Archive for May, 2010

Choosing a Family Physician-One of the Most Important Decisions You Will Ever Make

May 11, 2010

People are not just an amalgam of their body parts.  Men are not composed of large prostate glands, sclerosed coronary arteries, and rusty libidos, although sometimes it feels that way. We come in complex packets of various sizes, shapes and colors, and attached to families, jobs, communities and cultures. Just like everyone else, we need primary care physicians as our allies and advocates in staying healthy, and getting the best possible health care.

Your primary care doctor — either a family physician or a general internist — should be the captain of your healthcare ship. Primary care physicians not only can handle the majority of illnesses that you may experience, but they can work with you to keep you healthy. They can help you decide what makes sense in a world where numerous entities are hawking remedies for life’s ills, from pills to diets to operations. The primary care doctor can help you select from this bewildering array of options, and then be your advocate when you do need specialized care beyond his or her repertoire.

So what should the average man do to get the most out of the health care system? The following are my suggestions distilled from over 30 years of being a doctor:

1) Select a primary care doctor.

The time to choose a primary care doctor is before you need one. Ask your friends whom they go to. Check with local clinics and hospitals and see which primary care doctors work near your home or your job. Check and see if your wife or significant other or child has a family doctor who would take you into his or her practice.

Then go and interview the doctor, find out whether their philosophy of medical care jibes with yours. Discuss your approach to health and illness, and see whether they will support you in your quest. Check their training and references to make sure that they have the training and skill that you need. Make sure that they are board certified in their respective specialty. There are advantages to seeing the same doctor as other members of your family. But probably the personal chemistry between you and your doctor is the most important factor in this choice.

2) Visit your primary care physician before you’re sick.

Almost all doctors have health maintenance protocols that are aimed at men your age, and consist of a schedule of regular visits and diagnostic tests designed to catch important problems as early as possible. Make sure your health maintenance protocol is up to date. For most patients, this will involve a visit every year or two, depending on your age, back­ground, and the medical problems you may have accumulated along the way.

3) Negotiate a plan with your doctor.

Medicine is a team sport, you and your doctor share the quarterback duties. Your doctor has a set of guidelines that are based on medical science and the evidence it produces. You have a set of values and preferences that will determine which of those guidelines make sense for you. Work with your doctor to come up with an approach that makes sense for you.

4) When you do need specialty care, work through your primary care physician.

Specialists will give you their honest opinion about the best therapy for your problem, but your primary care physician will help you put it into context. Primary care doctors can also help to coordinate care among multiple providers, watch out for interactions among drugs or therapies, and will still be available to care for you after a more specific problem is resolved.

Bottom Line: It is almost impossible these days to sort out the best approach to health care. Your primary care physician is the strong­est ally in choosing a path that makes sense for you.  The few minutes you take to make this very important selection may just be the most important decision of your life.

11 Suggestions For Decreasing Prostate Symptoms

May 11, 2010

The prostate gland is walnut sized organ at the base of the bladder.  In order men the gland increases in size and causes symptoms such as going to the bathroom frequently, dribbling after urination, and getting up at night to urinate.  Here are a 11 suggestions that you might consider to relieve those symptoms.

1.  Don’t drink anything several hours before you go to sleep.

2.  Avoid caffeinated beverages such as coffee and tea as the caffeine acts as a diuretic

3.  Limit your alcohol consumption especially at the dinner meal.

4.  Avoid spicy foods.

5.  Take medications such as your diuretics or water pills early in the day when going to the bathroom to urinate is not such an inconvenience.

6.  Avoid antihistamines and decongestants

7.  Don’t hold off going to the restroom

8.  Use the clock to help with urination. Make an effort to urinate every 3-4 hours.  Putting your bladder on a schedule is very helpful and a good habit to have.

9. Go and then go again. Stand at the toilet and empty your bladder, walk away from the toilet for a minute or two and then return and try emptying the bladder again.

10. Avoid cold seats such as at football games in the winter.

11. If you bike ride, especially for long distances, stand on the pedals every 10 or 15 minutes to take the pressure off of your prostate gland.

Bottom Line: These steps won’t cure the enlarged prostate but they will lessen the symptoms.  If your symptoms persist, consider a visit to your urologist

How To Become a Better Patient-You Need to Ask the Vital Questions

May 10, 2010

It is not easy being a patient.  Most patients are nervous and anxious when visiting a doctor and often forget to ask vital questions that will impact their health.  Here are six questions that you should ask your physician when he\she prescribes a new medication:

1.  What does this medication do?  What is the purpose of the medication?

2. How will I know if the medication is working?  Can you tell me about how long I will have to wait before the medication begins to work?

3. What are the side effects of this medication?  What should I do if I experience these side effects?  How common are these side effects?

4. Why is this medication good or effective for my condition?

5. Are there any other non-medication alternatives that I could try that may do the same as the medication?

6. What are the consequences of not taking this medication?

7. Is this a new drug?  Would a less expensive generic drug work just as well?

By asking these questions, you will demonstrate to your doctor that you are actively involved in your medical care.  You now become a part of the “team” and there is no one who should be more interested in your care than you.

Male Infertility-It’s Not Always the Woman’s Fault

May 9, 2010

Nothing is more devastating to a couple than the inability to conceive and have a child.  Infertility is currently a problem for one out of five couples presently trying to have children.  In one-third of the couples the problem is due to a problem in the man; one-third is due to a female cause; and one third is due to both the man and the woman.  Therefore in nearly 2\3 of the couples, there is a male factor associated with the failure to conceive or for the woman to become pregnant.

Any couple embarking on an infertility work-up does so with some fear and reluctance.  It often helps to know what is ahead, to be informed and aware of how it will feel and what the doctor is hoping to find.

The nature of the infertility work-up necessitates that it become a priority in your daily life.  Suddenly, there are specific days that you must have intercourse.  In certain tests you even have to report to the doctor’s office a specific number of hours after intercourse.  As a result, spontaneous lovemaking becomes difficult.  Vacations and business trips become low priority.  Schedules have to be made to fit the demands of the testing cycle. Many women find it hard to take time off from work, especially if they don’t want it known that they are undergoing an infertility evaluation.  It is a stressful time.  Both husband and wife are being tested and scored.  There is a feeling of “pass or fail” and a real sense of despair if a test comes back showing questionable or negative results.  Women often feel frightened and violated by the infertility tests.  Men often feel helpless.  For the husband, testing is over if the semen analysis is normal.  In contrast, he may see his wife having to go through various tests which can be painful and frightening.  This understandably can upset both members of the couple.  Added to this worry and uncertainty is the lingering fear of what the doctor will find.  What if they indeed find an answer, but a discouraging one?  Suffice it to say that deciding to start an infertility workup is a big decision. (This paragraph could be deleted if you are pressed for space)

The following is an overview of the tests involved.  You may want to use it to understand what may be required medically or as a tool to double-check that you have had all the tests.

Initial Appointment

Some infertility specialists like to see the couple together for the first appointment.  This provides a opportunity for the couple to establish good communication with the doctor.  It also is an opportunity to evaluate what, if anything, has been done and what will be needed in the future.  The doctor will be able to explain tests to the couple and will give them a time frame in which he or she hopes to complete the evaluation.(Could be deleted)

The doctor will take a very careful medical history from the male. The doctor will want to know about the medical history of the immediate family.  Attention will be paid to details concerning previous surgery, infections, chronic illnesses, and hospitalizations.  Background information on smoking, alcohol intakes and medications and exposure to environmental or occupational toxins will be requested.  Of course, a reproductive history from both partners will be needed.  Details about the types of birth control practiced will be obtained.  In addition, any history of previous pregnancies should be discussed. Information about frequency and nature sexual intercourse and previous venereal disease is crucial in the evaluation.

Physical Examination

A physical examination of the male is usually done on the first visit.  The physical exam will include an examination of the genital organs, with the doctor noting size, position and condition of the penis and testes.  A rectal exam is done to determine the size and consistency of the prostate gland and seminal vesicles.  The doctor will also note the development of secondary sex characteristics such as hair and fat distribution.

The Medical Evaluation of the Male

Semen Analysis – This is the first and most informative test done on the male.  An analysis can be done any time because a man is not cyclic as women are.  Abstinence from intercourse for 48 hours before the analysis is suggested.  Abstinence for a longer period than two days is not necessary.  For the semen analysis, the doctor will ask the man to masturbate a specimen into a sterile container.  This can be done at home and kept at body temperature and delivered to the lab for evaluation.   Then the laboratory will examine the specimen under a  microscope looking for the number of sperm present, how fast the sperm are swimming (motility) and the shape of  the sperm (morphology).

A fertile semen specimen should have at least 20 million sperm, with at least 50% of the sperm motile and 50-60% with good morphology.  Normal volume is 2-5 cc.

Several additional tests may be done on the male if the semen analysis is not normal.

Evaluation for a varicocele is done by palpating the scrotum while the man is bearing down or coughing.  The link between the presence of a varicocele and infertility is not clearly understood.  The most common theory is that the presence of a varicocele causes poor circulation which ultimately inhibits normal sperm production.

In the event of a subfertile semen analysis, a small biopsy of both testicles may be done.  This procedure is done in a hospital under local or general anesthesia.  The testicular tissue is examined in the laboratory.  This test can tell the doctor if there is an absolute infertile state with no sperm-producing tissue present, or blockage in the vas deferens indicated by the presence of normal testicular tissue yet little or no sperm in the ejaculate.

Finally, if a blockage in the vas deferens is suspected during a testicular biopsy, a vasography can be done to pinpoint the area of  the blockage.  This is an x-ray study in which dye is injected into the vas deferens and a series of x-rays are taken.

Once an infertility work-up is underway it is  important that the couple get the results of each test as they are done.  Couples should ask  their doctors for explanations if need be.  It is your body and you have a right to know what is being discovered.  Sometimes it is wise to make a consultation appointment with your doctor if you feel confused or upset about the tests end results.  This is especially important if the work-up has been going on for a long time or if there is a male factor  problem as well as a female one, which is being treated by another doctor.  It is easy to feel helpless and powerless during an infertility work-up.  Good communication with your doctor can help alleviate some of these feelings.

If men have a normal semen analysis, then the focus shifts to the female partner.  For men who have decreased sperm counts or abnormal motility, there are medications that can be given to enhance the number of sperm and methods to put the sperm in contact with the egg.

Bottom Line: Infertility is problem that impacts the lives of many young couples hoping to conceive a child.  The man is cause of the problem in 50% of infertile couples.  Help is available and much can be done to help a couple make their dreams come true.

Male Infertility-Tips To Putting a Little Vim and Vigor Into Your Sperm Count

May 9, 2010

Patients with infertility can have some control of their reproductive function by living healthy lifestyles. Often some negative lifestyles may be contributing to their infertility. Therefore, if patients live healthy lifestyles, it is possible that there will be some improvement in their reproductive function. There may not be conclusive evidence for all these lifestyle recommendations, but rarely will following these guidelines hurt, and often they may help:

  1. Avoid excessive heat (avoid waterbeds, saunas, hot tubs, etc.).
  2. Limit coffee to 1 or 2 cups per day.
  3. Do not smoke.
  4. Do not use marijuana, cocaine, or other recreational drugs. Marijuana stays in the testes for over 2 weeks; so even using it once every two weeks will have a negative effect.
  5. Exercise regularly and moderately.
  6. Drink no more than 2 ounces of alcohol twice per week. Alcohol is a male reproductive tract toxin, which associates with a decrease in the percentages of normal sperm. Female should abstain from alcohol if pregnant.
  7. Have good nutritional habits, especially a diet rich in fresh fruits and leafy vegetables (organically grown foods).
  8. Be aware of sexual problems and do not hesitate to ask for medical help.
  9. Infertile men should educate themselves about health and reproduction.
  10. Seek emotional and/or psychological support; consider meditation to reduce stress.

Key Vitamins and Nutritional Supplements: Taking certain vitamins (C, E, B12, etc.) may help improve your fertility. The mechanism of action is believed to be as follows: The breakdown of oxygen as it passes through the cells in our body results in substances known as free radicals. Infertile men have a higher concentration of free radicals in their semen as compared to fertile men. Free radicals attack and destroy the membrane that surrounds sperm. Anti-oxidants fight against these bad effects. Therefore, Vitamins are natural anti-oxidants!

I suggest you also take:

Vitamin C (500 mg/day). It helps to protect sperm against free radical damage. It also guards sperm from oxidative damage. Many studies show that supplement Vitamin C also improves the quality of sperm in smokers and reduces sperm agglutination (a condition when sperm stick together, then fertility is reduced.).

Vitamin E (400 IUS/day). Vitamin E has an important function as an antioxidant. Therefore, Vitamin E supplements can decrease and mop up enough free radicals to prevent the damage to sperm cells.

Selenium (200 mcgs/day). A double-blind study shown that selenium supplement can significantly increase sperm motility.

Multivitamins containing zinc (20 mg). Zinc plays an important role for the male reproductive system. A lack of zinc can effect the normal sperm production. For men with low testosterone, zinc supplements may raise testosterone levels and increase sperm production.

Bottom Line:  All of these recommendations may not have scientific merit but they certainly won’t hurt you or cause any deterioration of your sperm count.

Varicocele-A Cause of Male Infertility

May 9, 2010

Varicocele is a mass of enlarged and dilated veins that develops in the spermatic cord within the scrotal sac. A varicocele can develop in one testicle or both, but in about 85% of cases it develops in the left testicle.

Incidence and Prevalence

Approximately 40% of infertile men have a varicocele and among men with secondary infertility -those who have fathered a child but are no longer able to do so-prevalence may be as high as 80%.

Signs and Symptoms

Most men who have a varicocele have no symptoms. Asymptomatic (i.e., symptom-free) cases are often diagnosed during a routine physical examination. Signs and symptoms include the following:

  • Ache in the testicle
  • Feeling of heaviness in the testicle(s)
  • Infertility-can suppress sperm counts and sperm movement
  • Shrinkage (atrophy) of the testicle(s)
  • Visible veins under the scrotal skin-the veins collapse when the man lies down
  • Recurrent or constant discomfort or pain in the genital region should be reported to a urologist to determine the cause.

Treatment

If the patient with varicocele is asymptomatic and infertility is not an issue, no treatment is warranted. If the discomfort is mild, the condition usually can be managed by wearing an athletic supporter or snug-fitting underwear during strenuous activity or exercise.

Surgery

If the varicocele causes pain or atrophy (rare) or if the condition is causing infertility (most common), surgery may be recommended. Most varicoceles can be corrected through a surgical procedure called varicocelectomy (i.e., surgically “tying off” the affected spermatic veins).

Surgical ligation

This treatment usually requires general or regional anesthesia. In this procedure, a 2- to 3-inch incision is made in the groin or lower abdomen, the affected veins are located visually, and the surgeon cuts the veins and ties them off above the varicocele to reroute the blood through unaffected veins. Surgery can be performed on an in- or outpatient basis. The patient typically can resume light activity within a week and strenuous activity in about 6 weeks.

About 50% of men who undergo varicocelectomy to correct infertility father children within the first year. It takes about 90 days for a sufficient quantity of new sperm to be produced to permit fertilization. Semen analysis usually is done at 3- and 6-month intervals after the operation.

Bottom Line: Varicoceles are very common and can be a cause of male infertility.  Help is available and most men can have improvement in their sperm counts after surgical correction

Pass That Kidney Stone-Use Alpha-Blockers

May 5, 2010

Kidney stones affect millions of American men and women.  When a kidney stone is in the ureter, the tube between the kidney and the bladder, and blocks the flow of urine, this causes severe pain on the affected side.  The stone causes spasm of the ureter and causes more pain and retards the passage of the stone out of the urinary tract.  This pain and discomfort is relieved with pain medication but the spasm of the muscles in the ureter can be relaxed with the use of alpha-blocker medications such as Cardura, Hytrin, Flomax, and Uroxatrol.

These drugs are used to treat a non-cancerous prostate condition known as benign prostatic hyperplasia (BPH). The drugs work by relaxing the smooth muscle in a channel that runs through the prostate gland, allowing for better urine flow.

Kidney Stones

Kidney stones are formations of crystals that have separated from the urine. The separation occurs within the urinary tract if the patient’s urine is lacking in the chemicals that normally prevent their formation. Most will pass through the tract without notice. The crystals that do not separate form into larger stones, which may be difficult to pass.

Alpha Blockers and Passing Stones

Alpha-blockers can assist in passing stones because when it relaxes the smooth muscle, water can pass through more easily. This may reduce the pain of passing kidney stones, and speed up their exit from the body.  Alpha-blockers must be obtained with a prescription.

Bottom Line: Kidney stones are a common painful condition affecting millions of Americans.  Stone passage can be facilitate by the use of alpha-blockers

Urinary Tract Infections in Men

May 4, 2010

Urinary tract infections (UTI) indicate inflammation anywhere within the urinary system.  In men it can occur in the kidneys, bladder, prostate or urethra.  UTIs are more common in women, but they also affect men, especially in men more than 50 years of age.  If UTIs are left untreated, they can result in spread of the infection and cause permanent kidney damage.

Prostate infections are the most common infections in men.  Acute prostatitis occurs when bacteria lodge in the prostate and produce symptoms such as fever, chills, difficulty with urination, back pain, or blood in the urine.  The treatment is antibiotics for 7-10 days.

Chronic bacterial prostatitis is similar to the acute infection but without the fever or chills.  These men also may have painful ejaculation and low back pain.  The treatment is also antibiotics but often the medication has to be taken several weeks or even months.  Men with chronic prostatitis also may be advised to avoid caffeine, alcohol, spicy foods and chocolate.

In many men, prostatitis occurs without identifying any bacterial culprit.  This is called abacterial prostatitis or prostadynia.  The symptoms are the same a chronic bacterial prostatitis.  The pain and vague urinary problems are a result of spasm or congestion of the pelvic floor muscles or congestion within the prostate gland itself.  In most instances, antibiotics are not helpful in treating this condition.  The treatment consists of anti-inflammatory medication, muscle relaxants or alpha blockers.

UTIs can also occur after instruments are inserted into the urinary tract such as catheters or tubes as they may transport bacteria from outside of the body to the bladder and prostate gland.

Previous infections such as some of the sexually transmitted diseases may leave scars in the urethra and cause it narrow or stricture.  This disrupts the normal flow of urine and may result in infections of the urinary tract.

The diagnosis of a UTI is made with a history, physical examination and a urinalysis and a urine culture.  The latter is a test that identifies the offending bacterial and the best antibiotic to treat the infection.  Occasionally, additional tests such as a CAT scan and cystoscopy are required.

General measures for treating UTIs in men include increasing the consumption of water. Alkaline substances, such as citrates, taken in water might improve symptoms. By making the urine more alkaline, they make the environment more hostile to bacterial growth and improve the results of antibiotic therapy.

Antibiotics are the mainstay of treatment. Trimethoprim (Trimpex) is currently the first choice for lower UTI , because it is cost-effective, well tolerated and works in 80 per cent of infections. Cephalosporins and quinolones are reserved as second line drugs in patients with lower UTI, but are first choices in patients with signs of kidney infection.

You can prevent UTIs by drinking lots of fluids every day, empty your bladder often and completely, practice safe sex, always use latex or polyurethane condoms, urinate after sex to flush out bacteria, if you are uncircumcised, and wash under the foreskin each time you take a bath or shower.

Although UTIs are aggravating and affect the quality of life of those with the condition, they do not cause prostate cancer, benign enlargement of the prostate, or perhaps more importantly, impotence.

Bottom Line: With an accurate diagnosis and the correct treatment, most cases of UTIs in men can be cured, treated or certainly controlled.

Herpes-The Other STD

May 4, 2010

Twenty five years ago, when someone had a herpes infection, they thought it was a curse for life.  Today, with other sexually transmitted diseases (STD) that are life-threatening, herpes infections are much less frightening and terrifying.

Herpes is one of the most common STDs and affects nearly 50 million Americans or one in five adolescents and adults have had herpes infections.  This article will review the cause, the symptoms, the diagnosis, the treatment and the prevention of this disease.

Herpes is caused by two different but closely related viruses.  Herpes type 1 (HSV-1) was usually associated with oral lesions and HSV-2 primarily affected the genital organs.  Today, we know that both viruses can be located in either the mouth or genital locations.

The most common symptoms are a recurring rash that develops into cluster of blisters or sores.  The sores may appear anywhere on the body, but in men, the most common areas are the penis, lips, mouth and anus.  In women they can occur around the labia of the vagina.  Other symptoms include pain, itching, burning with urination, fever, headaches, and a general run-down feeling or malaise.

Herpes is spread by touching, kissing, and sexual contact during vaginal, anal and oral intercourse.  Herpes is most contagious from the time the sores are visible until the sores are completely healed.    The first outbreak of sores usually begins from 2-20 days the virus enters the body.  The sores usually heal in about three weeks.  However, even thought the sores heal, the virus remains in the body.  Later it can “flare up” and result in a recurrence.  Recurrent outbreaks occur on average 4-6 times a year.  Once a person has herpes, the virus remains in the body in a dormant or inactive state forever.   Most men and women who have recurrent infections are unable to pinpoint what triggers a herpes outbreak.  Some will identify lack of sleep, poor diet, fatigue and stress as causes of recurrences.

While there is no cure for genital herpes, there are treatment options available.  Antiviral medications can shorten and prevent outbreaks during the period of time the person takes the medication. In addition, daily suppressive therapy for symptomatic herpes can reduce transmission to partners.  These antiviral drugs such as Zovirax, Valtrex and Famvir can speed up the healing of the sores, decreases the duration of symptoms and reduce the frequency of recurrences.

Prevention of herpes

The surest way to avoid transmission of sexually transmitted diseases, including genital herpes, is to abstain from sexual contact, or to be in a long-term mutually monogamous relationship with a partner who has been tested and is known to be uninfected.

Genital ulcer diseases can occur in both male and female genital areas that are covered or protected by a latex condom, as well as in areas that are not covered. Correct and consistent use of latex condoms can reduce the risk of genital herpes only when the infected area or site of potential exposure is protected. Since a condom may not cover all infected areas, even correct and consistent use of latex condoms cannot guarantee protection from genital herpes.

Persons with herpes should abstain from sexual activity with uninfected partners when lesions or other symptoms of herpes are present. It is important to know that even if a person does not have any symptoms he or she can still infect sex partners. Sex partners of infected persons should be advised that they may become infected. Sex partners can seek testing to determine if they are infected with HSV. A positive HSV-2 blood test most likely indicates a genital herpes infection.

Bottom line: Men and women with genital herpes can and do have happy, productive, and sexually fulfilling lives and can have healthy children, too.  For more information the National Herpes Resource Center at herpesnet@ashastd.org

Menopause and Bladder Control

May 4, 2010

Some women begin to have problems with their bladder and experience overactive bladder (gotta go, gotta go right now) and urinary incontinence or loss of urine at inopportune times at the time or shortly after menopause.

Does Menopause Affect Bladder Control?

Yes. Some women have bladder control problems after they stop having periods (menopause or change of life). If you are going through menopause, talk to your health care team.

After your periods end, your body stops making the female hormone estrogen. Estrogen may help keep the lining of the bladder and urethra healthy. A lack of estrogen could contribute to weakness of the bladder control muscles.

Pressure from coughing, sneezing or lifting can push urine through the weakened muscle. This kind of leakage is called stress incontinence.

Although there is no evidence that taking estrogen improves bladder control in women who have gone through menopause, small does may help thicken the bladder lining and decrease the incontinence.  Your doctor can suggest many other possible treatments to improve bladder control.

What Else Causes Bladder Control Problems in Older Women?

Sometimes bladder control problems are caused by other medical conditions. These problems include:

Infections

Nerve damage from diabetes or stroke

Heart problems

Medicines

Feeling depressed

Difficulty walking or moving

A very common kind of bladder control problem for older women is urge incontinence. This means the bladder muscles squeeze at the wrong time and cause leaks.

If you have this problem, your doctor can prescribe medication that can certainly alleviate that problem.

What Treatments Can Help You Regain Bladder Control?

Your doctor may recommend limiting foods or fluids, such as caffeine, which are bladder irritants and increase the desire to go the rest room.

There are also pelvic exercises that can strengthen the muscles in the urethra and the vagina.   Life’s events like childbirth and being overweight, can weaken the pelvic muscles.

Pelvic floor muscles are just like other muscles. Exercise can make them stronger. Women with bladder control problems can regain control through pelvic muscle exercises, also called Kegel exercises.

Exercising your pelvic floor muscles for just five minutes, three times a day can make a big difference to your bladder control. Exercise strengthens muscles that hold the bladder and many other organs in place.

Two pelvic muscles do most of the work. The biggest one stretches like a hammock. The other is shaped like a triangle. Both muscles prevent leaking of urine and stool.

Pelvic exercises begin with contracting the two major muscles that stretch across your pelvic floor. There are three methods to check for the correct muscles.

1.     Try to stop the flow of urine when you are sitting on the toilet. If you can do it, you are using the right muscles

2.     Imagine that you are trying to stop passing gas. Squeeze those same muscles you would use.

3.     Lie down and put your index finger inside your vagina. Squeeze as if you were trying to stop urine from coming out. If you feel tightness on your finger, you are squeezing the right pelvic muscle.

Do your pelvic exercises at least three times a day. You can exercise while lying on the floor, sitting at a desk or standing in the kitchen.

Be patient. Don’t give up. It’s just five minutes, three times a day. You may not feel your bladder control improve until after three to six weeks. Still, most women do notice an improvement after a few weeks.

Other treatments include inserting a device, a pessary, directly into the vagina to lift the urethra and the base of the bladder to its proper position behind the pubic bone.  And finally, if the conservative methods of medication, exercises, and dietary modification don’t work, then you should talk to your doctor about one of the surgical procedures that can lift the bladder into the proper position to prevent leakage

Bottom Line: No one needs to suffer the embarrassment of urinary incontinence.  Help is available for all those women who have bladder control problems