Archive for the ‘pelvic organ prolapse’ Category

Pelvic Pain-Perhaps There Is Light At The End of The Tunnel of Love

December 19, 2014

This blog will discuss the condition of vaginismus or severe pelvic pain which makes it difficult and often impossible for a woman to engage in pleasurable sexual intimacy. I will also discuss some of the common treatment options for this condition.

Vaginismus is caused by contraction of the muscles around the vagina making penetration difficult or impossible. Often the problem is caused by anxiety or worsened by the anticipation of pelvic pain. If a woman focuses on pelvic pain, her ability to concentrate on the pleasurable sensations of sexual intimacy may be affected, and often her sex drive will decline. This will perpetuate her pain, as decreased sexual excitement may lead to less vaginal lubrication and tight, contracted vaginal muscles, all of which may increase the unpleasant friction in the vagina during sexual intimacy. Emotional anxiety, which often results from painful sex, may have a negative impact on the sexual relationship. Sexual pain creates a vicious cycle, which needs to be addressed from multiple perspectives in order to be resolved.

Treatment often requires a referral to a physical therapist. Physical therapists are trained to provide treatment to restore function, facilitate movement, and most importantly, to relieve pain. Pelvic floor physical therapy is often helpful in the treatment of sexual problems in women.

A physical therapist may prescribe vaginal dilators to help overcome penetration anxiety and also to help gradually stretch the vaginal opening. Dilators are usually provided in a gradual manner starting with the smallest dilator that does not cause the woman any pain or discomfort.

Another treatment option is pelvic floor biofeedback. This involves the insertion of probe into the vagina. The probe measures the activity of the pelvic floor muscles and displays the activity on a computer monitor. The woman is able to visualize the activity of her vaginal muscles and learn to relax them as well as strengthen, stabilize, and coordinate the muscles that are used during sexual intimacy.

Finally electrical stimulation with a low voltage current can be useful to teach coordinated contraction of vaginal and pelvic musculature, and is useful in providing pain relief.

Bottom Line: Vaginismus is a terrible condition that results in loss of enjoyment in sexual intimacy, can impair a relationship between a woman and her partner, and can even lead to depression. Speak to your doctor and consider a referral to a physical therapist to help put the zing back into your bedroom.

When Something Is Coming Out “Down There”-Use of A Pessary To Treat Vaginal Prolapse

January 30, 2014

As women reach menopause, many women experience changes in the vagina which include incontinence of urine and pelvic organ prolapse where organs and tissues start coming out of the vagina. For mild problems of incontinence, Kegel exercises can help control the problem. For more extensive prolapse surgery is often necessary. For women who can’t have surgery or wish not to take the surgical option, a pessary is an alternative. This blog will discuss a vaginal pessary and how it can help women with urinary incontinence and vaginal prolapse.

A vaginal pessary is a removable device placed into the vagina. It is designed to support areas of 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

Your physician will fit your pessary to 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 health professional’s office. You may need to experiment with different kinds of pessaries to find one that feels right for you. Your health professional will teach you how to remove, clean, and reinsert the pessary on a regular schedule. The cleaning schedule is determined by the type of pelvic organ prolapse and the specific brand of pessary. If it is hard for you to remove and replace your pessary, you can have it done regularly at your doctor’s office.

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.1

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 (fistula) 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. Your pessary should be checked frequently by your health professional until both of you are satisfied with the fit.

In post menopausal women, estrogen (cream, ring, or tablets) is sometimes used with a pessary to help with irritation caused by the pessary.

Follow your health professional’s instructions for cleaning your pessary, because regular cleaning reduces the risk of complications. The cleaning schedule is determined by the type of pelvic organ prolapse and the specific brand of 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: Incontinence and prolapse are common concerns of many middle age, post-menopausal women. Certainly medications are a first line of treatment. For women who do not respond to medication and do not want to have surgery, a pessary is treatment option.

When Things Are Coming Out “Down There”-Pelvic Organ Prolapse

December 25, 2010

Pelvic organ prolapse is a common that affects more than 30 million American women in the United States.  Unfortunately, only 15% of women who have prolapse seek treatment from a doctor.  This article will define prolapse, discuss the symptoms of prolapse and discuss some of the treatment options.

Pelvic organ prolapse is a condition where there is a weakening of the support tissues or muscles of the pelvis.  The symptoms of POP include a bulge or lump in the vagina or a pulling or stretching sensation in the groin.  Women with POP may complain of difficulty with sexual intimacy.  They may also have urine and\or fecal incontinence.  They may also have difficulty with bowel movements or difficulty emptying their bladder.

The causes of POP include menopause, multiple pregnancies and childbirth, prior pelvic surgery, obesity, and as a consequence of the aging process.

Treatment options for POP

Conservative therapies including strengthening the pelvic floor muscles.  This can be easily accomplished with Kegel exercises.  These are exercises named after the doctor who devised the treatment, which consists of contracting and relaxing the muscles in the pelvis.  These are the same muscles which hold urine in and rectal gas in place.  A woman should do the Kegel exercises multiple times a day and should not expect any changes for several months until the muscles are strengthened.

For more information on Kegel exercises go to http://www.neilbaum.com/pelvic-exercises-for-women-kegel-exercises.html.

Another conservative therapy is the use of pessaries or plastic or rubber rings which are inserted into the vagina to restore the fallen organ back into the normal anatomic position.   Peccaries will work immediately but they have to be changed periodically in order to avoid vaginal infections.

Probably the most common treatment is surgical repair of the prolapse.  The surgery is used to strengthen structures around the vagina to maintain support of the structures and organs in the pelvis.  These procedures can usually be accomplished through the vaginal opening.  Most women can have the procedure on a one-day stay basis or remain in the hospital for just 24 hours.  Most women need little or no pain medication after the procedure and can return to all activities including heavy lifting, exercise, and sexual intimacy in 3-4 weeks after the procedure.

Most of the surgical procedures that restore the normal anatomy are 90% successful and most patients are very satisfied after the procedure.

Bottom Line:  If something isn’t right “down there” you don’t have to suffer in silence.  There are several treatment options to restore your normal anatomy.  You can have an improved quality of life and return to your normal activities within a short time.  If you have any questions, call your doctor.

 

 

 

 

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

A Kegel A Day Keeps the Doctor Away

April 22, 2010

Mary Ann is a 45-year old woman who loses urine (incontinence) when she coughs and sneezes.  She is provided with exercises to strengthen the pelvic floor muscles of her bladder. She does the exercises every day for 12 weeks and has significant improvement in her urinary symptoms.

There are many conditions that put stress on your pelvic floor muscles such as childbirth through vaginal deliveries, obesity, chronic coughing, and after menopause when there is a deficiency of estrogen or the female hormone produced in the ovaries.

When your pelvic floor muscles weaken, your pelvic organs descend and bulge into your vagina, a condition known as pelvic organ prolapse. The effects of pelvic organ prolapse range from uncomfortable pelvic pressure to leakage of urine or feces. Fortunately, Kegel exercises can strengthen pelvic muscles and delay or maybe even prevent pelvic organ prolapse.

How to perform Kegel exercises

It takes diligence to identify your pelvic floor muscles and learn how to contract and relax them. You can learn to identify the proper pelvic muscles by trying to stop the flow of urine while you’re going to the bathroom.

If you’re having trouble finding the right muscles, don’t be embarrassed to ask for help. Your doctor can give you important feedback so that you learn to isolate and exercise the correct muscles.

After you’ve identified your pelvic floor muscles contract your pelvic floor muscles and hold the contraction for three seconds then relax for three seconds.  Repeat this exercise 10 times.  After you have learned how to contract the pelvic muscles for 3 seconds, work up to keeping the muscles contracted for 10 seconds at a time, relaxing for 10 seconds between contractions.  Perform a set of 10 Kegel exercises three times a day. The exercises will get easier the more often you do them. You might make a practice of fitting in a set every time you do a routine task, such as sitting at a red light.

For those women who have trouble doing Kegel exercises, biofeedback training or electrical stimulation may help. In a biofeedback session, a nurse, therapist or technician will either insert a small monitoring probe into your vagina or place adhesive electrodes on the skin outside your vagina or rectal area. When you contract your pelvic floor muscles, you’ll see a measurement on a monitor that lets you know whether you’ve successfully contracted the right muscles. You’ll also be able to see how long you hold the contraction.

Results are not immediate or the first time you do the exercises.  You can expect to see some results, such as less frequent urine leakage, within about eight to 12 weeks. Your improvement may be dramatic — or, at the very least, you may keep your problems from worsening. As with other forms of physical activity, you need to make Kegel exercises a lifelong practice to reap lifelong rewards.

An added bonus: Kegel exercises may be helpful for women who have persistent problems reaching orgasm.

Bottom Line:  Many women have a problem of loss of urine with coughing and sneezing.  Kegel exercises are effective for very mild urinary incontinence.  It’s inexpensive, does not require use of medication, and if you are patient, it does, indeed, work.

Self Care for Women With Urinary Incontinence

March 30, 2010

Incontinence is a condition that results in the involuntary loss of urine without the owners’ permission. It is a condition that affects millions of American men and women. There are many changes that occur in the human body as we get older. Like many other bodily system, the urinary tract undergoes changes with age. These changes make middle age and older men and women more likely to become incontinent of urine as they grow older. It is important to remember that incontinence is not a necessary part of the aging process but it is more common in older men and women. There are a number of actions that women can take to decrease or even limit this embarrassing situation.

The skin around the outside of the vagina in women is called the “vulva”. This area includes the skin around the urethra and the vaginal “lips” or labia. Frequently, in incontinent women this area is red, raw, and sore from urine irritating the skin. If this is a problem for women, these tips may help make women more comfortable and avoid irritation of the bladder, urethra, and surrounding skin.

  • Women who are incontinent should wear cotton underwear instead of underwear made of synthetic material such as nylon. I also suggest that women do not wear synthetic pantyhose, especially not under pants or jeans. Women will also find that the underwear will be less irritating to the vulva if the underwear is washed in pure soap or soap flakes and not in harsh detergents or with the addition of fabric softeners. I suggest that women wash the vulvar area no more than twice a day, using only plan water or mild soap such as Ivory or Dove.
  • Women who are incontinent should avoid bath oils, bubble baths or bath salts. All of these can be very irritating to the already sensitive skin of the vulva. Vaginal deodorants or douches should also be avoided. Tampons should not be used as they may irritate the bladder and the urethra.
  • After bathing, the vulvar area should be gently dried with a towel, and then use a hair dryer on cool or low setting to dry the vulva completely.
  • If you need a powder to help keep the vulvar area dry, I suggest using ordinary cornstarch and not talcum powder.
  • Finally, try drinking pure water as much as possible and avoid caffeinated beverages such as coffee, tea, and cola beverages. Avoid alcohol especially in excess as alcohol may irritate the bladder and the urethra.

Nearly every woman with incontinence can be helped and most can be cured. If this is a problem that is affecting your quality of life, I suggest you contact your physician.

Urinary Incontinence-What It Is and What Can Be Done

March 30, 2010

What is urinary incontinence?

Urinary incontinence is the uncontrollable and involuntary loss of urine that affects more than 10 million Americans. Incontinence can be very embarrassing as it can interfere with a normal, full life. Fortunately, today something can be done about it and in most instances it can be cured completely.

What are the types of incontinence?

There are three common categories of urinary incontinence. These are stress incontinence, overflow incontinence, and urge incontinence. Although all people with incontinence experience a loss of bladder control, each type of incontinence has its own pattern of signs and symptoms. People with stress incontinence leak urine when they cough, sneeze, or laugh. They may be dry at night but leak upon getting up from the bed in the morning. People with urge incontinence wet themselves if they don’t get to the bathroom immediately. They get up frequently during the night to urinate. They go to the bathroom constantly. They may wet the bed at night. People with overflow incontinence take a long time to urinate and have a weak, dribbling stream with no force. They dribble small amounts of urine throughout the day and night.

What causes incontinence?

Stress incontinence is due to the loss of the support from the pelvic floor muscles. Commonly the pelvic organs bladder and uterus slip down into the vagina (vaginal prolapse). Overflow incontinence is to either a narrowing of the tube (the urethra) that allows the urine to exit from the body or inability of the bladder muscle to contract and expel the urine from the bladder. Urge incontinence can be a result of bladder irritability such as a urinary tract infection or to neurologic problems in the brain or spinal cord.

How is the diagnosis of urinary incontinence made?

An accurate diagnosis is the essential first step in the treatment of incontinence. The evaluation consists of a medical history followed by a thorough physical exam that includes a pelvic exam and a rectal exam. Certain diagnostic tests such as a urinalysis, urine culture, cystometrogram (bladder pressure test) and cystoscopy (inspection of the bladder with a small lighted tube) are usually required to complete the diagnostic evaluation.

What is the treatment for urinary incontinence?

The treatment for stress incontinence depends on the degree of anatomical abnormality. In mild cases pelvic exercises and/or medication may be all that’s needed. However, in more severe cases surgery is the best treatment. The treatment for overflow incontinence may be alleviated with medication or intermittent self-catheterization to drain out the urine. Surgery may be required when the cause is a narrowed urethra or a nerve problem. The treatment of urge incontinence consists of antibiotic medication to treat the infection or medication to relax the irritated bladder.

Summary

Urinary incontinence shouldn’t take over your life. It is almost always treatable, and often completely curable. Working as a team, we can put you back in control of your bladder and your life. That means you’ll be free-free to get a night of uninterrupted sleep, to travel comfortably, to be as active as you want to be. Instead of worrying about embarrassing accidents, you’ll be able to do the things you most enjoy.

Urinary Incontinence-Tests You May Need To Do

March 30, 2010

The purpose of the evaluation is to identify the cause of the incontinence, to determine the damage to the bladder and kidneys, and to select the appropriate treatment for the specific cause of the leakage. All of the tests can be performed in the office or as an outpatient at the hospital. All of the tests are associated with minimal discomfort. You can resume normal activity immediately following the procedures. The evaluation of urinary incontinence can include any of the following tests or procedures:

Cystoscopy – A local anesthetic is inserted into the urethra (the tube that drains the urine from the bladder). A small telescope is inserted in the urethra to examine the inside of the bladder. In women, a pelvic examination is performed at the end of the procedure. The examination takes approximately 5 minutes. After the procedure there may be a small amount of bleeding or mild burning with urination.

Flow Rate – This is a procedure to measure the efficiency of the bladder and the muscles or sphincters that hold the urine in the body. You will be asked to drink several glasses of water, When you feel that you have to urinate, you will be asked to urinate over a toilet that contains a recording device. The device will measure the volume of urine and the time it takes to empty your bladder.

Cystometrogram (CMG) – This is a procedure in which a small catheter (a plaster or rubber tube smaller than a pencil) is inserted into the bladder. The catheter is used to deliver sterile water or gas (carbon dioxide) into the bladder. You will be asked to describe the first sensation to urine and the strong urge to urinate. This procedure takes approximately 10-15 minutes. After the cystometrogram the catheter is removed and you will be asked to cough, strain and then urinate. This test is performed to determine the extent of leakage. You can expect some burning or passage of air with urination,

Voiding Diary – This is a record of the amount and time of day that urination takes place and when leakage occurs, (The amount of urination should be recorded in ounces.)

Voiding Cystourethrogram (VCUG) – This is an X-ray procedure in which a catheter is inserted in the bladder and the bladder filled with iodine. The catheter is removed and X-rays are taken while voiding.

Intravenous Pyelogram – This is an X-ray procedure that requires an injection of iodine into a vein and pictures are taken of the kidney at various time intervals. This determines the anatomy and the presence of damage to the kidneys. There is occasional nausea, bad taste in the mouth, or lightheartedness with the procedure. You will be asked to take laxatives before the procedure. (Please notify me or the radiologist if you are allergic to iodine or seafood.)

Not all of these diagnostic tests are required for each patient.

When Things Aren’t Right “Down There”-Pelvic Organ Prolapse

March 30, 2010

This is a common condition that affects millions of American women. It is a condition that occurs when one of the pelvic organs such as the uterus, bladder, intestines, or rectum protrudes through the vagina. Prolapse ranges from mild to severe levels where mild prolapse is found by the doctor at the time of a pelvic exam and a severe condition when the organs protrude the vaginal opening and is visible and can be felt by the women when she is in the standing position.

Prolapse is caused by a weakness in the muscles and support structures in the vagina that normally hold the pelvic organs in place and when weakened allows one of the organs such as bladder or uterus to drop into the vagina and when severe protrudes through the vaginal opening. The process of childbirth through the vagina stretches the vaginal muscles and supporting structures and weakens the vagina and allows the organs to drop into the vagina. Each additional vaginal delivery adds more stretch and leads to the potential for more prolapse. Also aging and the accompanying estrogen deficiency also promotes weakness of the vaginal muscles and promotes prolapse. Less common causes include obesity, asthma, bronchitis and other pulmonary conditions that are associated with chronic coughing.

Symptoms of Prolapse?

The most common symptom of prolapse is a feeling of pressure in the vaginal or rectal area. Women often describe a sensation as if they have a ball in the vagina. If the prolapse is severe, the woman can see the lump protruding from the vagina. If the protrusion is present all the time, the tissue can be come irritated and be associated with a discharge or bleeding. With more severe degrees of prolapse it may be difficult to urinate because the urethra, the tube that transports urine from the bladder to the outside of the body, becomes kinked causing the women to strain in order to empty the bladder. In rare situations the woman may be unable to urinate and have to go to the emergency room to have a catheter inserted. Occasionally, prolapse is associated with urinary incontinence especially when the woman coughs and sneezes. Sexual problems include irritated vaginal tissues and painful intercourse. When the rectum prolapses through the vagina, there may be a problem of constipation and the woman may have to insert her finger in the vagina to express the stool. With very severe prolapse the tubes from the kidney to the bladder or the ureters are kinked and can cause obstruction and lead to kidney failure if the prolapse is not repaired.

Treatment of Prolapse

There are two treatment options for prolapse especially if the prolapse is producing significant symptoms. These are the insertion of a pessary or surgical correction.

A pessary is a device that is usually made out of a plastic substance and is usually in the shape of a donut or ring. It is placed in the vagina, like a tampon, to restore the organs to their normal position. Pessaries are quite safe, although in some patients they seem to be associated with recurring bladder infections.

If a pessary works, and it is comfortable, it can be a lifetime treatment. It can be left in place for several months at a time, however, it needs to be removed and cleaned and then reinserted.

Surgery to correct prolapse is indicated if there are significant symptoms such as a protrusion that is uncomfortable or causes vaginal bleeding, for women who have difficulty with urination such as straining to urinate or urinary incontinence, or chronic constipation. If the uterus is prolapsed it may be necessary to have a hysterectomy as well as repair the prolapse. In addition, it may be necessary to repair incontinence. Most of the surgery is performed through the vagina and can be done on a one-day stay basis or with one overnight stay in the hospital. Women have to avoid heavy lifting for 4-6 months after the surgery and must abstain from sexual intercourse for a similar time period. The surgery is successful in most cases and restores the quality of life to those who suffer from this common condition.

For additional information please visit my website, www.neilbaum.

Some Practical Advice On the Management of Urinary Incontinence

March 30, 2010

If you suffer from incontinence, whatever else you do, these practical tips can make your symptoms less severe:

  • KEEP THE BLADDER AS CLOSE TO EMPTY AS POSSIBLE. Go to the restroom even when the urge is not overwhelming, and stay as long as it takes to empty the bladder.
  • TIME YOURSELF. If you lose control at regular intervals (say every four hours), empty your bladder before it happens. Wear a wrist alarm to remind you.
  • WEAR CLOTHES AND TROUSERS THAT ARE EASY TO OPEN, or remove quickly, so that you won’t lose time fumbling when you need to void.
  • CONSUME LESS alcohol, fruit juices, carbonated beverages, spicy foods, dairy products, sugar, and artificial sweeteners. These all can irritate the bladder and worsen your symptoms.
  • DON’T WEAR girdles, corsets, pants or high heels all can weaken the pelvic muscles that control urination.
  • TRY CROSSING YOUR LEGS before you sneeze or cough. Chances are you will leak less.
  • AVOID CAFFEINE in any form.  It is a diuretic for most people
  • DON’T SMOKE. Women who do are twice as lucky to become incontinent.