Welcome to the first edition of Live Without Limits, the newsletter! At Zmanti, we don’t believe in limits. So, on top of our incontinence underwear kits, we’re also launching this series to bring you behind the scenes with the thinkers, doers, and barrier-breakers who inspire us. From candid interviews with remarkable people carving their own paths to the raw, real behind-the-scenes of building and growing our own startup, consider this your regular, journalistic dose of fuel to help you move, lead, and live without limits.
Naturally, for our first-ever interview, we spoke an expert in all things incontinence — Dr. Meredith Wasserman, MD, MS.
Dr. Wasserman is a fellowship-trained urologist and urogynecologist practicing in Providence, Rhode Island. Her areas of clinical expertise include treatment of complex pelvic floor disorders, such as urinary incontinence, overactive bladder, pelvic organ prolapse, and female sexual disfunction.
Below, she tells us all about incontinence. Who does it affect? What should women know about it? What are potential solutions? Plus, how women often put their own healths on the back burner.
Team Zmanti: Let's start with the basics: what is urinary incontinence?
Dr. Wasserman: Urinary incontinence is the involuntary loss of urine. When it happens, the amount that leaks can be anywhere from a few drops to the entire bladder contents. There are a few different types of incontinence and it’s important to understand the differences because we treat each differently. The most common types are stress incontinence and urge incontinence. Stress incontinence occurs when there is pressure put onto the bladder from the abdominal muscles when we do things like coughing, sneezing, laughing, or exercise resulting in loss of urine. Urge incontinence happens when you have a strong desire to go to the bathroom and urine starts to come out before you have made it to the toilet.
Team Zmanti: What are three things you wish every woman knew about urinary incontinence?
Dr. Wasserman: Urinary incontinence is very common but that does not mean it is “normal” - we justify having it because our mothers, grandmothers, aunts have experienced it for decades and may not have sought treatment. Urinary incontinence is a treatable medical condition, and should not be a normalised part of aging as a woman.
Team Zmanti: What are the biggest misconceptions about urinary incontinence?
Dr. Wasserman: Many people will drink less water to decrease their incontinence. Drinking less does not decrease incontinence. In fact, drinking less water makes the urine more concentrated and this can be very irritating to the bladder leading to more urgency and increased risk of urinary infections.
Many people believe incontinence is something only older women experience. This is false, I treat women of all ages for incontinence because age is not the only risk factor for incontinence. Other risk factors include pregnancy and child birth, obesity, chronic cough, smoking, genetics and connective tissue disorders, among many others.
Team Zmanti: What keeps you up at night as a Urologist?
Dr. Wasserman: The silent suffering and shame that many women self-impose due to urinary incontinence and how often they put their own health on the backburner. The combination of these lead to del
ays in seeking care and more time not being able to enjoy life to the fullest. We have so many tools to help and often the first step of scheduling that appointment or ordering that first incontinence product can be the hardest.
Team Zmanti: What should a pregnant/postpartum woman know?
Dr. Wasserman: It is very common to experience urinary incontinence during and after pregnancy due to hormonal relaxation of the pelvic floor muscles and occasionally, pelvic floor injury with delivery. However, just because you experience incontinence does not mean it will always be a problem, many women will have improvement in their incontinence with time and in many cases it will resolve on its own or with the help of pelvic floor muscle training. Better yet, working with a pelvic floor physical therapist is a very safe and effective way to manage incontinence during this time.
Team Zmanti: What should a pre/post menopausal woman know?
Dr. Wasserman: The bladder, urethra and vaginal tissue are incredibly rich in receptors for hormones such as estrogen, progesterone and testosterone. These hormones play an important role in normal bladder and urethral function. When these hormones drop with menopause, many women can develop something we call “Genitourinary Syndrome of Menopause”, which includes not only vaginal dryness but also overactive bladder, stress incontinence and urge incontinence. Replacing these hormones directly in the vaginal tissue using a vaginal estrogen cream (not systemic hormone replacement therapy) is a safe and effective way to manage these symptoms.
Team Zmanti: What should women 70+ know?
Dr. Wasserman: First, local estrogen therapy is still important in this population - you can’t “age-out” of vaginal hormone therapy. In fact, the symptoms of Genitourinary Syndrome of Menopause can be progressive as the bladder and urethral tissue live without estrogen for longer periods of time. Second, we have to be more vigilant about protecting the vulvar tissue if incontinence becomes more severe, requiring the use of pads or incontinence products. This tissue is delicate and can become irritated and sometimes infected if we are not diligent with both barrier creams and using safe, effective incontinence products.
Team Zmanti: What are possible solutions for urinary incontinence?
Dr. Wasserman: There are a variety of options for treating urinary incontinence. First and foremost, it’s critical to establish a good foundation through bladder-healthy behaviors - and there are many of these. Examples include habits such as avoiding beverages that irritate your bladder, stopping fluids 2-4 hours before bed if you tend to wake up more than 2 times per night to pee or trying not to pee just because a toilet is nearby. I always educate my patients that there are many treatment options available but these are most effective when combined with healthy bladder habits. Once we have our foundation set, we can consider pelvic floor muscle training with or without the assistance of a pelvic floor physical therapist - this is a good treatment option for both stress and urge incontinence. Treatments beyond this are specific to the type of incontinence one experiences. For stress incontinence we might consider a vaginal insert or procedures such as urethral bulking injections or a urethral mesh sling. For urge incontinence we can try medications that help to relax the bladder or consider procedures such as bladder botox injections or we can even implant a small device under the skin that acts like a bladder pacemaker to help decrease the urge to go. These treatment options are typically offered by urologists and urogynecologists.
Team Zmanti: As a doctor, how do you measure success for treating urinary incontinence?
Dr. Wasserman: The most important is improvement in quality of life - we want to get patients back to the activities they are missing out on as a result of the incontinence or restore the self-confidence that can be shattered as a result of these conditions. Technically speaking when we look at the data on therapies for incontinence, we are often looking for at least a 50% improvement in symptoms - as many insurance companies will base coverage on this benchmark. However, depending on the therapy, this definition may change. Ultimately, the measure of success is individual to each patient.
Team Zmanti: Why would I buy the Zmanti Incontinence Underwear Kit if I am considering surgery to treat my urinary incontinence?
Dr. Wasserman: It’s important to use incontinence products that are safe for the vulvar tissue regardless of plans for surgery. As mentioned previously, we can’t promise every patient will be “dry” after any treatment, not just surgery. Some patients may still need support with incontinence products after initial treatment.
Team Zmanti: In testing, we noticed that urine “flows up,” aka, was absorbed more in the front of the pad than the back. Can you explain why this happens?
Dr. Wasserman: Urine flow will happen through the path of least resistance. Depending on anatomy, there may be less physical resistance for urine to travel forward rather than backward or straight down. Additionally, when a woman is sitting upright, the pelvis is tilted in a way that can make the urethra point forward rather than down.
Team Zmanti: How often do you recommend changing an incontinence pad to avoid irritation or infection?
Dr. Wasserman: Incontinence pads should be changed when you feel significant moisture or they appear saturated. They should not be reused unless they are designed for repeat use and reusable products should be washed with gentle detergent between each use.
Team Zmanti: How can I determine the absorption level I need for my urinary incontinence?
Dr. Wasserman: This depends on the brand you are using. Many brands will offer a guide to identify the level you need but often it is trial and error. Some brands will offer a fitting kit with a variety of absorbencies to see what works best for you. It’s never wrong to start heavy and work your way back to avoid soiling clothes in the process.
Team Zmanti: If my type of urinary incontinence is that I am unable to get to the bathroom in time before my bladder releases itself, how much absorption do I need in a product?
Dr. Wasserman: The bladder holds on average 400-600ml of urine when full. This is equivalent to 15-20oz.