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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.

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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 daily to learn tips on caring for loved ones with incontinence, overcoming symptoms, and first hand accounts from experts and those suffering from incontinence. 

 

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 An 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

Why You Shouldn't Just Live With OAB

Sarah Jenkins

A Guest Post By Steven G. Gregg, Ph.D., Executive Director, NAFC

Overactive bladder affects millions of American women and impacts their daily lives in many ways.  Some women experience mild symptoms – running to the bathroom a few times per day – without much more impact to their lives than that.  Others are on the other end of the spectrum – unable to make it to the restroom in time, dealing with constant leaks, and always living in fear of having an accident.  And while the medical community has made major strides in treatments available for OAB, many women continue to suffer in silence. 

NAFC recently conducted a survey of women dealing with OAB to see how many of them actually reach out to their doctor about their symptoms, how many receive treatment, and how many actively treat their condition.  And while some of the results were expected, many of the answers surprised us. 

When asked patients why they had not talked to their doctor about their condition, embarrassment topped the list.  This is not so shocking, given the nature of OAB.  However what really gave us pause is that of those who have never been diagnosed, 54% of women and 71% of men say they actually have had a discussion with their doctor.

These findings reveal that for different reasons, many are still not receiving treatment for OAB, a largely treatable condition.  While there are definitely those who are simply too embarrassed to talk to someone about their condition (I’ll get to that in a minute) many people are in fact reaching out to their doctors for help and, for some reason, they are not getting it.  Perhaps they are being prescribed a treatment that doesn’t work for them or has too many side effects.  Perhaps their doctor has brushed off their concerns without elevating them to a specialist, like a urologist, who may be able to provide a more customized treatment.  Or maybe the patients downplayed their symptoms due to their own embarrassment.  Whatever the case may be, it is startling that such a large percentage of people continue to suffer even after requesting help.  My advice to you would be this:  don’t settle! Continue to talk to your doctor (or another doctor, if yours won’t listen) and demand a treatment plan.  Educate yourself on your condition and the options available to you (NAFC is a great resource for this!).  There are so many treatment options – medication, physical therapy, botox, interstim, ptsn, surgery, etc.  Learn all you can about these so that you are aware of what is available and know what you are willing to try.   Be your own advocate and continue to push the medical professionals in your life to help put you on a path toward treatment.

Now, for those of you who are still too embarrassed to talk to your doctor at all, let’s talk about this.  Yes, OAB can be an embarrassing condition.  Yes, it can be hard to bring this subject up to your doctor.  And yes, based on our findings, your doctor may even imply that OAB is nothing to worry about.  But, let me tell you – OAB is not a part of getting older.  It’s not normal.  It can, and should be treated.  So it’s time, once and for all, to brush off your embarrassment, arm yourself with information about treatment options, and march into your doctor’s office to talk about this condition and demand treatment for it.  If your case is severe (and really, even if it’s not), you may ask for a referral to see a urologist to ensure you are seeing someone who is specialized in treating OAB.  And if you need help finding a specialist, use the NAFC locator tool to find one in your area.

What’s the main takeaway here?  If you struggle with symptoms of OAB, it’s time to get treatment.  OAB is something that no one has to live with and with so many treatment options available there is no reason that anyone should.  Take matters into your own hands, be brave, speak up, and demand treatment.  If you don’t do it for yourself, no one else will.

About Steve Gregg, PhD  
Steve Gregg is the Executive Director of the National Association for Continence. He has a PhD in exercise biochemistry from the University of California at Berkeley, and has spent his career in product marketing at agencies such as Ogilvy & Mather, Ammirati Puris Lintas, and most recently, at AbelsonTaylor, among the nation's leading medical marketing and advertising firms.  While at AbelsonTaylor, Steve played a key role in the company's direct-to-physician sleep aide category as well as their direct-to-consumer women's vein health and child nutrition efforts. Steve is also a world-class athlete, having medaled in nearly every major world swimming event, including the Olympic Games in 1976. 

"What I appreciate most about my role at the NAFC is that I have the opportunity to combine my executive leadership background with my passion for healthcare promotion - especially patient advocacy," Steve says. "It's a great challenge to increase awareness and understanding of continence issues, and we have the opportunity to make strides that can improve the lives for literally millions of friends and family members. I don't think I've ever had a more important mission in my entire career."

Put Yourself First

Sarah Jenkins

Women…the ultimate caregivers.  We take care of our spouse, our kids, our parents, our pets and all the nuances that come with keeping a house, a job, a family…a life.  We are superheroes!  In fact, we are so good at taking care of everyone and everything, we often tend to forget about one of the most important things we should be taking care of - ourselves.

And this is such a shame, really.  Because all the people and things that need us…they need us to be the best versions of ourselves.  That means getting good sleep, exercising, eating well, getting regular check ups, and maintaining a healthy weight. And those other nagging things we deal with all the time that get pushed to the backburner because we ‘don’t have time’, ‘it’s not that bad’, or ‘it’s just a part of getting older’ (ahem…incontinence)? Those deserve attention too. Because life is just too short to just live with them.  And most of the time, they are things that can be treated.

So women, please – think about yourselves this month and think about ways you can put yourself first.  Go for that walk, take a little extra time to make a deliciously healthy dinner, call your doctor for a check up.  Do something for yourself and you will see that the joy and health it brings you will spill over into all the other wonderful things you care about too.

Want to do something extra nice for yourself?  Take the NAFC 8-Week Challenge!

Is A Pessary Right For Me?

Sarah Jenkins

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Pelvic organ prolapse (POP) can cause a woman to experience many symptoms - incontinence, a heavy feeling in the vagina, or feeling like you are sitting on a ball are all associated with POP.  If you have struggled with a prolapse, have not found relief from physical therapy, and are not ready for surgery, a pessary may be a good option for you.

What is a pessary?

A pessary is a device that is inserted into the vagina to help support the organs that are usually supported by the pelvic floor (Uterus, Bladder and Rectum).  A pessary can reduce the symptoms associated with POP and can sometimes even eliminate them. 

How do I get a pessary?

Talk to your doctor about your options.  You will need to get fitted for a pessary, a process that can take several tries in order to get the right fit.  This is important, since an ill-fitting pessary can cause irritation to the vaginal wall which and create more complications. So be sure to tell your doctor if it feels uncomfortable or feels like it is placing too much pressure on the vaginal wall.

Who should use a Pessary?

Women who are experiencing mild symptoms, pregnant women or women who still wish to become pregnant, or women who wish not to have surgery are all good candidates for a pessary.

Are there any risks?

Most risks involve irritation from the pessary, which can be minimized by making sure that you get a good fit to begin with, and maintaining proper care of the pessary.  These risks include sores or bleeding in the vaginal wall, wearing away of the vaginal wall, or fistulas. 

What do I need to do?

Maintenance of a pessary is fairly simple – many women are able to remove and reinsert the pessary on their own, which allows for regular cleaning.  For women who do not wish to do this or have trouble removing it, they may have it done regularly at their doctor’s office.  You should see their doctor for follow up visits every 6 months to ensure there is no irritation or harm to the vagina from pessary use.  Your doctor will also clean the pessary and check for any deformation such as cracking to ensure it is still in good working order.  Replacements will be made as needed.

Who should I see?

A physical therapist specializing in women’s health, or a urologist can fit you for a pessary.  To find a specialist in your area, visit the NAFC Specialist Locator.

With Incontinence Treatment, Educating Yourself Is Half The Battle

Sarah Jenkins

Millions of Americans experience some form of incontinence.  And, while this condition affects both genders, if you are a woman, you are more likely to suffer from incontinence than men due to things like pregnancy, childbirth, and menopause. 

There are several different types of incontinence you may experience:

  • Stress Urinary Incontinence:  SUI occurs when any extra pressure placed on your bladder or abdomen causes you to leak urine.  Things like sneezing, laughing, or certain exercise all may trigger SUI.   
  • Urge Incontinence: Also known as Overactive Bladder, Urge Incontinence is the sudden, frequent feeling that you need to use the restroom. 
  • Mixed Incontinence: Many people suffer from both Stress Urinary Incontinence and Urge Incontinence combined.
  • Urinary Retention: This type of incontinence occurs when you are unable to completely empty your bladder, leading to leaks. 

The good news is that all of these conditions are treatable.  And now, more than ever, there are countless options for treatment, so if you haven’t yet found something that works for you, try again!  Here are some popular treatment options:

  • Absorbent products: Probably one of the most widely used treatment options, absorbent products are a good first line treatment for those who experience leaks.  There are many different types and fit is very important, so expect to try out a few and see what works best for you. And whatever you do, don’t use sanitary pads in place of absorbent products specifically designed for leaks – the two are made of different materials and sanitary pads are not designed to hold urine, so leaks are likely to occur if you use them for that purpose.
  • Behavioral Therapy:  Before trying out medication or other procedures, you may want to tweak some of your behaviors to see if they have any effect.  Things like altering your diet to eliminate bladder-irritating foods, starting a physical therapy routine, or practicing bladder retraining can all have an effect on managing your symptoms.
  • Medications: There are a number of medications that may help you with bladder control.  Most medications work by calming the bladder and reducing the spasms that sometimes happen and cause leakage.  Talk with your doctor about the different types and learn what may work best for you.
  • Non-invasive procedures: If you’ve tried medications and have not seen results, or experienced unwanted side effects, you may want to give a non-invasive procedure a try.  InterStim, Botox, and PTNS are all simple procedures that can be administered in a urologist’s office and can have a significant effect on symptoms and quality of life.  Talk with your doctor to learn more about these procedures and what you can expect if you choose to go this route.
  • Surgery:  Several surgical options exist for those experiencing urinary incontinence.  Surgery is often a more permanent solution, and is a common approach for many who have failed on other treatment plans.  But, it’s not for everyone, and may not always eliminate all your symptoms.  Be sure to talk to your doctor (usually a urological surgeon) about what may work for you and what you can expect after surgery.

Finding the best treatment plan for you requires you to play an active role.  Know your options and educate yourself about the different treatments available so you are better able to discuss them with your physician and make an informed decision together. 

To find a specialist in your area, visit the NAFC Specialist Locator and make an appointment today!

 

What To Expect With A Hysterectomy

Sarah Jenkins

A hysterectomy is a surgical procedure done to remove a woman’s uterus. There are several potential reasons a woman may need a hysterectomy:

  • Uterine Fibroids that cause bleeding, pain and other problems
  • Abnormal vaginal bleeding
  • Chronic pelvic pains
  • Endometriosis
  • Cancer of uterus, ovaries or cervix

This operation is either done to remove the part or the entire uterus after going through a rigorous and thorough checkup. In United States, 1 out of 3 women have gone through hysterectomy by the age they are 60.  It is the second most common surgery in women, followed only by cesarean delivery.  The majority of this operation is done to treat noncancerous conditions in women.

Even though a hysterectomy is a fairly safe surgery, there are certain side effects associated with it. Some of these include problems related to anesthesia, infection, bleeding, blood clots, injury to internal organs and loss of ovarian functions, which means no menstruation. Some women also experience less interest in sex, which can be treated with hormone therapy. And, if this surgery is done before a woman reaches menopause, she may experience menopausal type symptoms, such as hot flashes, mood swings, and vaginal dryness.

A common side effect of having a hysterectomy is incontinence. After the surgery, nerves of the bladder may be damaged because of their nearness to uterus. This can cause stress incontinence, the involuntary release of urine during things like exercise, sexual activity, sneezing or coughing – all of which put increased pressure on the abdomen. Fortunately, there are many treatment options available, so if you have incontinence as a result of a hysterectomy, talk to your doctor about what you can do.  Physical therapy, medication, and in extreme cases, even surgery can be used to treat the problem.

While many women are happy to be relieved of the symptoms they experienced prior to a hysterectomy, the changes to a woman’s body after surgery can be drastic. A full recovery after hysterectomy generally takes 6-8 weeks, after which it is advised to start doing regular activities with caution. The body may need additional time to adjust to changes in hormone levels. 

Even though this is a common surgery, having a hysterectomy is a major decision for most women. There are several procedures commonly used for hysterectomy like abdominal, vaginal or laparoscopic. Your doctor will be able to walk you through the pros and cons of each option, and help you decide on what is best for you. Visit the NAFC Specialist Locator to find a specialist in your area.

Healthy At Every Age

Steve Gregg

Many of us let far too much time go by without getting the proper checks.  Are you keeping up with your health? 

May and June are Women's and Men's Health months and we can't think of a better time to encourage you to go get a check up. Do you know the health exams you should be getting at every age? Visiting your doctor for regular check ups and tests is important in order to catch potential concerns and avoid future problems.

See below for a complete list of recommended tests by age from the National Institute of Health (NIH), and schedule an appointment with your doctor to take control of your health!

Women

Ages 18 – 39

Ages 40 – 64 

Over 65

 

Men 

Ages 18 – 39

Ages 40 – 54

Over 65

Preparing Your Pelvic Floor For Pregnancy And Beyond

Sarah Jenkins

A guest blog written by Michelle Herbst, PT

Congratulations! As you prepare for your baby there is a lot to think about. Doctor’s appointments. Baby showers. Child care. Nervous talks with the Dad-to-be. And, don’t forget - YOU. When you start sharing your news - everyone will give you advice. Some stories will be embellished for the good and others will be overstated for how difficult their pregnancy was. But, keep in mind - this is your experience.

Realistic Expectations:

Some Moms-to-be have problems with leakage. Others do not. A positive pregnancy test does not mean you will develop incontinence or a prolapse - which is a descent of the pelvic organs into the vaginal canal. But, normal changes during pregnancy and the process of labor and delivery can set up the conditions for incontinence and prolapse to occur.  

So, here is my advice as a Mom and a physical therapist for preparing your mind and body for your big day.

Kegel:

You will read about these. Your OB Nurse will ask, ‘Are you doing Kegels?’ But, why are Kegels so important during pregnancy?

Performing Kegels during pregnancy can help you prevent or manage bouts of leakage, and will also help you tune in and tone the muscles that will help push and slide your baby out of the birth canal. Here are a more few reasons why Kegels are so important:

-        To establish a mind-body connection of how the kegel muscles feel when activated.

-        To help create stability of spine and pelvis as your baby grows.

-        To prepare for the arrival of your baby and protection of your pelvic organs during delivery.

 

Labor can be quick or long. Labor can be easy or difficult. You do not get to choose. But, with preparation of your mind and muscles, along with the skills of your birthing team, the end result will be you holding your precious new baby.

Thoughts on Kegels during Pregnancy:

Think of the pelvic floor as a muscular sling that is tethered between your pelvic bone and tailbone. During pregnancy and labor the pelvic floor muscles lengthen but also need to be able push. The goal of performing Kegels during pregnancy is to improve the strength and function of the pelvic floor as well as encourage lengthening of the pelvic floor muscles.

When performing a Kegel it will feel like a gentle tightening and lifting up and in of the muscles between the pubic bone and tail bone. You may also feel a slight tightening between the belly button and pubic bone. That is your abdominals helping out too. That is OK. Now, hold the Kegel as you inhale and exhale. Relax, and let your pelvic floor muscles return to a normal resting tone or sensation.

The Kegel is a cyclic contraction. It is a shortening of the muscle fibers followed by a relaxation and lengthening of the muscles. If you contract the pelvic floor, and follow that with another pelvic floor contraction without focusing on letting the muscles relax and lengthen, you are training the pelvic floor to become shortened strong muscles not the lengthened strong muscles needed to help push and slide your baby out.

Squat:

Yes – squat. Deep squatting is a normal position to void and give birth. Performing a deep squat as an exercise will help you prepare for the positioning and muscle work needed during delivery.  Deep squatting will open your hips, aide in lengthening the pelvic floor and strengthen your glutes. 

How do I do this?

Slowly work into a squat. You may want to or need to keep your squat shallow by holding onto the back of a sturdy chair or counter top as you start bending at your hips and knees. Keep your gaze forward. Work on keeping your knees behind your toes or stacked above your ankle. Think about keeping your shins perpendicular to the floor. If you are able to get into a deep squat, you may want to place your hands at your chest and gently push your elbows to the inside of your knees.

How long and how many?

This will depend on you. You may want to focus on working into and holding the deep squat. Once you have achieved a deep squat you can work on relaxing into this position. Or, you may want to perform slow repetitions of a shallow squat to standing position and put your emphasis on tightening the glutes when returning to standing.

There really isn’t a right or wrong way – just your way and your focus or intent of the exercise. Pay attention to how you feel and listen to your body.

Your Story:

There will be aspects of your pregnancy and the arrival of your baby that you will not be able to control. But, remember, this is your story. You can prepare your mind and body to set up the best possible set of circumstances to deliver a healthy YOU to motherhood. 

Michelle Herbst, PT

Michelle Herbst, PT

Ask An Expert: Physical Therapy After Childbirth

Sarah Jenkins

Each month, we ask an expert to answer one of our reader's questions.  This month we're happy to welcome Victoria Yeisly, DPT as our expert contributor.

Question: I’ve heard that in Europe it is standard for most women to begin physical therapy to strengthen their pelvic floor as soon as they have given birth. Do you think women in the United States should be seeing a PT after having a baby, regardless of whether they are having symptoms or not?

Expert Answer: Absolutely!  I support this practice for any woman after having a baby, including both vaginal and C-section deliveries.  Think about it, during the pregnancy, the body changes so drastically, so quickly!  Ligaments loosen; alignment changes, hormones fluctuate, and anywhere from 20-50 lbs may be gained.  Then, you either push a baby out of your vagina or have a major abdominal surgery.  To think that the body just heals and is “back to normal” 6 weeks postpartum is just ridiculous.  In the OB practice where I work, there are 4 of us pelvic floor PTs integrated with the doctors and midwives to help serve this population so women can return to pre-baby function with greater ease and comfort.  In my opinion, this should be the standard of practice for all women.  At minimum, doctors and midwives should at least be making each woman aware of this treatment and let them decide if pelvic floor PT should be a part of their postpartum rehabilitation.  

Have a question you'd like answered? Ask us! Your question may be featured in an upcoming Ask An Expert post!

About Our Expert:  Victoria Yeisley, DPT, has been exclusively practicing pelvic floor physical therapy for the past eight years, with an emphasis on prenatal and post-partum care.  She currently lives in Chicago, IL, and practices at Northwestern Medical Group OBGYN, where she is integrated into the OBGYN healthcare team, as well as working at Chicago Physical Therapists, a private practice.  Victoria is passionate about the care and support of women during the childbearing years and her goal is to increase the awareness of the importance of women's health and treating pelvic floor dysfunction throughout the lifespan.  She is currently pregnant with her first child and expecting in June of 2016!

The Mama Body: Physical Therapy During And After Pregnancy

Sarah Jenkins

A Guest Blog by Lizanne Pastore PT, MA, COMT

Eighty percent of the bodily changes occurring during pregnancy happen in the first trimester!  Isn’t that astounding?  A woman’s body must adjust quickly to a 40% increase in fluid volume, increased heart and respiratory rates and myriad other changes that may affect us in different ways.  The fluid volume increase, for example, can make our connective tissues weaker—our tendons can get a little mushy and our nerves and blood vessels a bit softer.  This extra fluid and tissue weakening makes us more prone to things like leg swelling, varicosities, tendonitis, carpal tunnel syndrome, or sciatica.  

The hormonal changes in pregnancy play a big role in our metabolism, mood, memory and, of course, ligamentous laxity.  Some pregnant women experience instability not only in the pelvis and hips, but also in the joints of the spine, elbows, and wrists.  Our musculoskeletal system is taxed by these changes even before the baby gets very big.  Then, as baby grows, we might begin seeing rectus abdominis separation (“diastasis recti,”) spinal problems from posture and center of gravity changes, even rib dysfunction as the ribs are forced out and up to make room for belly.  Foot pain from falling arches from the sudden weight gain can occur, and on and on. 

In the pelvic girdle, there is a list of other maladies that can be downright scary to a pregnant or postpartum mama.  And most women are not warned about these potential problems.   Pelvic girdle pain manifesting as coccyx, pubic or sacroiliac joint pain; groin or hip pain; pelvic muscle or nerve pain; plus urinary or fecal incontinence or pelvic organ prolapse are some of the more common things occurring during or after pregnancy. 

After birth, as Mom is busy caring for her newborn and any other children at home—schlepping heavy car seats, strollers, laundry baskets, breastfeeding through the day and night, lifting ever-heavier babies into and out of cribs—she wonders why everything hurts, or why she feels a clicking in her pelvic bones when she lifts her leg!  Well, she is busy performing exceedingly challenging tasks with a sub-optimal musculo-skeletal-neural system (not to mention sleep deprivation!) 

It is well documented that both pregnancy and vaginal birth increases a woman’s risk of developing pelvic organ prolapse or becoming incontinent later in life.  And many women think that leaking during or after birth is “normal” because their friends, moms, aunts, and sisters leaked, plus there are 20 different brands of incontinence pads to choose from in the drugstore, so it “must” be normal.   

But this is wrong; leaking and pelvic organ prolapse is common, but not normal or OK.   The same holds true for back or pelvic pain.  Sure pregnancy puts demands on our bodies, but there is no reason to “put up” with pain, leaking, prolapse, numb hands or legs!  There is a health professional who knows all about this—a physical therapist specially trained in women’s health issues and the pelvic floor.  These PT’s are special – they understand the pregnant and postpartum body and are experts in negotiating a path to health and strength for women with special concerns.

After an initial assessment, which often includes a thorough pelvic muscle exam and possibly even a biofeedback analysis, the woman is prescribed a home program.  This program may include a combination of postural or corrective exercises, motor training or strengthening exercises, bladder and bowel re-training, special instruction to change movement strategies to limit stressors on the body, and even self-care techniques for pain or prolapse, such as self massage for constipation, or gentle inversions for prolapse. 

Wouldn’t it be amazing if every pregnant woman and new mama could have a visit with a PT like this?  Guess what – they can!  If you are reading this article and are pregnant talk about this option with your doctor.  And if you have friends, sisters, aunts and co-workers who might be pregnant or new moms, talk to them about it.  Tell them to ask their doctors for a referral to woman’s health physical therapist!  

Need help finding a qualified PT? Visit the NAFC Specialist Locator to find one in your area.

About the author:  A physical therapist for 29 years, Lizanne has specialized in treating women and men with complex pelvic floor and pelvic girdle issues since 2005.  She has worked primarily in San Francisco and the Bay Area, running a successful private practice for the past 18 years. She writes, lectures, and teaches about pelvic health at the professional and community levels and is currently a board member of the NAFC.