Posts Tagged ‘OAB’

Smoking Is Also Hazardous to Your Urologic Health.

November 26, 2016

It is given that smoking is deleterious to your lungs and heart causing lung cancer, chronic obstructive pulmonary disease and heart disease, just to name a few of the common medical conditions causes by smoking.  There are also urologic conditions that are affected by smoking.

Bladder cancer is 4th most common cancer in men with nearly 80,000 new cases each year in the united States.  Smoking causes harmful chemicals and drugs to collect in the urine.  These toxic chemical affect the lining of the bladder and increase your risk of bladder cancer.

Nearly 30 million American men have erectile dysfunction or impotence  This is usually due to a reduction of poor blood flow to the penis.  Smoking can harm blood vessels, when decrease the blood flow to the penis.  As a result, men will have difficulty obtaining and keeping an erection adequate for sexual intimacy.

Kidney cancer is in the top ten most common cancers in both men and women with nearly 60,000 new cases every year.  Smoking puts noxious chemicals from the lungs into the blood stream where it is filtered into the kidneys and can cause kidney cancer.

Kidney stones affect 1 million Americans and smoking is a known cause of having kidney stones and also for having recurrent kidney stones.

Painful bladder syndrome affects 12% of women.  The condition is irritated by smoking and produces more symptoms of pain and discomfort in the pelvis.

Overactive bladder (OAB) affects more than 30 million American men and women.  Smoking irritates the bladder and increase the frequency of urination.  Smoking also is associated with coughing that can increase urinary leakage.

Infertility caused by male factors affects 50% of all problems related to difficulty with achieving a pregnancy.  Smoking can harm the genetic make-up in eggs and sperm.  The infertility rate for smokers in nearly twice that for those men who do not smoke cigarettes.

Bottom Line:  Most people are looking for reasons to stop smoking.  There are so many medical conditions that are caused by or are made worse by smoking.  Talk to your doctor about some of the effective ways to achieve smoking cessation.

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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.

Foods and Fluids That Worsen Overactive Bladder

May 4, 2015

One of the most devastating problems affecting many men and women is the problem of overactive bladder. This is the bladder that has a mind of its own. When the bladder decides to empty its liquid contents and doesn’t wait for the owner’s permission, it is called overactive bladder.
There are some foods and beverages that you should avoid, since they could worsen your condition.

Water (too much or too little)
You might think that drinking less water will make you want to pee less often, but that theory backfires in reality. Drinking too little water causes your urine to become more concentrated, which can irritate your bladder. On the other hand, drinking too much water can be a problem as well. Try to find the right balance to meet your needs and avoid drinking a lot of water after 6 pm, so that you don’t keep waking up to go to the bathroom at night.

Caffeine
Coffee, tea, soft drinks and energy drinks all contain caffeine, which is a diuretic that causes your body to produce more urine. Drinking less caffeine will give you better control over your bladder.

Chocolate
Chocolate is another source of caffeine that can worsen your bladder control. If you don’t want to give up chocolate, try to consume it earlier in the day, or switch over to white chocolate.

Spicy foods
Spicy foods also irritate your bladder, so try to dial down the amount of chilli you add to your meals and avoid spicy snacks and sauces.

Citrus fruits
Citrus fruits like lemons, oranges, grapefruits and limes are all acidic. Acidic foods irritate your bladder and worsen urinary incontinence, so try to limit your intake of these fruits
Pineapples
Most people aren’t aware of this, but pineapples are actually acidic fruits as well. Limit your intake of pineapple and avoid drinking pineapple juice.

Tomatoes
Tomatoes also worsen urinary incontinence, since they are also acidic. They will be pretty hard to cut out of your diet, since tomato-based foods also have the same effect, so you would have to avoid sauces, gravies, ketchup, and other tomato-based items.

Onions
Onions can also irritate your bladder, so try to cut down your onion intake and avoid eating raw onions. You can even switch to a milder vegetable like shallots instead.

Cranberries
Cranberries are an effective remedy for urinary tract infections, however they are pretty acidic so they could reduce your control over your bladder.

Alcohol
All forms of alcohol dehydrate your body, but they do so by increasing the amount of urine, which means you need to visit the bathroom much more frequently. Alcohol also interferes with the signals that the brain sends to the bladder about when to release urine, so if you suffer from urge incontinence, where you sometimes lose control of your bladder, you should avoid alcohol as much as possible.

Sugar
Both sugar and artificial sweeteners affect the bladder. Try to cut sugar out of your diet for a few days and see whether it makes a difference to your bathroom habits.

Carbonated drinks
Avoid carbonated drinks like soft drinks, soda, sparkling water and fizzy juices. The fizz irritates your bladder, and makes you need to pee more often.

Sauces
Certain condiments like mustard, vinegar, soy sauce, ketchup and chili sauce can all worsen your condition, so consume them sparingly. Switch over to healthier chutneys and spices instead.

Processed foods
The artificial colors, flavors, additives and preservatives in processed foods could also be adding to the problem. Try to cut them out of your diet and eat more home-cooked meals instead.

Bottom Line: By modifying your diet you cannot cure overactive bladder but you certainly can use these techniques to help control the problem. It may not be necessary to eliminate completely all of these dietary irritants but if you can use them in moderation, your bladder will thank you!

Kegel Exercises For Men- Non-Medical Treatment of Overactive Bladder

July 31, 2014

For decades, women have been doing Kegel exercises (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, Kegel exercises 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.

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.

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.

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

Overactieve Bladder-Botox May Be a Solution

March 16, 2014

Overactive bladder or urinary frequency, urgency and urge incontinence affects millions of American men and women. Most men and women can be helped with medication. However, some suffers are unable to achieve any relief with medication or suffer from the side effects so that taking the medication is not possible. Now a new FDA treatment using Botox has been tested for those patients, mostly women, who have difficult to treat overactive bladder.

Botulinum toxin, otherwise known as Botox, has been historically used by the plastic surgery community to help alleviate wrinkles on the face. Botox relaxes muscular tissue. When used in the bladder, it can relax the bladder muscle resulting in fewer visits to the bathroom. Women who use the bathroom more than 8 times during the day and may be experiencing frequent bathroom trips at night may benefit from Botox treatment. Botox has been determined to be a safe and effective treatment for overactive bladder and urinary incontinence.

The procedure of Botox injections is simple, quick, and can easily be done in the office setting. It is typically done with the help of a cystoscope under local anesthesia but can also be done in the same day surgery setting under monitored anesthesia depending on patient preference. There are no incisions. The bladder is examined carefully with the cystoscope and Botox is injected into the bladder wall through a special needle passed through the cystoscope directly into the bladder muscle. Most patients tolerate the procedure very well, maximum benefit is obtained in about 2 weeks, and the treatment lasts 4 to 9 months and then can be repeated again.

Patients usually notice a reduction in their urinary frequency and urgency about 5 days after the procedure. If leakage occurred before Botox, there should be no leakage afterwards. There are a few reported side effects such as blood in the urine after the procedure but then clearing within a few days. Bladder infection may occur as a result of the minimally invasive procedure, so antibiotics are typically given as a precaution after the procedure. About 1 in 10 to 1 in 20 patients describe difficulty emptying the bladder after the procedure and may need to pass a urinary catheter intermittently to achieve complete emptying of the bladder for a few weeks post op.

Bottom Line: Overactive bladder is a common problem that affects the quality of lives of millions of American men and women. Most of patients can be helped with medication. Now Botox is available for those who find the medication ineffective or suffer from intolerable side effects.

OAB – WHEN YOU REALLY GOTTA GO!

July 10, 2013

OAB (over-active bladder) is found in both men and women and is associated with the symptoms of urgency, frequency, nocturia and urge incontinence.

Regulation of bladder storage and voiding involves both sympathetic and parasympathetic control.

Bladder voiding is primarily regulated by the parasympathetic nervous system via the neurotransmitter acetylcholine. Muscarinic receptors (M1-M3-M5) are mediated by acetylcholine in controlling the contraction of the bladder muscle and relaxation of the internal sphincter to facilitate voiding. M2 and M3 are predominate muscarinic receptors found in the bladder. The anti-muscarinic (Ditropan, Ditropan XL, Vesicare, Sanctura, Gelnique, Toviaz and Enablex) all work by blocking the receptor, leading to a reduction in bladder contractions. Because they block the acetylcholine receptor systemically, they can be associated with constipation and dry mouth.

Bladder storage is primarily regulated by the sympathetic nervous system via the neurotransmitter norepinephrine. Norepinephrine released from the sympathetic nerve activates the adrenergic receptors causing the bladder to relax and close the external sphincter. There are three types of beta adrenergic receptors expressed in the bladder. The beta-3 AR makes up 97% of bladder receptors and is predominately responsible for the detrusor muscle relaxation. The drug Myrbetriq has recently been released and is a Beta 3 adrenergic receptor agonist which leads to increased relaxation of the bladder. In contrast to the anti-muscarinics which cause constipation and dry mouth, this is much less common with Myrbetriq which has a small incidence of an increase in blood pressure. Monitoring the patient’s blood pressure is important in patients with a history of hypertension.

A Phase 3 trial in over 400 men and women complaining of OAB symptoms was recently conducted with 3 arms, Tolterodine ER (Detrol LA) Myrbetriq and placebo arm. The incidence of dry mouth was 5 times higher in the Detrol arm than in the Myrbetriq group (10% vs 2%).

It should be noted in all of the clinical trials with both Myrbetriq and the anti-muscarinics, the increase in urinary voided volume was typically in the range of only 1 or 2 ounces. Both approaches do result in a significant decrease in the incidence of urge incontinence.

A few key points that we have found important in treating OAB patients includes:
1. The treating doctor can use a combination of an anti-muscarinic and Myrbetriq to decrease symptoms of OAB especially in patients with severe symptoms that do not respond to either agent alone.
2. In contrast to prior thinking, there is a very small incidence of urinary retention with the use of either anti-muscarinics or Beta-3 agonists. However, caution should be used in men who really don’t have OAB but have impending urinary retention where they have large residual urine volumes as treatment with anticholinergics or a beta-3 agonist can only exacerbate the situation. Since most primary care physicians don’t have access to a bladder scan, but the PCP can use the tried and true old-fashioned way of simple percussion of the lower abdomen to determine if there is, indeed, significant residual urine.
3. The use of anti-muscarinics in patients with closed angle glaucoma is a contraindication. In patients with a history of glaucoma, we typically give the patients a prescription for their OAB suggest that the patient check with their ophthalmologist prior to initiating treatment.
4. There are a number of tips and coping suggestions in patients with over-active bladder that include: Timed voiding, reduction in caffeine and alcohol, reduction in fluids prior to bedtime and Kegel exercises when patients have strong urges to void. All of these suggestions can help. I provide the patient with a handout on coping suggestions which I have found effective. In fact, numerous studies have shown that behavior modification is as effective as medical therapy.
5. For patients who are unresponsive, an intake and output diary can be of help in determining how big a factor fluid intake can be, as well as, monitoring actual response to treatment.
6. It also is important to realize that many patients complain primarily of nocturia. Nocturia can be a result of numerous urologic as well as non-urologic conditions including CHF, venous insufficiency, and increased fluid intake at night. This is certainly a case where a voiding diary also can be of benefit. For patients whose primary complaint is nocturia, DDAVP .1 to .2 mg. can be used but it is important to monitor the serum sodium for hyponatremia.
7. For patients refractory to either combination or individual drug therapy, there are additional alternatives:
a. Percutaneous posterior tibial nerve stimulation involves a small acupuncture sized needle being placed in the ankle and a minimally perceived current transmitted up to the spinal lumbosacral nerve center where one can “reprogram” the bladder. This is indicated for patients unresponsive to oral medication.
b. For patients with refractory OAB symptoms, Interstim therapy can be utilized. Interstim involves an initial percutaneous trial followed by implanting leads from the spinal cord to the nerves supplying the bladder along with a programmed stimulator, which markedly suppresses and reduces urinary symptoms.

Please do not hesitate to contact me if I can be of assistance. I can be reached 504-891-8454 or email me at doctor whiz@gmail.com or via my website, http://www.neilbaum.com

Incontinence-Deep Six The Depends

June 3, 2013

You Don't Have to Depend On Depends!

You Don’t Have to Depend On Depends!


Urinary incontinence affects millions of American women. The involuntary loss of urine is one of life’s most embarrassing events. The best solution is not diapers or panty liners. Help is available and you can donate the diapers to the grandchildren.
Urinary incontinence isn’t an inevitable result of aging. Most women who have it can be helped or cured.
The best treatment depends on the cause of your incontinence and your personal preferences. Treatments include:

Recommended Related to Urinary Incontinence/OAB

Overactive Bladder (OAB)
Urinary incontinence, the involuntary loss of urine, affects an estimated 25 million Americans, mostly women. For most, incontinence is the result of problems controlling the bladder. For people with a type called functional incontinence, however, the problem lies in getting to and using the toilet when the need arises.

Behavioral training, such as bladder training and timed urination.
Bladder training (also called bladder retraining). This is used to treat urge incontinence. With bladder training, you slowly increase how long you can wait before having to urinate by trying to delay urination after you get the urge to go.
Timed urination. It can be used to treat both urge and stress incontinence. With timed urination, your doctor has you urinate on a schedule, even if you don’t have to go.
Prompted urination. It requires a caregiver to prompt the person to urinate. This technique is used mostly for people with a disability that gets in the way of using the bathroom on their own (functional incontinence).
Lifestyle changes and pelvic floor (Kegel) exercises.
Medicines. There are medications used to relax the bladder muscle. These are referred to as smooth muscle relaxants. Examples include Ditropan, Toviaz, Enablex, Detrol, and Vesicare
Medical devices. An example is a pessary which is helpful for pelvic organ prolapse
Surgery. For more information. This is intended for women with stress incontinence or loss of urine with coughing and sneezing.

Behavioral training, exercises and lifestyle changes, and medicines are usually tried first. If the problem does not get better, your doctor may try another treatment or do more tests.
When there is more than one cause for incontinence, the most significant cause is treated first, followed by treatment for the secondary cause, if needed.

Bottom Line: Incontinence is one of life’s greatest embarrassments. Treatment is available. You don’t have to depend on Depends!

Dr. Neil Baum is one of the authors of What’s Going On Down There-Improve Your Pelvic Health, which is available from Amazon.com

Book on Pelvic Health By Drs. Siddighi and Baum

Book on Pelvic Health By Drs. Siddighi and Baum