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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
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National Association for Continence is a national, private, non-profit 501(c)(3) organization dedicated to improving the quality of life of people with incontinence, voiding dysfunction, and related pelvic floor disorders. NAFC's purpose is to be the leading source for public education and advocacy about the causes, prevention, diagnosis, treatments, and management alternatives for incontinence.  

BHEALTH BLOG

The BHEALTH blog brings you tips and tricks on all things incontinence.  Log in daily to learn tips on caring for loved ones, overcoming symptoms, and first hand accounts from experts and those suffering from incontinence. 

 

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.  

Prolapse After Pregnancy – It’s Not Your Fault.

Sarah Jenkins

Around 6 weeks postpartum, I had expected to feel a bit more like myself.  I had avoided exploring anything in the vaginal area for fear of what I would find, but had felt a general heaviness since I had given birth.  Not knowing for sure if this was normal, I made an appointment with my doctor to get checked out. 

Upon examination, my doctor confirmed that I had a prolapsed bladder.  His tone was nonchalant, as if it was totally normal and something that just happened sometimes. 

I was completely shocked. What had gone wrong?  And why did I never hear that this was a possibility?  I immediately started blaming myself.  Why had I not done more kegels during my pregnancy?  Why didn’t I do more research to know that something like this could happen?  Did the decision to use a vacuum during the last bit of pushing influence this?  What could I have done to prevent this?

But the truth is, some women really are just more susceptible to prolapse.  While a prolapse can occur for many reasons, some women have more of a genetic risk for the condition due to the strength of the connective tissues.  It’s not your fault. 


That being said, there are some things that may help you either avoid a prolapse, or at least improve your symptoms if you have one:

  • Maintain a normal weight.  If you are overweight, you are more susceptible to a prolapse due to increased pressure inside the abdomen. 
  • Avoid constipation.  Becoming constipated can cause you to strain during bowel movements, increasing the chance of a prolapse.  Ensure you are eating a high fiber diet and drink plenty of water every day.
  • Keep active.  A regular exercise plan keeps your weight in check, and also helps promote healthy bowels.  Be sure to include your pelvic muscles in your daily workout routine too.
  • Avoid extra pressure inside the abdomen.  Things like lifting heavy objects, and chronic coughing, create persistent pressure, which can increase the likelihood of developing a prolapse, or making your symptoms worse if you have one.  Stay healthy and avoid strenuous lifting. 

Whatever you do though, don’t blame yourself for developing a prolapse.  Instead, use that energy to find out what you can do to improve your symptoms and treat the condition.  Talk to your doctor about your options, and find a qualified physical therapist to help you learn how to strengthen your muscles to improve symptoms.

Here’s What Your Doctor Won’t Tell You About Your Post-Pregnancy Recovery

Sarah Jenkins

As a pregnant woman, you are bombarded with information – books, blogs, websites, and even strangers on the street love to regale you with stories about what you can expect during this glorious time.  Overly emotional? Check.  Crazy heartburn? Yep.  Strange cravings?  You got it.  Everyone has heard these stories and for most women, it’s not all that surprising when they experience them.  

However, it’s what happens after pregnancy that no one talks about.  But they should. 

Urinary incontinence affects many women during pregnancy. The added stress and weight of your baby pushes down on your bladder, causing leakage that occurs when you cough, sneeze, or exert pressure on your abdominal muscles.  This is known as stress urinary incontinence, or SUI.   But did you know that you might also experience urinary incontinence after you have your baby?   

Most women will experience some leakage after they give birth.  This is natural.  After all, your body has been stretched and pushed to its limits during childbirth, especially if you have given birth vaginally.  However, while most women will see this symptom fade within the weeks after delivery, some will still experience leakage for months or even years after birth.  And even if you saw this symptom disappear after childbirth, there is still a chance you may find it reoccur later on in life.  

The good news is that there are things you can do to treat this problem.  Pelvic floor muscle exercises can help strengthen your muscles during pregnancy, and also restore your muscle function after you’ve given birth. Need some guidance on how to perform them?  Find a physical therapist that specializes in women’s health.  He or she will conduct a full examination, and show you how to perform the proper exercises for your condition.  A PT can be seen as soon as 6 weeks post partum to ensure that things are healing properly and to help you start getting your muscle control back.

The truth is, a good pelvic floor workout should be a part of your daily routine no matter where you are in life.  Pre-pregnancy, you’ll build up your muscle strength, which will help you if and when you become pregnant.  Postpartum exercises will help you get your muscle tone back to where it was before you had birth, which can help ease or even eliminate incontinence symptoms you might experience. And continuing these simple exercises into your later years will help keep you strong as your body and hormones change and make you more susceptible to incontinence symptoms.  So start today – it’s never too late, or too soon to get these muscles in check.

When The “Going Problem” Becomes A Growing Problem

Sarah Jenkins

Concluding his 3-part series on urinary incontinence in men suffering with benign prostatic hyperplasia, Dr. Richard Roach, of Advanced Urology in Oxford, FL, shares the story of a patient who found an alternative to chronic urinary catheter use.  

In my first two posts on the BHEALTH blog, I outlined the link between urinary retention and incontinence in men with benign prostatic hyperplasia (BPH) while highlighting some of the challenges of using indwelling catheters to treat BPH-related symptoms. For many individuals, there are significant drawbacks to long-term catheterization, among them a significantly heightened risk of infection and a variety of lifestyle restrictions. In this, my final post on BPH-related incontinence symptoms, I would like to share a story of one of my patients, and detail how an innovative treatment option transformed his life and ended his reliance on urinary catheters.  

Ray is a 65-year-old man who lives in The Villages, Florida. He was diagnosed with an enlarged prostate when he began experiencing severe BPH symptoms in October 2014. Like many men, he was placed on a Foley catheter, which drained his bladder but also led to discomfort, pain and self-consciousness. For more than six months, continuous use of the Foley catheter severely impacted even the most basic of Ray’s daily activities, and soon a series of urinary tract infections (UTI) led to frequent hospital stays. It was during one of his hospital visits that I was called to treat a UTI.

Ray had a very different future in mind before catheterization interrupted his life. He never envisioned himself spending the rest his days using a catheter; just six months earlier he was an avid golfer with a thriving social life and in relatively good health. Now he was weak, self-conscious about his leg bag and battling one infection after the other. 

During our first meeting he explained that much of his day revolved around catheter care. Ray explained that he was looking for a solution that worked with his lifestyle, not against it. Ray believed he was out of options, but he shared that he wanted just three things:

1.    Restore his continence and ability to naturally urinate
2.    End the recurring urinary tract infections
3.    Resume the daily activities he cherished most

And in Ray’s case, there was a solution. Several weeks after I first examined Ray, we inserted a temporary prostate stent to keep his urethra open and maintain urine flow. Prostatic stents are not yet widely adopted, but I have used them in my practice with great success. Like many patients using a temporary prostate stent with similar physical conditions, Ray immediately saw the benefits: he was able to fill and empty his bladder naturally, he had no more concerns about catheter maintenance, and he resumed nearly all of the daily activities that he couldn’t perform during his period of chronic catheterization. 

“Using the catheter was just not a nice way to live,” Ray told me. “With the stent in place, I felt normal again. Quite simply, I was able to resume my life. I felt healthier physically and mentally, just extremely fortunate to have found an option like the stent to replace the catheter and lead to a more permanent solution to my health problem. The stent saved me from using the Foley for the rest of my life.”

Ray’s case isn’t unique. Men all over the world struggle with incontinence due to BPH and other BPH symptoms. While some patients are not candidates for removal of the catheter, urologists have a wide variety of prostate treatment options. Every chronically catheterized patient should have a discussion with his urologist to understand if a catheter-free lifestyle is possible. 

As we close this series, I encourage all men suffering from symptoms of BPH (incontinence or otherwise) to bear in mind the importance of open dialogue and awareness of alternatives. Find out what treatment options are available to you; ask the right questions and be an informed healthcare consumer. It could make all the difference in the world. 

Best of health, and thanks for reading!

Dr. Richard Roach attended the University of Wisconsin-Madison Medical School and completed his residency at the University of Wisconsin-Madison Hospital and Clinics. After graduation, Dr. Roach moved to Minocqua, Wisconsin and joined the Marshfield Clinic, where he practiced for the next 26 years. In 2013, he moved to Florida and is currently a partner in Advanced Urology Institute. He is certified by the American Board of Urology. His specialties include plasma vaporization for BPH, treatment of female stress incontinence and penile prosthesis for ED. He is also an expert in laser & laparoscopic surgery.

Dr. Richard Roach attended the University of Wisconsin-Madison Medical School and completed his residency at the University of Wisconsin-Madison Hospital and Clinics. After graduation, Dr. Roach moved to Minocqua, Wisconsin and joined the Marshfield Clinic, where he practiced for the next 26 years. In 2013, he moved to Florida and is currently a partner in Advanced Urology Institute. He is certified by the American Board of Urology. His specialties include plasma vaporization for BPH, treatment of female stress incontinence and penile prosthesis for ED. He is also an expert in laser & laparoscopic surgery.

The Hidden (And Not-So-Hidden) Dangers Of Treating Incontinence With Urinary Catheters

Sarah Jenkins

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This is the second in a 3-part series on urinary incontinence in men suffering with benign prostatic hyperplasia. Dr. Richard Roach, of Advanced Urology in Oxford, FL, discusses the challenges of using urinary catheters to treat men with BPH-related incontinence, and the drawbacks of long-term catheterization.  

 

In my last BHEALTH blog post, we touched on the peculiar, yet common link between BPH and incontinence. Among other topics, we reviewed the progression of BPH disease state, to the point that symptoms begin to manifest themselves through urge and stress incontinence. Likewise, we also discussed the role that urinary catheters play in men who are not good candidates for BPH therapies.

So let’s now take a closer look at this population of men who must rely on urinary catheters to manage BPH-related incontinence symptoms, and examine the shortcomings of long-term catheter use:

Losing the ability to void naturally: The first (and most obvious) drawback of chronic catheter use is losing the ability to urinate at-will. Of course, managing supplies and components can be a hassle, but there are also health concerns associated with preventing your bladder to fill and empty on its own. Chronic catheterization, particularly with an indwelling catheter, can increase the risk for deterioration in overall bladder health, which can lead to a permanent inability to store and drain urine naturally, or even cancer.

Heightened infection risk: Perhaps the most immediate health concern with chronic catheter use is the heightened risk of infection. According to the Centers for Disease Control, more than 500,000 patients each year in the U.S. develop urinary tract infections (UTIs) while in the hospital, and indwelling urinary catheters (commonly known as Foley catheters, which reside inside the bladder for either a short or long period of time) are the leading cause. And the CDC numbers only count UTIs acquired while in the hospital; many others develop infections from long-term indwelling catheter use at home.

Compromises to quality of life: The last, but no less important, drawback of chronic catheter use is the impact on quality of life. Many men are simply unable to perform day-to-day activities inside and outside the home. The embarrassment or inconvenience of a drainage bag is a commonly lamented life-limiter, and some types of catheterization restrict a man’s ability to be sexually active, which can strain relationships.

These challenges represent the key reasons that healthcare professionals around the world are seeking alternatives to long-term catheter use. And though it’s not always feasible to have a catheter removed, it’s important to point out that there are alternatives to long-term catheterization.

The final post in this series will highlight the story of one such patient who stopped using a catheter after several challenge-fraught years, and gained back his ability to urinate when he wanted to – without components or supplies, without infections and (most importantly for him) without any significant compromises to his everyday life.

Read part 3 of this series here.

 

Dr. Richard Roach attended the University of Wisconsin-Madison Medical School and completed his residency at the University of Wisconsin-Madison Hospital and Clinics. After graduation, Dr. Roach moved to Minocqua, Wisconsin and joined the Marshfield Clinic, where he practiced for the next 26 years. In 2013, he moved to Florida and is currently a partner in Advanced Urology Institute. He is certified by the American Board of Urology. His specialties include plasma vaporization for BPH, treatment of female stress incontinence and penile prosthesis for ED. He is also an expert in laser & laparoscopic surgery.

Dr. Richard Roach attended the University of Wisconsin-Madison Medical School and completed his residency at the University of Wisconsin-Madison Hospital and Clinics. After graduation, Dr. Roach moved to Minocqua, Wisconsin and joined the Marshfield Clinic, where he practiced for the next 26 years. In 2013, he moved to Florida and is currently a partner in Advanced Urology Institute. He is certified by the American Board of Urology. His specialties include plasma vaporization for BPH, treatment of female stress incontinence and penile prosthesis for ED. He is also an expert in laser & laparoscopic surgery.

4 Bad Habits That May Be Contributing To Your Incontinence

Sarah Jenkins

Think Incontinence is just something that happens to us as we age?  Think again.  Incontinence affects over 25 million Americans, and can happen to anyone, at any age.  There are many things that may put you at risk for leaks, including these four lifestyle habits:

Smoking.  Need yet another reason to kick this bad habit?  Smoking is a bladder irritant, which can cause overactive bladder symptoms, such as urge incontinence.  Many think that the nicotine in cigarettes may increase bladder contractions, which can contribute to these symptoms.  In addition, chronic coughing, which many smokers experience, puts a tremendous amount of pressure on the pelvic floor, causing it to weaken over time.  Quit smoking for good to eliminate this possible contributor to incontinence.

Not getting good exercise.  Staying active every day is important for your overall health, but did you know that it also helps keep your bladder and bowel in check too?  Incorporating regular physical activity, such as walking for 30 minutes each day, helps to stimulate the muscular activity of your bowel, keeping you regular.  It also ensures that you maintain a healthy body weight, which reduces the pressure felt on your pelvic floor.  Incorporating specific pelvic floor exercises into your routine can ensure that you are maintaining good pelvic floor strength, which also helps you to better control leaks.

Keeping A Poor Diet.  We all know that eating well is important.  But a poor diet can also cause bladder or bowel problems by making you constipated.  Constipation contributes to bladder or bowel leakage in a few ways. The rectum and the bladder share many of the same nerves, and constipation can cause these nerves to be overactive and increase urinary frequency (a symptom of overactive bladder).  Additionally, chronic constipation can stretch the sphincter muscles over time, making them too weak and causing fecal incontinence.  Incorporating fiber into your diet can help to keep you regular and avoid constipation.

Not keeping your weight in check. Being overweight puts additional stress on the pelvic floor. Over time, this can cause the pelvic floor to weaken, and can lead to incontinence symptoms.  Obesity can also lead to Type 2 diabetes, which can cause nerve damage in the bladder or bowel.  Keep your weight in check by sticking to a daily exercise routine and maintaining a healthy diet.

 

When Going Gets Tough, The Tough Become Incontinent

Sarah Jenkins

This is the first in a 3-part series on urinary incontinence in men suffering with benign prostatic hyperplasia (BPH). Dr. Richard Roach, of Advanced Urology in Oxford, FL, discusses disease state, symptoms and treatments.

Bearing in mind the fantastic wealth of resources available on the National Association for Continence BHEALTH blog, I thought I would take the opportunity to focus on a somewhat lesser known facet of continence: the unique link between urinary retention and incontinence in men with benign prostatic hyperplasia (BPH).

The classic male patient with BPH often experiences both filling and emptying symptoms. These could manifest themselves in the form of frequency, urgency or weak stream, among others. Patients with BPH will often tell me they feel like they have to go all the time, but can’t seem to go when they stand at the urinal. It’s a perplexing (and frustrating) feeling.

So why am I contributing to a continence blog writing about a population of men who can’t pee? In short, these men often experience stress and overflow incontinence.

It’s counterintuitive, but when you give it some thought, it makes sense.

BPH causes the prostate to enlarge. This growth can cause narrowing of the prostatic urethra, which makes the process of urination more difficult. All the while, the bladder must work harder to overcome the resistance from the obstruction in the urethra. If left untreated, the bladder’s muscular lining will thicken, causing it to weaken and become less efficient at draining – in some cases irrevocably. 

It’s usually at this juncture that symptoms become severe. Men suffer from incomplete emptying, even after using the restroom, and always have the feeling of being “full.” Their frequent trips to the restroom at night cause sleep cycle interruptions. With the bladder stretched, sneezing, laughing or coughing can cause leakage, or in more extreme cases the bladder may leak because it’s simply too full.

If they haven’t found a urologist by this point, usually we find them … recovering in the hospital from acute urinary retention. In this setting, the most immediate relief comes in the form of catheterization, either from an indwelling or intermittent catheter. Usually, the patient’s bladder health and overall physiology dictate whether a de-obstructive procedure to remove prostate tissue will provide more permanent relief.

For a smaller percentage of men, particularly those who have aversions to the risk of surgery, or more commonly, health complications that prevent a surgical de-obstructive procedure, catheterization is the only solution. Yet chronic catheterization comes with several important drawbacks, including:

1.     Losing the ability to void naturally

2.     Heightened infection risk

3.     Compromises to quality of life

In the next post on this topic, we’ll delve into these three issues in more detail, as we take a closer look at urinary catheters. Part 3 of this series will also cover the amazing story of a patient who was brought back from the brink after years of struggling with chronic catheterization for BPH symptoms. But first, let me add a few closing thoughts on the theme of BPH-induced incontinence.

I can’t stress enough how important it is to get regular screenings for bladder and prostate health. Checkups like these should be likened to that of mammograms or stress tests. Furthermore, males experiencing the symptoms above should seek medical guidance from a urologist as early as possible, preferably well before incontinence becomes a focal point of symptoms.

Read Part 2 of this series here.

Dr. Richard Roach attended the University of Wisconsin-Madison Medical School and completed his residency at the University of Wisconsin-Madison Hospital and Clinics. After graduation, Dr. Roach moved to Minocqua, Wisconsin and joined the Marshfield Clinic, where he practiced for the next 26 years. In 2013, he moved to Florida and is currently a partner in Advanced Urology Institute. He is certified by the American Board of Urology. His specialties include plasma vaporization for BPH, treatment of female stress incontinence and penile prosthesis for ED. He is also an expert in laser & laparoscopic surgery.

Dr. Richard Roach attended the University of Wisconsin-Madison Medical School and completed his residency at the University of Wisconsin-Madison Hospital and Clinics. After graduation, Dr. Roach moved to Minocqua, Wisconsin and joined the Marshfield Clinic, where he practiced for the next 26 years. In 2013, he moved to Florida and is currently a partner in Advanced Urology Institute. He is certified by the American Board of Urology. His specialties include plasma vaporization for BPH, treatment of female stress incontinence and penile prosthesis for ED. He is also an expert in laser & laparoscopic surgery.

Incorporating pelvic floor exercises into your general workout routine - 3 best moves to add now.

Sarah Jenkins

A guest blog written by Michelle Herbst, PT

 

Pelvic Floor Exercises, or Kegels, is the contraction of the muscles between the pubic bone and tailbone. When a pelvic floor exercise is performed, the person should feel a gentle tightening and lifting sensation in the lower abdomen and perineum. The pelvic floor muscle contraction is complete when the muscles relax and let go of the contraction.

Please keep in mind these tips when performing a pelvic floor exercise to protect yourself from undue harm. One, you must be able to maintain your breath and therefore be able to inhale and exhale while performing a Kegel and avoid breath holding or bearing down. Two, your muscular effort should be around 75 to 80 percent. If you are exerting 100 percent effort, you are likely using the pelvic floor muscles and many other muscle groups as well.

There are many variations and progressions of a Kegel exercise. Here are few ideas to help you incorporate pelvic floor exercises into your daily routines.

Exercise One: Kegel Progression

The pelvic floor muscles are made of two muscle fiber types – fast and slow. Therefore, Kegels can be progressed by varying the hold time and intensity of the muscle contraction. One of my favorite progressions is simply lengthening the hold time followed by a few quick pelvic floor contractions. For example, a Kegel can be held for 5 seconds followed by 5 quick contractions. This Kegel Combo can be done in any position – seated, standing or lying down. It can be done to the beat of music while seated at a stop light or at the end of a cardio or lifting session when you are your mat working the abdominal exercises.

Exercise Two: Kegel with Breath Work

Yoga is the all the rage and you my find your zen when performing a Kegal with breath work. While your yoga instructor is cueing you in inhale and exhale think about what your pelvic floor. Typically, during focused breathing such as in a Yoga Class, there is always slight tension on the pelvic floor. However, you further engage the pelvic floor muscles when you forcibly exhale. During this type of exhalation, the pelvic floor muscles tighten further along with our deep abdominal muscles to push the air up and out of our lungs. Try it. It may transform your yoga practice.

Exercise Three: Kegel with Plank

Plank. It is a much loved and hated exercise. It is a great way to fully engage our core. And, to reap the benefits of the plank - you must focus on the pelvic floor. If your wrists and feet can tolerate a full plank – go for it! If you need to modify, do a half-plank on your knees. Or, try a wall plank by standing with your feet an arms-length away from the wall and placing your hands on the wall.

Here are a few head to toe cues to get you planking.

When in plank, the hands are stacked under the elbows and shoulders. The chin is slightly tucked lengthening the back of the neck. Your shoulder blades are pulled down and back towards the spine. The chest opens and the pelvis is slightly lifted. Your legs are hip width apart. In full plank, your ankles are 90 degrees as you weight bear through the toes. Now, draw your focus to your pelvic floor muscles.  When you tighten the Kegel muscles, you may feel like your tailbone lift up and in. Hold your plank and breathe. Smile too – you just may enjoy how strong you feel.

Michelle Herbst, PT

Michelle Herbst, PT

The Importance Of Posture

Sarah Jenkins

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When talking about incontinence and the pelvic floor, we often tend to hear advice about strengthening our muscles with exercises such as Kegels.  However, did you know that one of the best things you can do for your pelvic floor on a regular basis is to keep good posture?  Maintaining proper posture helps to keep the pelvic floor in the most optimal position to give good support and can prevent our muscles from being too loose ore to tense. 

So, what is good posture?  And how do you know if you are achieving it?  It takes practice, but with a little concentration you can learn how to hold good posture in both a standing and a sitting position.

We love this guide by Tasha Mulligan over at Hab-it on how to find your neutral spine and hold it in both a sitting and standing position.  Check it out, and start implementing good posture as one of the most essential tools to help you keep your pelvic floor in alignment.

Will Herbal Remedies Help My OAB Symptoms?

Sarah Jenkins

Thinking about trying to treat your overactive bladder with an herbal concoction?  Many think that an herbal treatment may be more natural than medication, but be careful – herbal remedies do not go through the same rigorous testing and approval process with the Food and Drug Administration (the FDA) as approved medications do.  This means that while some herbs may be effective, they can also be dangerous, and many have side effects that could counteract your efforts. 

Read this roundup of 5 popular herbs used to treat overactive bladder, and talk with your doctor before starting any treatment.  

UTIs - What Causes Them And How To Avoid Them

Sarah Jenkins

UTIs, or Urinary Tract Infections, will affect most women at some point in their lifetime.  UTI’s are recognized by the burning sensation they cause in the bladder or urethra (the tube that empties urine from the body) during urination, and the intense urge to urinate frequently – even if it is just a little amount.  Some women may also leak urine during a UTI, even if that isn’t something they normally experience.  Urine may also smell differently and appear cloudy or dark.  UTI’s are not pleasant, but there are things you can do to prevent them.

The first thing you need to know is why UTIs happen.  UTIs are caused by the presence of bacteria in the urinary tract, which can then travel up to the bladder.  And, while the urinary tract does have several safe guards, which naturally help it to flush bacteria out, infections can still occur.  Infections are more common in women primarily due to their anatomy.  Bacteria from the bowel can easily sneak into the urethra because it is so close to the anus (This is why we wipe front to back people!), and women have much shorter urethras than men, which means bacteria can more easily get into the bladder.   Certain conditions can make people more prone to UTIs – those who wear catheters may be at an increased risk since it is harder to flush bacteria out of the urinary tract. And anyone who has trouble emptying his or her bladder completely can also be at risk.  Sex can also contribute to UTIs since it can introduce new bacteria to the urethral opening.

The good news is that most UTIs don’t last long once treated.  Since the main cause of a UTI is often the presence of bacteria, antibiotics are usually used to treat them, and take roughly 2-3 days to work.  Drinking lots of water and fluids can also quicken your recovery time, because it helps you to flush out the bacteria out of your system. 

Here are some tips to avoid UTIs altogether:

  • Wipe front to back. Keeping the Urethra clean and avoiding contact with bacteria from the anus or bowel can help prevent bacteria from entering the urinary tract in the first place.
  • Drink lots of fluids.  Staying hydrated and drinking lots of water each day will help flush out any bacteria that may be present.
  • Urinate when you need to. Holding urine in the bladder for longer than necessary only increases the chance that bacteria will multiply and cause an infection.
  • Urinate after having sex. This helps get rid of any bacteria that may be lingering from intercourse.

If you do get a UTI, see a doctor right away for treatment. If left untreated, the bacteria can sometimes make its way to the kidneys and cause a more serious infection.

Pelvic Pain Disorder

Sarah Jenkins

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Pelvic pain is pain that you experience in the lowermost part of your abdomen and pelvis. It can occur in both men and women, however it is more common in women.  Depending on the specific cause of pelvic pain, it can vary in intensity and length.  There are several things that may contribute to pelvic pain.  

Many women experience pelvic pain due to gynecological problems or problems associated with pregnancy.  Some of these include: 

  • Endometriosis
  • Adenomyosis
  • Menstrual cramps (dysmenorrhea)
  • Ectopic pregnancy (or other pregnancy-related conditions)
  • Ovarian cancer
  • Vulvodynia
  • Mittelschmerz (ovulation pain)
  • Pelvic inflammatory disease (PID)
  • Ovarian cysts
  • Uterine fibroids

Some other causes of pelvic pain may be due to:

  • Diverticulitis
  • Appendicitis
  • Fibromyalgia
  • Colon cancer
  • Chronic constipation
  • Inguinal hernia
  • Crohn's disease

How is the cause of pelvic pain determined?

Talking to a doctor is the first step in determining the cause of your pelvic pain.  Your doctor will start off by asking you several questions about the type of pain you are experiencing, and also discuss your medical history to determine the cause.  He or she will also likely perform a physical exam and may perform some tests to figure out what is causing your pain. Depending on what you are experiencing, your doctor may check your blood, urine or stool, perform a pregnancy test, check for STDs, or even perform X-rays or Ultrasounds to better examine some of your internal organs.  

How is pelvic pain treated?

Your doctor will determine the appropriate treatment for your pelvic pain based on the cause, and how serious the pain is. They may recommend medications, or even surgical procedures.  Talk with your doctor about what you are experiencing to find the best solution.

Tips to keep incontinence from interfering with your sex life

Sarah Jenkins

If you struggle with incontinence and have concerns about leaking during sex, you're not alone. The American Foundation for Urologic Disease (AFUD) reports that one in three women with stress incontinence avoids sex due to fears of leaking during intercourse or orgasm. But incontinence during sex doesn't have to be an issue.  Below are some tips to manage your incontinence and reclaim your sex life.

  • Be Prepared. Believe it or not, your behavior prior to sex can have a big impact on your chances of leaking during the act.  Here are a few tips to help you avoid an uncomfortable situation:
    • Avoid bladder irritating foods or drinks a couple of hours before bedtime.  Not sure what your food and drink triggers are? There are some common ones, but you can also track your own habits for a week or so to determine what foods and drink you.
    • Limiting your fluids prior to having sex.
    • Practice "double voiding" prior to sex. This is when you go to the bathroom, wait a few minutes, and then go again to empty any residual urine that may still be present in the bladder.
    • Use protective bedding so that you are covered in case an accident does happen.
  • Try a new position. You may find that a new position creates less stress on your bladder muscles, making leakage less likely. 
  • Strengthen up down there. Regular pelvic floor workouts can do wonders for women who experience incontinence. An added bonus?  Studies have shown that by strengthening your pelvic floor muscles you may also experience stronger orgasms and find sex more satisfying.
  • Talk about it. While this is an uncomfortable discussion to have, the mere act of telling your partner about your condition may relieve some of the stress associated with it. 

 

Talk to your Doctor.

If you've tried the steps above to no avail, consider talking to your doctor about your condition. Incontinence is not a normal part of aging and many things can be done to correct the situation. Your doctor can tell you about options that will best fit your needs.  Need help finding a physician?  Click here.

Love Yourself First

Sarah Jenkins

Valentines Day is a time we often focus on others – those we love most – to tell them how we feel and how much they mean to us.  We at NAFC are all for that – having strong social and family connections is an important part of living a happy life.  But we think it’s also important to focus on you once in a while too. 

It’s kind of like the instructions you hear on an airplane – adults traveling with small children should attach their own emergency masks before helping their little ones.  This is sound advice – if you aren’t taking care of yourself and learning how to give yourself a break every now and then, you won’t be able to take care of and love those around you.  Love yourself first.  The rest will fall into line.

Now, go buy yourself some flowers, and check out these awesome quotes on self-love from Psychology Today for inspiration.

Four Tips On How To Date When You Have Incontinence.

Sarah Jenkins

Having incontinence can put a damper on a lot of activities for many.  Some people are so scared that they will have an accident they won’t leave their home, let alone go out with friends or on dates.  If this sounds like you, you should know that there are things you can do to treat your incontinence, and tricks you can use to survive the dating world.  See below for our top four tips on dating when you have incontinence.

1.     Know Your Options.  Being educated about what treatment options are available to you is half the battle.  Make an appointment with a doctor to talk about your symptoms and find a solution that’s right for you.  Don’t be scared of this step – your doctor can educate you on many types of treatments, ranging from very conservative, non-invasive approaches to more advanced options such as surgery. Once you start treating your incontinence, you’ll gain more confidence in your ability to go out without having to worry about leaks.

2.     Change up your habits.  Avoid indulging in bladder irritating foods when out and about to lessen the risk it will cause an accident.  Things like alcohol and caffeinated items are high on this list. Keeping a bladder diary for a couple of weeks can help you identify your triggers so that you know what you need to avoid in social situations.

3.     Plan ahead.  Know where the closest restrooms are so that if you need to head there in a hurry you won’t lose time searching around.  It can also be helpful to have an extra change of clothes on hand just in case an accident does happen.  Keep a spare in your bag or car for emergencies.

4.     Be open with those you love.  Thinking about being intimate when you have incontinence can be nerve-wracking, but opening up to your partner can help ease the tension and take a weight off your shoulders.  Talk to them before you’re in a situation to have sex so they know what to expect.  If they get hung up on it, chances are they aren’t worth your time anyway.  However, you’ll likely find that being open and honest with them will help you both relax a bit and will create an even more trusting and caring relationship.


Don’t let incontinence limit your social life.  Learning how to treat and manage it, and knowing your personal triggers, will give you the confidence to get out there and start living a more connected – and full – life.  





Incontinence During Sex - It Happens To Men Too

Sarah Jenkins

Prostate cancer is one of the most common types of cancer in men. According to the American Cancer Society, 1 in 7 men will get prostate cancer in their lifetime (only skin cancer has a higher rate).  And, while many men will go on to survive prostate cancer, the side effects of treatment can be difficult to deal with for many.

A common treatment for prostate cancer is a radical prostatectomy, or the complete removal of the prostate.  This is generally considered a good approach especially if the cancer is contained within the prostate gland and has not spread.  However, one side effect of this procedure is often incontinence.

Stress urinary incontinence, the type of incontinence that happens when you place pressure on the bladder, is common for men who have had their prostate removed or are undergoing other treatments for prostate cancer.  Treatment can sometimes weaken the bladder muscles, causing leakage when a man sneezes, coughs, exercises, or even during sex.  This can be extremely embarrassing for men, and can be discouraging when going through the healing process of having a prostatectomy.

The good news is that many men regain full control of their bladder with time after a prostatectomy.  However, in the meantime, here are some tips that may help you avoid some awkward situations in the bedroom:

·      Try to watch your fluid intake in the hours leading up to sex.

·      Avoid consuming bladder irritating food and drinks, such as caffeine, chocolate, or alcohol.

·      Prior to sex, completely empty your bladder.

·      Keep a thick towel nearby in case of any accidents

While this problem can be an embarrassing one, keep in mind that many men deal with this in the months after prostate cancer treatment and with time, this condition should improve.  If you still experience problems a few months after your treatment, talk to your urologist about treatments for incontinence.  He or she can help you navigate the many options available to you and find one that fits best with your needs.

 

How To Talk About Incontinence With Your Loved One.

Sarah Jenkins

Talking about incontinence is never easy.  Whether you are the one experiencing it, or someone close to you has been exhibiting symptoms, it is a conversation that most dread.  However, sharing this struggle with a loved one is perhaps one of the best things you can do in your path to recovery.  With a little advanced planning, a deep breath, and some honesty you’ll be able to get past this and move on to the next (and more productive) phase of this struggle – treatment.

 

When you’re the one struggling with incontinence.

Believe it or not, you may actually be on the easier end of this conversation.  As embarrassing as it may feel to open up to someone about this, if you are ready to do so, you have likely accepted that this has become a problem and are ready to receive support.  And who better to provide that support than a trusted friend or loved one?  Opening up to someone may not only provide you with the physical help you need, but also lift an emotional weight off your shoulders.  You don’t have to suffer through this alone.

 

 

When your loved one has incontinence.

If you’ve been noticing that a loved one seems to be having problems with incontinence, it may be time to talk with them about it to see how open they are to treatment.  This can sometimes be difficult – it is very likely that the person knows they have a problem, but may be too embarrassed to talk to anyone or do anything about it.  Depending on your relationship, it can also be hard for your loved one to admit.  For instance, a father who is cared for by his son or daughter may feel too proud to discuss this with his kids.  Start the conversation slowly by asking them about their general health, then move on to some of the signs of incontinence that you’ve noticed. Be prepared – they may get defensive and try to hide the problem.  If that happens, try again.  Be patient with them and try to be as accepting and understanding as possible. In time, they will likely open up to you once they see that your intentions are good and you are there to support them.

 

Our last tip?  Get some advice from those who have been there and understand.  As life changing as it may be, you are not the only one in the world who has ever struggled with this condition.  Whether you are looking to reach out to others who are experiencing it, or others who care for an incontinent loved one, there are many people out there who are discussing their problems on message boards and online forums.  Check out the NAFC message boards to get some tips on how others have touched on this delicate subject.

 

 

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