Missed Opportunity to Educate

Misinformation can be dangerous. With all due respect to author Dr. Jen Gunter, I found her most recent piece in The New York Times (link to article) lacking and misleading. In her recent article, “Is Incontinence Inevitable?” (1/14/20), she completely missed the opportunity to promote the benefits of pelvic floor physical therapy when it was handed to her on a silver platter.

The following questions was posed to her by a reader: “Dr. Gunter, I am a postmenopausal 63-year-old woman. I am wondering if the fate of all women my age and older is to wear pads for leakage. I understand your specialty is gynecology and not urology but thought you could weigh in on any advances in this area as the two specialties are related.”

Dr. Gunter proceeded to explain the difference between stress and urge incontinence and to cite several commonly known statistics about incontinence. She then offered several tips to her readers, the second of which was to limit fluid intake. According to her, the notion of drinking eight cups of water per day “is a myth.” I have found this to be completely not true. Anecdotally, patients who drink greater quantities of non-irritating, flat water fare better than patients who drink smaller quantities of poor-quality irritants (ex. caffeine, carbonated beverages, and artificial sweeteners). The solution isn’t to restrict fluids; it is to drink larger amounts of high-quality fluids to allow the bladder to fill and empty in a healthier manner.

She then encouraged readers to participate in Kegel exercises, both endurance and quick flicks exercises. The problem with this is that approximately 50% of people who attempt to perform Kegel exercises do not perform them properly and engage in substitution patterns. In other words, people use the wrong muscles, such as the buttocks or inner thigh muscles, rather than the pelvic floor muscles. The best way for people to learn how to correctly engage the pelvic floor muscles is with a physical therapist who can introduce the learner to the muscles by touching them through internal manual cuing.

While Dr. Gunter answered the question correctly, that incontinence is NOT inevitable, she neglected to mention a very important piece to the puzzle in addressing the issue. The fact that the words “physical therapy” did not appear once in the article was, in my opinion, an oversight on Dr. Gunter’s part. Pelvic floor physical therapy has helped many women improve their continence in a safe, conservative, and evidence-based manner. If you or anyone that you know stands to benefit from our services, please contact us at Revitalize Physical Therapy. It would be an honor and privilege to help you!

When Your U.T.I. Refuses to Die

U.T.I.s are getting harder to treat which is understandably driving people mad!

Not all infections are created equal, especially when it comes to those that affect the genitourinary system.

Matt Richtel explores this phenomenon in his recent article in The New York Times (July 13, 2019, link to article). More and more women have recently discovered the hard way that the same Bactrim and nitrofurantoin which cured urinary tract infections (U.T.I.s) in their twenties are no longer helping them in their forties. This previously successful course of antibiotics is failing due to the development of resistance towards the medications.

Doctors refer to these as drug resistant U.T.I.s., and they have the New York City Department of Health working overtime to better understand the nature of these infections. According to the department, approximately one third of U.T.I.s caused by E. coli (the leading cause of the infection) were found to be resistant to Bactrim. Ampicillin is also not as powerful as it used to be. Continued usage of ineffective medication results in treatment delay and proliferation of the infection. More women require hospitalization than in years prior, especially if the infection spreads to the kidneys, and utilization of intravenous antibiotics is also on the rise. U.T.I.s can be especially dangerous, even fatal, within the geriatric community. In 2002, the Centers for Disease Control and Prevention (CDC) estimated that approximately 13,000 people died annually from hospital acquired U.T.I.s.

Researchers have proposed both a short term and long term solution to this problem. The short term goal is to develop inexpensive and rapid diagnostic testing, particularly urine cultures, that would enable doctors to prescribe the proper antibiotic to kill the particular strain in question from the get-go. The long term goal involves creating a medical paradigm shift towards reduced utilization of antibiotics and only prescribing them when truly medically necessary. The more careful we are about selectively using antibiotics, the less resistance we will develop towards them.

Until that happens, I encourage you to be your own biggest advocate. You know your body better than any doctor you will ever visit, and if the medication you have been prescribed is not relieving your symptoms, please request a urine culture from your urologist.

In addition, recurrent U.T.I.s may result in overactivity of the pelvic floor muscles. This may manifest as urinary frequency, incomplete emptying of the bladder, bowel dysfunction, and/or pain during vaginal penetration. Pelvic floor physical therapy is a proven conservative treatment approach to address these symptoms. If you or someone you know stands to benefit from these services, please reach out to us at Revitalize Physical Therapy. We would love to have the opportunity to help you!