Archive for the ‘urgency incontinence’ Category

Caffeine And Urinary Incontinence

May 10, 2015

Urinary incontinence affects millions of American men. Caffeine may contribute to the problem. This blog will discuss a new study that implicates our dear cup of joe as a culprit for incontinence.

The amount of caffeine that’s typically found in just two cups of coffee may contribute to urinary incontinence in men, according to a new study.

The amount of caffeine that’s typically found in two cups of coffee may contribute to urinary incontinence in men. Therefore, men who are having problems with urinary incontinence should modify their caffeine intake.

The report doesn’t prove that caffeine causes bladder leakage, but the men in the study who consumed the most caffeine were more likely to have the problem than those who consumed the least.
Plenty of research has linked caffeine to incontinence among women. But little is known about whether there is a similar connection for men.

It’s estimated that 85% of Americans, myself included, consume caffeine regularly, both in beverages like coffee, tea and soft drinks, and in foods like candy, pastries and ice cream containing chocolate.
Estimates of urinary incontinence among US adult men range from 5% to 21%.

The recent study showed that the man who consumed an average of 169 mg of caffeine every day. That’s a little more than the typical 125 mg in a cup of coffee.

About 13% reported leaky bladder, but only 4.5% had a problem considered moderate or severe, i.e., more than a few drops of urine leakage during the course of a month.

After adjusting for the men’s age and other risk factors, the researchers found that those who consumed at least 234 mg of caffeine every day were 72% more likely to have moderate to severe urinary incontinence than those who consumed the least caffeine.

What the study found
Men who consumed more than 392 mg of caffeine daily were more than twice as likely to be incontinent.

Total water intake, in contrast, was not linked to a man’s risk of moderate to severe incontinence.

It’s not just a matter of how much fluid a person takes in. Dr Markland said that some research in women suggests caffeine irritates the bladder, and she believes that may also underlie the association in men.

Bottom Line: I don’t think it’s a call for action to stop drinking coffee but if you are having an incontinence problem, you may want to decrease your caffeine consuption.

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Things To Avoid If You Have Urge Incontinence

May 10, 2015

Overactive bladder is common problem affecting millions of American men and women. The condition impacts a person’s quality of life and can make them miserable. This blood will discuss non-medical solutions that won’t cure the problem but will help control OAB.

Urge incontinence is one of the four main types of urinary incontinence.
It involves the loss of urine as a result of strong, uncontrollable urges to urinate. Certain foods, drinks and medications can worsen those urges and therefore increase the severity of your incontinence.
Consider reducing your intake of these 6 things if you suffer from urge incontinence:

1. Caffeine

A number of studies have shown caffeine to worsen urinary incontinence. Caffeine is a diuretic which means it can increase your need to urinate. For those who suffer from urge incontinence, caffeine may make the urges worse, Health24’s resident GP Dr Owen Wiese explains.
Try limiting your intake of caffeine by cutting down on coffee, certain teas, energy drinks and caffeinated fizzy drinks.

2. Spicy foods
Spicy foods are commonly known to irritate the stomach and bowel but they have been found to have a similar effect on the bladder, Dr Wiese explains. Try to avoid cooking with chilli and other spices for a while to test if your symptoms improve.

3. Certain medication

There are a number of different medications that can increase the frequency or urgency to urinate. These include:
Hypertension medication:
– Diuretics such as Hydrochlorothiazide (Ridaq) and Furosemide (Lasix)
– ACE inhibitors such as Enalapril maleate (Pharmapress; Renitec) and Captopril (CaptoHexal; Zapto)
– Alpha-antagonists including Doxazosin maleate (Cardura) Prazosin (Pratsiol)
Muscular pain medication:
– Muscle relaxants including Baclofen (Lioresal) and Orphenadrine (Norflex, Disipal)

4. Sweeteners Artificial sweeteners such as aspartame that are commonly found in diet drinks and sugar-free foods can also cause incontinence. Like spicy foods, sweeteners are known to irritate the bladder. Try adding honey or agave syrup to your tea instead of sweeteners to prevent uncontrollable urges.

5. Alcohol

If you suffer from incontinence, alcohol intake is another lifestyle factor that could be aggravating your symptoms.
Like caffeine, alcohol is a diuretic and therefore increases your need to urinate. Also, being intoxicated can prevent you from realizing that you need to go to the bathroom or from getting to the bathroom in time.
Try to reduce the amount of alcohol you consume to better control your urges.

6. Citrus fruit

Citrus fruits cause the same problem as spicy foods and sweeteners. The acidity caused by the vitamin C in the fruit irritates the lining of the bladder which can increase the urge to urinate.
Try replacing citrus fruits with less acidic alternatives such as apples, watermelon and apricots.
While these different foods, beverages and medications can worsen urge incontinence, they can also have little affect on your incontinence at all. Some people are affected by alcohol and caffeine but not by citrus fruit or spicy foods.

Bottom Line: Urge incontinence is common problem but you can decrease the incontinent episodes by monitoring your foods and fluids. You don’t have to completely eliminate the culprits I’ve listed above you should decrease the consumption of these bladder irritants.

Urinary Incontinence-Don’t Suffer In Silence

December 20, 2014

Urinary incontinence is one of life’s most embarrassing problems. Millions of American women suffer from incontinence in silence. I see dozens of women every month with this problem and so many of them have been wearing pads and diapers for years because they were too embarrassed to bring up the problem with their physician. This blog will discuss the problem and why it is important to see a physician to get treatment.

There are millions of people who deal with the embarrassing and disruptive effects of urinary incontinence, yet it’s a health secret that is rarely discussed. Contrary to what a lot of people think, urinary incontinence is not a normal sign of aging. Yes, it is more common in older men and women but you don’t have to live with the problem as treatments are available.

There are several reasons for urinary incontinence, but for women, one of the most common is weakened muscles in the pelvic floor.
A woman’s body goes through many changes during a lifetime and weakness or injury to muscles in the pelvic floor can cause health issues for women of all ages. The group of muscles in the pelvic floor can be affected by aging, childbirth, posture or injury. This loss of support of the pelvic muscles can result in incontinence, pelvic pain, or pain with intercourse.

Weakened pelvic floor muscles can be strengthened with Kegel exercises. (see my website, http://www.neilbaum.com, for more information on Kegel exercises). For the problem of urgency and frequency and urge incontinence or overactive bladder, there are effective medications to treat this condition. Finally, for women with both kinds of incontinence due to weakened pelvic muscles, they can be treated successfully with physical therapy.

If you answer yes to any of these questions, you should speak to your physician as help is available:
Do you usually get a strong urge to urinate?
Do you always make it to the bathroom on time?
Do you leak urine when you sneeze or cough?
Do you leak urine during physical activity?
Do you get up more than once per night to urinate?
Do you feel heaviness in the pelvic area?

Bottom Line: If you’ve been keeping urinary incontinence a secret, you’re not alone. You don’t have to accept it. Help is available. Talk to your doctor.

Urinary Incontinence-Common Problem With Good Solutions

October 22, 2014

Millions of American women suffer from loss of urine or urinary incontinence. The problem is a source of embarrassment and lead to social isolation and even depression. This blog will discuss the three types of incontinence and offer some suggestions for solving the problem.

Some women with incontinence have only occasional leakage such as when they have a respiratory tract infection and have a severe coughing spell, while others may have a great deal of leakage on a daily basis. This can result in various limitations on activities, and can seriously impact quality of life. Bladder control issues are not a normal part of aging and they are not something you should have to live with.

Urologists and gynecologists are physicians with training in the evaluation, diagnosis, and treatment of conditions that include urinary incontinence.

There are three common categories of urinary incontinence.

  1. Stress incontinence is loss of urine that occurs with activities that increase abdominal pressure (such as sneezing, coughing, laughing, and exercising). This rise in pressure within the abdomen is transmitted to the pelvic organs including the bladder which can result in urine leaking through the urethra, the tube from the bladder to the outside of the body. This is usually due to weakness of the muscle that controls urination and support structures, often related to hormone (estrogen) deficiency which is common after menopause and prior vaginal delivery.
  1. Urge incontinence, which is also often referred to as overactive bladder, describes loss of urine with a sense of urgency or inability to hold urine long enough to reach a bathroom. This is usually due to over-activity of the bladder. Often women with urge incontinence report leaking with specific triggers such as running water or putting a key in the lock. Other associated symptoms often include frequent daytime and nighttime voids.
  1. Mixed incontinence is the common situation when women have components of both stress and urge incontinence.

Risk factors for the development of urinary incontinence include pregnancy, vaginal delivery, pelvic surgery, and pelvic radiation. Other potential risk factors include obesity, smoking, caffeine intake, chronic constipation leading to excessive straining, repetitive heavy lifting and neurological diseases such as multiple sclerosis. Certain basic interventions can reduce the risk of developing incontinence or even the severity of leakage.

For instance, maintaining a normal weight, or losing weight if overweight, can be extremely helpful. In fact, studies show that as little as a 10 percent loss in body weight can improve leakage symptoms by up to 50 percent. In addition, avoiding chronic straining which occurs with chronic constipation can prevent injury to the muscles and nerves of the pelvic floor. A diet with plenty of fiber and fluids, as well as good lifting technique, is key.

Next, if you are a smoker, strongly consider kicking the smoking habit. Besides improving your bladder health, there are countless other benefits to your overall well-being if you can quit. Also, avoid significant caffeine intake as it may be a major bladder irritant in some women.

Finally, make sure to keep your pelvic floor muscles nice and strong — this requires learning how to do Kegel exercises. (For more information on Kegel exercises, please go to my website, http://www.neilbaum.com)

Unfortunately, sometimes these basic interventions are not as successful as we would like. Luckily, a significant percentage of women who seek help for urinary incontinence will experience significant improvement in their leakage.

For this reason, women with bothersome leakage should always feel comfortable raising this issue with their physicians. A wide range of treatment options exist, ranging from physical therapy to surgery, and are being used every day to help women with leakage improve their quality of life. If your leakage is bothersome, get evaluated and learn about your treatment options.

Knowledge is power, and the more you know, the more confident you will be in directing your treatment.

Bottom Line: You don’t have to suffer the consequences of urinary incontinence. Help is available; you don’t have to depend on Depends!

Urinary Incontinence-When It Gets Wet Down There

September 4, 2014

Urinary incontinence affects millions of American men and women. It is a condition that is a source of embarrassment, depression, and lead to social isolation. This blog will review urinary incontinence and what can be done to help those who suffer from this condition.

People suffering from urinary incontinence — loss of bladder control — have been advised to seek prompt medical advice as simple lifestyle changes or medical treatment can cure some men and women with the problem and most can have improvement in their voiding symptoms.



Some patients may feel uncomfortable discussing incontinence with their doctor. But if incontinence is frequent or is affecting their quality of life, it is important to seek medical advice because urinary incontinence may also indicate a more serious underlying condition. 

The condition may restrict their activities and limit social interaction while it also poses an increased risk of falls in older adults as they rush to the toilet at night when the lighting is poor.



Common symptoms of urinary incontinence are occasional minor leaks of urine or wetting clothes frequently. Types of incontinence include stress incontinence, urge incontinence, overflow incontinence, mixed incontinence, and problems with emptying the bladder. Bladder irritants such as alcohol, caffeine, decaffeinated tea and coffee, carbonated drinks, and artificial sweeteners could cause urinary incontinence. 

 Foods high in spices, sugar or acid, especially citrus fruits, as well as medications can act as diuretics, or water pills, and by increasing the volume of urine result in urinary incontinence.



Urinary incontinence may also be caused by some easily treatable medical conditions, such as urinary tract infection, which irritates the bladder, causing strong urges to urinate, and sometimes incontinence. Other signs and symptoms of urinary tract infection include a burning sensation when urinating and foul-smelling urine.



Constipation is another cause as the rectum is located near the bladder and the two organs share many of the same nerves. Hard, compacted stools in your rectum cause these nerves to be overactive and increase urinary frequency and sometimes urinary retention.

Urinary incontinence can also be a persistent condition caused by underlying physical problems or changes, including pregnancy, childbirth, changes with age, menopause, hysterectomy, enlarged prostate, prostate cancer, obstruction and neurological disorders.



Urinary incontinence isn’t always preventable but certain factors can help decrease the risk of having the condition, such as maintaining a healthy weight; practicing pelvic floor exercises, especially during pregnancy; avoiding bladder irritants, such as caffeine and acidic foods; and eating more fiber, which can prevent constipation, a cause of urinary incontinence.


Urinary incontinence could be diagnosed by examining the bladder’s dynamics through an examination conducted with a device that assesses the bladder function. This can be done by taking an X-ray of the bladder at various stages in order to further support the diagnosis.



Bottom line: Don’t let incontinence get you down. See your doctor as you don’t have to suffer in silence

Kegel Exercises For Men- Non Medical Treatment of Overactive Bladder

July 24, 2014

For decades, women have been doing Kegel (named after the gynecologist who invited the exercises) to help control urinary incontinence. Now we know that regular, daily exercising of pelvic muscles can improve, and even prevent, urinary incontinence even in men.

Kegel or pelvic muscle exercises are discrete exercises that work the perineal or pubococcygeus muscles. In the past, they have been largely promoted by physicians to their female patients in an effort to aid with stress incontinence following childbirth. However, these same exercises are now being promoted to men in an effort to improve urinary incontinence, fecal continence, and even sexual health such as the treatment for erectile dysfunction and premature ejaculation. Unlike typical exercise routines, these exercises don’t require the participant to buy any weights or expensive machines. You don’t need a trainer, a gym membership, or any special equipment.

Kegel exercises primarily aid men with urinary incontinence. Besides preventing embarrassing urine leakage, they also decrease the urge to void. Secondly, they have been shown to help male sexual health by allowing some men’s erections to last longer when affected by sexual dysfunction and premature ejaculation. These benefits all equate to a better quality of life.
These exercises are often recommended to patients with weakened pelvic floor muscles such as patients with diabetes, patients having had a prostate surgery in the past such as a radical prostatectomy, or obese patients. It should also be mentioned that these exercises have not been scientifically proven to increase penis size and are thus not recommended solely for this purpose.
Kegel exercises are harmless if performed correctly. Chest and abdominal pain have been reported in some, but these occurrences are the result of inappropriately performed exercises.

How can men perform Kegel exercises?
Prior to beginning the exercises, it is important to correctly localize the pubococcygeus muscles. To achieve this, one can simply attempt to stop his urine flow midway through. The muscles allowing for the pause in urination are the ones targeted by the Kegel exercises.
There are many different techniques that can be used to efficiently strengthen one’s pelvic floor muscles. Women often use Kegel balls or Kegel weights to perform the exercises, but those are unnecessary for men.

The first technique requires a contraction of the anus muscles as if trying to hold in gas. The feeling of a pulling or lifting sensation on the anus tells you that you are performing the exercise correctly.

The second exercise is used to observe the movement of your penis vertically without moving the rest of your body. An elevator analogy can be used to illustrate the exercise. The anus, in this case, can represent an elevator. The goal of the exercise is to bring up the elevator over 5 seconds to its maximal level and then to bring it gradually back down to the resting level.
The techniques are interchangeable. Men can perform a different technique each day. However, the important thing is to always use only the pelvic muscles. When men first start performing these exercises, they may use other muscles to help them. Often, they may use their abdominal or gluteal maximus (buttocks) muscles. It is thus important to become aware of which muscles are being contracted. It is also important to avoid holding the breath or crossing the legs.

Arguably, one of the strongest points of Kegel exercises is that they can be performed anywhere without anyone but the participant noticing. Unlike typical core exercises for men requiring sit-ups, planking, or other unusual positions, Kegel exercises can be performed during a variety of activities such as shaving, sitting at one’s desk, or even while driving. This feature allows them to be universally accepted by men.

Men are accustomed to exercises such as push-ups or sit-ups. However, a very small proportion of them know how to efficiently perform Kegel exercises. This is unfortunate since many doctors recommend incorporating these into one’s core routine.
Unlike typical workouts for men, when it comes down to Kegel exercises, there is no magic number of sets one should do in a day. It is recommended, however, for men to perform at least two sessions of Kegel exercises every day. To keep things simple, men should perform their first session in the morning and their second at night. A session comprises of 10 to 30 individual contractions and relaxations exercises. Each exercise should last 10 seconds divided into 5 seconds of contraction and 5 seconds of relaxation. Once a man excels at performing these, he can do them in different positions. Of the 10 to 30 exercises, he can do one-third while laying down, one-third while sitting, and one-third while standing. Counting out loud certainly helps and as time goes by many men are surprised at the ease with which they can perform the exercises that at first seemed unnatural to them.

This is of greatest importance for men undergoing prostate surgery, either for prostate cancer needing radical prostatectomy (complete prostate removal) or for benign prostate hyperplasia (BPH) needing transurethral resection of the prostate. Both of such surgeries reduce the resistance to the bladder which can result in postsurgical urinary incontinence. As we can see from the following image, the anatomic changes reduce bladder outlet resistance. As such, strengthening the pelvic floor and sphincter are of paramount importance and Kegel exercises can help.

Bottom Line: Kegel exercises are not just for women with incontinence. They work for men, too. Results aren’t immediate so stick with it and you will be amazed at the results.

July 12, 2014

Urinary Problems Can Impact Your Sex

Overactive bladder or urge incontinence can have a significant impact on a man or woman’s quality of life include their ability to engage in sexual intimacy with their partner. This blog will discuss the concept of the overactive bladder and what can be done to tame the bladder and improve the intimacy of those who suffer from this condition.

OAB can take its toll in many areas of your life, including your romantic relationships. Women with OAB worry about urine leakage during sex or orgasm.

OAB or urinary incontinence can cause physical symptoms as well as fear, anxiety, and shame about sex and intimacy.
Unfortunately, many women with OAB will avoid sex altogether.
Unless you have a prolapsed bladder, sex is not dangerous and will not cause your bladder to become damaged.
Women may feel embarrassed by leakage during sex or orgasm, and even if their partner knows and says ‘It’s OK,’ it certainly can stop you from allowing oral sex.

Once you are open with your partner, you can face the situation together. For example, if there is urine incontinence during sex or orgasm, you may need a special sheet or towel.
Non-medication treatment for OAB

Natural Treatment for Overactive Bladder
Bladder training and pelvic floor exercises are just two natural treatments for overactive bladder. Research suggests that these non-drug remedies can be very effective for many women, and they have almost no side effects.
Before starting any OAB treatment, however, it’s important to understand bladder function and what factors may cause overactive bladder.
• Bladder training. This is the most common OAB treatment that doesn’t involve medication. Bladder training helps change the way you use the bathroom. Instead of going whenever you feel the urge, you urinate at set times of the day, called scheduled voiding. You learn to control the urge to go by waiting — for a few minutes at first, then gradually increasing to an hour or more between bathroom visits.
• Pelvic floor exercises. Just as you exercise to strengthen your arms, abs, and other parts of your body, you can exercise to strengthen the muscles that control urination. During these pelvic floor exercises, called Kegels, you tighten, hold, and then relax the muscles that you use to start and stop the flow of urination. Using a special form of training called biofeedback can help you locate the right muscles to squeeze. Start with just a few Kegel exercises at a time, and gradually work your way up to three sets of 10. Another method for strengthening pelvic floor muscles is with electrical stimulation, which sends a small electrical pulse to the area via electrodes placed in the vagina or rectum.
Until you get your overactive bladder under control, wearing absorbent pads can help hide any leakage that occurs.
Other behavioral tips for preventing incontinence include:
• Avoiding drinking caffeine or a lot of fluids before activities
Not drinking fluids right before you go to bed
I also suggest that before engaging in sexual intimacy, empty your bladder so there is less fluid in the bladder and not likely to trigger an unwanted bladder contraction.

Bottom Line: Intimacy can take place if either partner has an overactive bladder. Speak to your partner and your physician to find a solution for this common condition that doesn’t have to affect your sex life.

Urinary Incontinence is No Joking Matter

April 16, 2014

Have you ever heard someone say after telling a joke, “I laughed so hard, I peed my pants”? If it is indeed true, then it is no laughing matter. Incontinence affects millions of American men and women. It is more common as men and women age but can occur at any time and may impact a man or woman’s quality of life because of embarrassing leakage. It can affect a man or woman’s self-image and confidence.

There are two categories of urinary incontinence: stress incontinence and urge incontinence. Stress incontinence is due to laughing or sneezing. Basically, small amount of leakage occurs when the pressure in the belly is more than what the urethra – the urine tube leading out of the bladder – can stand. This is what happens when you laugh or sneeze and leak.

Urge incontinence occurs when the bladder contracts and forces usually large volume of urine out. People may describe a sudden urge to urinate, and they simply cannot make it in time to the bathroom. Sometimes both types of incontinence may be present and is referred to mixed incontinence.

Women are more likely to experience urinary incontinence because their anatomy predisposes them to leakage of urine. Also, hormonal changes occurring at the time of menopause with a decrease in estrogen levels, childbirth and aging make leakage more common for women. If the incontinence affects a woman’s day-to-day life and it keeps them from taking part in their daily activities, then they should take the initiative and obtain the assistance of the physicians.
Men with incontinence, on the other hand, should see their doctor as it may represent a more serious problem with their prostate gland.
The good news is that urinary incontinence can be treated. It may be as simple as behavioral changes quit, special exercises and medicines. In some cases it may involve surgery.

Bottom Line: Urinary incontinence affects millions of American men and women. It is not a condition that kills those who suffer but it does affect their quality of life. Help is available and most men and women who suffer from urinary incontinence can be helped. Remember you don’t have to depend on Depends!

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.

Urine Incontinence — It’s Nothing to Sneeze At

January 17, 2014

One of life’s most embarrassing experiences is not being able to control your urination and soiling your clothes forcing you to leave any situation where you are engaged with others. It is one of the last medical conditions to remain in the closet as many men and women fail to seek medical attention for this common problem.
This blog will discuss the 4 types of urinary incontinence and what treatment options are available for this common problem.

Urge Incontinence occurs in women with an overactive bladder who may not be able to get to the toilet in time to prevent leakage, even though they tighten up all of their pelvic muscles, because they can’t control the bladder and keep urine in. Overactive bladder that leads to urge incontinence affects about 17 percent of women, but it increases to over 50 percent after menopause. Overactive bladder isn’t a normal part of aging.

Stress incontinence is a much more common type of incontinence. Menopause contributes to this problem, but stretching and tearing of the pelvic muscles during childbirth definitely sets the stage. The reduced muscle tone causes the urethra to sag. When pressure builds up in the abdomen from a cough, sneeze, laugh, jump or lift, internal organs put pressure on the bladder and a small amount of urine may escape.

Overflow incontinence occurs when more urine collects in the bladder than the bladder can hold and the excess urine leaks out. It can be caused by blockage of the urinary tract or nerve damage caused by conditions such as diabetes, stroke, or injury.

Functional incontinence is not really a problem with the urinary tract. It happens to people who can’t move quickly, who have eye problems or who suffer from confusion or memory loss. They simply can’t get to the bathroom in time.

Certain prescription drugs such as diuretics and some tranquilizers, and smoking and eating spicy foods or artificial sweeteners, or drinking alcohol and caffeine can irritate the bladder and worsen incontinence.

Mixed incontinence is a combination of both stress and urge incontinence.

Today, there are many more options to consider, from medications, pelvic floor physical therapy, and surgery. The first step is to have a work up to diagnose the underlying problem so that an appropriate treatment plan can be put into place. Sometimes more than one treatment is needed.
Treatment options include:
1. Bladder training — This approach teaches you to urinate only at scheduled times and waiting longer between trips to the bathroom. Start by going to the bathroom every 30 to 60 minutes while you are awake, even if you don’t have to go. After about one week, slowly increase the time interval by 30 minutes every week.

2. Kegel exercises — Dr. Arnold Kegel, a gynecologist at the University of Southern California, developed the exercises to strengthen pelvic floor muscles in 1948. Kegel exercises are often the first line of treatment for the millions of women in the U.S. suffering from unexpected bladder leakage due to coughing, sneezing, laughing or exercise. This if defined as stress incontinence but many women experience frustration because they unknowingly don’t perform the Kegels effectively, which leads to no improvement in symptoms. Most men or women need to do the exercises for 3-6 months before any changes will occur.

3. Pelvic Floor Electrical Stimulation with Biofeedback Therapy — This treatment uses computer graphs and sounds you can hear to show you which muscles you are exercising so you can perfect the exercises. Physical therapists and other professionals specially trained in problems related to women’s health teach exercises for the pelvic floor, trunk, back and extremities that can help strengthen the pelvic muscles and improve bladder control. The physical therapist may use devices that use mild, comfortable, electrical stimulation to train the bladder muscles when and how to squeeze.

4. InTone is a new FDA listed Class II Medical Device for home use that has been shown to effectively strengthen the pelvic floormuscles and helps to prevent embarrassing leakage without surgery or medication and can be done in the privacy of home. InTone is like a personal trainer for Kegel exercises.

5. Medications — Estrogen can be very helpful in improving the symptoms of some cases of incontinence. Studies have demonstrated improvement in 40- 70 percent of women. I have found that estrogen cream (one fourth to half an applicator) works better than either tablets or patches for this particular problem. Medications called smooth muscle relaxants (examples are oxybutynin and tolterodine) can also help if the problem is caused by abnormal bladder contractions.

6. Pessaries — These donut-like plastic or rubber rings are similar to a diaphragm used for birth control. They are fit into the vagina to lift and offer added support for the bladder when the pelvic muscles are weak.

7. Surgery — There are many operations that have been developed to support the bladder and improve or correct incontinence. Women don’t need to have a hysterectomy in order to control urinary incontinence. Most of these operations for incontinence can be performed as one-day surgeries.

8. Botox– If you don’t respond to oral medications, you may be a candidate for Botox injections directly into the bladder muscle. This, too, can be done as a one-day stay procedure and usually produces relief of symptoms of frequency of urination and urgency of urination with urge incontinence

Bottom Line: Women don’t have to suffer in silence. Successful treatment options are available and most women can be helped and made more comfortable and reduce their embarrassment.