Saturday, February 21, 2009

Urinary Incontinence Treatment Options

There are a variety of ways to treat or even completely control urinary incontinence, but it depends on the cause. While there are sometimes multiple factors in play that cause this condition, treatment options are limited by patient motivation, cognitive level, physical impairment, or anatomic abnormalities of the urinary tract. For most, conservative management is the first line strategy and often is quite successful in decreasing the severity of leakage.

Behavior modification and bladder retraining are among the first strategies employed. Timed voiding and double voiding are habits that are easy to adopt and can help empty residual or retained urine from the bladder. Taking inventory of how much and what kinds of fluids are consumed over the course of the day is important. Caffeine intake in the form of coffee, tea, soda, or bladder irritants such as vinegar in salad dressing, citrus or other foods, if eaten in large quantity can be an easy culprit for bladder misbehavior. Simply reducing water consumption will less the sense of urinary urgency, frequency and incontinence, either urge or stress provoked. Timing of fluid consumption is also simple to adjust, that is, minimize caffeine or water at least 3 hours prior to bedtime to less nighttime bathroom trips.

Timing of medication during the day, such as when to take a diuretic/ water pill for high blood pressure, can impact frequency of bathroom trips. Diuretics force more urine production by the kidneys to lower blood pressure, but the bladder must still store and expel it. Forcing more urine production in the afternoon may leave someone relatively “drier” prior to bedtime, and may also less nighttime bathroom trips.

Pelvic floor retraining in the form of Kegel muscle exercises can help to strengthen the urinary sphincter and pelvic floor muscles to curb leakage of urine when a sneeze comes on or the urge becomes great. Squeezing down on the sphincter before sneezing gets the body ready for the rise in pressure that may force urine past the sphincter. Repetitively practicing Kegel muscle exercises can curb incontinence a great deal, but these exercises must be performed daily.

There are some “reversible” causes of incontinence which are not the bladder’s fault, but when addressed can lessen urinary leakage. Urinary tract infection can cause pain and urinary loss and simply antibiotic prescription can easily remedy this. Untreated diabetes can promote urine production and overwhelm the bladder leading to incontinence. In the elderly or frail population, delirium or dementia often lead to incontinence because of lack of perception of the need “to go”. Poor mobility due to weak or injured legs or back will hinder someone simply from getting to the bathroom in time and lead to an incontinence episode. Severe constipation, urethral tissue thinning from lack of estrogen, and even simply depression, are all treatable and reversible causes of incontinence. Those caring for others with cognitive impairments can prompt them to void on a schedule and maintain easy access to toilets to minimize urinary incontinence.

Medications for overactive bladder are frequently used in conjunction with bladder retraining since together the combination will have an additive effect. All overactive bladder medications essentially will confer the same benefit in a majority of those who are prescribed them. They can lower the sense of urgency, frequency, and urge incontinence by about 2/3. All can lead to common side effects such as dry mouth, dry eyes, and constipation. Avoiding overuse of other medications, such as diuretics, certain antidepressants, antihistamines, and cough or cold preparations may also have a significant impact on lower urinary incontinence. There are no medications that are approved to treat stress incontinence.

If medications for overactive bladder lead to undesirable side effects or do not work, a bladder neurostimulator may be placed to help control symptoms. Similar to a pacemaker, the neurostimulator, InterStim, dampens the urge signals from the bladder allowing for a normal voiding pattern. It is placed in the buttock and approximately ¾ of individuals who are symptomatic with urgency, frequency and urge incontinence can be treated permanently this way. It is considered minimally invasive and placed as an outpatient.

For stress incontinence that occurs with coughing, sneezing, laughing and exercise, minimally invasive outpatient procedures such as slings or urethral injections are highly successful and can achieve dryness in the majority of those who have it. A “sling” is narrow strip of mesh that can be placed under the urethra and serves as a backboard of support under the urethra during activity or coughing. Patients can return to work in a relatively short period of time after a brief recovery period. A urethral injection adds bulk or “beefs up” the urethra by injecting a substance via a scope into the urethra itself. It is an acceptable alternative for those who are not sling candidates. Pre-operative bladder testing with urodynamics and a full history and physical are required to assess who is an appropriate surgical candidate.

Wednesday, February 18, 2009

Doctors who Blog

Yesterday I was interviewed by Natalie Flanzer at Channel 3 in Phoenix. She was interested in doctors who kept blogs.

See the interivew here:


http://www.azfamily.com/video/index.html?nvid=333055&shu=1

Saturday, February 14, 2009

Television Interview on Female Incontinence

I was recently interviewed by Bob Caccamo, the Vice Mayor of Chandler, AZ on Chandler television, Channel 11.

I discussed female urinary incontinence and pelvic prolapse, among other topics.

Please see the interview here at the following link, paste it in your browser:

mms://cocsv01.chandleraz.gov/Chandler_In_Focus_Urological_Health

Friday, February 13, 2009

Female Urinary Incontinence

I recently had an article of mine published on the Google news feed at EmpowHer.com, a website for all female related health topics, and here is the the link:

http://www.empowher.com/news/herarticle/2009/02/13/what-urinary-incontinence

In addition, for those women in the Phoenix metro area, I will be on the Dr. Dan Health Show this Sunday morning at 6 AM speaking about female urinary incontinence as well. My program can be heard on simulcast on the following radio stations:

107.9 KMLE
101.5 Free Zone
94.5 KOOL

Tuesday, February 3, 2009

Cosmetic Vaginal Surgery?

Hmmm....This is a somewhat popular and edgy topic to speak about, lately, espeically with cosmetic vaginal procedures being spotlighted on some cable tv shows.

Cosmetic vaginal surgery is know by many names:

Vaginal Rejuvination
Vaginoplasty
“Designer Vagina”
“Down Under Makeover”
Vaginal Tightening
“Revirgination”

There are a lot of reasons someone may opt for this type of surgery. Actually, cosmetic vaginal surgery can be broken down into two main categories:

Vaginal tightening or vaginoplasty and labial reduction or labiaplasty.

Labiaplasty has slowly grown in popularity over the past decade. Women with long, fatty or hanging vaginal lips are candidates for labiaplasty. Essentially, the size of the labia are reduced to a narrow or slimmer size, depending on anatomy and patient desire. Some women have always had very noticeable labia, whereas others develop the problem after having children, or as they get older. Large labia can interfere and cause pain with sex, and can be uncomfortable with tight-fitting clothes. Labiaplasty is a form of vaginal rejuvenation. It can restore confidence as well as enhance sexual pleasure in some women.

Vaginplasty, ('vaginal tightening") is another female cosmetic surgery procedure that has risen in popularity as well. It involves tightening the vaginal muscles, and can be done in conjunction with labiaplasty. Women who have gone through multiple childbirths are often the best candidates for this procedure. Some women complain of a looseness of the vagina, with loss of sensation during sex, and decreased pleasure. Pelvic floor exercises, such as Kegels, do not address the sensation of a wide or loose vagina. Surgery for cystocele and rectocele (dropped bladder and dropped rectum) often include vaginal tightening, but vaginal tightening can be done on its own. The degree of tightness is improtant to quantify pre-op and can be done with dilators.

Patient expectations are important to gauge, and like any cosmetic surgery, can improve self-image, but it must be done for the right reasons.

Hymenoplasty, restoring the hymen, is performed most often on young women who want the surgery for religious or cultural reasons. The hymen is usually first torn with sexual intercourse, but can also tear with the use of tampons, masturbation or vigorous exercise/accidents/horsebacking riding. It is a very thin membrane of skin located in the lower 1/3 of the vagina.