Dr. Leslie Rickey treats women for a constellation of lower urinary tract symptoms, including incontinence. Ideally, she would like to have ways to better identify girls and women at risk and intervene earlier, but research has focused almost exclusively on developing better treatments rather than maintaining good bladder health. Dr. Rickey is committed to changing that.
The Associate Professor of Urology recruited a multidisciplinary team and successfully competed to make Yale one
of seven clinical sites in the nation for the Prevention of Lower Urinary Tract Symptoms (PLUS) consortium. The National Institute of Diabetes and Digestive and Kidney Diseases at the National Institutes of Health is funding the first large-scale study of bladder health in women. The PLUS consortium brings together a diverse group of investigators from the medical and social sciences that includes epidemiologists, clinicians, and prevention specialists. The group is taking the unique approach of using a public health lens to shift research and practice towards promotion of bladder health.
“Although lower urinary tract issues affect up to 1 in 3 women, bladder health isn’t something that people talk about,” said Dr. Rickey. She regularly sees patients who have coped long-term with incontinence by using pads, limiting fluid intake, avoiding exercise and travel, or by mapping out the bathrooms wherever they need to be. “Sooner or later, the
bladder dysfunction overwhelms their ability to compensate for it,” she said.
“I don’t want to downplay the extremely effective treatments we have for people with incontinence or overactive bladder,” said Dr. Rickey. “I utilize both non-surgical treatments and minimally invasive procedures for women that can really improve their quality of life.” However, she believes that there are women for whom earlier detection and intervention might prevent the need for a surgery down the line.
Dr. Rickey would like bladder problems to be destigmatized to the point where patients seek care earlier, when simpler remedies may solve the problem. Even more so, she wants to be able to offer advice on prevention. At present, however, little is known about the factors that protect women from bladder problems. In fact, one of the first goals of the project is to define what a healthy bladder is. No such standard exists now.
PLUS researchers hope to make discoveries that will substantially change the way clinicians support women, but those findings should not be confined to professional journals. “One of the things I really like about what I do is
education,” said Dr. Rickey. “The level of lower urinary tract information housed in the scientific community that doesn’t get well disseminated to the public is just stunning.” For this reason, the PLUS consortium has prioritized developing a robust community engagement network in order for community members to have input on everything from research constructs to language used in survey items and eventually, help with getting the message across to the public. There could even be implications for policy change, said Dr. Rickey, such as workplace rules about bathroom breaks or equitable toilet availability in work places, schools, and public spaces.
Dr. Rickey formed a team of people who had never worked together before but quickly bonded around the task. “I think it’s huge. It affects so many women throughout their lives and it can really limit the activities that women can be involved in later in their lives,” said Jessica Lewis, Deputy Director of Pregnancy Research at the Yale School of Public Health. “Our hope is that once women become more aware of their bladder health and realize there are things they can do, they will concentrate on those pieces of behaviors or environmental stressors that are modifiable.”
Each of the PLUS sites is conducting focus groups to learn more about women’s current knowledge and experience with bladder health. At Yale, the focus groups will concentrate on young women from the New Haven area. “It takes some skill to get young people to speak about a topic that they’ve never thought about,” said Dr. Deepa Camenga. Though Dr. Camenga, whose expertise is in adolescent health, has an office close to Dr. Rickey’s, they had never met before they began discussing the possibility of making Yale a PLUS site. One day, Dr. Camenga looked up from her desk to see a woman in scrubs, Dr. Rickey, a bit flushed because she’d just run from the operating room to get in a conversation between surgeries.
“Are you Doctor Camenga? I’ve been trying to meet you. Do you have a few minutes to talk to me?” she asked. Dr. Camenga laughs at the memory. “I thought, ‘Wow, that woman is excited.’” She continued: “I think this highlights the great diversity of experience at Yale. We were awarded this because Dr. Rickey was able to bring together people with very diverse experiences.”
Three years into the project, Dr. Rickey remains excited. “This is a large, public health issue that affects almost every girl or woman – it affects their physical and emotional health.”