Clinical Management of Urinary Incontinence in Women

Incontinence is a devastating condition affecting millions of American women. It is a source of embarrassment that results in women becoming reclusive and deciding not to engage in socialization. Urinary incontinence, defined as the involuntary leakage of urine, affects 20 million persons nationwide Help is available. You don’t have to depend on Depends! This blog will discuss the problem and the treatment options for urinary incontinence.
Most cases of urinary incontinence in women fall under one of three major subtypes: urge, stress, or mixed. I believe in going from tshe least invasive (behavioral modification) to more invasive (surgery) interventions is the best approach. Bladder retraining and pelvic floor muscle exercises are first-line treatments who present with urge incontinence or “I gotta go right now”! Medication with anticholinergic medications is another option for treating urge incontinence if behavioral therapy is unsuccessful; however, because of adverse effects such as constipation and blurred vision and confusion, these agents are not recommended in older adults.

Pelvic floor muscle exercises or Kegel exercises are considered first-line treatment for stress incontinence or loss of urine with coughing, laughing or sneezing. Alternatives for treating stress incontinence include vaginal pessaries. At this time no medications are approved by the U.S. Food and Drug Administration for treating stress incontinence. Minimally invasive procedures injection of periurethral bulking agents, can be used if stress incontinence does not respond to less invasive treatments.

Third line treatment consists of surgical interventions, such as sling and urethropexy procedures, should be reserved for stress incontinence that has not responded to other treatments.

Bottom Line: Women suffering from urinary incontinence do not have to suffer and should speak to their doctor about treatment options. Usually some of the options are helpful and can make women comfortable and able to engage in most activities without the embarrassment of the loss of urine.

Non-Medical Treatments of Urinary Incontinence

Incontinence is a devastating condition affecting millions of American women. It is a source of embarrassment that results in women becoming reclusive and deciding not to engage in socialization. Urinary incontinence, defined as the involuntary leakage of urine, affects 20 million persons nationwide Help is available. You don’t have to depend on Depends! This blog will discuss the problem and the non-medical treatment options for urinary incontinence.

WEIGHT LOSS
Women who are overweight or obese and who experience stress incontinence should be encouraged to lose weight, which has been shown to reduce the frequency of incontinence symptoms.32

BEHAVIORAL TREATMENTS
Pelvic floor muscle exercises are the mainstay of behavioral therapy for stress incontinence. Up to 38 percent of patients with stress incontinence alone who follow a pelvic floor muscle exercise regimen for at least three months experience a cure. Increased effectiveness is demonstrated in women undergoing longer training and in those following comprehensive clinic-based training rather than self-help booklets.
Manual feedback (palpating the pelvic muscles during the exercises) and biofeedback (using a vaginal or anal device that provides visual or audio feedback about pelvic muscle contraction) have been used to teach patients the correct technique. Weighted intravaginal cones have also been used for improving technique when women have difficulty identifying their pelvic floor muscles. Although these strategies may improve technique and, consequently, symptoms in the short term, there is no evidence that they result in higher rates of long-term improvement or cure than the exercises alone.

ELECTRICAL AND MAGNETIC STIMULATION
Electrical stimulation of the pelvic floor muscles with a vaginal or anal electrode can be used in women who cannot voluntarily contract pelvic floor muscles.13 This can be done at home and typically consists of two 15-minute sessions daily for 12 weeks. Medicare has approved its use in patients who have incontinence that does not respond to structured pelvic floor muscle exercise programs.

Extracorporeal magnetic innervation involves a series of treatments in which the patient sits, fully clothed, on a chair that generates a low-power magnetic field. Patients typically undergo two or three treatments per week for six to eight weeks. One early study showed this method to be most effective for women who have mild stress incontinence (i.e., using three sanitary pads per day or fewer). A more recent study found it to be more effective than sham treatment for women who are unable to generate adequate pelvic floor muscle contractions.

DEVICES
Vaginal inserts, including incontinence pessaries and incontinence tampons, can be used for treating stress incontinence in pregnant women, in those who are not surgical candidates, and in those whose symptoms have not responded to previous surgeries. Vaginal inserts compress the bladder neck and urethra, thus decreasing urine loss caused by stress incontinence. Although pessaries are not widely used, their associated risks and costs are low, and they achieve results quickly. There are few contraindications to pessary use (e.g., active pelvic infection, severe ulceration, allergy to product materials, noncompliance). Incontinence tampons, which also place pressure on the bladder neck, are available in Europe.
[corrected] Urethral plugs are devices that are inserted into the urethra to prevent urine loss during activities that cause stress incontinence (e.g., running). They are available in two lengths: 3.5 cm and 4.5 cm. There is limited evidence promoting or discouraging their use, and they are associated with a number of adverse effects, including urinary tract infection (occurring in up to 31 percent of women over a two-year period), hematuria or blood in the urine (3 percent), and migration into the bladder (1 percent). Despite this, multi-year studies indicate a high degree of patient satisfaction, and the likelihood of significant adverse effects diminishes with continued use.

Bottom Line: Urinary incontinence is a devastating problem affecting millions of American women. You don’t have to suffer in silence. Help is available; speak to your physician

Take Care of Yourself-How To Age Gracefully and Healthfully

We are living at a time of longevity. We can live longer and live better today than at any time in recorded history. It is possible with good health to live to 80,90, or even 100 years of age.

Start with setting a goal to live as long as you would like. Ask yourself, are you practicing habits today that will get you to that goal of your desired age.

The three areas that you need to keep in mind to achieve your goal.

1. Achieve an ideal weight. You need to get your weight under control. When you reach your ideal weight, make a commitment to remain at that level for the rest of your life. There should be no yo-yo of your weight but you must remain at the ideal weight for the rest of your life.

The best advice I have is to eat less and exercise more. The law of thermodynamics applies to weight loss. The law simply states the net heat supplied to the system equals the net work done by the system. Therefore, you need to consume fewer calories than you burn from exercise or you need to exercise harder and longer in order to burn more calories than you consume. There is no short cut. There are numerous websites that can help you with your diet and give you a ballpark on the caloric burning that takes place with every day exercises. (http://www.freedieting.com/tools/calorie_calculator.htm, http://calorielab.com/burned/, and http://www.myfitnesspal.com/exercise/lookup

2. Proper diet
Eat better quality foods and fewer of them. Eat more fruits, vegetables and good proteins such as lean meat, chicken, and fish. Eliminate soft drinks, deserts, candies and any other foods containing mostly sugar. Stop consuming extra salt. Eliminate any white flower products. Eat smaller portions and eat 4-6 times a day rather than 3 large meals. By taking control of your eating habits, you can take control of other areas of your life.

3. Exercise
A suggested exercise regimen is 200 minutes\week or 30 minutes a day. You can get all the exercise you need by going for a vigorous walk for 30-60 minutes 3 times a week.

You can even get exercise if you declare that you won’t take the elevator up the stairs or you can park your car 3-5 blocks further than your normal parking spot every day.

Bottom Line: set goals for your life regarding health and fitness and be disciplined to stick to those goals for the rest of your life. You need to make a daily plan and work your plan every day. This requires self-discipline but this self-discipline will help with the discipline you will need in other areas of your life.

Leaking Urine? You Don’t Have To Depend on Depends!

Urinary incontinence is one of the most discouraging and depression conditions that affects both men and women. Incontinence can lead to a reclusive life style because of embarrassment and even be a cause of nursing home admission.

Urinary incontinence affects millions of men and women. There are numerous medical treatment options and perhaps one of the easiest solutions is dietary modification. This blog will discuss some of the dietary changes that you can implement to help control your urinary incontinence.

The solution isn’t always to limit your water intake
Remember that if you don’t drink enough water, you might get dehydrated. The problem is, when you have incontinence, drinking a lot of water could also give you problems. Even, the recommended six to eight glasses of water a day can give you problem since you have incontinence. Now, if you don’t drink as much and you will only have little water in your body, this can irritate your bladder and this could make you go often. So, the best way is to ask your doctor what would work best for you.

Cut down on alcohol
Alcohol directly affects your bladder. This is diuretic – so, that makes you go more often to the comfort room. The problem with alcohol is that, this interferes with the signaling mechanism of the brain down to your bladder. So, if you have alcohol with you, you will not be able to control your bladder fully.
However, there are some people who can still control their bladder even if they are drinking alcohol. So, if you don’t want to stop alcohol, the best bet here is to stop it first – and then, add back little by little, so you will know how much of alcohol your body can tolerate.

Go low on the “joe” (caffeine)

You can find caffeine in your soft drinks, teas, chocolate and even in decaffeinated coffees – though in small quantity. The problem with caffeine is since it tells your body to get rid of liquid; you’ll keep on coming back to the comfort room. So, avoid them if you can.

However, if you really love that coffee zest, be sure to do it in the morning. Avoid it at night, though – especially after past 7 p.m. – if you don’t want that sleep disturbed. Be sure also to limit yourself to one or two caffeinated drinks a day.

Avoid Spicy Foods
Avoid eating spicy foods like Mexican, Chinese, chili peppers, chili, and horseradish. Remember that spicy foods can irritate the lining of your bladder -just like caffeine does.

Stay away from acidic foods
Acidic foods like citrus foods and juices – as, oranges and pineapple have acids that can irritate your bladder – just like what spicy foods and caffeine can do – which can make you feel on the go – always!
Tomatoes and cranberry juice are also acidic. Yes, cranberry juice may help bladder infections – but, this doesn’t help if your bladder is overactive. So, please stay away from them if you can.

The Whiz says go easy on the fizz
The carbonated drinks may not have caffeine, but they can irritate a sensitive bladder – and when your bladders are irritated, then you have that urge to go to the rest room as always.
You have to remember that diet is not the only way to go to control your urinary incontinence. You also have to check on your weight gain, diabetes, constipation, aging – and certain cancers (well, I hope this is not the case) since these conditions may cause you your problem.

Bottom Line: Now, if even after following those diet regimen and your condition is still not improving, it is time that you should check with your doctor.

Sperm Counts Really Do Count-Improving Sperm Quality

Infertility affects 24% of couples wishing to have a baby. Nearly 1\3 are due to female causes, 1\3 to male causes, and 1\3 are due to both the man and the female partner. Therefore, men are involved in 2\3 of the problems that are responsible for failure to achieve a pregnancy. The first test for any man is the semen analysis. This test is obtained after two days of abstinence or no ejaculation and submitted for a sperm count, sperm movement or motility, and the shape of the sperm.

The world’s largest study on the effects of lifestyle on the quality of sperm has been published this week, with some surprising findings.
Researchers at the universities of Manchester and Sheffield found that smoking cannabis can have a severe effect on male fertility, yet other lifestyle choices such as drinking alcohol and wearing tight briefs were not considered to cause problems, despite earlier reports suggesting otherwise.

Sperm quality has been in decline for decades, and scientists seem unable to make up their minds as to the exact causes, citing everything from smoking to an increased exposure to estrogen.
The latest evidence is good news for jockstrap-wearers and bad news for dope smokers, but how else can you improve your sperm count? Here are five recommendations from leading experts:

1. Eat red food
Last month a report published by Ohio’s Cleveland Clinic, following analysis of 12 studies conducted by different groups around the world, found that consumption of lycopene improved the quality, mobility and volume of sperm dramatically, increasing sperm count by up to 70 per cent. Lycopene is an essential nutrient found commonly in red fruit and vegetables such as tomatoes, strawberries, cherries and peppers.

2. Lay off the laptop
A 2011 study published in the journal Fertility and Sterility suggested there could be a link between using a laptop with a Wi-Fi connection and a reduction in sperm quality. Sperm samples from 29 men were stored normally and under a laptop connected to WiFi. The sperm stored under the laptop became more sluggish and showed signs of DNA damage.

3. Get off your bike
Cycling has myriad health benefits, but not when it comes to your sperm. A 2009 Spanish study found that a prolonged spell on your bike can severely affect the shape and quality of your sperm. After monitoring 15 Spanish triathletes with an average age of 33 the study found that those men that cycled 300 kilometers a week (about 160 miles) – had dered a fertility problem.

4. Keep your cool
The optimum temperature for sperm production is 34.5 degrees celsius, which is slightly below body temperature. A three-year University of California study in 2007 found that five out of 11 men who stopped taking hot baths (including saunas) experienced a sperm count rise of almost 500 per cent.

5. Drink coffee – Go For Joe-but not too much
In 2003, researchers from Sao Paolo University in Brazil studied 750 men and concluded that drinking coffee can improve the swimming speed, or motility, of human sperm, although whether this means pregnancy rates are higher among coffee drinkers is unclear.

Bottom Line: Men are part and parcel of the baby making equation. If you have any questions, see your urologist and start with a sperm count.

Meet the New Orleans magician / urologist who offers a March Madness vasectomy special

This article appeared in USA Today Sports
By: NATE SCOTT March 18, 2015 2:19 pm ET

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Dr. Neil “The Whiz” Baum is a New Orleans urologist and part-time magician who, every year at the start of March Madness, offers a vasectomy special to local men. The deal is patients get a scalpel-free vasectomy, a pizza, a Sports Illustrated swimsuit issue, a frozen gel pack, and a bell, so that patients can sit on the couch and ring for someone to “bring them a fresh beer or whatever they need.”

Dr. Baum hopped on the phone with For The Win to discuss his special, its popularity, and his friendship with Chicago Bears running back Matt Forte.

FTW: So I remember when I lived down in New Orleans, I used to hear about your special on the radio, and my friends and I thought it was the funniest thing in the world. Is it still happening?

NB: Oh yes. I have to limit it to about ten a weekend. I could probably do more. I want to make sure I’m not exhausted so I can enjoy the games myself. I limit it to ten each weekend.

FTW: When did this start?

NB: This started about 3 or 4 years ago. [It actually began back in 2009.] I’ve tried to do it for Super Bowl weekend and I’ve tried to do NBA playoffs, but neither worked, and I can’t figure out why.

But Super Bowl weekend, there are too many parties. No one wants to be by themselves. And NBA, I just don’t think it’s as big.

FTW: It’s also a lot more spread out, the NBA playoffs. Where March Madness all happens right in a row, so it’s OK to sit on the couch for a day.

NB: Yep. March Madness. It works every year. The patients love it.

FTW: Am I remembering wrong? Didn’t you at one point give out a bag of frozen peas with this special?

NB: We give out a gel pack now. And it has my name on it. It lasts longer than the frozen peas.

FTW: Are you still doing magic shows as “The Whiz”?

NB: Oh yeah. Absolutely. It’s so cool that I can call up people and say “Oh hi, it’s the Whiz,” and everyone who knows me and has interacted with my magic knows it’s me and gets the double entendre with my name: urologist and a magician. And my license plate is “THE WHIZ.”

FTW: I remember seeing it around New Orleans.

NB: Oh yeah. I gave my daughter Lauren my car once, she was in high school, and she didn’t quite have the confidence she has today. And she would scream: “I don’t want a car that has THE WHIZ on the back!”

FTW: So, to change topics a bit, Matt Forte used to live in your house when he was finishing up his degree at Tulane, right?

NB: Yes, Matt. He lived here for four months after his rookie year. We used to play ping pong. If I lost, I had to do 25 push-ups, and if he lost, he had to do 50 push-ups. And I used to beat him badly, for so many months, his big arms are due to me. [Laughs] No, no. He used to beat me. And the thing with Matt is, you can’t trash talk him. He’s been around all that. You can’t get under his skin, ever.

New Treatment For The Enlarged Prostate Gland-The UroLift

NEW ORLEANS – It’s a condition that men may not want to talk about, but it affects their sleep, their intimate relationships, and work.

But now there’s a new, simple fix for a common prostate condition.

Doug Depp is one of the millions of baby boomer men with a common health problem, Benign Prostatic Hyperplasia, called BPH.
“I was getting up 4, 5 times a night easy and feeling the discomforts of it. I couldn’t empty my bladder. I lost a lot of confidence in being able to go places, be comfortable,” said Depp, 68.

After the age of 50, the prostate gland, for some reason, grows. When it does, it squeezes down the size of the tube that urine flows through. It affects a man’s quality of life. But now there is a new procedure called UroLift System. It involves no cutting or heating away tissue in an O.R.

“I think this is a game changer, and the reason being is that often times men who have an enlarged prostate, are treated with medications. These medications affect their sex life,” explained Dr. Neil Baum, a urologist at Touro.

The UroLift has a pin on one side and a clip on the other. In less than an hour in the office or outpatient surgery, Dr. Baum inserts a few of the devices through the urethra. They permanently hold both sides of the enlarged prostate away from putting pressure on the urethra. Men can either be under mild IV sedation or a local anesthesia.

“This procedure, the UroLift, preserves sexual performance. The men have no problem with ejaculation. It doesn’t affect their erections and the beauty is when they have the procedure, they go out without a catheter most of the time, and they are able to urinate with improved stream immediately,” Dr. Baum explained.

Depp says there was not a lot of discomfort and a few days later he was 100 percent normal again.

“I used to always think of a place to go, you know, McDonald’s or some place you know, on the way, and you have to pick and choose but now it’s a lot more freedom not to worry about it,” laughs Depp.

The UroLift is FDA approved and most insurance companies pay for the procedure.

Achieve Serenity During March Madness With A No-Scalpel, No-Needle Vasectomy

March Madness is on the horizon and what an ideal time to have your vasectomy. A few years ago I had a program that generated a lot of enthusiasm for having your vasectomy on one of the weekends of March Madness. (http://neilbaum.com/wp-content/uploads/2013/08/YOURology-Update-March15.pdf)

What does March Madness and vasectomy have in common? You probably answered, “very little.” However, many men who opt for a vasectomy as a permanent form of contraception are making the decision to have their “prime cut” this week or next week so they can watch the Sweet Sixteen and Final Four while recovering from the 15 minute procedure that can be easily done in the doctor’s office without a scalpel or a needle.

Many male basketball fans may be looking for the perfect excuse to lounge in front of the television all week. Many urologists, including myself, have the perfect solution: Get a vasectomy, the perfect cut!
I am suggesting a “3-Point Shot” plan – one vasectomy, one free pizza, and one weekend excuse to watch college basketball.

It is common for many men to schedule the procedure on a Thursday or Friday so they can have the weekend to relax. While the NCAA tournament lasts longer than the recovery period for a vasectomy – which is usually 2-3 days – this is a good excuse for basketball aficionados to catch a few games while enjoying uninterrupted viewing of basketball games.

So if you want to have a few days to watch the games without interruption, call our office to schedule an appointment. For more information, go to my website, http://www.neilbaum, and watch a video about the procedure and how it can be performed without pain or discomfort.

No baby and no more tuitions: consider the no-scalpel, no-needle vasectomy.

Urinary Incontinence – Don’t Depend on Depends!

Urinary incontinence affects millions of American men and women. Help is available. You don’t have to suffer in silence.

If you notice a few drops of urine dribbling out when you laugh, cough or even sneeze, you may need to consult a general practitioner as these could be symptoms of urinary incontinence, or loss of voluntary control over one’s urination. In some cases there may be a total loss of urine from the urinary bladder while in other cases there could be partial leakage too. Most commonly seen in elderly males and females, this is a condition that could cause great embarrassment and mental agony. As the person loses control over his or her urination, it drips into his inner clothes without his knowledge and this causes stains, bad smells as well as embarrassment to the person in question. This problem can prevent the person from socializing as he\she is always preoccupied with the thought that the urine might leak out and others may come to know about his or her condition. As this is a problem that often affects the elderly, it could cause severe mental agony and sometimes elderly persons may even develop depression because of it.

Causes of incontinence

Some cases of incontinence are temporary and often, these instances are caused by an external or lifestyle factor. Drinking alcohol, caffeinated beverages, or too much of any fluid can cause a temporary loss of bladder control. Some medications — such as blood pressure drugs, muscle relaxants, sedatives, and some heart medicines — may also lead to a short spell of incontinence. A urinary tract infection may also lead to instances of incontinence.

Other causes of incontinence include:
Aging: As you age, your bladder muscles becomes weaker and incontinence becomes more likely. Any issues with your blood vessels will make this situation worse.
Vaginal delivery or surgery in the pelvis: Any damage caused to your pelvic floor muscles can lead to incontinence, since these muscles support your bladder. In some cases, they can be damaged or weakened by surgery—usually during a procedure to remove the uterus—or during childbirth.
Enlarged prostate: In nearly all men, the prostate gland enlarges with age. It is common for men to experience some incontinence as a result.
Cancer and stones: Prostate cancer in men, or bladder cancer in men or women can cause incontinence. In some cases, the cancer’s treatment will cause incontinence as a side-effect. A tumor, whether malignant or benign, can also cause incontinence by blocking the usual flow of urine. Kidney or bladder stones can also have the same effect, say experts.

Evaluation of the man or woman with incontinence
The condition is determined after a person records regular urine leakages. Diagnosis of urinary incontinence may involve a physical exam, an ultrasound, urodynamic testing and tests including cystoscopy, urinalysis and a bladder stress test. Sometimes, I may ask the person to keep a bladder diary.

Prevention
Although it is not always possible to prevent UI, one can lower its risk by practicing Kegel exercises, especially during pregnancy, following a healthy high-fiber diet, maintaining a healthy weight and avoiding caffeine and acidic foods.

Treatment of this condition
Most cases of urinary incontinence can be treated with lifestyle changes and bladder training exercises but medication and other coping strategies like use of diapers (that can absorb the excess urine) are also used if the problem is due to urgency or mixed incontinence. There are a few effective ways to put an end to your battle with incontinence, such as –

• Drink fluids in moderation
• Empty the bladder completely
• Lose weight
• Avoid drinking tea and coffee
• Stop drinking alcohol
• Treat digestive problems
• Read labels on medications
• Apart from these, there is a therapy to improve the symptoms of frequency, nocturia, urgency, and urge incontinence.
Treatment options also include anticholinergics, antispasmodic agents, and tricyclic antidepressants (Tofranil). Pharmacologic therapy for stress incontinence and an overactive bladder may be most effective when combined with a pelvic exercise regimen.

Some surgical procedures like tape or sling procedures, bladder suspension, urethral bulking agents, artificial urinary sphincter in men with incontinence after prostate surgery and other surgical procedures are available as treatment.

Bottom Line: Men and women who suffer from incontinence don’t have to suffer in silence and wear diapers. Help is available. See your doctor to discuss an evaluation and treatment options.

PSA Test For Diagnosis of Prostate Cancer-The Test That Just Might Save Your Life

The value of prostate-specific antigen (PSA) screening for prostate cancer is the subject of much debate today. Results from a large long-term European study provide important insight. The study was published in Lancet, which is a prestigious European medical journal.

Over 13 years, men who were offered PSA screening had a 21 percent lower risk of dying of prostate cancer than their counterparts who weren’t offered screening. Stated another way, PSA screening prevented one death for every 27 cases of prostate cancer it detected.

In spite of these results, there is no one-size-fits-all screening strategy. All men and their doctors should weigh the benefits and risks of screening based on the man’s individual circumstances and preferences.

Bottom Line: These findings provide confirmation that prostate cancer-related deaths are lower in men who are screened. I recommend annual PSA testing until age 75 and discontinue testing as prostate cancer is a slow growing malignancy and older men will often die WITH prostate cancer rather than FROM it.

ED (Erectile Dysfunction) – What About Natural Solutions? They May Be Dangerous To Your Health

ED (Erectile Dysfunction) – What About Natural Solutions?

ED is a common problem affecting over 30 million American men. For the past 10 years oral medication, Viagra, Cialis, and Levitra have been available for helping me achieve intimacy with their partners. A recent analysis by the FDA has revealed that some of the many over the counter (OTC) supplements contain the same active ingredient in Viagra but often at a higher more dangerous dose than what is prescribed by the doctor.

As reported by BuzzFeed, in the past week as many as 25 “natural supplements” meant to treat erectile dysfunction were found to contain sildenafil citrate, the same active ingredient found in prescription drugs such as Viagra.

Despite an obvious attempt at falsely advertising a prescription drug as an herbal remedy, the unregulated tainted supplements could cause serious harm and even death to those who unknowingly buy them.

Natural erectile dysfunction supplements are both one of the biggest sellers on the market for herbal treatments and one of the most likely to be tainted with unregulated ingredients. It’s suspected the FDA has only hit the tip of the iceberg regarding the current investigation into herbal erectile dysfunction.

The World Health Organization describes counterfeit drugs as a widespread problem, but it occurs most often in developing countries. For example, one study from 2012 found that around one-third of all available malaria medications sold in Asia and sub-Saharan Africa were counterfeit. A press release from the University of Michigan stated that counterfeit drugs kill around 700,000 people every year.

There is hope, though. Last year Pfizer made $1.7 billion off of Viagra sales. This large monetary stake that companies such as Pfizer have in prescription erectile dysfunction medication could be enough to push the regulation of fake drugs to priority level.

Bottom Line: There are effective drugs for treating ED. For the safety of your health and your erections, speak to your doctor or use only the medication prescribed by your physician.