that's going to just have amazing results with this. And the average life is seven years. So seven years for this bulk of med procedure and it can be redone up to three times, I believe is what the literature said. You can do it up to three times. So essentially, if in you know six or seven years it starts to get a little bit worse, I could repeat the procedure, I could do it another time. So I could potentially get like 21-ish years out of this, or maybe longer. It's not guaranteed that you would have to do it again in seven years, but you are able to do it again. Or if before that time I start to get a little bit of decrease in the results that I have, they can go in and just do a small top off of those areas and add a little bit more of the gel that they insert into the urethra. So that was the route that I went.

Speaker 1:

I can tell you now it's been what two months three months literally has changed my life. You don't realize how bad something has gotten until it's been fixed and then you go oh my gosh, this is what normal feels like. I had gotten so far away from normal that I had just kind of become accustomed to the way that I was living. And so since the day of that surgery I have had zero leakage. I can go for a good long walk, I can cough, I can sneeze, I can jump up and down. If I know I have to use the bathroom, I can go another half an hour to an hour just being able to kind of contract those muscles. It completely changed everything for me, and so I don't know why this procedure is not more widely talked about here in the United States.

Speaker 1:

I have been on this urine incontinence journey for a decade and it has never been mentioned to me until this last doctor, the urogynecologist. I am going to be sure to link my doctor the bulk of med, all of those different things here in the show notes. I can't wait to meet with my gynecologist here in town to let her know about this procedure that I had, just so that she can share it with patients, because she was frustrated, right along with me, that she didn't feel like she had a lot of great resources to give me, and so I just have talked to so many women, have had so many people reach out to my doctor to get appointments with him, and the crazy, crazy thing is the bladder sling surgery is a massive surgery. It's inpatient, it's hours, it has a lot of complications and it is crazy expensive, right? My bulk of med procedure in office, billed to insurance, was $1,600. I ended up paying $134 out of pocket because of how it was billed as an inpatient, just specialist office visit. But even if I had to pay for that out of pocket 100% $1,600, which is about, I think, what I paid probably right about what I paid for physical therapy because I was paying like $40 per session. So I've actually probably yeah, I probably paid about $1,200 for PT pelvic floor therapy but was able to get this procedure for $1,600, billed to insurance $130 out of pocket and it has drastically changed my life.

Speaker 1:

And because of that, and because this is something that I know so many women struggle with, I just feel like it is something that I have to share. I have to be able to take a humble pill here and not worry that people listen to this and go oh my gosh, nikki used to pee her pants. Well, yes, indeed, friends, I did, and so if you're listening to this and you're a young'un, maybe make sure your mom knows about this. This is a real thing and I just hope that more and more people are able to find out about this procedure and maybe do it as an initial step to try to help some of that issue before having to move to something more extreme like a bladder sling. So I hope that some of you are listening and you go oh my gosh, this might be the thing for me. This might change my life. It totally changed my life and I am excited to share it with anybody else who is on this same journey.

Speaker 1:

So that is a little inside peek to my bulk amid procedure that I am now two months in. I will continue to keep you all updated on if any of those results change. But they have said pretty much if at this stage it's doing as well as it is in eliminating my issues, that I probably am good to go and this will just be the new normal for me, which I am so grateful for. So if you have any other specific questions, feel free. I'm happy to walk anybody more personally or over a phone conversation or text message a little bit more into the ins and outs of that surgery. But again, if I link stuff here, you'll be able to find that online and be able to watch a procedure or two just to kind of see how it is.

Speaker 1:

The pain was definitely intense but manageable, and I would do it a gazillion times over to have the results that I have. So just putting that out there and I hope a lot of you are able to maybe see my doctor or find a doctor near you that does this I would highly recommend that you do an office visit with a urogynecologist. I just feel like that was just the perfect fit for me to have it be a gynecologist who also is a urologist that is specializing specifically in bladder issues. I don't know. I just felt like that was a really, really good fit and somebody who had done quite a few procedures with really, really good reviews. So if you live anywhere driving distance or I'm telling you, this doctor and his staff was so great I would get on a plane and fly to come do this procedure here, since it is so non-invasive and you could literally take a flight home the next day. Most likely it would be worth a flight here. This guy is that good. So, anyhow, that's my story.

Speaker 1:

I hope that it has been a little aha, maybe for some of you to not have to continue to live with some of these frustrations that are just part of being a woman and having children and our bodies going through a lot. So again, have any questions, reach out. Be sure to share this episode with others that you know are struggling with the same. We've got to share the world on what this European gold standard is that we are not hearing enough about here in the United States. So until next week, friends, take care.