On Race, Health, And Leaking

09/25/18

By Dr. UC Ossai

Over the past few years, I’ve been making a conscious effort to talk to my friends a lot more about the concept of race. In my lived experience as a Black woman, I often find myself entangled in situations where the extra layer of race has a profound influence on my physical and emotional safety, how I navigate my work environment, relationships and dating, and expectations of my dancing abilities (I’m just kidding...I’m an amazing dancer, though). It’s important for my non-Black friends to see my perspective, just as it’s important for me to see theirs.    

Don’t get me wrong, these conversations aren’t always easy. Emotions can run high. People get uncomfortable. Anuses get clenched. Audible sighs and grunts occur. But we all survive the conversations and keep them going because they help us understand each other, and our interactions with all the systems (education, justice, and healthcare, to name a few) that are based on the value society assigns to our different races.

You’re probably asking yourself: What does this all have to do with pelvic floor disorders? Urinary incontinence? When people sit together and talk about their aches, pains, and bladder issues, the last thing that comes to mind is race. Even me! But, as a medical professional, I know that urinary incontinence (UI) is not exactly an equal opportunity employer, even though it employs a lot of women.

The truth is, research shows that the occurrence and actual type of UI a woman has differs by race. Mind. Blown. For example, stress urinary incontinence (leakage when you laugh, cough, or sneeze) is more likely to occur in White women, whereas urge urinary incontinence (urinary leakage that occurs with an urge to pee or an overactive bladder) is more likely to occur in Black and Latina women. The story gets even more complicated when we look at women’s knowledge of how to treat UI.

In general, the sad reality is that people of all genders are poorly informed about the treatment options available to them, but women of color (WOC) are disproportionately impacted by this knowledge gap. One study found that WOC were less likely to know that pelvic floor exercises can be effective in addressing UI, and they were more likely to think that surgery is the only treatment option. This kind of racial knowledge gap is a massive bummer because, on the ground level, it means that WOC (Latina women, in particular) experience significant delays in accessing care, which leads to worsening of symptoms and lower quality of life. 

Along with most of the world, I was taught that racial health care disparities were a direct result of the choices we make when it comes to diet, exercise, whether or not a person is taking enough “me time,” lack of insurance, and socioeconomic status. The thing is, this way of looking at health—as everyone’s individual responsibility—is woefully incomplete. In communities of color, our individual health (and access to healthcare) is really a mixed bag that’s heavily influenced by factors like systemic racism and implicit bias (from healthcare providers, society, and beyond).  

There’s also a well-documented general lack of trust in the medical community due to historically unethical medical research practices (Tuskegee syphilis studies, Henrietta Lacks, Puerto Rico Pill trials, and more) within communities of color. It might seem abstract, but the impact of these factors is too real, and includes more than leaking. Most recently, the chronic stress of discrimination has been directly linked to the increased rates of maternal and infant mortality among Black women, even when they control for factors like insurance coverage, socioeconomic status, and education level.

Kickstarting change

The best way to address a complex issue like this is to simply start acknowledging it, so we can dismantle it piece by piece. So pour a glass of your favorite beverage, and let’s get to work. Here are three ways to start breaking down racial barriers to accessing quality pelvic healthcare:

  • Loose lips sink poorly informed ships. Start talking about the things that make you uncomfortable (urinary incontinence, sexual pain, racism, sexism) in mixed company. Anytime you’re having a conversation and the faces in the room reflect different genders, ages, physical and mental abilities, race, and ethnicity, your learning and understanding will only be elevated.
  • Shut the nonsense down. If you witness injustice of any kind, speak up and shut it down immediately. Your voice can make a difference in the culture of your workplace, friend circle, and even family.
  • Lastly, from the medical professional in me: Women of color, participate in research and please encourage your friends to do the same! Most of the research in pelvic floor dysfunction is done of White women; which doesn’t quite get a full picture of pelvic floor dysfunction, particularly urinary incontinence. Before participating in a study, have a conversation with the researchers on their plan to disseminate the information into the community, as well as the potential side-effects. Before conducting any research study, researchers must submit their project for approval to an Institutional Review Board (IRB), who are tasked with ensuring that no ethical violations are occurring in the research of human subjects. This should be clearly marked in consent forms you sign before participating in any study.

To improve quality of life for all women living with pelvic floor dysfunction—especially women of color—we need to recognize and address systemic factors like racism that amplify the issue. We need to bring these conversations to the kitchen table. Just a little UC logic.

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Dr. Uchenna Ossai is a sex-positive pelvic health physical therapist, sex educator, and counselor. Follow her on Facebook, Instagram, and Twitter.



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