Incontinence-There’s An App For That

Now an app is available, iDry, that helps men and women suffering from urinary incontinence log data on their urinary symptoms, provides reminders for exercises to help control the condition, and enables users to share progress with their physician. The app can also provide predictions for future success. It is available in a free version and a premium version that allows users to create their own interventions and E-mail charts and log data to their doctor. This is available for iPhone and iPad and more information is available at http://www.idry.org.

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.

Your Morning Cup of Jo Won’t Make You Go (Urinate)

Go ahead and have a sip, it won’t affect your bladder

For years the standard advice doctors gave patients was that coffee\caffeine contributed to urinary incontinence. Now we know that women with urinary incontinence who also enjoy their regular cup of coffee or tea don’t have to worry about the extra caffeine making their condition worse.
The new research stands in contrast to the common recommendation that women with incontinence avoid caffeinated foods and beverages.

A recent study from Harvard showed that women with moderate incontinence shouldn’t be concerned about their caffeine consumption. All women, even those without incontinence, need to know that caffeine increases the production of urine and may give some the urge to urinate.

The researchers looked at data on roughly 21,500 women enrolled in two large studies, each of which tracked the long-term health of U.S. nurses through surveys starting in the 1970s or 1980s. The study included women with moderate incontinence — defined as leaking urine one to three times per month — from participants who were asked about incontinence and caffeine consumption in 2002 or 2003.

The women were questioned about how much caffeine they consumed in the form of coffee, tea, soda or chocolate. Two years later, when they were again surveyed about incontinence, about 20% said their symptoms had gotten worse and they now leaked urine at least once per week.
The percentage of women with urinary incontinence progression was similar across categories of baseline level of caffeine intake. Similarly, they were unable to find a link between increased caffeine consumption and worsening urinary symptoms — either for general incontinence or for overactive bladder in particular.

Bottom Line: If you are a woman with mild to moderate urinary incontinence, caffeine in moderation will probably not worsen your urinary symptoms
SOURCE: http://bit.ly/IJ1RzF (April 23, 2012 in Journal of Obstetrics & Gynecology)

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 Handle On Overactive Bladder

As many as one in four adult women experience episodes of urine leaking involuntarily, according to the National Association for Continence. And about 17% of women and 16% of men have continuing problems with overactive bladder (OAB).
If you have OAB, you know how difficult and embarrassing it can be to manage your overactive bladder at work. How can you keep things dry and professional? Many experts will advise you to try behavioral therapy, and if that fails, seek medical or surgical treatment. All that can take time. Here are some tips to help you manage OAB at the office, at the shop, and on the road.
1. Don’t dehydrate yourself at work.
You may think you should restrict beverages so you’ll urinate less, but fluid restriction can be counterproductive.
Cutting back on your fluid consumption results in a dark colored urine which is highly concentrated; this actually acts as a bladder irritant.
2. Keep on schedule.
Scheduled fluid intake and urination are the keys to managing OAB. If you know you’ll have a big presentation at noon, stop drinking fluids at about 11 a.m., and then take a bathroom break right before your big appearance.
3. Know where the restrooms are located.
Familiarize yourself with all the restrooms on your floor, especially when you’re on a visit to a different office or at a conference. This is often called “toilet mapping” and can increase your security when you know exactly where the restrooms are.
4. Give yourself an exit.
The power spot at most work meeting is at the front of the room. But if you have an overactive bladder, sit in the back of the room and at the end of the aisle for presentations.
5. Know your triggers.
Stay away from obvious OAB triggers in work situations — coffee and anything else with caffeine, acidic drinks like orange juice, chocolate, and spicy foods.
6. Plan your travels.
Choose airline seats ahead of time if at all possible so that you can have an aisle seat near the restroom.
7. Make friends when traveling.
Solicit help from flight attendants when traveling. For example, explain your situation, and ask if they can let you know ahead of time when the seat belt light is about to come on so you can go to the bathroom first.
8. Involve your boss.
Most supervisors will be reasonable about scheduling regular bathroom breaks.
I can assure that doctors who treat patients with OAB will write letters confirming the condition so that the boss doesn’t think it’s just an excuse to get another break.
9. Kegel-keep squeezing
The pelvic floor contractions called Kegels are a great way to keep your bladder muscles strong in general, and you can do them without people noticing.
Even if you haven’t been doing Kegels regularly, if the urge to urinate hits, a quick series of pelvic floor contractions can sometimes abate that sensation until you can get to the bathroom.
See my article on Kegels at http://www.neilbaum.com/kegel-exercises-for-men.html
10. Don’t fear the pad.
If you know you’re going to be having a horribly hectic day, wear a pad or other protective undergarment that day. For men, there are “condom catheter” devices, that can collect urine until you can change. Condom catheters allows a little more control so that in the worst-case situation, you’re not going to have a visible accident.
11. Get help!
You don’t have to live with overactive bladder, at work or at home. People wait an average of seven years before seeking professional help for continence issues, but there’s no need to suffer in silence.
Bottom Line: The overactive bladder can be tamed. Start with your family physician. Your doctor may refer you to a urologist or urogynecologist, who can discuss your options for medication, behavioral therapies, or surgery.

This article was excerpted from 11 Ways to Manage OAB at Work

By Gina Shaw

http://www.webmd.com/urinary-incontinence-oab/america-asks-11/oab-work

When Your Bladder Ruins a Good Night’s Sleep-Taming the Overactive Bladder

Nothing ruins a good night’s sleep more than getting up multiple times to empty your bladder. Often those millions of American men and women are exhausted in the morning because their sleep was interrupted to many times. Now there’s a few steps you can take to tame that overactive bladder.

For the approximately 16% of people over the age of 18 who have an overactive bladder (OAB), getting up two or more times a night can become a regular occurrence. Even if they make it to the bathroom in time, they wake up so often to urinate that they aren’t getting a good night’s sleep.
Generally, the amount of urine in our bodies decreases and becomes more concentrated at night, so we can sleep six or eight hours without having to get up to use the bathroom more than once. But many people with OAB have nocturia, the need to urinate several times a night, which interrupts their sleep cycles.
Even worse, there are some men and women who are particularly sound sleepers or can’t get out of bed fast enough can wind up with wet sheets.
Take these steps to prevent accidents from happening:
Limit your fluid intake before bedtime. Try not to drink any liquids after 5 p.m. or 6 p.m.
Avoid foods and beverages that can irritate your bladder. If you can’t cut them out entirely, skip them in the hours before bedtime to help prevent nocturia. That includes:
Caffeine, which is a diuretic, which increases urine output
Alcohol
Citrus juices
Cranberry juice — though it is touted as great for bladder health, it is actually an irritant if you have OAB
Spicy foods, like curries
Acidic foods, such as tomatoes and tomato sauces
Chocolate
Artificial sweeteners

Double-void before bed or urinate twice, right before bed. For example, you can go to the bathroom, then brush your teeth and go through the rest of your bedtime routine. Then, just before you’re about to lie down — even if you don’t feel like you have to go — try to urinate and see if you can squeeze out another tablespoon or so.

Do Kegel exercises. Done regularly, they help control an overactive bladder. They will trigger a reflex mechanism to relax the bladder. If you feel a tremendous urge to urinate, doing a Kegel before you run to the bathroom will help settle down the bladder spasm and help you hold it until you get there.
Kegels simply involve contracting and releasing the muscles around the opening of your urethra, just as you do when going to the bathroom. You can learn what a Kegel exercise feels like by starting, then stopping, your urine stream. Start with three sets of 8-12 contractions. Hold them for six to 10 seconds each and perform these three to four times per week.

OAB and Your Sex Life
OAB can interfere with sexual intimacy another important activity that takes place in the bed. There’s nothing that can shut down an intimate moment faster than realizing you’ve lost control of your bladder during sexual intimacy — something that happens for many people with OAB. About 15% of my patients report having incontinence during sex.

When you’re being intimate, you’re used to secretions and moistness, but the thought that it’s actually urine leakage is really upsetting and uncomfortable. Usually it’s the female patient who has the leakage, and it’s actually more bothersome for her than for her partner.

Tips for Getting Your Groove Back
There are some things you can do to ward off discomfort or embarrassment during sex.

Talk about it. First, know that your partner will probably be a lot more understanding than you expect. Then bring it up before you have intercourse. Plan and prepare for sex, just as you do for bedtime. Double-void, cut back on fluids, and avoid foods and beverages that are likely to irritate your bladder. This means passing up that romantic glass of wine to get you in the mood.

Keep up the Kegels. Doing these several times a day — and even during intercourse — will help prevent urine leakage during sex.
All of these approaches can help you manage your overactive bladder at night, letting you get a better night’s sleep and have a more active and satisfying sex life.
Bottom Line: An overactive bladder can wreck havoc with sleep, your sex life, and your entire life. I suggest you try these few self-help ideas. If they do not resolve the problem, then contact your doctor, urologist or gynecologist. Help is available. You don’t have to be embarrassed and tired because your overactive bladder is controlling your life.

This article has been modified from “Putting an Overactive Bladder to Bed-Insights for Good Sleep and Good Sex”
By Gina Shaw

http://www.webmd.com/urinary-incontinence-oab/oab-11/sex-and-sleep

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

Men’s Health Talk

Please join me for a talk on men’s health at St. Charles Surgical Hospital (1717 St. Charles Avenue) on 8-26-10 at 6:30 P.M. Talk is free and refreshments will be served.