Treatment Options for Men With Prostate Cancer-Side Effects You Need to Know

Prostate Cancer is the most common cancer in middle aged and older men.  It is the second most common cause following lung cancer of death from cancer in men.

This article will discuss the most common treatment options for prostate cancer and what are the side effects of these treatments.

For younger men with localized disease, surgical removal of the prostate gland either with an open 6-8-inch incision or through a robotic prostatectomy-5 small pencil-sized holes in the lower abdomen that removes the entire prostate gland.

Temporary or even permanent erectile dysfunction (impotence) occurs in many of the men who undergo surgery.  Urinary incontinence, inability to control the flow of urine, occurs in 3-30% of men who have their prostate gland surgically removed.

For older men or for men who have prostate cancer beyond the prostate gland, radiation therapy is treatment option.   The side effects include temporary fatigue, diarrhea or other bowel problems, urgency of urination, and impotence (ED).

For men with spread of prostate cancer beyond the prostate into the bones or lymph nodes, then hormonal therapy is often recommended.  Hormone therapy is used in men with advanced, high-grade prostate cancer. Hormone therapy is also used in men who cancer has recurred after being treated with radiation therapy or surgery.  This is usually determined with an elevation of the PSA level.  Prostate cancer is very sensitive to testosterone, the male hormone produced in the testicles, and removal of testosterone reduces the cancer and helps control the disease but does not cure the problem.

The side effects of hormonal therapy include reduced libido, hot flashes, softening of bones or osteoporosis which leads to bone fractures, impotence, loss of muscle mass, fatigue, weight gain, and increased risk of heart disease and diabetes.

Chemotherapy is indicated for men who do not respond to removing the testosterone produced by the testicles.  Chemotherapy leads to hair loss, nausea\vomiting, diarrhea, fatigue, muscle pain, and weight loss.

Proton therapy is a similar to external radiation that targets difficult to reach tumors and is designed to allow higher doses of radiation to be delivered to the prostate with fewer side effects.

Bottom Line:  Over the past few years there have been numerous options available for the management of localized prostate cancer and even prostate cancer that has spread beyond the prostate gland.  New Orleans has several doctors who are national and even global experts in managing prostate cancer.  For more information, contact your doctor.

Pelvic floor exercises for men

Historically, pelvic floor exercises, have been recommended for women with urinary incontinence.  However, doctors have discovered that these same exercises are useful for men as well.  This blog will discuss the use of pelvic floor exercise for men.

The muscles of the pelvic floor not only hold organs in place, but they are also important for bladder control. Because these muscles often weaken with age, men are advised to exercise them regularly by doing pelvic floor exercises in order to maintain their continence of urine as well as having improvement in their sexual functioning.

What are the pelvic floor muscles?

The muscles that support the organs in the pelvic area are known as pubococcygeus or pelvic floor muscles. These muscles are like a trampoline or sling that stretches along the bottom of the pelvic area from the pubic bone in the front to the tail bone (or coccyx) at the back, as well as from side to side between the sitting bones. In men, they support both the bladder and the bowel, with the urethra (the tube carrying urine from the bladder) and the rectum (back passage) passing through the muscles. Pelvic floor muscles are also important for erectile function, and they work with other muscles to help stabilise the back. 

Why exercise the pelvic floor muscles?

The pelvic floor muscles naturally stretch and weaken with age, which can gradually make them less efficient. The muscles can also be weakened in men who often strain to empty their bowels – such as having constipation on a regular basis – who have a chronic cough, bronchitis or asthma, who perform tasks that involve repeated heavy lifting, and who are overweight or generally unfit. Having surgery for an enlarged prostate gland can cause the pelvic floor muscles to weaken, as can neurological damage such as from a stroke, diabetes, multiple sclerosis or a spinal injury.

Weak pelvic floor muscles in men can lead to stress urinary incontinence, in which small amounts of urine leak when pressure is placed on the bladder – for example, when bending forward, sitting, coughing or laughing – or urge incontinence, when there is an urgent need to urinate more often. You may leak just a few drops of urine, have a dribble after you finish urinating or leak a steady stream of urine. Weak pelvic floor muscles can affect erectile function too.

However, in a similar way that you can strengthen the muscles of your arms or legs through exercise, you can also strengthen your pelvic floor muscles.

These exercises are also recommended for men prior to having surgery for an enlarged prostate or prostate cancer to help improve their bladder control. They are also recommended for men who experience chronic pelvic pain syndrome – performing the exercises when pain starts can help to interrupt a cycle of pain-spasm-pain.

How can you find your pelvic floor muscles?

Before you start doing pelvic floor muscle exercises, it’s important to find the correct muscles to ensure you are exercising them. The next time you urinate, stop urinating mid-stream and concentrate on the muscles that allowed you to do this – these are also the same ones you use to prevent passing wind. Once you have emptied your bladder (don’t stop the flow mid-stream more than once), try contracting the same muscles – you should notice the base of your penis rising towards your tummy and see your testicles move up as you contract the muscles.

Another way to find your pelvic floor muscles is to sit comfortably or lie down, ensuring the muscles of your abdomen, thighs and buttocks are relaxed. Now, tighten only the muscles that control your back passage as if you are trying to avoid passing wind for a few seconds, then relax.

To ensure you aren’t squeezing other muscles, try squeezing your pelvic floor muscles again and:

• Rest your hand on your tummy – you should not feel your abdominal muscles tighten
• Pay attention to your breath – if you are holding your breath, you are using your chest muscles; try to breathe normally while squeezing your pelvic floor muscles
• Sit in front of a mirror – if you notice your body moving up and down, even slightly, you are squeezing your buttocks
• Watch your thighs – their muscles should be relaxed without noticeable movement in the upper legs. 

How should men do pelvic floor exercises?

Now that you’ve identified your pelvic floor muscles, simply contract them, squeezing and drawing up the muscles around your urethra and back passage at the same time, and holding them for a count of 5, then release the muscles slowly. By doing this simple technique, you have just flexed your pelvic floor muscles. Don’t hold your breath, and make sure you are not working other muscles such as those in the buttocks, thighs or abdominal area.

Wait a few seconds before repeating the technique, doing a set of 8-10 squeezes using strong slow contractions, then follow with one set of 8-10 quick rapid contractions. Repeat this sequence 4-5 times a day. Once you find it easy, you can increase the count for longer, up to 10 seconds. However, take care you don’t over-exercise the muscles and cause muscle fatigue towards the end of the day, thereby increasing urine leakage.

It will take 4-6 weeks before you notice any improvement, but after about 3 months you should experience the full benefit of doing pelvic floor exercises. At this point, you can change your routine to doing pelvic floor exercises twice a day.

If you have problems with incontinence or have recently had prostate surgery, you may be referred to a specialist who will help train you in how to do the exercise correctly and establish a program based on the strength of your muscles.

Pelvic floor exercises take very little time and can be done while sitting, standing, lying down or walking. Because others will not notice the muscles moving, you can do them discreetly during your everyday activities, such as while on a bus or train, sitting in a car, even standing in a queue – the main thing is to get into a routine of doing them every day. Try getting into the practice of doing them at the same time, such as when brushing your, after urinating, when commuting home from work or during advert breaks while watching the TV in the evening.

Bottom Line:  Pelvic floor exercises aren’t just for women but men can also benefit from these exercises.  Men should consider doing these exercises that don’t require any equipment, very little time, and have very effective results.

Urinary Incontinence: Gotta Go, Gotta Go Right Now!

Urinary incontinence affects millions of Americans and causes havoc with their lives.  It I a source of embarrassment, shame and often depression.  Other medical consequences of incontinence include skin irritation, urinary tract infections, and pelvic pain.  This blog will discuss treatment options including medications and non-medical solutions.

Urinary incontinence means that the person suffering from it starts losing his/her control over the bladder. This leads to several kinds of problems of the urinary system including sudden urination, slow but steady leakage of urine, or dripping of urine when one undertakes a physically stressful exercise like lifting weight.  Those who have incontinence often lose urine with coughing, laughing, or sneezing.

Although this is a common medical problem, many suffers continue to suffer in silence, living a secluded and reclusive life.

While these causes cannot be controlled, it is important to take note of and control factors that can worsen the condition:

Medication

If you have a problem of urinary incontinence and the symptoms have gone from bad to worse, you need to check with your doctor about the medication or drugs you have been taking. For, chances are that some of these may be exacerbating the problem. Certain drugs to treat high blood pressure are linked to an increase in incontinence.

Alpha blockers dilate blood vessels to reduce blood pressure and they also often relax the muscles of the bladder, furthering urine flow. Some drugs to treat depression can contribute to worsening incontinence symptoms.

Anti-depressants work by relaxing the nerves of the mind and may also affect the ability of the bladder muscles to contract (side effects).

Diuretics are another set of drugs that are associated with increased

urination. In fact, these drugs are also called ‘water pills’, and are designed to flush out excess salt from your body to treat conditions like high blood pressure.

Caffeine

Caffeine is an important component of our daily lives as most of us consume it through coffee, tea and chocolates. Excessive consumption of caffeine is associated with the problem of increased urination. While mild consumption doesn’t have a negative effect, excess consumption can affect the renal system, as caffeine is a stimulant. It stimulates the cardiovascular system, increasing the heart rate as well as blood pressure. This increases the rate of blood to be filtered. It also relaxes the bladder’s detrusor muscles, causing them to feel fuller more frequently. So, limiting caffeine intake is healthy.

Type 2 diabetes

Type 2 diabetes is a major health concern of today as it affects the functioning of the entire body. It also increases the risk of urinary incontinence, as well as its severity. Efforts should be made to prevent and control diabetes by keeping your weight under control, exercising regularly and leading a healthy lifestyle.

Excessive weight also puts extra pressure on the pelvic muscles and weakens them. Therefore, it is also important to control body weight.

Solutions

Besides controlling the aforementioned factors, it is important to take medical help to treat and manage urinary incontinence.

In some patients, adopting behavioral changes may help. For example, decreasing fluid intake to average levels, urinating more frequently to decrease the amount of urine that is held in the bladder and keeping regular bowel habits (as constipation can worsen the problem) may have a positive effect.

Pelvic muscle training exercises, aka Kegel exercises, can specifically help those who suffer from incontinence. The exercises help patients exercise better control of their detrusor muscles.

Weight loss has also been shown to help decrease symptoms in overweight people.

Bottom Line:  Urinary incontinence is a common condition affecting millions of American men and women.  Help is available and no one needs to “depend on Depends”!

Men You Don’t Have To Depend on Depends After Prostate Surgery

Many men after prostate surgery will have a problem of urinary incontinence. The good news is that it is usually temporary and lasts only a few days or weeks. However, after prostate cancer surgery, the incontinence may be worse and last for a longer period of time. Help is available. Men can use Kegel exercises, which are the same exercises, that women use who have a problem of losing urine.

About 30 percent of prostate cancer patients nationally are affected by incontinence a year after surgery, and another 14 percent still feel the effects after five years.

Urinary incontinence has been shown to cause significant distress in men following prostate cancer treatments. Men become reclusive and even depressed if they have incontinence. Men are afraid to travel or attend other social gatherings because there may not be a restroom nearby.

A study from the Cleveland clinic detailed results from 244 men randomly assigned to one of three approaches to reduce leakage and manage symptoms.

The first two approaches offered the men one session of biofeedback-assisted pelvic exercises and six biweekly sessions—either in a peer support group or by phone—to learn how to self-manage their symptoms. In the biofeedback sessions the men learned how to perform Kegel exercises.

In the third approach, men received information and a doctor’s directions for care or sought information on their own.

By the third month, the first two methods—biofeedback, plus support group or telephone contact—showed better results. The number of leakage episodes decreased.

At the last assessment at six months, the men receiving biofeedback and support recorded the greatest reduction in leakage amount.

For more information on Kegel exercises please go to my website, www.neilbaum.com or copy and paste this into your browser: http://neilbaum.com/articles/kegel-exercises-for-men-2

Bottom Line: urinary leakage can be depressing for both men and women. Help is available. Just remember, a Kegel a day can keep the doctor away!

Non-Medical Steps To Control Bladder or Urine Leaks (Overactive Bladder)

Urine Leaks/loss of bladder control is common among women and is one of the most embarrassing maladies affecting anyone who suffers from this problem.

The condition affects women between ages 18 through 65 and it could get worse it not properly managed.

Loss of bladder control/urine leaks/urinary incontinence can be contained with simple lifestyle changes without having to undergo any form of surgery or take any medications with its associated side effects.

Tips that work:

1. Kegels

Kegels are known to help tighten the pelvic floor muscle. Try ‘squeezing’ the pelvic muscle slowly.

A common way to do this is to stop urine flow while at it counting up to 20 before starting the flow, holding each squeeze for 10 seconds.

2. Reduce fluids intake

Drink water when you have to/regularly but don’t drink too much to overwork the bladder.

3. Reduce acidic foods in your diet

Foods with high acid content should be reduced. Oranges, apples, lemon and alcohol contain acid known to irritate the bladder. If you have urinary incontinence, reduce intake of these foods.

4. Relax

It’s best to relax as this also helps the whole body relax which reports reveal could reduce urinary incontinence.

5. Use tampons

You can use tampons to stay dry especially when involved in high impact activities or moving around a lot.

Tampons slightly lift up the urethra (which is the bladder opening) to support it when you are moving around. Be sure to remove it as soon as you are done with the activity.

Bottom Line: You don’t have to suffer in silence. Help is available. If you suffer from urinary incontinence or other problems “down there”, see your doctor.

For more information on “down there”, I recommend my book, What’s Going On Down There- Improve Your Pelvic Health, available from Amazon.com (http://www.amazon.com/Whats-Going-Down-There-Siddighi/dp/1477140220/ref=sr_1_13?ie=UTF8&qid=1442165577&sr=8-13&keywords=What%27s+Going+On+Down+There)

What’s Going On Down There-Improve Your Pelvic Health (amazon.com)

Kegel Your Way To Treating Urinary Incontinence

Urinary incontinence affects millions of American women. Certainly there are medications and surgery that can help control the problem. However, first line treatment is often natural methods and exercises to help with women suffering from urinary incontinence.

Many people don’t realize it, but physiotherapy is a really effective, low-risk treatment for urinary incontinence. Here is how physiotherapy can help you.

Physiotherapy is one of the best and most effective treatments for urinary incontinence. Not only is it a low-risk solution, but a good physiotherapist can help you retrain your bladder and strengthen your pelvic floor muscles to help resolve the problem.
Depending on the different types of urinary incontinence, there are many different exercises and ways in which physiotherapy is beneficial. Leaking isn’t just a symptom of a weak pelvic floor, it could also be a sign of muscles that are too tight as a result of knots in the pelvic floor, endometriosis or even constipation. This is why a full assessment is vital.
1. Stress incontinence: This refers to the involuntary need to urinate when there is increased intra-abdominal pressure – such as coughing, jumping or running. The pelvic floor muscles are not being used properly to keep the bladder closed when it is subjected to pressure.
2. Urge incontinence: Also known as an overactive bladder, this is characterized by an overwhelming need to urinate and the involuntary passing of urine because of this. Sometimes this can be triggered by something as small as hearing running water or seeing the toilet.
3. Mixed incontinence: This is a combination of both forms.
A physiotherapist should be able to diagnose the type of incontinence following a short examination which includes obtaining details about your bladder control, your health history including any surgeries or pregnancies, your diet and your current lifestyle.
The ultimate goal of physiotherapy is to help you regain control of your bladder, and is primarily focused on the pelvic floor muscles and how to tighten or relax them so that they function properly to keep you dry.

Exercises and treatments
Behavioral modification, which involves re-learning how to go to the toilet and learning how to effectively empty the bladder. Simple as it sounds, she says some incontinence issues stem from bad toilet-going habits such as pre-emptive urination (going to the toilet when you don’t actually need to), as well as straining excessively when on the toilet. Both put unnecessary pressure on the bladder and weaken it over time.
Pelvic Floor Exercises are probably the most well known forms of exercise for pelvic dysfunction. This involves a conscious tightening of the muscle around the anus, vagina and front passage to “lift it up” and inwards without clenching the buttocks. These can either be done in a slow-squeeze and hold or a fast squeeze with no hold. Both are most commonly known as Kegel exercises and are designed to strengthen the pelvic floor.
Neuromuscular stimulation is another method used which activates nerves and their associated muscles. In the case of incontinence, an internal probe with light electrical currents is applied to the pelvic floor to stimulate the nerves and cause muscle contractions with the aim of teaching the correct action and use of the pelvic floor muscles or calming of overactive nerve responses.
Weighted vaginal cones are plastic, cone-shaped devices which the physiotherapist inserts into the vagina to help exercise the pelvic floor muscles. Weights can be added to them or removed and they work by gradually stretching the vaginal opening as the cone drops lower. This stimulates the pelvic floor to contract and tighten up to try and hold the cone in place. It’s the sensation of falling out which triggers a contraction to keep it in.
Bladder retraining literally means retraining the bladder how to work. Although bladder training can take at least six weeks before it has a noticeable effect, many people find it a successful endeavor.
Tips for training the bladder:
– Don’t pee “just in case”: Try to wait a little longer when you feel the need to urinate, which will stretch the bladder and encourage it to hold bigger volumes.
– Keep calm: When the urge to go appears, try to sit down and hold a pelvic floor contraction hard enough to prevent leaking for as long as you are able, allowing the “desperate urge” to pass, and buying you a few more minutes.
– Keep hydrated: Don’t restrict your fluid intake as this will only result in stronger urine, which will only irritate the bladder. If you wake to go to the loo during the night, however, limit your liquid intake two hours before bed.
– Limit caffeine and alcohol: Some bladders react negatively to caffeine and alcohol and limiting your intake of these substances may reduce your need to urinate.

Bottom Line: Urinary incontinence can almost always be controlled and in some cases actually cured. Help is available. Speak to your doctor.

Urinary Incontinence In Women Athletes-Don’t Suffer In Silence!

One of the most common, but rarely discussed issues that female athletes face is urinary incontinence during exercise. This phenomenon is also known as stress urinary incontinence and is defined as the involuntary leaking of urine during activities like running, jumping, laughing or coughing. This problem affects nearly 50% of women who exercise but mostly only a few drops come out and not considered a significant problem. This can often be controlled using Kegel exercises. (see my website for more information on Kegel exercises, http://www.neilbaum.com)

One study estimates that leaking of urine occurs in 47% of exercising women (average age was 38 years in this study). Many attribute this problem due to pregnancy and childbirth; however, studies have shown that 25-28% of high school and collegiate athletes who have never been pregnant report stress urinary incontinence. These numbers are even higher in sports that significantly increase the intra-pelvic pressure like gymnastics and trampoline where 60-80% of athletes report incontinence!
What’s the Cause of Stress Urinary Incontinence (SUI)?
In most cases, SUI is caused by a dysfunctional pelvic floor. The pelvic floor is made up of muscles, connective tissue and sphincters. These three types of structures have three main functions: 1) stabilize the spine and the pelvis, 2) support the pelvic organs, and 3) control the retention and release of urine and stool.
One reason the pelvic floor can become dysfunctional is that the muscles and connective tissues become stretched or weak during or after pregnancy. However, they can also become too tight or “stay on” too much of the time, so that they can’t contract quickly or strong enough during high-impact activities, like in running or jumping sports.
The Impact of SUI
Stress urinary incontinence is not only embarrassing for women, but many either stop exercising altogether or stop doing sports/activities that they love to avoid this problem. In addition, pelvic floor dysfunction can also lead to pain – during intercourse or at rest, so this problem can negatively impact many areas of women’s lives.
Treating SUI
Fortunately, there are several ways to improve pelvic floor function and stop episodes of incontinence. The first step is to be evaluated by a physician who specializes in the pelvic floor (certain sports medicine physicians, gynecologists or urologynecologists). Often patients are referred to women’s health physical therapists to learn exercises to improve their pelvic floor function. It’s important to note that the exercise regimen is more unique and comprehensive than Kegel’s for every woman. Some women improve with Kegel’s, but others need to learn to relax their pelvic floor rather than strengthen it. In addition to therapy, there are medications, injections and surgical procedures that can be used if necessary.
Bottom Line:
For the female athlete, pelvic floor dysfunction and incontinence is under-reported, under-diagnosed and under-treated. It can lead to women avoiding sports or exercise as well as decreased performance. With the right diagnosis and treatment, it can be completely resolved. Don’t suffer in silence. See your doctor.

Adult Bedwetting-Don’t Depend on Depends!

For most adults they remain dry at night and diaper free from time they are toddlers until they end up in a nursing home. However, there are times when even adults have problems with bedwetting.

When you think of bed wetting, you usually think of children and toilet training, but adults can have bedwetting too. Bedwetting can be categorized into two general types, primary and secondary bedwetting. Primary bedwetting means that the person was never successfully toilet trained and wet the bed for as long as he or she can remember. Secondary bedwetting means that the person was successfully toilet trained and confidently dry at night for a period of time, but subsequently developed bedwetting.

The onset of bedwetting in adults is most often the result of a more serious underlying problem than when it occurs in children. This means that if a man or women develops bedwetting, it demands prompt evaluation and treatment.

Causes of Bedwetting in Adults
In women, it’s probably a previously undiagnosed neurologic condition. After urethral obstruction, neurologic conditions are the second most common cause in men. Neurologic conditions can cause bedwetting by one of two mechanisms. Firstly, the bladder may cease to work at all and there is a large amount of residual urine in the bladder, which simply spills over at night – this is called overflow incontinence. Overflow incontinence is most commonly seen with ruptured discs and spinal cord tumors. It is also seen after operations for cancer of the female cervix and uterus and after surgery for rectal cancer. Secondly, there may be involuntary bladder contractions which result in incontinence. This is most often seen with such conditions as multiple sclerosis, cerebrovascular accident, Parkinson’s disease and other degenerative neurologic diseases.
Patients who present with bedwetting need an evaluation consisting of history, a physical exam, a urinalysis, and testing of the bladder and the muscles (sphincter) that are responsible for holding the urine inside the body.

Bottom Line: Many times bedwetting can be treated with medications. Nearly everyone with the problem can be helped and significantly improved after a thorough evaluation has been conducted and the cause of the problem has been identified.

Caffeine And Urinary Incontinence

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.

Help For An Overactive Bladder (OAB)

Nothing is more distressing than losing urine and unable to reach a toilet in a timely fashion. It is a source of embarrassment, anxiety, and even depression.

Your bladder can start to present problems at menopause as sneezing, laughing, increased urgency and frequent night calls can disturb your sleep and your peace of mind.

This is particularly true at menopause when up to 40% of women are affected by OAB. Unfairly perhaps, but women do suffer urinary incontinence four to five times as often as men.
Some of that has to do with pregnancy and childbirth, which can weaken the vagina, the pelvic floor muscles, and the ligaments that support the bladder. This can cause the bladder to be pushed out of place, making it harder for the muscles to perform. That’s why you may leak a little urine when you sneeze, cough, or laugh.

Symptoms of OAB:
* increased urinary frequency
* a sudden urge to urinate
* the need to urinate during the night
* difficulty getting to the bathroom without leaking

Types of Incontinence
There are two separate types of incontinence:
Type 1: Stress incontinence leads to leakage of urine when the pressure in the abdomen is higher than the sphincter pressure. Normally, contraction of the pelvic floor muscles compresses the urethra [bladder outlet] and prevents loss of urine and stress incontinence. Loss can happen with sneezing, coughing and during exercise such as lifting, jumping and walking.
Type 2: Urge incontinence is when an uncontrollable need to pass urine occurs due to over activity of the bladder wall muscle. Typically this occurs as you put the key in the front door or when water is running. There is generally no weakness in the pelvic floor muscles or muscles controlling the bladder outlet. This is also known as overactive bladder syndrome.

Mixed incontinence occurs when there is muscle weakness and and uncontrollable urge to go to the toilet together.

The hormone factor
For women, the bladder and urethra have hormone receptors and it is estrogen that affects the health of the pelvic muscles and the urinary tract. It is estrogen that helps to preserve the strength and flexibility of supportive pelvic and bladder tissues so low levels may be part of the reason these supportive tissues sometimes weaken as a woman ages and may also contribute to muscular pressure around the urethra.
Estrogen can improve the flow of blood and strengthen the tissue around the urethra so women who are low in body weight at menopause may not be producing sufficient for this purpose. Often prescribed are low-dose topical estrogen creams or patches but according to the Mayo Clinic, scientific evidence to support this treatment is lacking.
Low estrogen generally indicates even lower progesterone levels so a combination cream of both hormones can be effective.

When to get help
Bladder weakness can affect many areas of your life from disturbed sleep, to your sex life and embarrassment in public over urinary accidents. This can make it hard to enjoy everyday activities and so many women don’t seek help but these signs indicate you have a problem:
• urinate more than eight times in a 24-hour period
• get up in the night to urinate
• experience frequent leaking
• have changed your activities to accommodate your symptoms

How to help yourself
There are many types of surgery for stress incontinence and although this can be helpful, as time goes by a number of women will get a return of their urine leakage between 5 to 10 years after surgery. It is better to try and manage the condition by first trying pelvic floor muscle exercises which are an inexpensive and effective method of treating mild stress incontinence.

Often referred to as Kegel exercises you could follow the plan below. First you need to be able to identify your pelvic floor muscles and learn how to contract and relax them. To do this, stop urination in midstream. If you succeed, you’ve got the right muscles. Then practice this as below:
* Once you’ve identified your pelvic floor muscles, empty your bladder and lie on your back. Tighten your pelvic floor muscles, hold the contraction for five seconds, and then relax for five seconds. Try it four or five times in a row. Work up to keeping the muscles contracted for 10 seconds at a time, relaxing for 10 seconds between contractions.
* Maintain your focus. For best results, focus on tightening only your pelvic floor muscles. Be careful not to flex the muscles in your abdomen, thighs or buttocks. Avoid holding your breath. Instead, breathe freely during the exercises.
* Repeat 3 times a day. Aim for at least three sets of 10 repetitions a day.
More information:
Unfortunately at menopause women tend to put on weight, and being overweight can make bladder problems more common. Sleep at menopause is also often disturbed for this reason and for this progesterone does help aid sleep and rebalance hormones to help with any weight loss.
However for women who do need additional estrogen as well as progesterone and are not overweight a combination cream is usually more effective for the bladder.

Bottom Line: Incontinence and OAB are common maladies affecting millions of American women. You don’t have to depend on Depends! Help is available. Speak to your doctor.