Pioneer in Female Urology
Written by Jan Jaben-Eilon Thursday, February 03 2011
Snapshot: Dr. Jenelle Foote
Dr. Jenelle Foote is a urologist, and vice president of Midtown Urology P.C. and Midtown Urology Surgical Center in Atlanta. She’s also a pioneer in medical research of female urology and sexual dysfunction. A native Ohioan with a passion for medicine, she received her undergraduate degree from Duquesne University in 1978. After she received her medical doctorate from Temple University in 1984, she did her internship and residency at Albert Einstein Medical Center in Philadelphia. She completed her residency at the University of Colorado Health Services Center in Denver. She also did a fellowship in female urology, incontinence, and reconstructive surgery at Kaiser Permanente Medical Center in Los Angeles.
In 2002, the National Association for Continence bestowed its Continence Care Champion award to Foote because of her service as a role model to other doctors in her field and her contributions to research, clinical practice, and education. She recommends that women with incontinence access that group’s website at www.nafc.org.
She has a 9-year-old daughter, a stepdaughter, and lives with her husband in Atlanta.
Womenetics: Perhaps it’s because of my age or the increase in TV commercials about products for incontinence or overactive bladder, but I only heard of these issues in the past few years. Is an overactive bladder particularly associated with middle age, and is it more of an issue now because of the aging of the baby boomer generation?
Jenelle Foote: First, I want to say, as a physician, I think the direct consumer advertising for bladder problems has been wonderful. It’s something people have a hard time talking about and many keep it to themselves. There are so many myths out there, such as there’s nothing that can be done or maybe it’s not that big of a problem. The advertising gives us the language to speak, and it validates that this is a real problem.
The first ad came out more than 10 years ago and the term we now use professionally, overactive bladder, was actually created as a marketing tool by the pharmceutical companies. Now it’s the common language of physicians. But yes, you are right, we hear more about overactive bladders (OAB) because of the baby boomers. They are a smart group of people who, unlike their mothers who didn’t want to take care of this, won’t sit at home and be embarrassed or ashamed. There are more products on the market, and I think it’s right that we need to market directly to consumers partly because doctors still participate in the stigma, although that’s changing. The pharmaceutical companies have done a good job, but it’s because the patients are coming in to see doctors and saying, ”I have a problem.”
I must add there are an increasing number of professional seminars for doctors who hadn’t been trained in this issue, and in the last 20 years, incontinence has come out of the closet.
Womenetics: What exactly are the symptoms of incontinence and overactive bladder?
Foote: There are several types of incontinence, which essentially means an involuntary loss of urine. The most common is “urge incontinence,” which means there’s an urge to urinate and the person can’t hold it. The bladder is pushing it out.
The second most common is called “stress incontinence,” which doesn’t mean the person is stressed, but that there is pressure on the abdomen. It is linked to laughter, coughing, or lifting something heavy and results in a spurt of urine.
The third type is “functional incontinence,” which is not as common. Our aging parents may have it. It’s a function of voiding which is complicated: First a person must sense her bladder is full, then she must get to the toilet, undress herself, and all that time must hold it in. If the person is disabled, it becomes more difficult. A person with Alzheimer’s, for instance, has disordered thinking. So instead of going from A to B to C to D, she may go from A to D. The equipment might work fine, but the functionality is impaired. She may have inappropriate voiding.
The last and least common type is “total incontinence,” in which the bladder is leaking continuously.
These are the four general categories but someone can have any one or more types and the treatment is different for each. Overactive bladder refers to frequency and urgency, but it may not be incontinence. Some don’t leak, but I know of some women who don’t drink when they leave the house because they feel the urgency too much. But this doesn’t address the problem.
There’s also “giggle hyperreflexia,” which is specifically in women and girls. They pee on themselves when they giggle. It’s not common though.
Womenetics: Your research is in female urology and sexual dysfunction. Is there a connection?
Foote: Female urology is a specialty dealing with women and the training is different from general training in urology. It’s because of the kinds of incontinence women have, which are due to the urethra tube and issues of pain around that. Female sexual dysfunction is a field that is not under one specialty. Some urologists deal with this, and some gynecologists or internists deal with it. But gynecologists are trained about fertility and pregnancy. They treat infections and cancer. But when it comes to sexual satisfaction, most gynecologists don’t get any special training. But this is important for urologists.
The level of knowledge for men’s sexual dysfuncion in evaluation and treatment is so far ahead of women. What do we have for us? Hardly anything. The amount of research for each is also so different. I became involved because patients would ask me since their gynecologists didn’t know anything about it. It’s just missing in their training.
What is driving the research for female sexual dysfunction is the baby boomer women who say, there’s Viagra for men, what do you have for me? We’re living longer and healthier after menopause and we want sex, especially as men are more functional than they used to be.
Womenetics: I read that 85 percent of Americans with incontinence are female. Why are women more impacted?
Foote: This has to do with anatomy. Babies are sometimes to blame. There are different stresses on the pelvic floors, which are a series of muscles and ligaments that the uterus and bladder sit on. You must keep these pelvic floors strong so you won’t have incontinence.
Womenetics: Do gynecologists deal with these issues or should women see urologists if there’s a problem?
Foote: I tell women to see their gynecologist first, but they can refer you to someone else if they don’t know. Most of my referrals are from gynecologists. There are also urogynecologists. Maybe 12 in Atlanta. This is now a subspecialty of gynecology.
Womenetics: What are the main treatment options for overactive bladder and incontinence?
Foote: Kegal exercises are exercises to strengthen the pelvic floor. They work on the series of muscles in the pelvis. If you tighten up like when you want to stop the stream of urine, or tighten your bottom if you don’t want to pass gas, those are the muscles. If you tighten the muscles 10 times in the morning and 10 times at night, over three to four weeks, you see improvement. This can eliminate stress incontinence. Or you can see a physical therapist. But a lot of it is education, understanding your body. You might need to change your diet and not have foods that irritate the bladder, like orange juice or a cola drink. Also, OAB medicines can be very helpful, but only after you’ve tried everything else. There are surgeries, even on an outpatient basis which can be helpful. The vast majority of patients are better with a variety of treatment.
Womenetics: How did you choose this specialty?
Foote: I trained in general surgery, but there was a lot of life and death stuff, which was wrenching for me. Every time I lost a patient, I’d go to the bathroom and cry. It’s a personality thing. This is the one thing that intrigued me. There were few women in urology, and I thought, ”Why not?” I saw it as a challenge, and I was fortunate to have good role models, women who allowed me to see that it was a good field. I still like surgery; I like fixing things with my hands. It gives me a feeling of satisfaction to fix things. And urologists as a group are good-natured people. You must have a good sense of humor dealing with urology and gynecology.
Womenetics: Is this a good medical specialty for female physicians?
Foote: I think so. We’re up to 2 percent or the urologists in the United States. There’s a lot of variety in the field and most practice general urology. There’s some pediatric urology, too. I think it’s an interesting world.
Womenetics: How old were you when you decided to become a doctor?
Foote: I was a chemist in St. Thomas in the Virgin Islands. I was 22 and very bored. I waited tables nights and weekends and really enjoyed that. I’m a people person. I needed something to blend scientist and people. I think my mother, who is a retired lab technician, always thought I’d be a doctor. My sister and I were always around physicians and medical things.
Womenetics: What are your favorite hobbies?
Foote: My job is very time consuming, and I have a 9-year-old daughter so I’m busy with her activities. I try to keep myself fit with regular exercise. I like to travel, as does my husband. I’d like to take a family trip to the West and visit our national parks, one right after another. Do some camping and hiking.
Jan Jaben-Eilon was a founding staff writer of the Atlanta Business Chronicle. Since then, she has been the international editor of Advertising Age magazine and has written for such publications as The New York Times, International Herald Tribune, Washington Journalism Review, and Consumer Reports. She is the author of soon-to-be-published (There is) Life After Cancer. Jan and her husband have homes in Atlanta and Jerusalem.
