Losing Your Urine When You Cough Or Sneeze-Treating Incontinence With a Pessary

Pessary For Treating Mild Stress Incontinence

Stress urinary incontinence or loss of urine with coughing, sneezing, or even bending over to put on your shoes affects millions of American women. Often times a woman is looking for a treatment that does not involve medication or surgery. For certain women a vaginal pessary is an option. A pessary is a removable device placed into the vagina. It is designed to support areas of the pelvis such as occurs with pelvic organ prolapse.
There are a variety of pessaries available, made of rubber, plastic, or silicone-based material. Among common types of pessaries are the inflatable , the doughnut, and the Gellhorn.

Frequent Urination: Causes and Treatments
Gotta go all the time? The technical name for your problem is frequent urination or overactive bladder. In most people the bladder is able to store urine until it is convenient to go to the toilet, typically four to eight times a day. Needing to go more than eight times a day or waking up in the night to go to the bathroom could mean you’re drinking too much and/or too close to bedtime. Or it could signal a health problem.

Why It Is Done
Pessaries are used as a nonsurgical approach to the treatment of pelvic organ prolapse. They are frequently used to treat uterine prolapse in young women during pregnancy. In this instance, the pessary holds the uterus in the correct position before it enlarges and becomes trapped in the vaginal canal.
Pessaries are also used when symptoms of pelvic organ prolapse are mild or when childbearing is not complete. They can be used in women who have other serious chronic health problems, such as heart or lung disease, that make a surgical procedure more dangerous.

Pessaries are sometimes used to see what the effect of surgery for pelvic organ prolapse will be on urinary symptoms. This is called a “pessary test.” If you have a problem with incontinence with a pessary inserted, a separate surgery to fix the incontinence problem may be done at the same time as a prolapse surgery
How Well It Works
Pessaries do not cure pelvic organ prolapse but help manage and slow the progression of prolapse by adding support to the vagina and increasing tightness of the tissues and muscles of the pelvis. Symptoms improve in many women who use a pessary, and for some women symptoms go away.

You will need to see a doctor to be fitted for a pessary which will hold the pelvic organs in position without causing discomfort. Pessaries come in a variety of sizes and should be fitted carefully.

What To Expect After Treatment
Your pessary will be fitted in your doctor’s office. You may need to experiment with different kinds of pessaries to find one that feels right. The pessary needs to be remove, clean, and reinsert the pessary on a regular schedule. Most often this is done by the doctor or his\her staff but some women prefer to do this themselves. The cleaning schedule is determined by the type of pelvic organ prolapse and the specific brand of pessary.

Risks
Possible complications from wearing a pessary include:
• Open sores in the vaginal wall.
• Bleeding.
• Wearing away of the vaginal wall. In severe cases, an opening can form between the vagina and the rectum.
• Bulging of the rectum against the vaginal wall (rectocele formation).

Complications can be minimized by having a pessary that fits correctly and that does not put too much pressure on the wall of the vagina.
In post menopausal women, estrogen (cream, ring, or tablets) is sometimes used with a pessary to help with irritation caused by the pessary.
What To Think About

Pessaries often are an effective tool for managing pelvic organ prolapse without surgery. They may be the best choice if you are a young woman who has not finished having children, if you have been told that surgery would be risky for you, or if you do not wish to have surgery for other reasons.
A pessary may not be a good choice after having a hysterectomy. This is because the walls of the vagina are no longer held in place by the uterus and cervix. Women with severe prolapse following a hysterectomy may have difficulty keeping the pessary in place.
Many women can have sexual intercourse with their pessary in place. But you cannot insert a diaphragm (a round rubber device used as a barrier method of birth control) while wearing a pessary. If you have not reached menopause, you may want to discuss birth control with your doctor.


Bottom Line: Stress incontinence is common condition affecting millions of American women. The treatment with a pessary is an option that does not require the use of medication or surgery.

For more information on women’s health, I suggest my new book, What’s Going On Down There-Everything You Need To KnowAbout Your Pelvic Health. the book is available from Amazon.com

New book on women’s health

Gotta Go Right Now? Here’s How To Discard Your Depends For Your Next Airplane Trip

Don’t Depend on Depends

Many men and women suffer from urinary incontinence making travel difficult or nearly impossible. Here are 10 tips and tricks that you might consider before your next flight to lessen the embarrassment of urinary incontinence.

1. Request an aisle seat in back of plane so you have ready access to the restroom. Reserve your seat ahead of your departure dates. Plan to go to the restroom and empty your bladder before your plane departs. Once on board the aircraft and after take off plan to use the restroom before the drink cart come down the aisle as you may be sent back to your seat before you can use the restroom.
2. Explain your medical condition to flight attendant before take-off. The flight attendant can alert you before they turn on seat belt sign making it possible for you to use the restroom. The attendant can help you get off plane for connecting flight if you are at the back the plane.
3. Be aware that you cannot use the bathroom during ascent (short) and descent (long)
4. Wear adult diaper or protective underwear for the trip. You should have a carry-on duffel bag with extra undergarments, pads, antibacterial soap, and an empty plastic bag for soiled clothing.
5. Be mindful of your fluids. It is not a good idea to dehydrate yourself for long periods before departure. To do so will lead to a concentrated urine which is irritating to the bladder and may promote bladder contractions. Drink 6 cups of fluid per day but time it appropriately to your flight departure.
6. Avoid bladder irritants (coffee, alcohol, carbonate drinks, artificial sweeteners, citrus)
7. Suppress the urge by doing Turbo Kegels, which I will describe in the next blog.
8. Voiding by the clock. Don’t wait for your bladder to become full or over distended. Urinate every 2-3 hours especially on long flights.
9. Take your medications prescribed by your doctor. I suggest that you make sure to take at least for 2 weeks before travel
10. Use a waterproof skin barrier ointment (zinc oxide) to protect skin if you do have frequent accidents

Bottom Line: If you have urinary incontinence, you may have problems with airline travel. Applying a few of these principles may just make that flight more enjoyable and less stressful.

For more information on urinary incontinence, I recommend my new book,
The Complete Guide To Women’s Pelvic Health which is available at Amazon.com

New book on women’s health

Put Away Your Depends-Treatment Options Without Medication or Surgery

Losing urine that requires a woman to wear Depends is a very depressing situation.  It is very embarrassing for women to go to the pharmacy or grocery store and her box of Depends in her cart is very discouraging and a source of great anxiety.  There are nearly 13 million women who have incontinence and many of them have not talked to their doctor about the problem and suffer in silence.

 

Stress incontinence, which is more common in women, causes urine to leak when you laugh or cough. Overactive bladder, also called urge incontinence, is caused by urinary muscle spasms that cause an urgency to urinate. If you leak urine when you cough, laugh, sneeze, or exercise, you have stress incontinence. Mental stress does not cause stress incontinence. The “stress” is pressure on the bladder. When your pelvic and sphincter muscles are strong, they can handle the extra pressure from a cough, sneeze, exercise, or laugh. But when those muscles are weak, that sudden pressure can push urine out of the bladder.

In stress incontinence, weak pelvic muscles can let urine escape when a cough or other action puts pressure on the bladder.

 

Some treatments are as simple as changing some daily habits.

I recommend that women try the simplest treatment choices first. Kegel exercises strengthen the pelvic muscles and don’t require any equipment. The trick is finding the right muscles to squeeze. It is the same muscles that you contract to stop your urine stream or to prevent you from passing gas from your rectum.  After about 6 to 8 weeks, you should notice that you have fewer leaks and more bladder control. Use the pelvic muscle exercise log included with the Kegel Exercise Tips sheet  to keep track of your progress.




Timed voiding. By keeping track of the times you leak urine, you may notice certain times of day when you are most likely to have an accident. You can use that information to make planned trips to the bathroom ahead of time to avoid the accident. Once you have established a safe pattern, you can build your bladder control by stretching out the time between trips to the bathroom. By forcing your pelvic muscles to hold on longer, you make those muscles stronger.

 

Diet changes. You may notice that certain foods and drinks cause you to urinate more often. You may find that avoiding caffeinated drinks like coffee, tea, or cola helps your bladder control. You can choose the decaf version of your favorite drink. Make sure you are not drinking too much fluid because that will cause you to make a large amount of urine. If you are bothered by nighttime urination, drink most of your fluids during the day and limit your drinking after dinner. You should not, however, avoid drinking fluids for fear of having an accident. Some foods may irritate your bladder and cause urgency. Talk with your doctor about diet changes that might affect your bladder.

 

Weight loss. Extra body weight puts extra pressure on your bladder. By losing weight, you may be able to relieve some of that pressure and regain your bladder control.

 

Bottom Line: Incontinence doesn’t kill a woman but it does steal her quality of life.  Often times these simple techniques will help reduce urinary incontinence.  If you have any questions.  See your doctor

 

I have also written a book, What’s Going On Down There-The Complete Guide To Women’s Pelvic Health, and there is an entire chapter on urinary incontinence.  The book is available from Amazon.com

 

 

New book on women’s health

Getting Tighter “Down There”-Kegel Exercises Improve Vaginal Tone

Have you just had a baby and find that you are lossy goosey down there? If so you might want to consider doing regular Kegel exercises to tighten the tone of your vagina.

Two ultrasound studies of women who exercised their vaginal muscles did find that their muscles were thicker and stronger after pelvic floor muscle training. Among women with urine leakage, their thinner muscles became the thickness of healthy women’s pelvic floor muscles. Additionally, they had less urine leakage — whether the problem was from stress or urge types of incontinence.

The use of vaginal cones and/or Kegel exercises to increase muscle strength were both found to improve tone and decrease urine loss. While some of these studies did not measure vaginal tightness per se, when muscle bulk is increased, a woman can voluntarily contract those muscles to make the vaginal opening tighter.

Bottom Line: Kegel exercises will not only help with the problem of urinary incontinence but will make women tighter “down there”

A Kegel A Day Keeps the Depends (TM) Away

Urinary incontinence is a devastating problem affecting millions of American women. For women with mild to moderate loss of urine with coughing and sneezing, Kegel exercises can M)improve urinary control and decrease the use of absorbent pads and even the use of Depends.

Kegel exercises strengthen the pelvic floor muscles, which support the uterus, bladder and bowel. You can do Kegel exercises discreetly just about anytime, whether you’re driving in your car, sitting at your desk or relaxing on the couch.
Many factors can weaken your pelvic floor muscles, from pregnancy and childbirth to aging, which is associated with estrogen deficiency and being overweight. This may allow your pelvic organs to descend and bulge into your vagina — a condition known as pelvic organ prolapse. Kegel exercises can help delay or even prevent pelvic organ prolapse and the related symptoms.
Another huge benefit of Kegel exercises includes assistance for women who have persistent problems reaching orgasm. I am not sure how this works but I have heard so many anecdotal success stories that I am convinced that Kegel exercises are effective.

I have recommended a device, the Laselle by Intimina (http://www.intimina.com/en/kegel-exercisers-laselle.php), for women with incontinence issues.

Laselle Spheres For Kegel Exercises

There is documented evidence that has concluded that pelvic exercises should be included in first-line conservative management programs for women with urinary incontinence. The Laselle Kegel exercisers are elegantly crafted spheres with an attached string for easy insertion and removal that helps women gain objective evidence that they are doing the exercises correctly.

These weighted spheres, which if worn discreetly inside the vagina during daily activities, give women the most complete intimate workout, helping women to locate their pelvic floor muscles and providing a solid object for women to flex around for more effective strengthening. Within each sphere is a weighted ball that responds to your body’s movements, causing gentle kinetic vibrations to help prompt your pelvic floor muscles to contract and relax as you walk around.

Laselle Kegel exercisers are available in three different weights. These three different weights provide different levels of resistance and can be combined and adapted to your routine as your pelvic floor becomes stronger, helping you to unlock the full potential that this muscle set offers.

Correct performance of Kegel exercises
1. Contract your pelvic floor muscles, lift the exerciser(s) upwards
2. Hold the contraction for 2-10 seconds, while taking deep breaths
3. Release the contraction
4. Rest & relax for a minimum of your hold time, or for as long as you need before repeating the exercise
Repeat 10 times for a Kegel set, if this is challenging, reduce your repetitions to an amount that is comfortable for you.
For an efficient workout, perform a Kegel set 3 times a week on alternative weekdays
Correct Kegels do not involve tensing the abdomen, squeezing the buttocks, or straining and pushing down when contracting.

Performing Kegel Exercises Correctly

Bottom Line: Incontinence is a common problem affecting millions of American women. Kegel exercises are an effective method of solving the problem. Laselle spheres by Intimina are an easy way to get started.

Ladies, When You Gotta Go –It May Just Affect Your Sex Life

Overactive bladder (OAB) can rain havoc on your sex life. OAB is marked by the near constant urge to urinate, which can lead to urinary incontinence or leakage. This occurs because your bladder involuntarily contracts when it isn’t full. From medication side effects and neurological conditions to urinary tract infections and pregnancy, the potential causes of OAB in women vary.
If you are a woman with OAB, sexual intimacy may worsen the symptoms of OAB. Some women are apprehensive about the loss of urine during sexual intimacy and will avoid intimacy to avoid embarrassment. OAB or urinary incontinence can cause physical symptoms as well as fear, anxiety, and shame about sex and intimacy. Most women find it very difficult to discuss their OAB symptoms with men especially if those urinary symptoms occur at the time of sexual intimacy.
Most women with OAB can be helped with medication. Also, sometimes simple actions like using the restroom before sexual intimacy may alleviate the problem. There are dietary modifications such as omitting caffeine and alcohol several hours before you anticipate you are going to be sexually active can reduce the symptoms of OAB. Also there are medications that cause OAB and it may be something as simple as speaking with your doctor and changing your current medication regimen to one that doesn’t cause OAB symptoms. Most patients can be helped with medication and behavior changes to decrease the bladder irritation that results in OAB symptoms.
Unfortunately, many women with OAB will just avoid sex altogether. They think it’s bad for their bladder and that it will make it worse, so they stay away from that whole area. Unless you have a prolapsed bladder or a protrusion from your vagina intercourse is not dangerous and will not damage your bladder.
Sometimes being forthright and honest with your partner is best course of action. Once you are open with your partner, you can face the situation together. If there is urine incontinence during sex or orgasm, you may need a towel. This is something that should be done before you hit the bedroom sheets. Sex experts advise bringing up OAB and sex fears long before intimacy occurs.
Bottom Line: Overactive bladder doesn’t kill you; it just ruins your life. It doesn’t have to be that way. Speak to your partner and your doctor and, this too, shall pass.

This blog was modified from an article on WebMD: OAB: How it Affects Sex and Intimacy, WebMD Feature, By Denise Mann

When You Gotta Go-Putting a Brake On The Overactive Bladder

You’ve seen the ads on T.V. and if you have an overactive bladder you can relate to those women who an intense urge to go to the restroom immediately and if you aren’t able to make it in time you will pee on yourself. This is a great source of embarrassment and can even make women social reclusive.
Urge incontinence occurs when an overactive bladder spasms or contracts at the wrong times. You may leak urine when you sleep or feel the need to pee after drinking a little water, even though you know your bladder isn’t full. This sensation can be a result of nerve damage or abnormal signals from the nerves to the brain. Medical conditions and certain medications — such as diuretics – can aggravate it.
Whatever the source, you don’t have to feel that your OAB symptoms are beyond your control or that they are controlling your life. In fact, you may be able to take control over them just by making some changes in your everyday behavior. Try these practical tips to get started.
Start by eliminating bladder irritants such as caffeine, nicotine, and alcohol. All of these irritate the bladder. Caffeine also acts as a diuretic, meaning it causes you to urinate more. Cutting out the big three can be tough. Try these strategies:
Think about how much water you drink. This can be difficult in New Orleans where we lose so much water through sweating and we are thirsty and have to replenish the excess water loss. Drink plain water when you’re thirsty, from four to eight 8-ounce glasses a day. You’ll know you’re drinking enough if your urine is light yellow or almost colorless. Sip water throughout the day, instead of gulping down a lot at one time. If you take a diuretic, like Lasix or hydrochlorothiazide, try taking the diuretic in the morning. That way you should be able to empty your bladder by bedtime.

In addition to cutting down or eliminating alcohol and caffeine drinks, limiting other foods or beverages may help OAB. Try cutting back on:
Acidic foods and beverages, such as tomatoes, pineapple, and citrus fruits such as oranges, grapefruit, lemons, and limes
Salty foods, which can make you thirstier and make you drink more liquids
Spicy foods, such as chilies, which can irritate the bladder
Carbonated beverages, such as sodas or seltzer

It’s possible to retrain your bladder to hold more urine for longer periods of time. Better muscle control can also help. Ask your doctor for a specific plan and stick with it — it can take up to three months to see results. These strategies may be part of your plan:
Exercises that combat the overactive bladder. Kegels strengthen the pelvic floor muscles that hold up the bladder. They also help reconnect nerve impulse communication between the bladder and the brain. To do them, lie on your bed or the floor and squeeze the pelvic muscles as if you were trying to prevent passing gas from your rectum. Hold the contraction for a count of three; then relax for a count of three. Do Kegels three times a day for five minutes at a time.

Tension, diet, and being overweight can all contribute to urinary incontinence. The good news is that you can do something about all three:
Eat more vegetables and fiber. Fiber helps you avoid constipation, which may help reduce pressure on your bladder.
Reduce tension. Tense situations can make you to feel as if you need to pee Deep breathing exercises are one of the tools that can ease tension.
Exercise. If you’re overweight, losing weight will keep extra pounds from adding to the pressure on your bladder. Exercise may aggravate stress incontinence, though.
When you need to go, then go. Holding back too much can create other problems. For example, teachers and nurses may have bladder problems because they wait too long between bathroom breaks.

Bottom Line: Though urge incontinence is uncomfortable, it’s also very treatable. Changes in your lifestyle and habits can play a part in treating it.

This blog has been modified from: Urge Incontinence: Tips for Daily Life, By Louise Chang, MD

For the Golfer Who Has It All-His Bladder Will Also Say Thank You For The Uro-Club

This may sound like a joke, but it’s not. A Board Certified Urologist, practicing in Florida, a place where golf is played year round developed this novel solution that impacts so many men on the golf course.  Urinary frequency (a condition that can begin in men, as early as their mid 30’s, and usually due to prostate enlargement) is something that can change the quality of man’s life. Even if you don’t have this problem, let’s face it, there are not too many bathrooms on the golf course.

These are the very patients that inspired the urologist to create the UroClub™.  A camouflaged portable urinal, designed to be discrete, sanitary and create an air of privacy! It looks like an ordinary golf club and comes equipped with a unique removable golf towel clipped to the shaft that functions as a privacy shield!  Not even your closest partner will know for sure what you are doing!

Imagine, giving the appearance of taking a practice swing with your “putter”, while both privately and confidentially, you are able to relieve yourself and your bladder without any embarrassment! This can be accomplished easily while standing by the golf cart and even at the concession stand so you can buy another beer, as well. Have the confidence to drink whatever you wish during your game and not worry if you’ll make it to the clubhouse in time!

 

Bottom Line: I don’t play golf and I haven’t tried the UroClub but I think it sounds like a unique approach to a problem that affects so many middle age golfers.  This club could keep you out of the “woods”!  Fore!*

* a warning during a golf game when it appears possible that a golf ball may hit other players or spectators

Want To Tame That Overactive Bladder? Here’s 10 Food Groups to Avoid

1. Avoid citrus juices like oranges, grapefruit, and pineapple

These fruits are highly acidic and irritate the bladder.

2. Avoid Chocolate

Chocolate contains caffeine, a substance that irritates the bladder.

3. Avoid: Caffeine containing beverages such as Coffee and black tea

Caffeine is a diuretic, which causes you to urinate more often, and the caffeine stimulates the bladder. Even decaf versions have this effect. That’s because decaffeinated coffee and tea are seldom caffeine-free.  Herbal teas are without caffeine and are not bladder irritating.

4. Avoid: Hot sauce, chili peppers, wasabi

Spicy nachos, hot peppers, jambalaya, kabobs, and curries are significant bladder irritants.

5. Avoid: Sugar and honey

Sugars tend to stimulate the bladder. Know that for some people, even artificial sweeteners (such as aspartame) are bladder irritants.  Good news: Stevia is a natural sweetener that does not irritate the bladder.

6. Avoid Tomatoes

Tomatoes, like citrus fruits, are acidic; hence their bladder-irritating quality.

7. Avoid Alcohol

Alcohol interferes with brain signals that tell you when to “go.” It’s also a dehydrator and a diuretic that makes you need to go to the bathroom more.

8. Avoid milk and cheese

Different dairy products tend to affect people differently. For some, all dairy is a bladder-baddie. Others are bothered only by very rich and creamy milk products, such as cream cheese, sour cream, or aged cheeses.

9. Avoid Energy drinks

These drinks are very high in caffeine, which bothers the bladder.

10. Avoid Carbonated Drinks

Quenching your thirst with a carbonated beverage (colas, other flavors, fizzy water, seltzer) is counterproductive if you have an overactive bladder. The carbonation is a bladder trigger, an effect that’s intensified if the drink also contains caffeine. You may consider drinking straight water or one of the flavored vitamin waters.

Now I’ve told you what to avoid.  How about what to add to your diet?  Numero Uno is good, ol’ water.   If you drink too little (fewer than about eight cups a day), urine becomes concentrated, which can cause even more bladder irritation.

Bottom Line: There are so many foods and fluids that cause bladder irritability.  I suggest you look at your diet and see if you are consuming too many of these foods and fluids that exacerbate your condition.  Your bladder will thank you!

Pay attention to the color and smell of your urine

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by Neil Baum, MD

Most of us are uncomfortable talking about our waste products, urine and feces. However, changes in the color and odor may signify disease that can be treated or prevented. This article will review causes of discoloration of urine and when there is a change in the odor of urine.

For hundreds of years doctors have looked at urine as a barometer of what is happening in the body. The urine can tell what you have been eating, how much fluid you are consuming, and what diseases you may have. Early doctors even tasted the urine of their patients in order to diagnose their medical conditions. Fortunately, we have made progress and a simple urinalysis can make this determination in seconds.

Urine is an important part of the body’s regulation process. Its job is to remove the extra water and wastes that the kidneys filter out of the blood. The urine is there primarily to get rid of toxins or things that would otherwise build up in the body that would be bad for the body.

When you notice that your urine has changed color, or there’s a strange odor emanating from the toilet, the cause might be something as harmless as what you had for dinner such as asparagus. It also might be a sign of a more serious condition, such as an infection or cancer.

Color changes

Urine normally varies from pale yellow to deep amber, depending on the concentration of the urine, which is determined by the amount of fluid you consume. Darker urine is usually a sign that you’re not drinking enough water. Correction is as simple as consuming more liquids, especially water.

The opposite is also true. If your urine is very pale, it means that you’re either drinking a lot of fluid, or you’re taking a diuretic or water pill which is a drug that forces the body to eliminate excess water.

Urine can turn a rainbow of colors, and an unusual hue isn’t necessarily cause for alarm. Certain medications can turn the urine fluorescent green or blue, the carotene in carrots can tint it orange, and vitamins can give it a yellow hue. Pyridium, a medication, which is used to treat burning on urination, will turn the urine orange-red.

Seeing red is typically a sign that there is blood in the urine, but before you panic, know that a little blood can produce a dramatic color change. Just like a drop of food coloring will add color to a large volume of food or fluids, it only takes one drop of blood to turn an entire toilet bowl red.

Red urine is usually an ominous sign and can indicate an infection or maybe even cancer. Red blood is a real warning sign and should prompt you to see your doctor or urologist, a doctor who specializes in disease of the kidneys and bladder.

Odor changes

Urine normally doesn’t have a very strong smell. If your urine has a foul odor, you could have an infection or urinary stones, which can create an ammonia-like odor. Diabetics might notice that their urine smells sweet, because of excess sugar.

Some foods can also change urine odor. Asparagus is among the most notorious. What people are smelling when they eat asparagus is the breakdown of a sulfur compound called methyl mercaptan (the same compound found in garlic).

How often do you need to go?

How often you need to go can be as important an indicator of your health as the color or smell of your urine. Most people take bathroom breaks about six to eight times a day, but you might go more or less depending on how much fluid you drink. If you’re constantly feeling the urge to go and it’s not because you’re not drinking extra fluid, causes can include:

• overactive bladder (when you gotta go, you gotta go!)
• urinary tract infection
• interstitial cystitis (painful urination without an infection)
• prostate gland enlargement
• diabetes

The opposite problem, not going to the bathroom enough, can occur when there is a blockage or infection. Or, it can be the result of bad bathroom habits. Some people — especially teachers, surgeons, and anyone else who doesn’t have time for regular bathroom breaks throughout the day — tend to hold it in.

Delaying urination can also cause problems. The bladder can develop a chronic over-distension and will not empty completely. As a result urine is left in the bladder and can be a source for developing a urinary tract infection.

Develop good bathroom habits. Drink whenever you’re thirsty, but certainly increase your fluids before going outside in the hot summer sun or before exercising.

If you’re getting up during the night to use the bathroom, stop drinking three to four hours before bedtime. Limit caffeine, which can irritate the lining of the bladder. Also watch your intake of alcohol, which can have an effect similar to a diuretic.

Finally, don’t hold it in. Don’t delay answering the call of the rest room. Your bladder will thank you.

Bottom Line: Pay attention to the color and odor of your urine. If there is a change, contact your physician.

Neil Baum is a urologist at Touro Infirmary and can be reached at his self-titled site, Neil Baum, MD, or on Facebook and Twitter.