Clinical Management of Urinary Incontinence in Women

Incontinence is a devastating condition affecting millions of American women. It is a source of embarrassment that results in women becoming reclusive and deciding not to engage in socialization. Urinary incontinence, defined as the involuntary leakage of urine, affects 20 million persons nationwide Help is available. You don’t have to depend on Depends! This blog will discuss the problem and the treatment options for urinary incontinence.
Most cases of urinary incontinence in women fall under one of three major subtypes: urge, stress, or mixed. I believe in going from tshe least invasive (behavioral modification) to more invasive (surgery) interventions is the best approach. Bladder retraining and pelvic floor muscle exercises are first-line treatments who present with urge incontinence or “I gotta go right now”! Medication with anticholinergic medications is another option for treating urge incontinence if behavioral therapy is unsuccessful; however, because of adverse effects such as constipation and blurred vision and confusion, these agents are not recommended in older adults.

Pelvic floor muscle exercises or Kegel exercises are considered first-line treatment for stress incontinence or loss of urine with coughing, laughing or sneezing. Alternatives for treating stress incontinence include vaginal pessaries. At this time no medications are approved by the U.S. Food and Drug Administration for treating stress incontinence. Minimally invasive procedures injection of periurethral bulking agents, can be used if stress incontinence does not respond to less invasive treatments.

Third line treatment consists of surgical interventions, such as sling and urethropexy procedures, should be reserved for stress incontinence that has not responded to other treatments.

Bottom Line: Women suffering from urinary incontinence do not have to suffer and should speak to their doctor about treatment options. Usually some of the options are helpful and can make women comfortable and able to engage in most activities without the embarrassment of the loss of urine.

Non-Medical Treatments of Urinary Incontinence

Incontinence is a devastating condition affecting millions of American women. It is a source of embarrassment that results in women becoming reclusive and deciding not to engage in socialization. Urinary incontinence, defined as the involuntary leakage of urine, affects 20 million persons nationwide Help is available. You don’t have to depend on Depends! This blog will discuss the problem and the non-medical treatment options for urinary incontinence.

WEIGHT LOSS
Women who are overweight or obese and who experience stress incontinence should be encouraged to lose weight, which has been shown to reduce the frequency of incontinence symptoms.32

BEHAVIORAL TREATMENTS
Pelvic floor muscle exercises are the mainstay of behavioral therapy for stress incontinence. Up to 38 percent of patients with stress incontinence alone who follow a pelvic floor muscle exercise regimen for at least three months experience a cure. Increased effectiveness is demonstrated in women undergoing longer training and in those following comprehensive clinic-based training rather than self-help booklets.
Manual feedback (palpating the pelvic muscles during the exercises) and biofeedback (using a vaginal or anal device that provides visual or audio feedback about pelvic muscle contraction) have been used to teach patients the correct technique. Weighted intravaginal cones have also been used for improving technique when women have difficulty identifying their pelvic floor muscles. Although these strategies may improve technique and, consequently, symptoms in the short term, there is no evidence that they result in higher rates of long-term improvement or cure than the exercises alone.

ELECTRICAL AND MAGNETIC STIMULATION
Electrical stimulation of the pelvic floor muscles with a vaginal or anal electrode can be used in women who cannot voluntarily contract pelvic floor muscles.13 This can be done at home and typically consists of two 15-minute sessions daily for 12 weeks. Medicare has approved its use in patients who have incontinence that does not respond to structured pelvic floor muscle exercise programs.

Extracorporeal magnetic innervation involves a series of treatments in which the patient sits, fully clothed, on a chair that generates a low-power magnetic field. Patients typically undergo two or three treatments per week for six to eight weeks. One early study showed this method to be most effective for women who have mild stress incontinence (i.e., using three sanitary pads per day or fewer). A more recent study found it to be more effective than sham treatment for women who are unable to generate adequate pelvic floor muscle contractions.

DEVICES
Vaginal inserts, including incontinence pessaries and incontinence tampons, can be used for treating stress incontinence in pregnant women, in those who are not surgical candidates, and in those whose symptoms have not responded to previous surgeries. Vaginal inserts compress the bladder neck and urethra, thus decreasing urine loss caused by stress incontinence. Although pessaries are not widely used, their associated risks and costs are low, and they achieve results quickly. There are few contraindications to pessary use (e.g., active pelvic infection, severe ulceration, allergy to product materials, noncompliance). Incontinence tampons, which also place pressure on the bladder neck, are available in Europe.
[corrected] Urethral plugs are devices that are inserted into the urethra to prevent urine loss during activities that cause stress incontinence (e.g., running). They are available in two lengths: 3.5 cm and 4.5 cm. There is limited evidence promoting or discouraging their use, and they are associated with a number of adverse effects, including urinary tract infection (occurring in up to 31 percent of women over a two-year period), hematuria or blood in the urine (3 percent), and migration into the bladder (1 percent). Despite this, multi-year studies indicate a high degree of patient satisfaction, and the likelihood of significant adverse effects diminishes with continued use.

Bottom Line: Urinary incontinence is a devastating problem affecting millions of American women. You don’t have to suffer in silence. Help is available; speak to your physician

Non Medical Ways to Boost Testosterone Levels

Testosterone is the male hormone produced in the testicles and it is responsible for man’s sex drive. Low testosterone levels can impact a man’s sexual performance. This blog will discuss life-style changes that men can make to improve their testosterone levels.

The sex hormone testosterone is often touted as helping men maintain their vitality and virility, but levels begin to dip naturally by about 1 percent a year after age 30. Signs that your testosterone may be declining more rapidly include loss of energy, decreased sex drive, irritation or anger, and trouble sleeping.
Although testosterone supplementation is effective, there are risks and side effects that make life style changes a more attractive alternative. There are many tried and true drug-free and hormone-free ways to maintain testosterone levels.

Deep Six the Sauce (Alcohol)
A glass of wine with dinner is no problem, but overdrinking is not a good idea. Moderate alcohol consumption for men is a max of two drinks a day, with one being a 5-ounce glass of wine.

Shed Some Pounds
Being overweight or obese can increase risk for heart disease and certain cancers, but extra weight also increase the risk for low testosterone levels. Research published in Diabetes Care in June 2010 showed that 40 percent of obese men had lower-than-normal testosterone readings, and this percentage increased to 50 percent among obese men with diabetes. Weight loss can be a hormone-free way to combat low T. A benefit of weight loss for obese men is that the penis will appear to be longer because of the loss of the abdominal fat. I usually tell men that every 30 pound weight loss increases the length of the penis by 1.5 inches.

Send Out a Stress SOS
A study done at the University of Texas at Austin in 2010 suggested that the stress hormone cortisol may block the beneficial testosterone. When our stress levels are up, our testosterone can go down.

Regular exercise helps reduce stress levels as well as help you maintain a normal weight, so it packs a double whammy against low testosterone levels. Other stress reduction techniques, like deep breathing, can also serve as natural testosterone support.

Take a Big Dose of Vitamin “E”-Exercise
Exercise can help maintain your testosterone levels and avoid some of the symptoms of low T.
Research in the September 2011 issue of the Journal of Strength and Conditioning Research backs this up. The study showed that a 4-week sprint-interval training program helped boost testosterone levels in a drug-free fashion among wrestlers.

Sleep And Sex
A small study conducted at the University of Chicago School of Medicine found that men who slept less than five hours a night for one week had lower levels of testosterone than when they had a full night’s sleep.
When you are sleep deprived, it impacts levels of the stress hormone cortisol, which reduces testosterone just like stress can. A sleep-deprived state is a testosterone-deprived state. Everyone’s sleep needs are different, but it’s important that you wake up feeling refreshed.

Avoid Plastic Bottles
The controversial chemical bisphenol A (BPA) is found in many plastic water bottles as well as in the lining of food and beverage cans, and exposure to this plasticizer may result in low T. BPA can act like the female hormone estrogen in the body, which means it can lower levels of testosterone,
Don’t cook foods wrapped in plastic in the microwave, and try to drink from a glass or a steel thermos. The more flexible a plastic bottle, the more likely it is to leach BPA and affect the testosterone level

Think Zinc
If you take a multivitamin with zinc or eat oysters every day, your zinc levels are probably within the normal range. Aim for 12 to 15 milligrams a day to help stave off low T.

Some Fat Is Your Friend

Men who eat a low-fat diet have lower testosterone, because the body makes testosterone from cholesterol. But this doesn’t mean you should eat unhealthy bad fats. Instead choose healthy fats such as those found in avocado, nuts, and olive oil. These fats will boost testosterone naturally, but they won’t raise blood levels of artery-clogging cholesterol.

Skip the Sugar

Every time you eat sugar, testosterone is decreased, likely because the sugar causes a high insulin level which can decrease the testosterone level.
Bottom Line: Low testosterone levels are a treatable condition that affects millions of men. There are options that don’t require medication that also improve your overall health and wellness.

Tummy Tuck Improves Incontinence

Stress incontinence affects millions of American women. This is a condition that results in loss of urine with coughing and sneezing or any activity that increases the pressure in the abdomen that puts pressure on the bladder and overcomes the muscle in the urethra that is responsible for holding urine in the bladder.

Findings from a study published in the Aesthetic Surgery Journal indicate that a tummy tuck not only improves body contour, but may also alleviate symptoms of stress urinary incontinence, especially among patients who have not undergone previous C- section.

The study surveyed women, who underwent a tummy tuck, to ascertain changes in their stress urinary incontinence symptoms. The study found was that a tummy tuck significantly alleviated the symptoms of stress urinary incontinence in 60% of patients, especially in patients who hadn’t undergone previous C-section.

Bottom Line: Now there’s another reason to have that bikini look this summer!

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

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

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.

2. 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.

3. 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

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.

Weight Loss Surgery May Help Ease Urinary Incontinence

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 Men-You Don’t Have to Depend on Depends

Loss of urine is one of man’s most devastating maladies. It usually is related to problems with the bladder or the prostate gland especially after prostate gland surgery.

Male Stress Urinary Incontinence (SUI) also known as, Post-Prostatectomy Incontinence, commonly occurs following a surgical procedure to remove a cancerous prostate. Studies have indicated that as many as 90% of men report leakage in the first few weeks following surgery for removal of the prostate gland, after removal of the catheter. Over the course of the first year, SUI can be a significant problem impacting the quality of life of men who suffer from this condition.

Fortunately, there are effective treatment options for many cases of post-prostatectomy incontinence. Men often say the leakage from post-prostatectomy incontinence is worse than the actual cancer. Unfortunately, there is a lack of information for men with stress urinary incontinence.

Urinary incontinence can be short-term or long-lasting (chronic). Short-term incontinence is often caused by other health problems or treatments.
Chronic urinary incontinence can be categorized as:
• Stress incontinence means that you leak urine when you sneeze, cough, laugh, lift something, change position, or do something that puts stress or strain on your bladder.
• Urge incontinence is an urge to urinate that’s so strong that you can’t make it to the toilet in time. It also happens when your bladder squeezes when it shouldn’t. This can happen even when you have only a small amount of urine in your bladder. Overactive bladder is a kind of urge incontinence. But not everyone with an overactive bladder leaks urine.
• Overflow incontinence means that you have the urge to urinate, but you can release only a small amount. Since your bladder doesn’t empty as it should, it then leaks urine later.
• Total incontinence means that you are always leaking urine. It happens when the sphincter muscle no longer works.
• Functional incontinence means that you can’t make it to the bathroom in time to urinate. This is usually because something got in your way or you were not able to walk there on your own.

Different types of incontinence have different causes.
• Stress incontinence can happen when the prostate gland is removed. If there has been damage to the nerves or to the sphincter, the lower part of the bladder may not have enough support. Keeping urine in the bladder is then up to the sphincter alone.
• Urge incontinence is caused by bladder muscles that squeeze so hard that the sphincter can’t hold back the urine. This causes a very strong urge to urinate.
• Overflow incontinence can be caused by something blocking the urethra, which leads to urine building up in the bladder. This is often caused by an enlarged prostate gland or a narrow urethra. It may also happen because of weak bladder muscles.
In men, incontinence is often related to prostate problems or treatments.
Drinking alcohol can make urinary incontinence worse. Taking prescription or over-the-counter drugs such as diuretics, antidepressants, sedatives, narcotics, or nonprescription cold and diet medicines can also affect your symptoms.
The diagnosis is easily made with a careful history and physical exam. Your doctor will do a test on your urine to be certain there is no evidence of infection. Often this is enough to help the doctor find the cause of the incontinence. You may need other tests if the leaking is caused by more than one problem or if the cause is unclear.
Treatments depend on the type of incontinence you have and how much it affects your life. Your treatment may include medicines, simple Kegel exercises, or both. A few men need surgery, but most don’t.
There are also some things you can do at home. In many cases, these lifestyle changes can be enough to control incontinence.
• Cut back on caffeine drinks, such as coffee and tea. Also cut back on fizzy drinks like soda pop. And limit alcohol to no more than 1 drink a day.
• Eat foods high in fiber to help avoid constipation.
• Don’t smoke. If you need help quitting, talk to your doctor about stop-smoking programs and medicines. These can increase your chances of quitting for good.
• Stay at a healthy weight.
• Try simple pelvic-floor exercises like Kegels.
• Go to the bathroom at several set times each day and avoid your bladder getting to full. Wear clothes that you can remove easily. Make your path to the bathroom as clear and quick as you can.
• When you urinate, practice double voiding. This means going as much as you can, relaxing for a moment, and then going again.
• Use a diary to keep track of your symptoms and any leaking of urine. This can help you and your doctor find the best treatment for you.
If you have symptoms of urinary incontinence, don’t be embarrassed to tell your doctor. Most people with incontinence can be helped or cured.

Bottom Line: Urinary incontinence in men affects their quality of life. Help is available and it begins with sharing the problem with your doctor.

A Balloon In The Bladder-A New Treatment For Incontinence

Laughter is the best medicine; but not for overactive bladder! This is a common condition affecting 15 million American men and women. Now a new novel treatment that does not require surgery is currently undergoing clinical studies in the United States in order to achieve FDA approval.

Stress urinary incontinence or loss of urine with coughing, sneezing, laughing, or even bending over to tie your shoes is the most prevalent form of incontinence among women, affects an estimated 140 million women worldwide. SUI is defined as the inability of the bladder to store urine during normal everyday physical activities without sudden increases in bladder pressure.

The Solace Bladder Control System is a non-surgical alternative to involuntary urinary leakage. The Solace Bladder Control Balloon is a small, lightweight device that floats within the urinary bladder. The balloon is designed to eliminate or reduce involuntary urinary leakage. It acts as a “shock absorber” to reduce the temporary pressure changes in the bladder that cause urinary leakage.

The Solace Bladder Control Balloon procedure is performed in the physician’s office. No medication or preparation is required before the procedure. The physician places the Solace Bladder Control Balloon into the bladder through a small tube inserted into the bladder under a local anesthetic. Pressure reduction is immediate. The balloon can be removed at any time.

For more information on the Bladder Control Balloon go to http://www.stopsui.com.

Bottom Line: Incontinence is a common condition that affects millions of American men and women. At the present time there is no medication to treat this problem. The Bladder Control Balloon may be a treatment option.

Questions I Am Frequently “Axed”

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