Can your ANKLE stop you from leaking? A surprising new approach for treating OAB

The following transcript was generated electronically. Please let us know if you see any transcribing errors and we’ll get them corrected immediately. 

Bruce Kassover: What could a tiny device implanted near your ankle possibly have to do with bladder control? Quite a lot, as it turns out. Today, Dr. Alex Rogers joins us to explain an innovative new treatment for overactive bladder and why patients have more reasons than ever to seek help.

Welcome to Life Without Leaks, a podcast by the National Association for Continence. NAFC is America’s leading advocate for people with bladder and bowel conditions, with resources, connections to doctors, and a welcoming community of patients, physicians, and caregivers. All available at nafc.org. 

Welcome back to another episode of Life Without Leaks. I’m your host, Bruce Kassover, and joining us is Sarah Jenkins, the Executive Director for the National Association for Continence. Welcome Sarah.

Sarah Jenkins: Thanks so much, Bruce. 

Bruce Kassover: Yeah. I’m looking forward to today’s conversation because we’re going to be talking with Dr. Alex Rogers. She is a board certified urologist specializing in female urology incontinence care. She’s in Colorado now where she operates her Bladder Boutique Clinic in Lafayette, Colorado, just outside of Boulder. So welcome Dr. Rogers. Thank you for joining us today. 

Dr. Rogers: Yeah, thanks for having me today. 

Bruce Kassover: Excellent. We’re going to be talking about some new technology and new treatment therapies that might really be very helpful for people with OAB. But before we even get there, I was wondering if you could tell us a little bit about yourself, how you got to be on this podcast today? 

Dr. Rogers: Yeah. I am a urologist. I focus in female urology and especially in incontinence treatments. But I did a urology residency after med school and then I did a fellowship just in voiding dysfunction.

And I actually had a very robust practice in Central California for 10 years. And then I started a new clinic in the northern Denver market. It’s in Lafayette, Colorado. And I really like helping people objectively improve their bladder symptoms. And it’s been really exciting being able to work in this space because in the last 15 years we’ve actually added a lot of new therapies and devices and really changed the landscape of what we can offer patients. 

Bruce Kassover: So now you are dealing with, what sort of patient profile do you normally deal with? Who comes into your office? 

Dr. Rogers: Yeah, it’s a whole spectrum. I have patients who are starting to be just a little bit bothered by having more leakage, and they look at options and they land on me and they’re early in, in the pathway of how bothered they are by their symptoms. And then I have a lot of patients where I may be a fifth opinion or they are soaking diapers, severely frustrated, and they’re a little further along in how much they’re suffering from their leakage.

So a very broad spectrum of patients. Many patients who are treatment naive and then many patients who’ve tried a lot of things and still not landed on the relief that they’re seeking. 

Bruce Kassover: I really like that phrase, “treatment naive,” because it’s something that we seem to hear a lot when we talk with healthcare professionals, is that people know that there’s a problem, but they have no idea that there are solutions.

So how does that work, typically? When somebody comes in. Are they fatalistic? Do they expect, oh, there’s nothing that they’re going to be able to do for me, but I at least got to give it a try, or are people… 

Dr. Rogers: Yeah. Yeah, I like that word “fatalistic.” I have patients on a daily basis that come in fatalistic and on the positive for me, like it sets the bar really low when all they know is that they leak, that they’re bothered by it and they think the only treatment option is incontinence products, which as we know are costly, not ideal to wear, they’re filling up our landfills at a faster rate than baby diapers. So yeah, people come in and they have no clue that we have safer meds, that we have advancements in devices, that we do crazy things like Botox treatments. So that is something I really enjoy about what I do, where people come in not knowing anything, and they may leave the visit with, “Wow, there actually are things that might be able to help me with this issue that drove me to come and see you.”

Bruce Kassover: It’s got to be, it has to be really rewarding and to give people hope where they really didn’t think that there was any before. 

Dr. Rogers: Yeah. Sometimes, like, hope is, that’s definitely like the first step. And then you hopefully develop a relationship where over time we can get to a better place together.

Bruce Kassover: That’s great. So now you have people who come in, they have symptoms, and we know that incontinence comes in a lot of different varieties. So how does that work, helping them? Did do you have to educate them about even the differences in, say, overactive bladder versus urge incontinence, or do, did they come in with some idea already of what they might have? 

Dr. Rogers: 99.9% of the time, all they know is that they leak and that it bothers them, and then that’s where there’s an enormous education opportunity to break it into, is it more overactive bladder, which is the four symptoms of urgency where you feel like you have to rush to the bathroom. Urge urinary continence where you’re rushing and you don’t make it in time and you have wetness. Frequency where you’re going too much, eight plus more times in a day and getting up at night at least once or more than twice. And as we know, that impact on sleep can be very dramatic for many patients, versus, that’s overactive bladder…

You can also have leakage from stress incontinence where a high abdominal pressure event like coughing or sneezing or lifting weights, you have loss of urine because you don’t have enough resistance to hold the urine in, and that’s stress incontinence. And a lot of patients, men and women, but more women, can have both. They can have both stress incontinence where there’s not enough resistance with a high pressure event like a cough. And you can have overactive bladder where you have that urgency in rushing, not making it or that signal to go too often, whether during the day or night, where that nerve signal to the bladder on that on the highway, all the way from the brain down the spinal cord to the sacral nerves that connect to the bladder, and tell the bladder, when to go and not to go are misfiring and people are having that signal cause these symptoms of urgency and rushing, not making it in time.

Bruce Kassover: That makes perfect sense. Now, today we really wanted to focus on overactive bladder in particular. And you’ve already talked a little bit about what it is and how it’s different than other types of incontinence. If I’m a patient and I’m starting to experience leaks, are there some particular signs I should be looking for that tell me, “Oh, this is probably OAB?” 

Dr. Rogers: Yeah. You’re, when you go out, you’re constantly thinking about, where’s the bathroom? I want a bathroom map. I’m going to the airport. I’m nervous about how I’m going to play in my security checkpoint around that, number one.

Number two, in the morning, you feel like right when you get up you have to get to the bathroom, alcohol, spicy food, you feel like you have to rush to the bathroom and maybe you cannot control it. You’re starting to just have unannounced leakage that comes out without warning. And one of the more interesting ones that I’ve learned over the years is little old ladies come and see me and they go, “When I sit to stand, I just start gushing.”

And so all of these, I feel these signs of overactive bladder, which can, becomes more prevalent with each decade of life, where as we age, up to 40% of us will have overactive bladder as women. 

Bruce Kassover: So 40%, that is pretty significant. What about men? 

Dr. Rogers: Yeah, no, overactive bladder is a very predominant syndrome in men. And in fact, as men and women age, overactive bladder symptoms become more bothersome in men past age 65. And a lot of times with men, it’s all “Oh, it’s your prostate. Oh, you’re obstructed. Oh, we need to take care of that.” Which, yes, that may be the case. There’s also this whole component of overactive bladder in men that often, I think, is undertreated underdressed, and we could do a better job of helping men with overactive bladder.

Bruce Kassover: That’s really good to know. So let’s say that I have leaking and it’s becoming bothersome, and I decide I’m actually going to muster up the courage to go and talk to somebody about it, which is, a challenge in itself. But I go into your office, what happens? 

Dr. Rogers: Yeah. I want to back it up just a little bit, and I want to say if you’re bothered by leakage there are a lot of barriers to just getting to the right person. So many barriers to land with someone like me who’s very specialized in this.

If you’re leaking and you’re bothered by it, half the time, you’ll not bring it up to a healthcare professional. And half the time the healthcare professional won’t ask. Okay, so there, so it takes years for people to finally land with a specialist who will help them.

So number one is navigating to a specialist who will help you, whether it’s a urogynecologist or a urologist like myself, so that when you finally have that visit, you’re going to land with someone that is going to give you many options and explain things as opposed to say, “Oh, let’s talk about that at the next visit. Or maybe you could do some Kegels for that,” which, nothing against Kegels, I think I have a lot of patients who’ve been dismissed when they finally raise their hand and said, “Hey, I’m bothered by this.” And they still didn’t land with a specialist.

So people really need to advocate for themselves and their loved ones to make sure that they end up with someone who’s going to help them. If they finally end up with me, whether it’s self-driven or referral from a primary care professional, we’re going to talk about what are the symptoms, what is the leakage? Is it overactive bladder? Is it stress incontinence? Is it both?

We’re going to talk about behavioral modifications. How much water are you drinking? What is your irritant intake? Coffee, caffeine, alcohol, spicy food, citrus. It’s incredible how many patients say, “I didn’t know my five cups of coffee was why I had to rush to the bathroom more in the morning. I didn’t know my wine intake in the evening is potentiating why I get up at night.” So definitely behavioral modifications. It’s really important to review those. And then I’m all about a big algorithm of, “Here is the menu of treatment options.” Because the reality is we’re probably not going to fix this overnight.

And so my website, Bladder Boutique, has a ton of patient education materials on it. Anyone can go to it. And I try to synthesize options based on what anecdotally I’ve seen and based on data. So it’s all summarized right there because my, that way it just, it’s big picture. And then if you want to deep dive on a treatment offering, you can always do that.

So my goal is, “What is your problem? What are your options? And what is our treatment plan going forward?” And this may take some trial and error to get some relief for you. 

Bruce Kassover: I appreciate that you mentioned your website by the way, because we always want to make sure that people who are listening have an opportunity to go and see you and hear directly from you, beyond just this podcast. What is the URL for that website? 

Dr. Rogers: It is www.bladderboutique.com. If you just Google “Bladder Boutique,” you’ll land on it. 

Bruce Kassover: I love it. That’s great. And we will also put a link in the show notes, so nobody has to worry about remembering that, but it sounds pretty memorable to me.

Now you talked about, yeah, if somebody’s drinking five cups of coffee in the morning and they don’t realize that can be contributing to their bladder issues, then you know, that’s, another question, I imagine. I’m going to ask you something that may not wind up on the final podcast. But, you’re in Colorado. Colorado is one of the beer capitals of the country. So you’re out you’re at the sports bar, you’re watching the game eating chicken wings, and you’re drinking beer. And all of a sudden, about 45 minutes an hour into it. You have to go and it like breaks the seal and all of a sudden you find you’re going every 10 minutes after that, what is going on with your bladder that it was fine for an hour and all of a sudden it’s, you can’t you’re squirming in your seat.

Dr. Rogers: Yeah. So essentially just. All these irritants. Coffee, caffeine, alcohol, spicy foods, they get processed in the kidneys, and then that filters down to your bladder and the bladder lining, it’s very sensitive. It’s this urothelial lining, and it’s like skin. So just like we have skin irritants that certain things make our skin itchy or dry, those same irritants that we ingest can hit the bladder lining and then it makes it more irritable and causes that urgency and frequency.

So my thing with patients is, culturally, we live in a time where we have a lot of bladder irritants. When I was growing up, there was no LaCroix lime water, right? And now that is as prevalent as tap water in our society.

So I’m not saying eliminate all these things that bring you happiness and joy, like coffee. But at least be mindful. And especially mindful of having five cups of coffee and then thinking you’re going to drive a car for five hours. Just awareness. But I’m not here to torture people ’cause I like my three cups of coffee every day. I’m not going to eliminate that completely. 

Bruce Kassover: I’m with you on that one. So tell me this I come in, we realize that the, what the problem is or we have a sense of what the problem is. What sort of treatment options do you recommend initially, aside from the behavioral modifications? Are there medications that you would go to next? Or what would your next, next step be? If the behavioral modifications are not really enough? 

Dr. Rogers: Yeah. The nice thing is that the, there’s recent guideline changes per urology society where we’re trying to make it more linear and shared decision making where it is a menu of options and you can bounce around on what is appealing to you and not make it such, such a hierarchy and this pyramid.

But I will say this, typically I like to start with a sample of a med that’s usually very well tolerated and safe, so that you’re walking out the door with something that might help you immediately. And if you don’t tolerate it, you can always stop it. Because we have, for a long time since the seventies, treated patients with these very inexpensive anticholinergics.

But unfortunately they have some really intolerable side effects, like dry mouth, dry eyes, constipation, and increasing data where there’s a lot of concern about cognitive risk, and no one wants to be taking a med long-term that potentially can increase your risk of things like dementia. I don’t blame patients for feeling that way.

Although they’re cheap, they have issues, and 80% of patients will quit that kind of med within six months.

Bruce Kassover: 80%. That’s a pretty, pretty high number. 

Dr. Rogers: It’s pretty depressing, right? I don’t think anyone goes to med school to only treat 20% of their patients at six months with a therapy.

In my practice I’ve really only, I try and stick to what I call beta agonists, and those help with bladder control. The problem is there’s, there are two good options where they have a much better side effect profile and certainly no risk to cognitive issues. But they can be expensive. So access can be an issue for some patients, but I still think it can be a good place to start to see if we can get patients some relief and it needs to check all the boxes: they need to work well, they need to be tolerated, and most importantly, they have to be affordable.

So if we can’t check all those boxes and the patient has to be willing to take a daily med. Some patients don’t want to take a daily med, they don’t take any meds. Or conversely, they take 14 meds, so they may find that an unappealing option. And that’s not unreasonable. And so then beyond meds there are other options like neuromodulation in various forms or Botox injections of the bladder muscle. 

Bruce Kassover: Botox is, my mom would certainly want to get Botox just because she’d like to be able to get Botox and that would do it for her.

But the neuromodulation is interesting and I understand that there is actually some new or different sorts of neuromodulation treatments then we often talk about, normally we talk a lot about sacral neuromodulation, but there’s another product that you wanted to introduce people to. Can you tell us a little bit about what that is? 

Dr. Rogers: Yeah, so correct. We’ve had sacral neuromodulation approved since 1997, and that is stimulation to the sacral nerves which sit near the bladder. And stimulating nerves that are mis-signaling, misfiring will actually make nerves behave, whether it’s for pain or bladder control.

Downstream from the bladder, the highway of nerves actually goes down to the tibial nerve at the lower leg. And dating back thousands of years, Chinese medicine, we know that peripheral stimulation of nerves with things like needles can be restorative. And so targeting the tibial nerve for bladder control is not new.

And we’ve had what we call tibial nerve stimulation approved for other delivery forms, and we have placed needles in the tibial nerve and then applied externally electrical stimulation to that needle. Typically for a 30-minute session, initially once a week, and then for 12 weeks you do that and if you have a positive effect, then go monthly.

But there’s been a lot of work in, what if we could do an implant that’s small in this area to deliver energy to this tibial nerve and get that positive effect on bladder control? So there have been research in this area since, in the last 10 years, and we now have three FDA-approved products, approved products for tibial implants in the lower leg.

And the newest one is a product called Altaviva by Medtronic, which is approved in the fall of 2025. And essentially, it’s a small little rectangular implant. It’s placed under just local anesthetic, which is nice, ’cause typically with sacral, it’s done in two phases, a testing phase, and then a second phase where we actually place the implant, versus with this tibial implant, we place it with just one phase with local anesthetic. So for patients where deep sedative is challenging or general anesthetic, this is a nice option that it’s just done with local.

So this little implant, it’s placed above the tibial nerve in a very safe space between the skin and a layer called the fascia. It’s activated the same day and we’re able to set the device to go off at 30 minute intervals, typically a couple times a week. And then hopefully we have a positive effect on bladder control or urge incontinence where you rush and leak within a few weeks.

It’s a nice device to add to my toolbox where we take out some of the manual labor of what we tra traditionally were doing with tibial stimulation to get a positive effect and perhaps much less invasive than the sacro neuromodulation procedures that we do. That, they all have a place, they’re all perfectly imperfect, but maybe we’re checking some different boxes with this tibial implant to get more patients treated.

Bruce Kassover: Okay, now I have a question about this. Maybe tell us a little bit more about the tibial nerve, the sacral nerve, the relationship between these nerves and your bladder, because it just sounds a little science fictiony that you’re going to place something under my skin by my ankle, and that’s somehow going to stop me from having urgency and leaks and issues like that. What is this witchcraft that we’re talking about? 

Dr. Rogers: Yeah, no it’s definitely not witchcraft. Because once again it’s been used in Chinese medicine for thousands of years and then tibial nerve stimulation using just a needle has been FDA-approved for over a decade, and we have great data showing that stimulation of the tibial nerve helps with bladder control. And, essentially, that tibial nerve, it’s part of this nerve highway where the tibial nerve is connected up the leg to the sacral nerves and lumbar nerves, and actually stimulation down on the tibial nerve, that signaling travels all the way up the spinal cord up to the brain, back down the spinal cord and for bladder control, and in lab data where they’ve stimulated the tibial nerve and then they do MRI scans of the brain, we see changes in brain activity with the stimulation. So although it sounds hokey and like witchcraft, we have a lot of data which proves that stimulation target helps with bladder control.

Bruce Kassover: That’s very cool to hear. Now you also mentioned how there has been approved tibial procedures for a while, and that was just done, that’s done in office, right? That, that you have to come routinely to do that for a period of time if you have it the old-fashioned way?

Dr. Rogers: Yep. And there’s a lot of barriers to that. So first, just driving and parking and copays and having a good team that places that needle precisely and sitting there for 30 minutes. And so having to come to that once a week for 12 weeks for 30 minutes and then monthly, that is very high burden for many patients. I’m in Colorado where there’s weather and there’s traffic and parking’s difficult. So it’s just not the most practical treatment solution in a lot of markets. So if we can get the stimulation with, you know, placement with one little local procedure, and then the therapy’s automated and going off on its own, and it’s a 15-year battery life, and it doesn’t have any imaging constraints, it’s much more of a set-it-and-forget-it concept than the burden of what we previously were doing with tibial needle stimulation in the office. 

Bruce Kassover: That makes sense. So tell me this, I get the implant. How well does it actually work? What could I expect in terms of results? 

Dr. Rogers: Yeah, I would say two thirds of patients are going to have at least a 50% improvement in their urge urinary incontinence leakage. 70% subjectively are going to say definitely it has improved my quality life and my burden. And what I like about this therapy is I’m all about layering treatments, so we can always, take this treatment and then add on something like a safe med and try and bridge that gap. Because the reality is, in what we do in this space, whatever the treatment modality, our cure rate is on average about 20%. So the more tools we have to layer on, the more we might hit people’s goals for relief. 

Bruce Kassover: Okay, so I’m getting excited about this because it sounds like, “I have a problem and there may be a real cure.” You’re talking about half of people who try this see some form of improvement. But we know that any medical procedure or medication or treatment, not everybody is always a good candidate. Who is and who isn’t a good candidate for this? 

Dr. Rogers: Yeah, that’s really important. So when we’re making even a small incision, it’s only two centimeters and placing this implant, we want really good, safe outcomes. And although it’s very forgiving to do this under local, when people have poor leg pathology, they’re probably not a great candidate.

So poorly controlled diabetes, bad neuropathy, poor circulation of the legs, any prior ankle surgeries where that area may be compromised, replacing an implant. These are really important things.

So when I am considering any therapy with patients, I always want the best outcome. So there’s, there are certain things about every therapy where not everyone’s a candidate for every therapy, but certainly leg integrity is very important to assess and discuss and medical history, so that, number one, we get safe healing, and number two, we increase the chances of being a responder. 

Bruce Kassover: That sounds perfectly reasonable. Now, if I am still interested in this, but I have one of those issues that you’re talking about, would I be perhaps a candidate for the older, more traditional needle approach to tibial nerve stimulation?

Dr. Rogers: Absolutely. You may have less of a chance of responding but it’s very safe to do either needle stimulation… I also want to bring up you can do just, what I call TENS stimulation, where you buy a cheap TENS unit off Amazon, and they’re just little sticky patches. And you can place those patches on the lower leg.

It’s on my website how to do it, but you could do home stimulation with a TENS unit and potentially get improvement in your symptoms. Also, if you have bad leg integrity, you’re still a candidate for, potentially a candidate for other things like Botox or sacral neuromodulation, surgery or medication. So, just, my goal is, with our menu and therapy options, that we can find something that is safe to try and may help you. 

Sarah Jenkins: I guess I would just ask like, when a patient comes to see you, what, how do you determine which of these options to suggest to them? Is InterStim, Altaviva, they all are great options, but what makes someone an Altaviva patient over an InterStim patient?

Dr. Rogers: Here’s the deal. When you look at the data, we’re really terrible at appealing to patients. So even amongst fellowship trained specialists like myself, half of patients may stop seeing us by the second visit, and like 80% by the third visit. And I don’t think it’s because we don’t want to help patients or have things to offer them. I think they look at what we have and maybe they’re like, “That sounds like a lot, or, I don’t want to do that.” So by adding things like Altaviva, I’m hoping that we can appeal more to patients and engage patients more. So it’s not so much me picking what you want. It’s together deciding what we are willing to do to try and get you better.

Because I can recommend a procedure was sedative or deep sedative, general anesthesia. And you may just say, ” I don’t want to do that.” And then maybe have good legs and something like Altaviva is more appealing because it’s just a local and not a deep, sedative and it’s not a multi-phase procedure.

So I’m just excited that we have something that maybe may expand how many we treat. Because we know that between 80% of patients stopping meds at six months and only 3% of patients getting one of these advanced therapies amongst a specialist, we’re not treating like over 75% of these patients. It doesn’t matter what I tell you to do. You have to be on board with wanting to do it. So, I’ve always found, the more you can offer, the more something might speak to someone and it may appeal to them, and they may be willing to try it.

Bruce Kassover: So that makes me think that, there really is hope for a lot of people out there. And there, there are treatment options that can make a real difference for them. But we know that a lot of patients are still very reluctant to actually move forward because it’s just hard to talk about this sort of stuff. 

Dr. Rogers: Yep. 

Bruce Kassover: And they really don’t want to, they’re just afraid to mention it to even friends or family, let alone a complete stranger. So what do you suggest for somebody who really is either sitting on the fence or just really obstinate about, “No I will not go see somebody”? What do you say to help get them through the door? 

Dr. Rogers: Yeah. It’s just really sad how many people I see and they’ve just suffered in silence for so long and then they finally laying with me and they’re like, “Oh my God, if I just known there were like things that we could try.” And also normalizing this, it just carries such a stigma and people should know that it’s really common, people are talking about it, but don’t worry, you’re not alone, and there are specialists that, like, can help you and you need to find one of them and be seen by them.

So it’s just, it’s, I hate hearing people say, “I, God, I just wish I had come to see you like years ago. Years.” That’s just really unfortunate. So I think there’s just so much work to be done around people being able to raise their hand and get to someone. That, that’s just one of our biggest problems that people stay silent and don’t speak up and just don’t get any treatment. So, anything we can do to improve that. There’s so many things in healthcare that we’ve de-stigmatized, menopause and erectile dysfunction and wrinkles and breast care and all these things. Yet we still are, this issue is just living in a black box. 

Bruce Kassover: Yeah, it really is unfortunate. When people get help, it does not only improve those physical symptoms, but I’m sure that you probably find it rewarding to see how it improves their mental health as well. Can you talk a little bit about what, before-and-after, the sort of the mental toll it takes and how that can really be lifted as well?

Dr. Rogers: Yeah, the data’s real. The social isolation that occurs, depression, anxiety, withdrawing. People change their lives to stay home bound. That is. Real things that have been proven. And so we get people more dry, then they can start interacting again.

People are also funny about it. Like, “I’m finally like purchasing white pants,” and “I’m finally not wearing buying coats that go below my buttocks.” And people are just wearing black. Yeah, no people change their lifestyles if they can get more dry and have more control. 

Bruce Kassover: That makes sense. Unless of course you Johnny Cash, in which case you are always going to want to wear black regardless. So now, when you have these issues developing for many people they don’t happen all at once or all of a sudden, it’s oh my God, I have this massive problem. It could start slowly and over time, and it does have that toll that, that mental challenge, the challenge to self-esteem that it presents, that’s happened slowly over a period of time and it starts to feel normal for people and sometimes they don’t even realize, I would imagine that, that they’re starting to fall into this anxiety, depression sort-of spiral.

 What can people do who are on this path towards worsening conditions to recognize, “You know what, I need to get help now.” What can we do so that they don’t wait forever? 

Dr. Rogers: Yeah. One of the things you can do, and I have ’em on my website, do a three day bladder diary. It’s amazing when I have people do this and they come in with it and they’re like, “I didn’t know it was so bad until I put pen to paper and, wow, like, this is really dictating my life.” And if you don’t want to do pen to paper with a printed diary, Medtronic, they actually have a fabulous app that you can download from their website. And called My Journey. I think it may be My Future now, but I will say collecting that objective data and then, that can really hit home how much this is affecting you.

Bruce Kassover: I love hearing that, and I also want to give ourselves a little bit of a plug, because if anybody goes to nafc.org, if you look, we have a whole page of diaries that are free to download. These trackers are very simple and we always recommend, like you, you track for a short period of time and, do it before your appointment. Take it into the physicians so that you give them a little additional data as well. You learn a lot from those as a physician, don’t you? 

Dr. Rogers: It just can really quantify severity. Because subjectively I try and get accuracy from that. But when you know the numbers don’t lie, when there’s seven leaks in a day and a level four, four urgency all day every day.

Bruce Kassover: That makes perfect sense and I really appreciate you sharing all this information with us, but this is Life Without Leaks. So one of the things we always like to do before our guests depart is ask if you happen to have one little hint, tip strategy, a bit of advice to help those who are listening live a life without leaks. So I’m wondering if you might be able to share one with us today. 

Dr. Rogers: I just want to implore to you that if you finally are like, “I’ve reached my limit. I really want help with this,” that you land with someone who’s really passionate about trying to improve where you’re at and offers many different treatment options to try and get you there, so that when you finally put the time and energy into going to see that person, even if it’s a remote visit, you’re going to have the highest chance of having success.

And so I think it’s very important that when you finally try and have life without leaks, that you land with the right person who’s going to work really hard to try and get you to the best place possible. 

Bruce Kassover: That is outstanding advice and I Appreciate you sharing it with us, and I appreciate you sharing all of these insights today, so I hope that people get a lot out of it and definitely take you up on that and actually go and see somebody and get the help that is already out there waiting for them. So thank you for joining us. 

Dr. Rogers: Thanks, Bruce. It was a pleasure. 

Bruce Kassover: Life Without Leaks has been brought to you by the National Association for Continence. Our music is Rainbows by Kevin McLeod. More information about NAFC is available online at nafc.org.