After Baby Bodies: Lets Talk About It

Leaking when you sneeze. Rushing to the bathroom and still not making it. Sex that hurts and somehow gets framed as “just part of getting older.” We’re done accepting that narrative, and we brought in a specialist who lives in the quality-of-life space every day: urogynecologist Dr. Kana Kanajao. 

We talk about what a urogynecologist actually treats and why pelvic floor health belongs on every woman’s care team, especially in perimenopause and postmenopause. Dr. Kanajao breaks down stress urinary incontinence in plain language, then walks through the real-world options: Kegel work, pelvic floor physical therapy, urethral bulking, and the gold-standard sling procedure. We also dig into how life logistics matter, like recovery time, lifting restrictions, and why some treatments are easier to fit into a busy schedule. 

Then we shift to urgency and frequency, including the term “bathroom mapping” and what it can signal about overactive bladder. We cover common triggers like bladder irritants (hello, venti coffees and bubbly drinks), plus risk factors like chronic constipation and heavy lifting. Finally, we talk hormones and tissue health, including why vaginal estrogen can be a game-changer for some women and why you deserve a plan that matches your goals, not a pad aisle workaround. 

If this hits close to home, share this with a friend who’s been told to “just deal with it,” and make sure you subscribe and leave us a review so more women find these options sooner.

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Transcript

Kelli 0:26

Hey everybody, welcome back to another episode of Tattoos and Telehealth. Um, I am Kelly White, Board Certified Feedly Nurse Practitioner. This is my good friend and colleague, Nicole Baldwin, another board certified Feenly Nurse Practitioner. And we have a special guest today. Um, we have Dr. Kana

Welcome And Medical Disclaimer

Kelli 0:41

Jao joining us. Um, and we have some exciting things to talk about. If you follow us, listen to us, you kind of got a little sneak peek last week about what we were going to chat about. But before we get started, our um legal team always makes us say that listening or participating in this podcast does not constitute a patient-provider relationship. This is not constituted as medical advice. So please consult with your provider. If you don't have a provider, get one. Um, we are just a few gals chatting it up and trying to keep things fun as we do it. So, Dr. Kanajow, please tell us what you do, why you're here, why it's so important, and why should women of all ages, but specifically peri- and postmenopausal women, why should they have you in their back pocket?

SPEAKER_02 1:23

Hi, thank you so much for that sweet introduction. That was incredible. Um, I am a euro gynecologist trained through OBGYN. And I am excited to be here, fellowship trained. And why do you need

What A Urogynecologist Actually Does

SPEAKER_02 1:38

a urogynecologist? That's a great question. I think just like women are doing the mommy makeover, you've got to have somebody on your pelvic health team. So um recognizing what's going on on the pelvic floor, the muscles, the bladder, the bowels, um, and especially with inner course and things like that, a urogynecologist is the best thing to have in your back pocket. So we did additional training on top of the general um OBGYN. We did an extra three years in Eurogyne. Um, and it gives us more of a surgical technique to be helpful. But most importantly, is um we can talk to you about everything body after babies. That's what we do.

Nicole 2:18

Nice. I love that. I love that. That's amazing. I did not realize it was another three years after OBGen. I didn't either.

Kelli 2:25

I didn't realize it. So you went through a full OBGYN rotation, like C-sections, birthing babies, all the fun stuff. You were covered in amniotic fluid, legit.

SPEAKER_02 2:34

That's right. That's right. So I did first of four years of undergrad and then um did my undergrad in med school at the University of Miami and then residency in Sinai, New York, which was so fun. I bet. After four years of delivering babies, I was done. And I always loved um just women and, like I said, body after babies. I loved women's health, moms who were always running after everybody else, taking care of everyone else. And it was just a pleasure to be able to be part of the quality of life conversation where you know, people are normalizing things like leakage and urgency and UTIs and pain with intercourse. And it's just not normal to have those things. And so being um in this field has been super eye-opening just to know how few people know about it and what we do and the fact that we're here. So um it's been really funny that a lot of women have started to come in um and I've asked them how they found out about us, and they've told me it's through Chat GPT.

Kelli 3:41

Isn't that awesome?

SPEAKER_02 3:43

GT knows the um stuff to say.

Kelli 3:47

So I um I spent my first seven years as a nurse practitioner in women's health. And I got to follow around a great OB Gen. I got my first assist right out of school. So I assisted her all of her C-sections, all of her

Why Leakage And Pain Aren’t Normal

Kelli 4:00

gin surgeries. It was a lot of fun. Um, but I was like you, I was really shocked by the number of women that just thought, you know, like most of us, oh, you know, after you have kids, you're just gonna pee when you sneeze and that's okay. Or, or oh, you know, as you get older, you know, you're just gonna have painful intercourse, and that's just the way that it is. And I'm just shocked even now, you know, like fast forward 21 years, and it's still that way. Women just think that we have to suffer as we get older because that's just the way it has always been. And it hurts my heart because no, ma'am, you don't. It is not, it doesn't have to be that way. It should never have had to be the stigma. Women have always been put on the back burner with their health. They've been told just deal with it. And I'm sorry, but I'm of the I'm of the um thought process that if a man's testosterone dropped as rapidly as a woman's does overnight when they go through menopause, they would put that man in the hospital.

SPEAKER_02 4:51

Yes. Yes, I would say if a man was leaking and you told him to wear a diaper, he would say, No. Heck no. He would tell you where to go real fast. Exactly. But women, I think I remember Brooke where she's like walking in the commercials about with her pads. Yes, you know, we're just told, oh, just put throw a pad on. It's normal to do that. And um, yeah, standing on that soapbox for a minute, you know, men would never ever in so tell women what are their options?

Kelli 5:24

So let's start with women that have had vaginal deliveries first. We're gonna go there first because I have some questions for you about those that haven't yet. But um, women that have had vaginal deliveries and now they, you know, they sneeze, they pee, they cough, they pee, they bend over, they pee, they squat, they pee, everything they pee. What

Stress Incontinence Options After Birth

Kelli 5:39

what are their options?

SPEAKER_02 5:40

Great question. So, you know, we generally talk about four options for that kind of leakage. It's called stress incontinence, which just means that when there is stress applied, which is like coughing, laughing, jumping jack, being on a trampoline, you're gonna notice that leakage and that your is dropping and we're leaking from it. So that happens, even if we had a C-section, carrying a baby for nine months is a risk factor for it. Um, of course, when you deliver vaginally, just think of those, you know, ligaments, they're just gonna pull right off and you can't bring them back on. The treatments are four options. One is Kegel exercises. A lot of women are doing that on their own. You know, they're doing their best, they've got their apps, they've got all these device training options. That's a great option. It's about 60% improvement. The second would be pelvic floor physical therapy. Um, pelvic floor therapists are, you know, right hand. Amazing. You know, they're amazing. They really work with the pelvic floor. I think even in Europe, they give you six weeks of just part of the postpartum care is to have pelvic floor therapy to really.

Kelli 6:46

Isn't it amazing that women in Europe get such great postpartum maternal care?

SPEAKER_02 6:50

Yes, it is so based on prophylactics, so things that can be helpful later versus treating what's already happened. So that kind of screening is so incredible. Um, and then the other two options are more advanced. You know, we've got options like a bulking agent that kind of fills the urethra, kind of like where they get lip fillers from. They get it from us. So the same way we can poof our lips open, we can poof the urethra closed to stop all of that leaking. Seriously? Yes, and it's a great option because no restriction. A lot of women who are, you know, picking up their small babies, they've got to go to work tomorrow. You know, they don't have that um FMLA time off where they need to really take two weeks. It's a great option because they can be right back in the office the next day. Wow. Wow. Yeah. And it's a really, it's a really nice opportunity for them. Um, the other is the gold standard, it's the sling. Um, and it is a little piece of mesh. We put it right underneath the urethra. So every time you cough, laugh, jumping jack, it's like stepping on a garden hose. You're able to stop the leakage right away. Um, that does require six weeks of no heavy lifting. So I think that can be sometimes hard to accommodate into women's schedules. Um, but it's the gold standard, 90% effective. You know, I love that procedure just because as a surgeon, you love that kind of outcome metric. They come back, they're so happy, they're jumping on the trampolines, they're doing the things, they're lifting the groceries. Um, they're, you know, it's embarrassing to walk around with pads and an extra change of clothes and just that feeling like, ugh, do I smell? Is it urine? You know, that whole feeling. So it's a pleasure.

Kelli 8:34

But those of you that's awesome. So, what about women? So let's fast forward. And this is kind of where um this is near and dear to me because I I've never had children. I was never able to. Um, so I don't have children, and I'm now perimenopausal, and I will still pee when I sneeze and I lift heavy, heavy

Perimenopause Risk Factors And Hormones

Kelli 8:54

weights. And if I'm lifting super heavy, it's gonna happen. And I tell people, gravity still works against you. It is still a thing, especially people that have had constipation their whole life, that are used to straining. Like there is still a world where you don't have to carry a baby and have a vaginal delivery for you to have age-related incontinence because of this state in your life. So, can you can you speak to that? Like, can you can have you seen patients with that?

SPEAKER_02 9:24

Absolutely. Um, and that's such a great point to bring up the risk factors. You know, perimenopause is a huge risk factor. We have a lot of vaginal receptors on our bladder and our vagina. And when that decreases, it makes it hard. It's kind of like, you know, if you put um a rubber band outside in the sun, it gets less elastic and easier to break. So that same idea is happening with your pelvic floor. You know, vaginal estrogen cream is huge. It's like a lotion for dry skin. Using it can be super helpful. I think if you're in the perimenopausal status, though, it's definitely a good idea to look at systemic hormones because that's if you're a candidate for it, um, it's a great idea to help with your pelvic health too. Um, and then a lot of lifestyle choices. You know, I've had a lot of public stocks unloaders, you know, Costco unloaders. Um, you know, if you're working in medicine and you're the one who's pulling and pushing these patients, you know, these are huge um, you know, heavy grunting sessions, chronic constipation, another huge um risk factor that will have you bare down on your pelvic floor, and your pelvic floor feels that eight hours a day, seven days a week, you know.

Kelli 10:40

So um there's all kinds of, you know, med spalls out there that offer, you know, certain types of vaginal lasers and all these funky treatments. What what's the juice behind that? Is that is that really a thing? Is that something women should be exploring? Should they be like going to

Vaginal Lasers And Realistic Results

Kelli 10:55

their local med spa and saying, hey, do the laser thing? Like, what is that?

SPEAKER_02 10:58

Yeah, that's a great question. We also have a vaginal laser. It's a CO2 ablative laser that takes off um, you know, a portion of the vagina, the skin, in order to improve that for you. Um, I think the short end of that answer is really based on multiple types of metrics that people take into account. I think cost through insurance, um, time off.

Kelli 11:24

Um is that covered through insurance? Is that something people can expect their insurance to cover, you think?

SPEAKER_02 11:29

Vaginal lasers, for sure not. Um, yes, they are covered, but to the metric that you are covered in your insurance, which I feel like is a whole other conversation. Um but sometimes those costs can be so high that people want to find alternative options for it. And I think these are great options. The improvement that you're gonna find with self-directed keto exercises, pelvic floor therapy, and these vaginal lasers are anywhere to 60 to 70 percent. So a lot of women, for them, that's success. You know, if I'm having more good days than bad days, I'm gonna go for that run. I'm gonna, you know, jump on that trampoline. But other women are like, no way, I need 100% sex success. I'm looking for zero pad counts. I'm looking for not carrying any more underwear with me. And for women, advanced treatments are probably the better bet to get you closer to zero.

Kelli 12:21

That's awesome. So, what would you say is your most common complaint when women come to you? What do you see as the majority of women in your clinic?

SPEAKER_02 12:32

Um, I would say some level of leakage with

Common Complaints And Bladder Irritants

SPEAKER_02 12:36

cough, laugh, and sneeze, pain with intercourse, hormonal, um, any of those prolapse urgency, a lot of urgency. Gotta go, gotta go. You know, we're drinking more poppies, olli waters, bubbly drinks. Um, I'm seeing that younger and younger. You know, it used to be something that was really reserved for 45, 50-year-old women, but it's starting now at 25 to 30-year-old women who are coming in. You know, they're drinking venti coffees twice a day. That's those are huge bladder irritants, you know. So it just now they're bathroom mapping. They know where every bathroom is, they're running to the bathroom every time they've got to go, but so they don't make it. Um, so we're seeing a lot of that and and a lot of bladder irritants issues.

Nicole 13:24

I like that you said bat, did you say bathroom mapping? Bathroom mapping, yep. That is that is definitely a term that I think a lot of listeners can like we didn't know it was a term, right? Until you I'm like, wait a minute, that's a thing. But it's it is a thing, but that's it's perfect. Like that's perfect to call that. Wow.

Kelli 13:47

So like what do you mean by bathroom mapping?

SPEAKER_02 13:50

Bathroom mapping is knowing where all the bathrooms are. So a lot of women will go to the grocery store, they'll go to the bathroom, then they'll go and check out, they'll go back to the bathroom before they get back in their car or wherever they're going, they want

Bathroom Mapping And Overactive Bladder

SPEAKER_02 14:02

to know where they are, where the bathrooms are and how quickly they can get there. And so um bathroom maps. A lot of yeah, bathroom maps, they know the maps. Um, and so that happens a lot with urgency and frequency. Um, it's called overactive bladder. So if you remember that commercial where the bladder is pulling the woman out of the, you know, um wedding situation and she's on a date and she's running out or, you know, um, it's a whole quality of life thing, you know, you shouldn't have to be knowing where all the bathrooms are. You should be able to hold your urine for four to five hours at a time, use the restroom four to six times um a day, and not, you know, urinate on your way there. So it's really the idea that when your signal gets to your brain that you've got to go to the bathroom, you have enough time to get there, pull down your pants, sit down, go to the bathroom, and then you're, you know, and at that time you urinate. Anything, any urination before then is technically abnormal and can be managed.

Kelli 15:04

That's great. That's great. I'm sitting here thinking to myself, I'll probably urinate 10 or 12 times a day. But I drink a lot of water in my defense. I drink a lot of water because I work out quite a bit. But now I'm sitting here thinking to myself, gosh, is that I'm probably not normal.

SPEAKER_02 15:20

I'm probably not okay. I also think like the amount of water you drink, it's like you should your urine should be clear yellow, but like if it's white, you know, but there's so many things that go into it. People trying to drink a lot of fluid, you know, weight loss options, GLP ones now. Um, so there's a lot of factors that go into it.

Nicole 15:42

So, Dr. Kanajao, where where is your practice? If a patient wanted to pick your brain and make an appointment with you, where are you located? How can patients find you specifically?

SPEAKER_02 15:53

Yeah, we are located at Trinity Um and Wesley Chapel

How To Find Dr. Kanajao

SPEAKER_02 15:57

Eurogynecology. So one of our options are right there on 54 and Ducks Lau in Starkey Ranch area. And our second location is in Wesley Chapel. And you can make a phone call, um, go to our website or click the book now button and you can book there as well.

Nicole 16:13

So this is in Florida. For those of you who aren't in Florida, make a trip to Florida to see Dr. Canagow. Um, so Trinity and Wesley Chapel. Yep. Okay. So Yep. So that's where she's located, and you can find her, you can find her online. And um Kelly, any last minute things before we uh let her get back to work?

Kelli 16:34

Um, I guess last but not least, Dr. Canajao, if there's anything that you would tell women that you wish you had known before, you know, like if women wish if you wish women had known this, what would it be? You just wish they would know this.

SPEAKER_02 16:48

I

Advocate For Yourself And Closing

SPEAKER_02 16:49

wish that they would know that there's something they can do for what they're feeling and it's not normal. I can't tell you how many women come in, have something done, and say to me, I should have done this six years ago. And if you're in the middle of the night Googling something, it's you know, someone's telling you it's normal. I wish people would talk about it more with their friend circles, their book clubs, their podcasting. I think the more awareness the better, because um, you know, you have to be your own health advocate. You've got to be the one to say, hey, this is bothering me and I shouldn't have to do it. I shouldn't have to look at it.

Nicole 17:25

So I think your podcast should be Bodies After Babies.

unknown 17:29

Yes.

Kelli 17:30

Yes. Do it.

Nicole 17:33

Yeah. Anyway, just a thought. There's just a lot of people that are out there struggling. So, but anyway, thank you so much for joining us today. And for the rest of you, we will see you next time. All right, guys, take care.