Archive for the ‘Urinary Incontinence’ Category

Urinary Incontinence- You Are Not Alone and You Don’t Have To Suffer In Silence

October 22, 2014

I am writing this blog to let you know that incontinence is common in middle aged and older women. One in four women struggle at least occasionally with incontinence. One in five people over 40 deal with an overactive bladder or inability to control the urge and reach the toilet in a timely fashion. One in three women over 80 are incontinent.

Unfortunately many doctors don’t raise the issue with patients during visits, and many patients are uncomfortable of bringing up the subject with their healthcare provider.

The critical valves in a woman’s pelvis seem to become a problem as we age. As women age they get leaky valves in the colon, heart, and the lower urinary tract. The quality of the supporting tissues and structures fail as women get older. It fails as women have other types of treatments. Neurologically, things can fail. In this country, one of the problems we have is morbid obesity and that certainly increases the risk of urinary incontinence, leakage.

For most women with urinary incontinence there are almost always conservative options that don’t involve surgery.

Often very simple lifestyle changes can help patients tremendously, without any invasive therapy, without any medication, without any surgeries.

It begins with the diet. There are certain foods that are irritative to the lower urinary tract. The most common culprits are alcohol, caffeine, spicy food, acidic food.

Next are exercises: Doing pelvic floor exercises, Kegel exercises, for both men and women, can be helpful.

Are there medical and surgical options and when do those come into play?  Yes, there are medications for treating overactive bladder.

Surgical options are something that are considred after they’ve failed conservative therapies.

The most important thing in this population is improving quality of life, and in order to get at that, your doctor needs to look at the entire person. Patients need to understand that they need to get involved in long-term exercise routines and dietary modification will be helpful.

Most of incontinence is not life-threatening, but if people leak and they can’t see, and they’re up in the middle of the night and they fall, the mortality rates are high.

Bottom Line:  Urinary incontinence is a common condition that impacts the quality of life of millions of American women.  Help is available and often conservative treatments will control the problem.  For more information consult with your gynecologist or your urologist.

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!

Treating urinary incontinence-Don’t Be Pampered by Pampers

September 24, 2014

Many women experience incontinence after childbirth. Fortunately, most women have a temporary problem that usually subsides with time. However, there some women that have a persistent problem that lasts for a longer period of time.

After nine months of pregnancy and a rollercoaster of experiences with a changing body, it’s easy to chalk up bladder leaks after delivery to one more outcome of childbirth. While that’s true for many women, other conditions could be responsible for urinary incontinence —the inability to control the release of urine from one’s bladder —if a woman is having difficulties controlling urination two months post pregnancy or more.

The problem is common and nothing to be embarrassed about since many new moms experience urinary incontinence after baby’s arrival.

The condition is caused by the stretching and tearing of supporting structures including ligaments, tendons, nerves and muscles, resulting in a weakened pelvic floor. The extent of the stretching or tearing varies in each person. Incontinence often resolves itself within a couple months after delivering the baby when the structures have repaired themselves naturally.

According to the National Association for Continence, approximately 25 million adult Americans experience temporary or chronic urinary incontinence. UI can strike at any age, although women over age 50 are the most likely to develop the condition. In many cases, UI is often temporary—such as during or after pregnancy for a short while — or results from an underlying medical condition.

The most common form of incontinence in women post pregnancy is stress incontinence, which consists of losing urine when pressure is exerted on the bladder by coughing, sneezing, laughing, exercising or lifting something heavy. Another common form of urinary incontinence post pregnancy is known as urge incontinence —described as an intense urge to urinate, followed by an involuntary loss of urine. Many women will experience a mixture of both forms, which medical professionals refer to as mixed incontinence.

Urinary incontinence can affect a woman in many different ways. It’s more than just an awkward issue that makes it hard to not leak urine. The impact of incontinence on a woman’s personal life can be distressing. Women often avoid going out because they are embarrassed by their frequent bathroom usage. The problem can greatly affect a woman’s sex life, especially when suffering from stress incontinence. Many patients will talk to providers about the changes in relationships that take place in their intimate lives as a result of urinary incontinence.

Women with incontinence have to rearrange their lives. They have to buy pads, which can be expensive. It can irritate their skin. They are all emotionally challenging things to deal with especially after just having a baby. It has added to the stress of having a baby in general.

There are several different ways to treat urinary incontinence.

The most important thing is to allow the muscles to repair themselves. While some cases of urinary incontinence will disappear a few weeks after a woman gives birth, women should seek medical treatment if they are still experiencing leakage after two months.

Pelvic floor exercises, commonly known as Kegal exercises, can often improve urinary incontinence. The exercises strengthen the urinary sphincter and the muscles that help control urination. A physical therapist or professional recommended by a physician can provide insight on whether a patient is properly contracting muscles to help improve the condition.

I also recommend keeping a bladder diary for those dealing with urinary incontinence, which can help normalize fluid intake. Often times women, out of wanting to remain hydrated, can drink several liters more than is necessary causing their bladders to remain over filled. A bladder diary can help to realize this problem, she says.

Another option available to treat urinary incontinence is what’s known as a vaginal pessary. The device can be put in the vagina to support the structures that help prevent urinary continence. The device can serve as a bridge to allow activities like walks and hikes while a woman rehabilitates her muscles.

It takes only one baby for the problem to occur, and the subject of urinary incontinence should not be taboo. I suggest that women ask their physicians about the problem

Bottom line: Urinary incontinence is common after childbirth. Most women will have the problem resolve without any treatment. If the problem persists after several months, then medical attention is recommended.

Losing Your Urine? It May Be Due to Your Medications

September 4, 2014

Urinary incontinence impacts millions of American men and women. Often times the solution may be to have your doctor check your medications and see if the medications may be the culprit.
There are four groups of medications doctors commonly recommend that can cause or increase incontinence. If you are taking any of these, you should let your doctor know about your incontinence and discuss your medications (both prescription and over-the-counter) to see if there is another approach to control or eliminate the problem.
The most common incontinence problems arise from medications in the following four categories:

1. Diuretics to reduce excess fluid
Diuretics, also known as “water pills,” stimulate the kidneys to expel unneeded water and salt from your tissues and bloodstream into the urine. Getting rid of excess fluid makes it easier for your heart to pump. There are a number of diuretic drugs, but one of the most common is furosemide (Lasix®).
Approximately 20 percent of the U.S. population suffers from overactive bladder symptoms which consists of urgency of urination and loss of urine when the man or woman cannot reach the toilet in a timely fashion.
Many of those patients also have high blood pressure or vascular conditions, such as swelling of the feet or ankles. These conditions are often treated with diuretic therapies that make their bladder condition worse in terms of urgency and frequency.
A first step is to make sure you are following your doctor’s prescription instructions exactly. As an alternative to water pills you might try restricting salt in your diet and exercising for weight loss. Both of these can reduce salt retention and hypertension naturally. Also, if you take diuretics, use them in the morning so you have frequency during the day and not at night after you go to sleep.

2. Alpha blockers for hypertension
Another class of drugs used to reduce high blood pressure or hypertension by dilating your blood vessels can also cause problems. These medicines are known as alpha blockers. Some of the most common are Cardura®, Minipress® and Hytrin®.
Men typically take these to treat an enlarged prostate (benign prostatic hyperplasia or BPH) which can restrict urination by putting pressure on the urethra. By relaxing the muscles in the bladder neck, alpha blockers allow smoother urine flow for those patients but may result in incontinence.

3. Antidepressants and narcotic pain relievers
Some antidepressants and pain medications can prevent the bladder from contracting completely so that it does not empty. That gives rise to urgency or frequency or voiding dysfunction. They can also decrease your awareness of the need to void.
Some of these drugs can also cause constipation. Constipation, in turn, can cause indirect bladder incontinence because being constipated takes up more room in the pelvis that the bladder needs to expand. Also, a full rectum can press on the bladder and result in stimulation of the bladder to contract and result in urgency and frequency as well as incontinence.

4. Sedatives and sleeping pills
Using sedatives and sleeping pills can present a problem, especially if you already have incontinence. They can decrease your awareness of the need to void while you are sleeping.
The best way to address this situation is to take other steps to relax and improve your sleep. Getting more exercise earlier in the day to make you tired, for example, can help. It’s also important to maintain a regular bedtime and wake-up schedule. Try to find other ways to relax before bed — meditation, reading a book or listening to soothing music or sound effects (e.g., rain or waves) — can also help you sleep better.

Bottom line: the side effects of medication can result in urinary incontinence. If you think this is a problem, check with your physician.

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

Weight Loss Surgery May Help Ease Urinary Incontinence

August 6, 2014

Urinary incontinence is a condition that significantly impacts a woman’s quality of life. Many have tried medical, non-medical, and surgical solutions. However, there is one sure way to improve control of urine loss and that is weight loss. Weight-loss surgery appears to have an additional side benefit — it may improve urinary incontinence symptoms in women.

A study found that nearly half of women in a weight-loss surgery program reported having incontinence prior to the procedure. After surgery, most of those women said their urinary symptoms either improved or disappeared.

The women “lost almost 30 percent of their body weight, and about two-thirds who had incontinence at the start were cured at one year with that amount of weight loss. Among those who continued to have incontinence, their incontinence frequency improved.

The women included in the study were severely obese, with a median BMI (body mass index) of 46. (Normal BMI is 25 or less. A women who is 5 feet 4 inches tall who weighs 268 pounds has a BMI of 46.

Health experts refer to obesity and incontinence as the “twin epidemics.” 25 to 50 percent of women have urinary incontinence. Of those, 70 percent are obese or a BMI greater than 25.

There are several types of weight loss surgery — also known as bariatric surgery. Most of the women in the study had procedures known as Roux-en-Y gastric bypass or gastric banding.

The improvement in incontinence symptoms continued during the study follow-up.

Both the weight loss and the improvement in incontinence lasted through three years. At year three, [about] 60 percent had remission. Remissions were defined as less than weekly episodes of incontinence. A quarter were completely dry.

The amount of weight loss was the strongest predictor of whether incontinence would improve or go away. Losing more pounds made urinary symptom improvement more likely.

In a previous study, a six-month focused program of weight loss and diet information helped reduce incontinence in obese women better than four weekly education sessions about weight loss and physical activity.

Personally, I have patients who have lost weight and it ended their stress incontinence. Those who lost by nonsurgical means also noticed improvement.

Weight loss improves leakage, probably due to less pressure on the bladder, less weight pressing on the bladder from above and beside. So it stands to reason that bariatric surgery would also benefit the problem of incontinence.

Like all surgeries, bariatric surgeries are not without risk. The procedures are accompanied by possibility of infection, blood clots and heart attacks, among others.
Costs for the surgery range greatly, from about $12,000 to $26,000, but are sometimes covered under insurance policies.

Bottom line: Incontinence affects millions of American women. Many women who are incontinent of urine are also overweight. A weight loss program may result in improvement in urinary incontinence.

Read more at http://www.philly.com/philly/health/topics/HealthDay689981_20140723_Weight_Loss_Surgery_May_Help_Ease_Urinary_Incontinence.html#aKqadsre5sGCHck4.99

Incontinence in Women-You Don’t Have To Depend on Depends!

August 6, 2014

Many women suffer in silence with their problem of urinary incontinence. About 1\3 of women between 40-70 have a problem of urinary incontinence and it is more common in women after menopause. This blog will discuss the problem and what are some solutions to this common condition that affects the quality of life of so many women.

Urinary incontinence, the loss of bladder control, is a common and often embarrassing problem. The severity ranges from occasionally leaking urine during a cough or sneeze to having an urge to urinate that’s so sudden and strong it’s impossible to get to a toilet in time.

Having accidents as an adult can be deeply embarrassing and most women don’t want to talk about it, yet it is far more common than many sufferers realize.

And the condition not only affects women’s confidence – it can also lead to mental health issues. Half (51 per cent) of women with adult incontinence (AI) also suffer from depression.

Because of the embarrassment surrounding the condition 60 per cent never seek help from their doctors, and of those who do 28 per cent delay seeking treatment for up to three to five years because they are ashamed.
Yet this common phenomenon can happen to women at any age and for many reasons including childbirth, the menopause or strenuous exercise.
This condition can also affect patient’s sex lives, with more than a quarter admitting it made them worry about sexual intimacy with their partners.

A large majority women said they had to change everything from the clothes they wear, the bags they carry, the way they travel, where they go and how they socialize.
They don’t always realize that help is available and that there are the right products out there that offer the comfort and protection women need to live life to the full.

Low impact sports such as cycling, yoga or elliptical machine exercises are ideal activities for keeping fit without affecting a sensitive bladder condition.

Abdominal workouts such as sit ups, crunches or plank kicks place a lot of pressure on the pelvic floor. Opt for alternative exercises where breathing or the position itself supports the pelvic floor.

PELVIC FLOOR EXERCISES
Pelvic floor exercises and targeted Pilates and yoga exercises can be particularly helpful. By practicing at least three times a day, they can help strengthen the pelvic floor muscles and give more control when needed..

DRINK JUST ENOUGH
There’s no need to avoid drinking in order to reduce the urge to visit the bathroom. Limiting water intake makes urine more concentrated, which boosts the chances of bladder irritation.

NO HEAVY LIFTING
Lifting heavy objects is particularly bad for the pelvic floor and back. Ask for help instead.
Just Say No To Caffeine
Caffeine, alcohol and carbonated drinks could be your new worst enemies. Try limiting coffee, tea and carbonated beverages for a week or two as they can irritate a sensitive bladder.

SET A SCHEDULE
Your bladder is trainable. If you need to pass water frequently and need to rush to the restroom, ask your PCP about a daily schedule for building up the bladder’s holding capacity. Remember, allow your bladder to empty completely each time you go to the toilet.

WEAR BACK-UP
A growing number of pads for day and night use as well as absorbent underwear and bed pads are available at high street pharmacy chains. Wearing one may be the difference between being stuck at home and feeling able to go out for periods of time.
Most cases can be improved with simple lifestyle changes and pelvic floor exercises as well as by finding the right products for you.

Bottom Line: By doing daily pelvic floor exercises, you can decrease your incontinent episodes and not only build your pelvic floor muscles but also build your confidence.

Mind Over Bladder-Stress Reduction Used To Treat Overactive Bladder*

June 28, 2014

Overactive bladder (OAB) or when you gotta go, you gotta go affects millions of American men and women. OAB is a condition that significantly impacts the quality of life of those who suffer from this problem.

Now there is evidence that relaxing the mind may be helpful when it comes to reducing bladder urge issues, according to a new study completed at the University of Utah. Thirty women participated in an eight-week study and were followed for one year comparing the impact of mindfulness-based stress reduction (MBSR) with yoga on urinary urge incontinence, a challenge faced by as many as 26 percent of women in the United States.

Those affected may experience large, unpredictable leakage of urine which can be psychologically and socially devastating.

Older women are often the ones experiencing this incontinence, though it’s not clear why. Weaker muscles and neurological elements are likely the culprit. Medications are effective initially but not long-term and can have bothersome side effects.

Twelve months after participating in the study, the women who studied mindfulness-based stress reduction had 66.7 percent fewer urinary urge incontinence episodes compared with the control group, which saw only 16.7 percent reduction at that time. It may help to help calm the mind so the emotional area of the brain is not activated and thus allows the person to learn to reframe the normal urge sensations from their bladder.

More study is needed and the next step for researchers is to secure a National Institutes of Health grant to conduct the study on a larger group of women in the next several years.

Bottom Line: Learning techniques of stress reduction may be helpful for those who suffer from overactive bladder.

*this blog was inspired by an article in WebMD which appeared at: http://www.webmd.com/urinary-incontinence-oab/news/20090508/mind-over-bladder-may-lessen-leaks

Urinary Incontinence-You Don’t Have To Depend On Depends

June 3, 2014

Probably nothing is more depressing to a man or woman than losing control of their bladder. We tend to take for granted the act of urination and being able to urinate into a toilet when it is socially convenient. When any man or woman has to resort to pads, panty liners, or diapers, that is a very discouraging and often a depressing event in their lives. This can lead to the person restricting their social activities, becoming reclusive and even becoming depressed.
For a person who has lost control over her bladder life can be very difficult. It means he\she would lead a restricted life, think twice before stepping out of the house, and will be unable to undertake journeys. In short, he\she will lead a life that is far from normal.
It is a debilitating ailment that can make life immensely difficult. Urinary incontinence that results in sudden loss of bladder control is both embarrassing and distressing. A sudden, uncontrollable urge to urinate often leads to involuntary loss of urine in such people. However, lack of awareness and taboo associated with the problem often causes people to suffer in silence, when in fact, they should seek medical help.
Involuntary actions of the bladder muscles may be a result of damage to the nerves of the bladder, to the spinal cord and brain, or to the bladder muscles. Multiple sclerosis, Parkinson’s disease, Alzheimer’s disease, stroke, and injury can also harm bladder nerves or muscles. While factors like injury, stroke, diabetes, and multiple sclerosis are common to both men and women, what makes the disorder twice as common in women than in men is the fact that they deliver babies and suffer menopause.
During pregnancy, when babies push down the bladder and urethra (the tube from the bladder to the outside of the body that transports urine from the bladder to the toilet), this weakens muscles of the pelvic floor and the bladder. Labor can weaken pelvic floor muscles and damage nerves that control the bladder. After menopause too, women experience problems with bladder control.
Urinary incontinence is of different types and a large number of women suffer from some or the other form of this problem. In some people with urinary incontinence exercises can be helpful. Kegel exercises performed several times a day can strengthen the muscles in the pelvis and helpf with the control of urination. Botulinum Toxin can be helpful in treating the symptoms and can give relief for up to 10 months. In fact, FDA has recently given a go ahead for the use of Botulinum Toxin for treating symptoms of urinary incontinence in certain neurological cases.

Bottom Line: Incontinence is not a natural consequence of aging. It is not something you have to live with. Help is available. You don’t have to depend on Depends!

Questions I Am Frequently “Axed”

May 12, 2014

I often discuss common medical conditions with patients and questions come up on multiple occasions. I have recorded these questions and will answer them periodically on this blog site. If you have any questions you like me to answer, please let me hear from you, nbaum@neilbaum.com.

I am 31 years old and have just had a baby. When can I resume sexual intimacy with my husband?
Whether you give birth vaginally or by C-section, your body will need time to heal. Many health care providers recommend waiting four to six weeks before having sex. This allows time for the cervix to close, postpartum bleeding to stop, and any tears or repaired lacerations to heal.
The other important timeline is your own. Some women feel ready to resume sex within a few weeks of giving birth, while others need a few months — or even longer. Factors such as fatigue, stress and fear of pain all can take a toll on your sex drive. If you have any questions contact your obstetrician.

I have loss of urine when I cough or sneeze or do any kind of exercise. My doctor said I have stress incontinence and he recommended a vaginal sling using mesh material. Is this safe?

Surgery to decrease or prevent urine leakage can be done through the vagina or abdomen. The urethra or bladder neck is supported with either stitches alone or with tissue surgically removed from other parts of the body such as the abdominal wall or leg (fascial sling), with tissue from another person (donor tissue) or with material such as surgical mesh (mesh sling).

Surgical mesh in the form of a “sling” (sometimes called “tape”) is permanently implanted to support the urethra or bladder neck in order to correct SUI. This is commonly referred to as a “sling procedure.”

The use of surgical mesh slings to treat SUI provides a less invasive approach than non-mesh repairs, which require a larger incision in the abdominal wall. The multi-incision sling procedure can be performed using three incisions, in two ways: with one vaginal incision and two lower abdominal incisions, called retropubic; or with one vaginal incision and two groin/thigh incisions, called transobturator. There is also a “mini-sling” procedure that utilizes a shorter piece of surgical mesh, which may be done with only one incision.

Complications of this type of procedure are rare but may occur. The most common complications include bleeding and infection, erosion or infection of the graft material (possibly requiring further surgery), injury to nearby structures, pain, inability to urinate (retention of urine), recurrent or worsening incontinence, new or worse vaginal prolapse, urgency or urge type-incontinence.

I am 65 years old man and had my prostate gland removed for prostate cancer three years ago. My PSA test is rising after several years being at an undetectable level. Is there anything else I can do?

First, I would get the test repeated. Although mistakes are rare, you need to confirm the results with a second test. Next a test has to be done to see if there has been any spread or recurrence of the cancer at the location of the surgical removal of the prostate gland. There are several tests that can be useful for this purpose including a bone scan to see if there has been any spread to the bones.

For men with less than five years life expectancy or with other medical conditions that may affect their longevity, then no treatment is needed and watchful waiting is an option.

For men with spread to other organs or to lymph nodes, hormone therapy is a consideration. This usually consists of medication to decrease the testosterone level which almost always results in loss of libido and erectile dysfunction.

Finally, if there is localized disease in the pelvis, radiation therapy is an option after surgery has failed to cure the disease.

The bottom line is that a rising PSA after surgery is usually treatable.

To Your Good Health,
Dr. Neil Baum