In this episode, I'll break down the real reasons behind getting up at night to pee, a condition called nocturia. From overactive bladder to fluid intake and systemic conditions like sleep apnea or diabetes, and why looking at the whole picture is essential. I'll also discuss effective treatments from bladder training to Botox and why a 3-day voiding diary is a crucial first step in figuring it all out.

Timeline:

00:30 Introduction to Nighttime Urination Issues 

01:06 Understanding Nocturia

 02:58 Common Causes of Frequent Nighttime Urination 

03:23 Bladder Issues and Treatments 

05:19 Evaluating Fluid Intake 

06:26 Medical Conditions Affecting Urine Production 

07:41 Importance of Accurate Voiding Diaries 

08:21 Conclusion and Key Takeaways 

08:58 Sleep Apnea and Its Impact on Nocturia 

11:14 Recent Studies and Treatments 

11:59 Final Thoughts and Recommendations

If you've ever been prescribed medication for overactive bladder, you might wonder what it's actually doing and what the risks are. In this episode, I break down the two main types of medications used to treat OAB: anticholinergics and beta-3 agonists. We'll talk about how they work, the side effects (including memory concerns), and how to weigh the benefits and risks. I also explore alternative options like Botox and nerve stimulation, and why shared decision-making with your provider matters more than ever. If bladder urgency or leaking has been part of your life, this episode will help you make informed, confident choices about your treatment path.

For more information on this topic: 

https://journals.lww.com/fpmrs/abstract/2017/05000/augs_consensus_statement__association_of.4.aspx#:~:text=Given%20the%20available%20evidence%2C%20which,medications%20in%20patients%20at%20risk.

https://pubmed.ncbi.nlm.nih.gov/34213600/

Timeline

00:30 Introduction to Overactive Bladder 

00:48 Behavioral Treatments for Overactive Bladder 

00:57 Medications for Overactive Bladder 

01:18 Anticholinergic Medications and Memory Concerns 

01:37 Types of Medications for Overactive Bladder 

03:55 Studies on Anticholinergics and Cognitive Impairment 

03:23 Clinical Guidelines and Recommendations 

04:26 Prevalence and Types of Overactive Bladder 

05:00 Side Effects and Risk Factors 

05:38 Research Findings on Anticholinergics 

08:32 Considerations for Prescribing Medications 

10:38 Alternative Treatments and Final Thoughts

 In this episode, I'm talking about something I see all the time in my practice but that too many women still suffer through in silence: Genitourinary Syndrome of Menopause (GSM). This condition shows up in women as estrogen levels decline, most commonly during and after menopause.

If you've been dealing with vaginal dryness, itching, pain with intercourse, or repeated urinary tract infections, you're not alone, and it may be GSM.

I walk you through the updated guidelines from the American Urologic Association (AUA) and the American Urogynecologic Society (AUGS) for diagnosing and treating GSM. We talk about what symptoms to look for and the full range of treatment options, including hormonal and non-hormonal therapies, so you can make informed decisions that work for you.

In this episode, I also cover:

• Why follow-up care is just as important as starting treatment
• How shared decision-making with your provider changes outcomes
• What research still needs to catch up when it comes to cost and access

If you've ever wondered if your symptoms are "just aging" or felt unsure about what's normal after menopause, this episode is for you. My goal is to empower you with information and make sure you know you're not alone.

For more information on this study: https://www.auanet.org/guidelines-and-quality/guidelines/genitourinary-syndrome-of-menopause

Timeline:

00:30 Introduction to Genital Urinary Syndrome of Menopause 

01:25 Understanding the Symptoms and Diagnosis 

03:15 Guidelines for Treatment 

06:09 Hormonal Treatments and Recommendations 

07:43 Non-Hormonal Treatments and Considerations 

08:49 Energy-Based Treatments and Their Efficacy 

10:36 Cancer Concerns and Hormonal Treatments 

13:14 Follow-Up and Long-Term Management 

14:04 Conclusion and Future Research

In this episode, I sat down with Dr. Suzette Sutherland, a seasoned urologist who recently transitioned from the University of Washington to a large urology group in Arizona. Dr. Sutherland shares her expertise on treating overactive bladder (OAB) and the latest innovation in neuromodulation therapies, specifically focusing on the efficacy and safety of tibial nerve stimulation. We discuss the evolution of treatment guidelines, the pros and cons of various therapies, including medications, Botox, and sacral nerve stimulation, and dive deep into the promising results from the FDA-approved Revi device from BlueWind. Dr. Sutherland also sheds light on patient selection, procedural details, and patient compliance, while offering insights into the future of OAB treatments.

For information on the REVI   https://bluewindmedical.com/

Timeline:

00:30 Introduction and Guest Introduction
01:10 Understanding Overactive Bladder and Treatment Options
02:19 Tibial Nerve Stimulation: A New Approach
02:40 Changes in Treatment Guidelines
05:57 Mechanism of Tibial Nerve Stimulation
09:38 Implantable Tibial Nerve Stimulation Devices
13:39 Patient Experience and Compliance
17:54 Comparing Neuromodulation Devices
25:37 Comparing Revi and Eco Devices
26:32 Understanding Device Placement and Stimulation Frequency
27:18 Battery Life and Replacement Concerns
29:33 New Devices on the Horizon
30:03 Meta-Analysis of Tibial Nerve Stimulation
32:49 Patient Choices: Sacral Nerve Stimulation vs. Tibial Nerve Stimulation
38:22 The Role of Botox in Bladder Treatment
46:14 Challenges and Innovations in Urogynecology

If you've tried lifestyle changes and medications for overactive bladder, but you're still dealing with urgency, frequency, or leaks, you're not out of options. In this episode, I break down tibial nerve stimulation, a lesser-known but powerful treatment for overactive bladder that's often overlooked in early care plans.

I discuss what neuromodulation means in pelvic health, and how it works, why the tibial nerve (yes, the one near your ankle!) plays a key role in calming bladder activity, the differences between transcutaneous, percutaneous, and implant-based tibial nerve stimulation, what to expect from the procedure, how often it's done, and why so many women tolerate it well, and the best part? Minimal side effects and multiple delivery methods make this a versatile, low-risk option for many women, especially if medications haven't worked.

For more information on this subject, check out:
S2E12: Finding Freedom with Sacral Nerve Stimulation
S2E35:Innovations in Overactive Bladder Solutions with Isaac Oppenheim
Livezida.com
Avation.com

Timeline

00:30 Introduction to Tibial Nerve Stimulation 
01:14 Understanding Neuromodulation 
02:05 Causes and Symptoms of Overactive Bladder 
03:13 Sacral Nerve Stimulation Overview
04:21 Focusing on Tibial Nerve Stimulation 
06:18 Transcutaneous Tibial Nerve Stimulation 
11:47 Percutaneous Tibial Nerve Stimulation 
16:20 Conclusion and Future Episodes

In this episode, I’m answering some of the most common (and commonly avoided) questions about women’s pelvic health, questions that too often go unasked but deeply affect the quality of life.

We dive into the difference between a rectocele and rectal prolapse, what causes urinary leakage during sex (and what you can do about it), and how to know when it’s time to seek care for incontinence. I also share why early education and intervention matter so much, and why these conversations belong in every doctor’s office, whether your provider is male or female.

Suppose you’ve been putting off asking about your symptoms or don’t know what to expect at an urogynecology visit. In that case, you’ll also get practical tips to help you prepare, feel confident, and advocate for yourself.

This episode reminds you that your pelvic health matters, and your questions deserve answers.

This week's podcast is about prolapse—what it is, how it affects daily life, and what you can do about it. A few weeks ago, I joined Janice Mitchell from MyPFM and had the chance to answer some incredible questions from her coaching group. The conversation was honest, insightful, and filled with the kinds of questions I hear every day in my practice.
We talked about whether prolapse can improve after childbirth, how to manage symptoms without surgery, and what to know if you're considering one. I also shared tips on pessary use and how to find a skilled urogynecologist and even addressed one of the most personal topics: sex and prolapse.
If prolapse has left you feeling unsure or overlooked, this episode is for you. These are the questions real women ask and the answers they deserve. Listen and learn.
 

https://thewomensbladderdoctor.com/

Timeline:

00:30 Introduction to Prolapse Discussion 

01:02 Understanding Rectocele and Postpartum Recovery 

02:39 Non-Surgical Options for Prolapse Management 

03:46 Physical Therapy Techniques for Prolapse 

05:26 Innovative Tools and Devices for Prolapse 

07:06 Prolapse Surgery: Expectations and Outcomes 

08:04 The Mesh Controversy in Prolapse Surgery 

10:17 Pessaries: Types and Usage 

12:48 Choosing the Right Urogynecologist 

14:34 Final Thoughts and Q&A

This episode was inspired by a recent coaching group I joined with Janice Mitchell, a pelvic floor physical therapist with incredible insight and compassion. The women in that group had thoughtful, important questions about recurrent urinary tract infections, which I often hear in my practice.

So today, we're diving into that discussion and sharing it with you.

If you've ever dealt with bladder infections that come and go (and come back again), this episode will help you better understand what's going on and what you can do about it.

Together with Janice, we cover:

• What truly defines a UTI and why urine cultures matter
• How low estrogen levels and tight pelvic floor muscles can mimic UTI symptoms
• The role of vaginal estrogen and other medical options in treatment and prevention
• What to expect from your provider—and how to advocate for better care

You're in the right place if you're tired of the cycle and want answers that make sense. 

mypfm.com

Timeline:

00:30 Introduction and Overview

01:19 Understanding UTIs: Causes and Symptoms

05:01 Diagnosing UTIs: Tests and Procedures

09:03 Treatment Options for UTIs

09:43 Vaginal Estrogen: Benefits and Usage

15:17 Preventing UTIs: Tips and Recommendations

18:04 Addressing Bleeding During or After Sex

In this episode, I interview Janice Mitchell, a pelvic floor physical therapist and founder of the Pelvic Bra. This external support device helps with pelvic floor issues like prolapse. We discuss Janice’s personal experiences and the development of the pelvic bra, likening it to an industrial-strength thong that provides perineal compression. Janice explains how the device works and its benefits, and shares feedback from users who have found significant relief from symptoms such as stress urinary incontinence and bladder control issues. Highlighting the option for live Zoom fittings and upcoming restocks due to high demand. Join this insightful conversation to understand more about the innovative solutions for pelvic floor health and how the pelvic bra can help you or someone you know. 

mypelvicbra.shop

Timeline

00:30 Introduction and Guest Welcome 

01:40 Understanding the Pelvic Bra 

04:03 Anatomy and Prolapse Explained 

06:15 Benefits and Use Cases of the Pelvic Bra 

07:42 Target Audience and Design Insights 

17:10 Feedback and Real-Life Experiences 

28:21 Sizing, Return Policy, and Availability 

33:28 Conclusion and Future Plans

In this episode, I address the common questions I'm asked about the risk of urinary incontinence following surgery, specifically focusing on hysterectomy, prolapse repairs, and hip replacement. I discuss several key studies, including a 2000meta-analysis by Jeanette Brown and a 2023 paper in the American Journal of Obstetrics and Gynecology, which highlights the significant risks associated with these surgeries. I also provide tips on pelvic floor strengthening and the benefits of different surgical approaches to help minimize incontinence. I discuss how hip replacement surgery can have varying impacts on bladder function and the importance of a holistic view of the body's interconnectedness.

https://pubmed.ncbi.nlm.nih.gov/10950229/

https://www.nejm.org/doi/full/10.1056/NEJMoa054208

https://pubmed.ncbi.nlm.nih.gov/24408744/

https://pubmed.ncbi.nlm.nih.gov/36300551/

Timeline:

00:30 Introduction to Urinary Incontinence Risks
00:59 Hysterectomy and Urinary Incontinence
04:17 Prolapse Repairs and Bladder Leaking
06:15 Hip Replacement and Bladder Function
08:59 Conclusion and Key Takeaways