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GET ACTIVE

Encourage others to start talking and gain control of their bladder health!  We've made it simple for you to share National Bladder Health Week news, resources, tips and tools with your friends, family and healthcare providers.  We have a variety of  simple activities you can choose from to promote awareness of bladder health.  They are cut and paste one of the sample newsletter or emails below.

1415 Stuart Engals Blvd
Mt Pleasant, SC, 29464
United States

843 419-5307

NAFC is a non-profit offering resources for people struggling with incontinence, adult bedwetting, OAB, SUI, nocturia, neurogenic bladder, and pelvic floor disorders like prolapse. 

INCONTINENCE STORIES FROM EXPERTS AND REAL PEOPLE | BHEALTH

Log in to the BHealth blog to hear expert advice, real stories from people suffering from incontinence issues, tips on managing adult bedwetting, how to care for a loved one, and how to maintain a healthy pelvic floor.

 

Why You Shouldn't Use A Maxi-Pad For Incontinence

Sarah Jenkins

Why You Shouldn't Use Maxi Pads For Incontinence

Any woman with incontinence knows the feeling – you’re walking down the absorbent isle and instead of reaching for an absorbent pad made for leaks, you turn and look at the maxi pads.  After all, it’s much less embarrassing to grab a box of those than to admit that you need pads for a leaky bladder, right?

Maybe. But consider this – the products are designed to do entirely different things.  In fact, you are doing yourself a huge disservice if you think you will be able to manage leaks with maxi pads.  Here are the 3 reasons why:

  1. Absorbency. Menstrual pads are designed to hold menstrual flow whereas incontinence pads are designed to absorb the rapid flow of urine. Additionally, incontinence pads are designed to absorb and hold much more fluid than menstrual pads, which means you will have fewer leaks.
  2. Odor Control. Many bladder control pads are made with a wicking fabric that draws moisture away from the skin and eliminates urine odors. Some also contain special gels that change the urine into a more solid substance, which helps with odor.
  3. Skin Protection. The same wicking fabric and gel that help control odor also help protect the skin. Incontinence pads neutralize acidic urine, which can cause skin rashes if left unchanged.

If you’re still too embarrassed to purchase an absorbent product in the store, there are many great online retailers who will ship the product directly to your house, allowing you to purchase the right product for your needs from the privacy of your own home.

Ask The Expert: Protective Underwear or Adult Absorbent Briefs - What's The Difference?

Sarah Jenkins

ask the expert - bedwetting

Each month, we ask our expert panel to answer one of our reader's questions. To learn more about the NAFC Expert Panel, and how to submit your own question, see below.

Q: What is the difference between protective underwear (pull-ups) and adult absorbent briefs?

A: In the world of absorbent products, it can be hard to find something that works with your needs.  Most adults who wet the bed use some type of protection, usually protective underwear, or an adult absorbent brief.  

Protective underwear are designed to mimic real underwear, and, unlike absorbent briefs, do not have any tape or velcro siding. Many who prefer this pull-on option like it because of it’s convenience - pull ups are easy to put on or remove, and give users a sense of freedom from the typical brief style.  

Absorbent briefs are similar to protective underwear, but have side tabs that can be adjusted for comfort and fit.  Although they may not be as convenient, many prefer this option since they are able to adjust the side tabs, therefore creating a more custom, snug fit which can prevent leaks.  

Choosing the option that is right for you or your loved one may involve some trial and error, and will depend on your circumstances. Do you wake up often at night to use the restroom? Protective underwear may work best for you due to the ease of pulling them on and off. Do you care for someone who is more bedridden and needs more assistance with getting in and out of bed or changing clothes?  Briefs may be preferred since the tabs make it easier to find a good fit and can be easier for caretakers to change.  

Of course, finding a product that will keep you dry is the biggest goal, and relies heavily on fit (it shouldn’t be too big or too small), absorbency (look for products that are specific to night-time use), and function.  Don’t be afraid to try lots of options until you find something that fits well and is comfortable.  

 

 

Causes Of Adult Bedwetting And How To Manage It

Sarah Jenkins

adult bedwetting causes

Christine Pruneau BSN, RAC-CT

Enuresis, or bed-wetting, is commonly associated with children but night time incontinence also affects adults, both young and old. While this can be an embarrassing condition, it is one that can be treated. In many cases, adult bedwetting can be a symptom of another condition, so the first step is determining the root cause. From there, finding ways to manage nighttime leaks can help make you more comfortable as you undergo appropriate treatment.

There are many potential causes of bed-wetting in adults, both young and old:

  • Causes in younger adults:
  • Diabetes – new or undiagnosed
  • Medication side effects
  • Sleep apnea, or not awakening to the sensation of a full bladder
  • Manufacturing large amount of urine at night
  • Underdeveloped bladder
  • Urinary tract infection or kidney/bladder stones
  • Chronic constipation
  • Weak pelvic floor muscles (mostly females)
  • Neurological disorder or injury

In older adults, causes might also include:

  • Bladder cancer or tumor
  • Prostate cancer or enlargement
  • Overactive bladder
  • Weak pelvic floor muscles
  • Dementia

If you are experiencing adult bedwetting, you should speak with a doctor, who will usually start by performing a complete physical examination that includes lab analysis of urine and blood.  A referral to a specialist might be needed where additional tests would be ordered such as an abdominal ultrasound, neurological exam and other urological procedures.

Treatment of bedwetting in adults centers on the root cause.  Many times the incontinence is reversible once the underlying cause is identified.  Determining the origin is often the biggest challenge but definitely worth pursuing.  Until there is a diagnosis and treatment regimen, it is important to keep yourself dry and comfortable during the night.  There are several options for this:

Absorbent products. Adult protective underwear works wonders in protecting skin, bedding and clothing from urine when the need is moderate.  For the best performance of these products, make sure they are the correct size and worn comfortably snug. Protective underwear or briefs are comfortable to wear and are available at drug stores, medical equipment providers and online retailers. In addition, protective bedding, such as waterproof pads and mattress covers can help make cleanup easy in the event there is overnight leakage.

Kegel exercises.  Pelvic floor strengthening has proven to help adults of all ages with urge incontinence and bedwetting.  A stronger pelvic floor could reduce the number of bedwetting episodes and allow a person to get to the bathroom in time to void.  A physical therapist trained in incontinence care can be very helpful with these exercises.

Here are some other ideas, but patients should speak to their doctor before trying:

Set an alarm to awaken during the night to toilet.  If the patient is wet before the time of the alarm, set the alarm to an earlier time until finding the ideal hour of the night to toilet.

Watch fluid intake.  Limiting after-dinner fluids will likely reduce urine production at night.  But PLEASE NOTE: if someone is very physically active into the evening hours, or could become dehydrated for any reason, this would not be recommended.

Prescription Drugs.  Medications to control incontinence is directed at treating the underlying cause.  In cases where there is urge incontinence, some medications may help to relax the detrusor muscle contractions of the bladder.  This type of incontinence is more common in older adults, but can certainly effect younger and middle-age adults as well.  For those suffering from a lack of vasopressin (a chemical that keeps the body from eliminating too much fluid), Desmopressin is a drug that replaces vasopressin in the body.  This is often associated with diabetes insipidus, brain tumor or head injury.  Careful assessment by a specialist would be in order in this case.

Night time incontinence may differ with younger and older adults but can be treated and managed in most cases.  Perseverance and motivation on the part of both patients and providers are key to managing nighttime incontinence.  Know that adult bedwetting is not your fault, and, while it should not be considered normal, it does occur in many people. The good news is that adult bedwetting is something that can be managed with the right tools, and speaking with a physician can help you find the underlying cause and proper treatment.

Christine Pruneau RN, BSN, RAC-CT has 25 years of experience in clinical education for a long term care and home health. She is a frequent speaker on the subject of continence management and has a special interest in restorative health in both adults and children.  Christine is the Clinical Director for Home Care Division at First Quality Healthcare.

Think Bedwetting Is A Children's Issue? Think Again. Bedwetting In Adults Is More Common Than You Realize.

Sarah Jenkins

Adult Bedwetting Survey, Bedwetting Kit

We’ve been talking about adult bedwetting this month, a condition that affects over 5,000,000 people in the United States.  For those who don’t deal with this situation (also known as nocturia) nightly, it may seem not seem to be a big deal, but for the millions that pray every night to wake up dry, it can be a source of constant worry, frustration, and embarrassment.  

NAFC recently conducted an online survey in an effort to better understand the types of things adults who struggle with bedwetting go through. In just one month, we received a total of over 600 responses from both patients and caregivers detailing the specifics of their bedwetting, what they do to manage it, and the extent to which the condition affects them.  What we heard was very surprising.

The age range of those experiencing bedwetting varied greatly, but surprisingly, the majority of respondents were neither very young or old – falling within the ages of 18-44.   And while 1/3 had only been suffering for a few months, over half of our respondents had been dealing with bedwetting for 2 years or more.  

And yet, even though many struggle with this condition for years, over 60% had never talked to their doctor about the problem, and 71% have not been diagnosed with an incontinence condition.

However, the lack of diagnosis does not mean that this condition does not bother them.  Most people who visited NAFC.org came because bedwetting was affecting their quality of life, and their personal relationships.  They are frustrated, and are looking for treatments to their bedwetting.  And, when asked what the biggest challenge is, “Embarrassment” topped the list, which explains why many likely do not seek treatment from a professional.  In fact, embarrassment is such a big factor with adult bedwetting, that it prevents not only lifestyle – like visiting or hanging out with friends, and productivity at work - but in several cases, it even prevents people from  making major life decisions, like getting married, because they are too afraid of someone else finding out about their condition.

For Caregivers, keeping things clean and getting their loved one to talk about their bedwetting problem was the biggest challenge.  Many people who wet the bed do not want to address the issue – again, because they are embarrassed, and are afraid of how their loved one will view them.

Armed with these results, we at NAFC have committed ourselves to providing greater help to those struggling with bedwetting.  This month, in combination with HDIS, we launched the NAFC Dry Night Solution Kit, designed specifically for adult who wet the bed.  Patients who sign up for the kit will receive an email with access to educational brochures about bedwetting, as well as a dedicated number they can call to reach a qualified representative, and discuss the types of problems they are having.  The representative will ask several detailed questions (how much leakage, how often, how many times per night/per week, etc.) and will assemble a custom kit designed specifically for the patient.  And, because getting the right fit for a product is so important, the rep is also trained to provide fit recommendations to ensure that the products that they send out will work well for the individual.  

“We are delighted to offer this bedwetting kit as a resource for those touched by this condition,” says Steven Gregg, Executive Director of NAFC.  “Too many people suffer from adult bedwetting and we believe this kit will help them find the tools they need to manage and treat the condition.  We hope that the ease of getting a kit will further reduce the shame and embarrassment that comes along with this condition.”


To speak with a professional representative, and to order your kit, sign up here.  

Dry Night Solution

Announcing NAFC's New Dry Night Solution Kit: A Treatment Option For Adult Bedwetters

Sarah Jenkins

We are thrilled to announce a new offering from NAFC, in partnership with HDIS, for the many adults who struggle with bedwetting.

Over 5,000,000 American adults of all ages experience bedwetting.  This problem can be isolating and embarrassing, and can lead to many frustrated mornings.  Many people with this condition keep it a secret, and struggle with finding the right products or solutions to help them. Fortunately, there’s no reason why anyone should have to wake up wet.  

The new NAFC Dry Night Solution Kit provides education and customized products to fit your specific needs.  When you sign up to get your kit, you’ll get immediate access to educational brochures chock full of great info on what causes bedwetting and what you can do about it.  You’ll also receive a number to call, where you’ll have the chance to speak with a qualified professional who will assemble a custom kit full of products that will help you wake up dry.  

Kits are available for a limited time.  To order yours, start by filling out the form on this page.  You’ll then receive an email with access to digital bedwetting brochures, and a phone number and promotion code to use to get your Dry Night Solution Kit.  

Order your kit today!  

Adult Bedwetting: Stories And Tips From Real People

Sarah Jenkins

Adult Bedwetting Stories and Tips

Adult bedwetting. It’s a rarely talked about condition, but is one that affects many people.  In fact, NAFC receives more visits to the adult bedwetting pages than any other page on our site.  People struggle with this condition for all sorts of reasons – spinal cord injuries, neurological diseases, and even stress can cause bedwetting.  And sometimes there can be seemingly no cause at all, which makes it all the more frustrating to address. Most people who wet the bed are desperate for a solution.  They find it deeply embarrassing, and it greatly affects their quality of life, as they are constantly dealing with keeping things clean and worried about how it will affect current or future relationships.


The good news is there are ways to manage it.  We asked people who live with adult bedwetting to share their best tips and stories with us. And now, we’re sharing them with you.  If you’re longing to wake up dry in the morning, keep reading!

Don’t be afraid to talk to your doctor! 

“Don’t believe everything you read on the Internet. I have been wearing continence products for over a decade now – disposable underwear during the day, and fitted briefs at night. I’ve never had a Dr., RN, or Tech gasp in terror that one of their patients is wearing an incontinence garment, I’ve never had them ask to change me, mock me, or announce my issues to a crowded room.  Doctors are professionals, and they see incontinent people all the time. If you are having incontinence issues, you definitely need to see a Doctor, but don’t be nervous about it. If incontinence was that uncommon, they wouldn’t have aisles dedicated to it in every big box store across the US.”

If your doctor isn’t addressing your needs, find a new one!

“My first Urologist really wanted to focus on medication. I was all for that if it would make my problem go away, but it didn't and it had undesirable side effects. When the medication didn't work the Urologist referred me to a physical therapist and a psychologist, convinced my continence issues were the result of depression. They weren't, and that was when I opted to go with another Urologist. Not every Cop that pulls you over is going to give you a ticket, and not every Doctor is going to focus on what works for you. My second Doctor was focused on how it affected me and how to manage it, and it proved to be a more fruitful relationship. I also think RNs are great to talk to. The Dr. is supposed to be the expert, but in my experience Nurses tend to focus on reality and moving forward. Doctors tend to only focus on cures, even if that isn't a realistic goal.”

Don’t be afraid of adult absorbent products and find one that fits correctly!

“I initially went to what I now see as comical lengths to avoid dealing with my continence issues. I first tried the male guards, which are not designed for nighttime incontinence. When those proved futile I tried buying Goodnites (not designed for a grown man and very ill-fitting), figuring if the store clerk saw me buying bedwetting products designed for juveniles, she would assume that they were for a younger sibling. In retrospect, the clerk at a pharmacy or a grocery store is indifferent to what you buy. I think that is a big thing people initially get hung up on, and they needn’t. I typically buy continence supplies online these days, but no one cares what you are buying as long as you have the cash to pay for it. What is important is buying an incontinence product that works for you and you will use. At night I wear a fitted brief, which is an adult diaper. Initially it was very upsetting, but it gets better with time. Wearing a diaper keeps me dry, my bed dry, my girlfriend dry, and I get a good night’s sleep.  It took me a while to get over the hump of accepting that this was what I had to wear to bed, but eventually I got over it. Now it is just a thing I do at night, no different than brushing my teeth and flossing.”

“The best thing to do is accept that you have the condition and take steps to manage it. Look into products like mattress protectors, bed pads or even diapers. I'm 29 and know how frustrating it is. But I've accepted that diapers are my best option for me. Trust me, taking off a wet diaper in the morning is WAY better than having to change and launder sheets and clothes.” 

Don’t be scared to open up about your condition with your loved ones.

“Everyone is different, but I think that if you are in a relationship with someone and you have an illness or injury, that isn’t going to change things. I was straightforward with my girlfriend and we moved on together. We are still intimate. We still sleep together. We just keep my nighttime attire exclusive of our love life. “

Your attitude can make a huge difference!

“I used to "suffer" with bed wetting but once I became resigned to it, protected myself from its effects with good thick diapers, and changed my attitude about it, the suffering left. For many of us and maybe even you this is simply a condition in life to deal with. Let the suffering go and just accept it as a reality for yourself. You will be much happier and content.”

“I developed continence problems as the result of an unexpected side effect of surgery when I was 14 years old. I'm 74 now. So I've been dealing with these issues for 60 years. I've never been reliably dry at night since then. I was in diapers 24/7 for a couple of years after the surgery, but I managed to develop enough daytime control to go without a diaper except at night by the time I went to university. However, my incontinence increased again when I was in my forties; and I've been in diapers 24/7 since then. Incontinence is just a part of my life, and diapers are the kind of underpants that I wear. I do not "suffer"! I just manage my incontinence as a nuisance that isn't much worse than needing to wear glasses or going bald and not nearly as bad as my arthritis.”

“If your bedwetting is treatable, see the necessary doctors and get it treated. However, if it's chronic and not going to go away, acceptance and management with good diapers are the keys. "Suffering" is optional. I recommend just getting on with your life. Incontinence in general and bedwetting in particular are nuisances that need not ruin your life unless you let them. So don't let them do so.”

Find a support group!

“One of the best things that happened to me happened as a result of the NAFC forum. There was an incontinence panel put together, where individuals were part of a focus group and discussed how incontinence affected their life. I appreciate forums like this because you can discuss issues with other people facing them, but in the real world I always keep my private life private. That focus group meant a lot to me because I had a chance to talk with other people (even just on the phone) that had the same problem and the same concerns. I realized then that everyone worries about people noticing. Everyone worries about odor and stigma. And everyone (at least in the group) wears some sort of protection. That was actually a big weight of my chest being able to talk to people about it that were outside my extended family and the medical field, and if the opportunity presents itself again I highly encourage people to participate. The first 10 minutes are a little awkward, but after that people open up and you realize you aren't alone.” 

Need more support with bedwetting?  Check out our new Dry Night Solution Kit, which offers education and custom products designed to fit your specific needs. 

 

ASK THE EXPERT: HOW DO I TALK TO MY LOVED ONE ABOUT INCONTINENCE?

Sarah Jenkins

AskTheExpert-01.jpg

Question: I’ve had a hard time discussing my father’s incontinence with him - he is so embarrassed by it and never wants to address it. How can I bring the subject up without making him uncomfortable?

Answer:  Caring for a parent with incontinence can be very hard.  After all, you’ve both played opposite roles for most of your life, with your parent providing most of the care for you. When a parent becomes dependent on their child, and especially when they are experiencing something like incontinence, it can make them feel ashamed and embarrassed. They may try to hard to hide their incontinence, or brush off mention of it and try to avoid the subject all together.

Start slowly. Discuss their health and condition and then talk to them about some of the incontinence symptoms you’ve witnessed.  Be patient - they may have some reservations in discussing their problem with you at first. But give them some time - once they feel comfortable, they’ll open up to you and you’ll be able to work on a management plan together.  

Caregivers In An Aging Population

Sarah Jenkins

caregiving in an aging population

Sally was 56 when she first decided to invite her dad to live with her. He was 80 years old and had been suffering with a slight form of dementia for a few years. Recently, his episodes had gotten worse and she decided that the time had come where she simply could not leave him on his own.  

Because she was an only child, most of the burden of care fell on her.  And while she was happy to do it, it was more challenging than she could have ever realized. Her already busy life was suddenly filled with even more responsibilities: helping him with his daily activities, accompanying him to doctor’s appointments, researching medical needs and performing tasks that were new to her. It didn't take long to reach the point where her career was suffering. While her boss was understanding, she had to reduce her hours just to be available to her father when he needed her. The financial strain was as great as the emotional one.

Sally’s issues aren't unique. So many who find themselves in a caregiver role are forced to make the same sacrifices, and the stresses can be overwhelming. And now that our population is aging quickly, these issues are only going to increase.

 The AARP estimates that by 2050 there will be only 3 potential caregivers for every person aged 80 and above. That’s a drastic difference from today’s 7-to-1 ratio.

Why the sharp decline?  In just 10 years, the oldest of the Baby Boomer generation will be slipping into their 80’s, and with them, the need for additional care. Unfortunately, with the population expected to grow at just a 1% pace over the next several years, the caregiver ratio simply won’t be able to keep up. The AARP estimates that over the next several years we’ll see a steady decline in the ration of caregivers to older adults, with the sharpest decline happening as the Baby Boomers reach their 80’s.

What are the implications here? In the coming years, caregivers will need more support than ever before.  The greater number of caregivers will create an increased need for nationwide Long Term Services and Support.  And workplace policies will need to accommodate flexible work schedules to allow caregivers the extra time they so desperately need. And, care for the caregivers themselves will need to be addressed to ensure that they have the tools to take care of themselves, as well as their loved ones.  Things such as providing extra funding or tax credits to caregivers, creating more resources for caregivers to ensure they have the tools and skills needed to care for their loved ones, adjusting FMLA laws to allow for greater workplace flexibility and time off, and making adjustments to medicare and medicaid to cover caregiver coordination services are just a few of the things that can be done to avert this growing crisis.  Putting these types of resources and policies in place is crucial in the coming years if we want to support the caregiving community and our growing, older population.

Choosing The Right Long-Term-Care Facility For Your Loved One.

Sarah Jenkins

Choosing The Right Long-Term Care Facility

Making the decision to place a loved one in a long-term care facility can be difficult. Feelings of guilt and sadness are often present, despite how necessary the decision may be. But there are many situations where a long-term care facility can provide more help to a loved one than you can – and it doesn’t have to be as grim as many imagine it to be.  In fact, there are many wonderful facilities in the US that provide excellent care.  Be sure to visit the home, or have a trusted friend visit one if you are unable to, and keep this list of things to consider when reviewing your options. (Summarized list from The Centers for Medicare & Medicaid Services’ Your Guide To Choosing a Nursing Home or Other Long-Term Care)

Things to Consider When Choosing A Care Facility

Quality of life.

  • Will my loved one be treated in a respectful way?
  • How will the nursing home help my loved one participate in social, recreational, religious, or cultural activities that are important to him/her?
  • Do the residents get to choose what time to get up, go to sleep, or bathe?
  • Can the residents have visitors at any time?  Can they bring pets?
  • Can residents decorate their living space any way they want?
  • What is privacy like?
  • Are the residents able to leave the premises?
  • What services are provided? Are they the services my loved one needs?
  • Can we get a copy of any resident policies that must be followed?

Quality of care.

  • What’s a plan of care, who makes it, and what does it look like?
  • Will my loved one and I be included in planning my care?
  • Who are the doctors who will care for my loved one? Can he/she still see their personal doctors?
  • If a resident has a problem with confusion and wanders, how does the staff handle this type of behavior?
  • Does the nursing home’s inspection report show quality of care problems?
  • How often are residents checked on and what is the average wait time if they need assistance?

Location & Availability.

  • Is the nursing home close to family and friends?
  • Is a bed available now, or can my loved one’s name be added to a waiting list?

Staffing.

  • Is there enough staff to give my loved one the care he/she needs?
  • Will my loved one have the same staff people take care of him/her day to day.
  • How many Certified Nursing Assistants are there and how many residents is a CNA assigned to work with during each shift and during meals? (Note: Nursing homes are required to post this information.)
  • What type of therapy is available at this facility?
  • Is there a social worker available? Can we meet him or her? (Note: Nursing homes must provide medically related social services, but if the nursing home has less than 120 beds, it doesn’t have to have a full-time social worker on staff.

Food & Dining.

  • Does the nursing home have food service that my loved one would be happy with and can they provide for special dietary needs? 
  • Does the nursing home provide a pleasant dining experience?
  • Does staff help residents eat and drink at mealtimes if needed?
  • Are there options and substitutes available if they don’t like a particular meal?

Language.

  • Is my loved one’s primary language spoken by staff that will work directly with them? If not, is an interpreter available to help them communicate their needs?

Security.

  • Does the nursing home provide a safe environment? Is it locked at night?
  • Will my loved one’s personal belongings be secure in their room?

Preventive Care.

  • Do residents get preventive care to help keep them healthy? Does the facility help make arrangements to see specialists? (Note: Nursing homes must either provide treatment, or help make appointments and provide transportation to see a specialist.)
  • Is there a screening program for vaccinations, like flu and pneumonia? (Note: Nursing homes are required to provide flu shots each year, but residents have the right to refuse if they don’t want the shot, have already been immunized during the immunization period, or if the shots are medically contraindicated.)

Hospitals.

  • Is there an arrangement with a nearby hospital for emergencies and can personal doctors care for my loved one at that hospital?

Licensing & Certification.

  • Is the nursing home and current administrator licensed in my loved one’s state?  (Have they met certain state or local government agency standards?)
  • Is the nursing home Medicare- and/or Medicaid-certified? (Note: “Certified” means the nursing home meets Medicare and/or Medicaid regulations and the nursing home has passed and continues to pass an inspection survey done by the State Survey Agency. If they’re certified, make sure they haven’t recently lost, or are about to lose their certification.

Charges & fees.

  • Will the nursing home tell me in writing about their services, charges, and fees before my loved one moves into the home? What is included and what is extra? (Note: Medicare- and/or Medicaid-certified nursing homes must tell you this information in writing.) 

To read the full guide, click here.

 

 

Prostate Cancer: The Case For Watchful Waiting

Sarah Jenkins

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Prostate cancer is one of the leading cancer causes of death in men in the US.  The American Cancer Society estimates that approximately 1 in 7 men will be diagnosed with prostate cancer in his lifetime.  But, while this is a widespread condition, and treatment is sometimes warranted, the medical industry has begun to see a shift in the treatment of prostate cancer, choosing to actively monitor patients over time instead of choosing to perform surgery or conduct radiation immediately.  This treatment path is called “watchful waiting”, and is becoming more and more common for men with prostate cancer.

To understand why watchful waiting is becoming a more popular trend, let’s back up a bit and explain a little more about the diagnosis of prostate cancer.  The average age of men diagnosed with prostate cancer is 66 years old.  Common treatment options for prostate cancer have included medication, surgery to remove the prostate, chemotherapy, radiation, and even hormone therapy.  And while these treatments have become more and more effective over the years, they cause unwanted side effects (such as incontinence and impotence) and pose serious risks (like blood clots in the legs and lungs, heart attack, pneumonia, and infections.) There has been much debate around whether or not the benefits of treatment outweigh the added side effects and risks that are introduced when one undergoes these types of therapies.  Additionally, it is not clear if these treatment options will completely eliminate the cancer.  For those patients who are low risk, the benefit of aggressive treatment compared to the potential side effects may just not be worth it. 

What types of patients may be good candidates for watchful waiting?  Those who are not seeing any symptoms from the cancer, those whose cancer is small, and located only in the prostate, and those whose cancer is expected to grow slowly all may benefit from this type of treatment.  Additionally, older men who have a life expectancy of less than 10 years may not benefit from the added years that surgery can offer, making them a better candidate for watchful waiting. 

However, if the cancer is growing steadily, or spreading beyond the prostate, more aggressive treatment is usually recommended.  Men who are diagnosed young may also benefit from more aggressive treatment, as there is a greater chance that the cancer may grow worse over a longer span of time.

Whatever stage you are at, only you and your doctor can decide what is best for you.  Be sure to talk with him or her about the risks and benefits associated with each treatment path prior to making a final decision. 

Ask The Expert: Surgery For BPH?

Sarah Jenkins

NAFC Ask The Expert

Each month, we ask our expert panel to answer one of our reader's questions. To learn more about the NAFC Expert Panel, and how to submit your own question, see below.

Question: What types of surgery options are available for BPH?

Answer: BPH, or Benign Prostatic Hyperplasia, is when a man’s prostate is enlarged.  BPH is a common occurrence in aging men, but may not always require surgery.  Surgery may be considered if you have certain issues (you can’t urinate, have seen blood in your urine, have a partial blockage in your urethra, or have kidney damage), or if your symptoms are so bothersome that surgery makes sense to you.

The typical surgical option that is usually used is transurethral surgery of the prostate.  This is where surgical instruments are passed through the opening in the penis to the prostate. Transurethral resection of the prostate (TURP) is the most common type of transurethral surgery used for BPH. This is when a portion of the prostate is removed.  Other methods of removing some of the prostate include laser therapies, transurethral microwave therapy (TUMT), or transurethral needle ablation (TUNA).  Transurethral incision of the prostate (TUIP) is also sometimes used, which places incisions on the prostate which help to relax the opening to the bladder and allow urine to flow from the bladder more freely.

If you are considering surgery for BPH, talk with your doctor about these options and decide together which one may be the best for you.

The NAFC Expert Panel is made up of some of the top medical professionals in the fields of urology, urogynecology, physical therapy, and surgery. Each month, the experts weigh in on important topics and answers to your questions.  To have one of your questions featured in our Ask an Expert series, send it to us here.

What Exactly Is Sacral Neuromodulation?

Sarah Jenkins

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For those of us with incontinence, we’ve heard about all the mainstream treatment options available – in fact, we’ve probably tried many of them.  Absorbents are a mainstay in our bags, we’ve been on one or two medications to try to control the problem, and may have even tried physical therapy.  We’ve heard some talk of surgical procedures but just aren’t sure we’re ready for that yet.  But did you know that there are other procedures out there to treat this problem too? Ones that are simple to perform in a doctor’s office? 

Sacral neuromodulation (SNM) is a procedure that is performed in your doctor’s office and modulates the nerve activity between the brain and the bladder through electric stimulation of the sacral nerve. The sacral nerve delivers signals between the brain and the bladder.  SNM helps to control these signals, so that the bladder functions normally. 

SNM involves 2 phases – an evaluation phase and an implantation phase.  During the evaluation phase, which lasts around 2 weeks and is designed to see if SNM will be a beneficial option to you, a thin, temporary wire is inserted in your lower back, near the sacral nerves, which control the bladder.  A device is connected to the wire, which delivers electric stimulation to the sacral nerves.

Once your doctor has determined that SNM will be effective for you, the wire used during the evaluation period will be removed and a more permanent device, similar to a pacemaker is implanted just under the skin, usually in the buttocks.  Your doctor will monitor you over time, but in most cases, it has shown to be effective in patients for as many as five years.

SNM is a good option to consider when other treatments, such as physical therapy and medication, have failed.  To find out more about SNM and if it is right for you, talk to your urologist.

Need help finding a urologist in your area? Use the NAFC Specialist Locator!  

Can OAB Be Treated With Surgery?

Sarah Jenkins

When Dalia was 28, she had her first child. She’d had a normal pregnancy, and like many of her friends, had some light leakage after birth, but nothing serious.  Baby #2 followed two years later, and baby #3 one year after that.  It was then that she really began to see a difference in her bladder control. “It was like the flood gates had suddenly opened,” Dalia said.  “Any little thing could trigger an urgent bathroom visit.”  Concerned, Dalia went to her doctor to ask what could be done.  After trying several options that had no effect, or uncomfortable side effects, her doctor finally suggested surgery.  “I was really nervous at first – surgery sounds like such a scary word,” she said.  After reviewing all the options, Dalia’s doctor recommended Interstim to treat her incontinence. Interstim therapy is a form of sacral nerve stimulation, where a device is implanted, usually in the buttocks and helps to block the messages sent by an overactive bladder to the brain, telling the brain that you need to use the restroom.  After the procedure, she saw immediate improvement. “I can’t believe that I waited as long as I did to have this done,” she said. “It’s been a life changer.”

Many women like Dalia suffer from overactive bladder – the urgent and frequent need to use the restroom.  It is estimated that over 33 million people in America struggle with the condition.  And while there are many treatment options available, they don’t always work for everyone.  Initial treatment options like physical therapy, diet regulation, and bladder retraining can do wonders for many, and medications can often help those suffering from OAB.  However some still don’t find relief from these options, and some medications can cause unwanted side effects.  Luckily, there are several surgical options that are effective in improving OAB symptoms. 

What are my options?

Sacral Nerve Stimulation. 

This procedure, like the one Dalia had, regulates the nerve impulses in the bladder.  A small pulse generator is implanted under the skin and blocks messages sent by your bladder to your brain, regulating the nerve impulses in your bladder and reducing the need to urinate unnecessarily. The device can remain in place for as long as you need it, and the process is an outpatient procedure that uses local anesthesia and mild sedation.

Augmentation Cystoplasty.

Augmentation Cystoplasty, is a procedure that increases the size of the bladder.  Often used in severe cases after other treatments have failed, it enables the bladder to store more urine. Your doctor will take a small piece of tissue from your intestine and add it onto the wall of the bladder to enlarge it.  In some cases, a catheter may be needed to empty the bladder after this procedure has been performed.

Urinary Diversion.

Urinary Diversion reroutes the tubes that lead from the kidneys to the bladder to outside of the body through the abdominal wall.  Urine is then collected in an ostomy bag – a specially designed bag to be worn on the abdomen.  This option does require some maintenance, however it allows you to live an active life post surgery. 

Talk To Your Doctor.

Surgery is a common approach for many who have failed on other treatment plans, and your doctor will be able to help you find the best option.  It is important to talk with your doctor to determine not only what type of surgery might work best for you but also when might be the best time to have it.  For example, women who are still interested in having children may wish to wait, since childbirth may compromise any surgery that has already been performed.  Additionally, be sure to ask your doctor about what you can expect post surgery – some surgeries are designed to treat specific symptoms of incontinence, so you may still need medication or physical therapy to treat the other symptoms you experience.

If you are considering surgery, a urological surgeon can help talk through your options.  Visit the NAFC Specialist Locator to find one near you.  (www.nafc.org/find-a-doctor)

 

Pelvic Floor Exercises Specifically For Men

Sarah Jenkins

A guest blog written by Michelle Herbst, PT

As a physical therapist specializing in pelvic floor rehabilitation we are referred to as women’s health physical therapists. But, this a little of a misnomer as men have pelvic floors and can have concerns too. In my experience, men participating in pelvic floor rehabilitation make the best patients. They are engaged, compliant and determined to positively affect their condition.  

Kegels for Men:

Kegels for men can help with erectile dysfunction and urinary and fecal incontinence. They are most effective when performed in a consistent, specific manner and progressed slowly over time. Here are a few ideas and tips for men to consider when performing kegels.

A kegel is a contraction of the pelvic floor muscles. It feels like a gentle pulling up and in of the pelvic floor followed by a relaxation of the entire muscle group. The kegel contraction begins with a slight lift of the tail bone moving forward as a gentle tightening of the muscles between and tail bone and pubic bone. Lastly, the lower abdominals contract slightly. Then the muscles gently release or relax. There may be a feeling of a reversal of the contraction sequence.

There is no need for weights as our body weight and gravity provide resistance. The contraction is a sub-maximal in effort. If kegels are performed too hard and too fast the result may be muscle soreness and aggravation of symptoms. Performing a submaximal contraction is key and mild muscle soreness may be expected.

Avoid breath holding when kegeling. Repetitive contraction of the pelvic floor while holding the breath could aggravate prior back injuries or make pelvic floor symptoms worse. Normal breathing is the standard when kegeling. Your face should not be turning red. After normal breathing while kegeling is mastered you can further enhance the kegel during exhalation. A long exhalation during a kegel - such as you would blowing out a candle - can allow you to improve muscle performance. Here, give it a try: gently tighten the pelvic floor – take a deep breath in and slowing exhale like you are blowing out a candle while holding the kegel muscle contraction. Then release.

Kegels should be progressed gradually and can be progressed by increasing the hold time and number of repetitions. For example, when you first begin kegeling, you will want to measure how long you can hold the muscle contraction before the muscles ‘give away’ and release the kegel. If you can hold one kegel for 3 seconds, without breath holding, use that as your benchmark for holding time.  Next, work your way up to 10 contractions of 3-second holds. Repeat another set of 10 later in the day. Eventually you may work up to completing multiple sets of 10, 3 to 5 times per day while advancing the kegel-hold time to 10 seconds. And, please remember to relax between each consecutive kegel to avoid moderate muscle soreness.

Try kegeling in different positions. Use the above suggestions of progressing the kegel hold time and repetition and apply to your place in space. The combined effect of body weight and gravity can increase the resistance and difficulty of the kegel. For example, if you have been performing your kegels while lying down, try to perform them in a seated position, followed by standing and during your daily activities.

Lastly, consistency and patience are key. If you don’t take your medicine you will not get well. Continue to perform your kegels daily while your symptoms are improving and to maintain your gains. Be creative and patient with progressing kegels. Depending on your starting point it may take weeks or months to progress to performing multiple repetitions in functional positions. Do not give up too soon. Kegels - they are not just for women and can greatly improve a man’s overall health and quality of life. Give them a try.

 

Know The Symptoms Of Prostate Cancer

Sarah Jenkins

Apart from skin cancer, prostate is the most common cancer among men.  And while a large number of men are diagnosed with the condition each year, the survival rate for prostate cancer is generally high if caught early on. There are no warning signs, which is why it is important for men to begin getting screened for prostate cancer at age 50.  However, common symptoms often emerge once the cancer has already started.  These may include any of the following:

  • Frequent urination
  • Weak urine stream
  • Inability to empty the bladder
  • Leaking urine
  • UTI’s, which may feel like a burning sensation during urination or ejaculation
  • Blood in the urine or semen
  • Erectile dysfunction
  • Bone pain or discomfort, especially in pelvis or lower part of the body

It’s important to note that many of the above symptoms can have other causes too.  Enlarged prostate can cause many of the same symptoms as prostate cancer due to the extra pressure placed on the urethra.  Talk to your doctor about any symptoms you’re experiencing so he or she can determine the appropriate course of action.

Need help finding a physician? Use the NAFC Specialist Locator to find one near you.

The Importance of Diet & Exercise In Preventing Diabetes

Sarah Jenkins

We all know the importance of maintaining a healthy diet and getting consistent exercise into our daily lives.  But with over 29.1 million Americans living with Type 2 diabetes – that’s nearly 10% of us! – it’s more important than ever that we get ourselves in check. 

Type 2 diabetes is marked by high levels of blood sugar.  Typically, insulin (produced by the pancreas) helps process sugar (glucose) in the body. However, over time, those with Type 2 diabetes develop insulin resistance, a condition where the body does not use insulin properly and allows glucose to build up in the blood.  This starves the cells for energy and, over time, can create lots of other damage in the body, including to the eyes, kidneys, nerves, or the heart.  Nerve damage can sometimes also occur in the bladder, causing diabetics to experience incontinence. While men and women are both at risk for developing diabetes, men have been found to be more susceptible to the disease based purely on biology.

Many people with type 2 diabetes can control their blood sugar with a healthy diet and regular exercise.  What does this look like? A diet rich in vegetables (these should take up half your plate!), fruit, lean protein, whole grains, low-fat dairy in moderate amounts, and healthy fats from things like avocado and nuts is best.  Additionally, getting 30 minutes of good exercises per day (think brisk walking, strength training, and stretching) at least 5 days a week can help keep your blood glucose in check, and lower your risk for diabetes, heart disease and stroke. 

Want to learn more about how to prevent or manage diabetes with diet and exercise? Check out the recommendations from the American Diabetes Association and get yourself on the right path today.

Ask An Expert: Botox for OAB

Sarah Jenkins

Each month, we ask our expert panel to answer one of our reader's questions. To learn more about the NAFC Expert Panel, and how to submit your own question, see below.

Question: I’ve heard that Botox can help with OAB – is this true?  I thought Botox was used for wrinkles!

Answer: Yes! Besides being used to treat wrinkles, Botox has also been approved to treat Overactive Bladder symptoms, such as the strong need to urinate, urgency, urgency incontinence, and frequency of using the bathroom.  When you have OAB, your bladder muscles contract uncontrollably and you feel the frequent need to empty your bladder.  Botox works by blocking the signals that trigger OAB, and is administered with a small tube (cystoscope) that is inserted through the urethra. BOTOX goes through a small needle into multiple areas of your bladder muscle. Treatments take only about an hour in your doctor’s office and may be needed as few as 1-2 times per year.  Botox can provide significant relief to patients suffering from OAB by reducing many of the symptoms normally experienced, including leakage.  BOTOX should be administered by a trained specialist such as a Urologist or Urogynecologist.  To find a specialist  near you, visit the NAFC Specialist Locator.

The NAFC Expert Panel is made up of some of the top medical professionals in the fields of urology, urogynecology, physical therapy, and surgery. Each month, the experts weigh in on important topics and answers to your questions.  To have one of your questions featured in our Ask an Expert series, send it to us here.

Sign Up For The NAFC 8-Week Challenge

Sarah Jenkins

NAFC has always been a promoter of good health, which can benefit so many aspects of our lives.  We believe that even small improvements made over a series of time can make a huge difference.  That is why we are excited to announce the launch of the new NAFC 8-Week Challenge for Better Bladder Health.  

Because Incontinence can often be a side effect of an underlying condition, it can potentially say a lot about your health so it’s important to not ignore it.  And even if it exists on it’s own, it deserves to be treated.

NAFC is challenging you to improve your bladder health.  Choose one of four 8-week challenges listed here and NAFC will send you tips and tricks along the way to help you succeed.  At the end of the 8 weeks, two lucky participants will win a free month membership to Core Power Yoga (valued at $190) to help them continue on their treatment path toward better bladder and overall health. 

So go ahead – take a step toward improving your bladder health by joining us, and others, in the NAFC 8-week challenge.  Completing any one of the challenges will get you that much closer to a life without leaks.

Accept The Challenge!

Why Didn't Anyone Tell Me?

Sarah Jenkins

A Guest Blog By Sally Connor

I am a 38-year old woman, and I am angry. Angry that my body has changed so much since I’ve had children, angry that I developed a prolapsed bladder after the birth of my first son, angry that I can no longer run the way I used to without making several trips to the bathroom, or worse, wetting myself. I am angry with my doctors for not telling me that this may be a side effect of pregnancy and that there were steps I could have taken to prevent it. I’m angry with other women for not telling me that it has happened to them. I am angry for my sheer ignorance of the situation until it happened to me. But more than anything, I am angry that no one knows any of this because in our society, it feels too embarrassing to really talk about.

When we are young, we don’t think about these things. Before I had children, I don’t think that I ever even gave the pelvic floor much thought. Quite frankly, I didn’t even know what it was.  Here is what I didn’t know:  That the pelvic floor muscles act as a basket, supporting your bladder, uterus, and rectum. It is also connected to and supported by your deepest core muscles – your transverse abdominus (below the ‘six pack’ abs) and your multifidus (the tiny muscles that support the spine), and is affected by almost every movement you make.  The pelvic floor, what I now refer to as the epicenter of my body, is called upon every time you sit, stand, squat, walk, and even breathe. So I ask, why is it that we don’t hear more about this vital web of muscles? Why are we kept in the dark until it is too late? Because, really, much of this can usually be prevented. The pelvic floor, just like any other muscle in the body, can be strengthened and trained. With regular exercise, the pelvic floor and the supporting muscles around it can provide a strong foundation for continence for your entire life. But, like any other muscle, if it is already in a weakened state, and then becomes traumatized by something like childbirth, well, the damage is done. That is the case with prolapse. You can try to repair it, and may see marked improvement through physical therapy, or even surgery, but once the damage is done, it is done. 

It doesn’t mean that there is no hope though. I know this. I have seen great improvement in my symptoms and am grateful to have had access to a very skilled physical therapist who was able to show me how to strengthen things up ‘down there’. But, I still do experience some symptoms and I can’t help wonder if things would be the same had I been more aware of this muscle and what I should have been doing to keep it strong prior to and during pregnancy. 

With over 25 million Americans experiencing incontinence, I am baffled that the issue is not publically talked about more often. It is estimated that about 40% of women will experience prolapse at some point in their life. When will we decide that these conditions deserve attention? Talking about them would encourage more people to get help, and, maybe even more importantly, take steps to prevent it. Instead, the silence only encourages the shame, embarrassment, and isolation that many people with incontinence experience.  It does nothing to help those who are experiencing the issue to know there are ways to treat it.  Nor does it educate those who have not experienced it to know that this is something that should be considered. Until we can all be more open and recognize that this is a problem worth talking about (shouting about!), we will be a society that continues to allow it’s people to ‘quietly manage their symptoms’ instead of really preventing or treating them. 

So please, speak up about your incontinence, your prolapse, or any other pelvic floor issue you may have. While it may be common, it’s not normal, and is nothing that anyone should have to suffer with in silence.

About the author:  Sally Connor is a mother, wife, entrepreneur, and homemaker who suffered a prolapse after giving birth to her son. She has refused to let this symptom rule her life and strives to increase awareness of pelvic floor issues and what women can do about them by simply talking more about the issue.  She hopes that one day pelvic floor issues and incontinence will be a less taboo subject.

The Pelvic Floor As We Age. A look at how it changes through the different phases of life (pregnancy/menopause/etc.).

Sarah Jenkins

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A Guest Post By Michelle Herbst, PT

Times have changed. The pelvic floor was once considered a taboo subject. As women age their birthing history and overall muscle weakness may catch up with them.  A healthy pelvic floor can be achieved as we age but often times little attention is paid to our pelvic floor until it starts to fail. It can be difficult for women to seek medical attention due to feelings of embarrassment and despair. But, advances in health care and knowledge of the aging process allows today’s women to seek effective treatments.

Let’s step back and take a closer look at the pelvic floor as we age.

The pelvic floor is a sling supporting our abdominal and pelvic organs. It is made up of our muscles and connective tissues which I like to think of as our active and passive pelvic support structures. The pelvic floor muscles, or active pelvic support structures, create a muscular sling whereas our passive pelvic support structures are made of connective tissue called fascia. Fascia is a spider-web like material traveling through and covering the pelvic floor.

The active and passive pelvic support system are one in the same. They are knitted together interlacing creating a dynamic basin of support. Healthy pelvic support system work together controlling our sphincters, limit the downward descent of the pelvic organs and aide in sexual appreciation. Damage or weakness to the pelvic support system may result in symptoms of pelvic floor dysfunctions resulting in leakage and pelvic organ prolapse.

The pelvic floor over time.     

Pregnancy, child birth and the post-partum period is a time of great change. The interlacing nature of the active and passive pelvic floor support systems protect the mother and baby as they both grown. Child birth calls on the pelvic support system to push and slide the baby out into the world. The pelvic floor muscles can heal in as quickly as 6 weeks after delivery. But, the physical strain of living and creating new life can be taxing on the pelvic support system leaving it overstretched and weak.

The prescription is often kegels and post-partum kegels can be hard to do. The muscles are lengthened, very weak and trying to ‘reconnect’ to their nerve supply. In an attempt to ‘get it all done’, the post-partum mom is often multi-tasking while doing kegels. Their brain is preoccupied, sleep deprived and foggy. Despite good intentions, many new mothers ‘muscle their way through’ relying on other muscle groups to assist or do the job of the pelvic floor. Overtime with due diligence and a sleeping baby – the brain fog lifts, kegels are consistent and pelvic floor muscles recover allowing the new mom to return to and enjoy life’s pleasures and adventures.

Life continues to click at a fast pace.  The biological process of aging ticks away. The passage of time can be bittersweet. In the 3rd through 5th decades of a woman’s life, she will begin to experience a gradual loss in overall muscle strength and tensile strength of their connective tissue. In their 4th and 5th decades, peri-menopause ushers in a decrease in circulating estrogen and progesterone. The conclusion of these gradual changes are marked by menopause which is typically complete during the 5th decade. Life starts to catch up with you. The birthing of children, past injuries, the development of chronic health conditions and your family history may predispose the active and passive support system to overall weakening and loss of integrity resulting in leakage, organ prolapse and decline in sexual function.

What to do?

1.     Protect and strengthen your active pelvic support system by engaging in a strength program and doing your kegels. Peak muscle strength occurs in twenties or thirties. And, unless a woman is engaging in a strength program she will begin lose muscle mass and strength.

2.     Protect the passive pelvic support system by avoiding straining during bowel movements and avoid holding your breath while lifting, pushing and pulling. The passive pelvic support system can not ‘fix itself’ and will need to rely strength of the active pelvic support system. So, revisit number 1 again and again and again …

3.     Stay healthy and seek out your doctor’s advice when you are sick or notice your first sign of leakage or prolapse. The treatment often times isn’t as bad as you think it will be.

Michelle Herbst, PT

Michelle Herbst, PT