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Eating Your Way Through Constipation

Sarah Jenkins

Diet habits to avoid constipation

Being constipated is a very uncomfortable situation, leaving many people stressed and impatient. For some, constipation further aggravates bladder control issues and for others, the problem is merely uncomfortable. Regardless of how your bladder is affected, the impatience and stress caused by constipation only makes the whole situation worse.

Thankfully, constipation is usually a situation fixed by better eating habits and/or a change in medication. Talk to your doctor about your constipation and consider bringing in a bowel diary of how often you pass a bowel movement.

If medication is the sole catalyst, your doctor should be able to advise a healthy alternative. And if eating a more fibrous diet is in the books for you, consider trying these ten constipation-fighting foods.

      Popcorn
      Nuts
      Beans and Legumes
      Grapes
      Broccoli
      Flax Seeds
      Pineapple Juice
      Bran
      Figs
      Prunes

What foods or drinks do you use to combat constipation?

Ask The Expert: What's The Difference Between IBS And Crohn's Disease?

Sarah Jenkins

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’s the difference between IBS and Crohn’s Disease? Could I have both?

Answer: While both of these conditions seem to have similar symptoms, they are in fact different, and, yes, it is possible for someone to have both at the same time. Here’s a quick breakdown of the two:

Crohn’s Disease is a chronic, inflammatory bowel disease that affects parts of the digestive tract. Symptoms often include diarrhea, a frequent need to move your bowels, stomach pain, and bloating (all symptoms of IBS). However, with Crohn’s disease, patients also may notice things like vomiting, tiredness, weight loss, fever, or even bleeding.  It’s not certain what causes Crohn’s disease, but most experts believe it is an abnormality in the immune system that can trigger the condition. Chron’s disease is also more common in those with a family history of the disease.

IBS (also called “spastic colon”) carries similar symptoms to Crohn’s disease – cue the diarrhea, frequent trips to the bathroom, and stomach pain.  However, treatment for Crohn’s disease and IBS are different so it pays to be examined for both so that you understand what is causing your symptoms and you can treat it appropriately.  Testing for both conditions can be done with a physical exam, blood test, and usually a colonoscopy or other type of endoscopy procedure.

If you experience any symptoms related to IBS or Crohn’s disease, make an appointment with your doctor today to get tested.

Are you an expert in incontinence care? Would you like to join the NAFC expert panel? Have a question you'd like answered? Contact us!

Could Alcohol Consumption Be Contributing To Your Incontinence Or Bedwetting Problem?

Sarah Jenkins

Alcohol and incontinence 

Eric was 43 when he first woke up wet. He had no idea what had happened to him, but after a couple of minutes he realized:  he had wet the bed. He was shocked – this had never happened to him before and he had no idea why it was happening now.

The bedwetting continued a couple of times a month for a few months until he finally knew something had to be done.  He noticed that he seemed to only wet the bed after he had had a few drinks with his buddies during their regular poker night. “I don’t usually drink much, but I like to have a few beers with the guys during our regular hang out.  I decided to try switching to water for the next couple of poker nights just to see what would happen.” Sure enough, once he omitted the alcohol, things improved dramatically.

Eric’s situation is not uncommon. Over 35 million American adults suffer from incontinence, and nearly 5 million have a bedwetting problem. And, while alcohol cannot be attributed to all of these cases, it is definitely something to try omitting for a while if you do suffer from incontinence. Sometimes, simple lifestyle changes can make a huge difference.

Alcohol on it’s own doesn’t cause incontinence, but for those who are prone to bladder leaks, it can be a trigger.  Alcohol is a diuretic, which means that in increases the production of urine and can also cause a person to need to use the restroom more often. Not only that, alcohol irritates the bladder, which can make overactive bladder symptoms worse. It’s worth it to try eliminating alcohol if you have incontinence. (Especially if you tend to drink to excess.)

Alcohol isn’t the only thing you should watch out for if you struggle with bladder leakage.  The following foods and drinks can also irritate the bladder:

  • Caffeinated beverages like coffee and tea
  • Chocolate (it contains caffeine too!)
  • Carbonated drinks
  • Spicy foods
  • Citrus foods
  • Acidic foods, such as tomatoes
  • Cranberry juice
  • Sugar – including artificial sweeteners
  • Certain medications

If you are experiencing incontinence, try eliminating some of these foods from your diet to see if it makes a difference. It may help you to keep a bladder diary during this experiment to record how what you eat affects your bladder leaks. And if you experience bedwetting, definitely try skipping that nightly glass of wine. As Eric discovered, sometimes making simple lifestyle changes can make a huge difference.  “I’m dry again! I miss having a drink with the guys, but it’s something I can live without if it means I don’t wet the bed.”

Want a handy cheat sheet of foods to avoid if you have incontinence? Print out our free download of foods that may trigger incontinence and hang it on your fridge for easy reference!

What I've Learned About IBS And How To Treat It.

Sarah Jenkins

IBS, Bowel Health, And How To Treat It

I was fairly young when I first started having bowel trouble. A consistently nervous young woman, I was constantly in a state of worry – about school, boys, and friendships – pretty much the normal run of the mill high school concerns. My mother always said I had “nervous bowels”, and my family became accustomed to stopping frequently to use the restroom on trips, and always asking me if I had to go before leaving the house.  The pain I felt sometimes with bloating or cramping was attributed to my nerves.  And while my family was fairly sympathetic to my condition, I experienced a lot of eye-rolling growing up when my symptoms would strike (“We have to stop for Annette again?” my brother would say. “She just went!”) It was a normal occurrence that lasted into my college years, and then later as I started a family.  And while it was inconvenient and could definitely be painful at times – it wasn’t until after the birth of my first child that I thought about it as a “condition” that could actually be treated. 

IBS, or irritable bowel syndrome, is when you have an overly sensitive colon or large intestine.  This may result in the contents of your bowel moving too quickly, resulting in diarrhea, or too slowly, resulting in constipation. (Both of which I have experienced, although my symptoms tend to lie more in the former camp, causing me to constantly race to the bathroom for fear of an accident).  Symptoms also can include cramping or abdominal pain, bloating, gas, or mucus in the stool. The condition is more common than you may think. As many as 1 in 5 American adults have IBS, the majority of them being women. And, this is not an old persons disease either – IBS strikes young, commonly in ages younger than 45.

I was finally diagnosed at age 28 – a whopping 13 years after I started experiencing symptoms, and I wish I had thought to seek help earlier.  My doctor told me that there are many things that can contribute to IBS. Things like hormones, certain types of food, and stress (I guess my mother was right) may all impact IBS symptoms.  Since the cause is of IBS is not known, treatments usually focus on relieving symptoms so that you can live as normally as possible.  Below is a list of treatments my doctor discussed with me.

Behavioral Changes: 

Diet.  Many foods can trigger IBS. And, while they might not be the same for everyone, there are some common triggers that have been identified:

  • Alcohol
  • Caffeine (including coffee, chocolate)
  • Dairy products
  • Sugar-free sweeteners
  • High-gas foods, such as beans, cabbage, cauliflower, broccoli, raw fruits or carbonated beverages)
  • Fatty foods
  • FODMAPs (types of carbohydrates that are found in certain grans, vegetables fruits and dairy products)
  • Gluten

One of the first things I did when starting treatment was to keep a bowel diary, which tracked the foods I ate and how they effected me. This was a huge help in learning my food triggers.  I also learned to eat more frequent, smaller meals, which helped ease my symptoms. (Although those who experience more constipation may see improvement by eating larger amounts of high-fiber foods.)

Stress Management. This was a huge one for me.  It turns out, your brain controls your bowels, so if you’re a hand wringer like me, it may end up making you run to the bathroom more often than you’d like.  Learning ways to control stress was a game changer and I saw a huge improvement with these steps:

  • Meditation – Just taking the time to quite your mind can do wonders in helping you manage stress on a regular basis.
  • Physical Exercise – Regular exercise is a great de-stressor and, if you have constipation, can help keep things moving in that department too.  I walk regularly and practice yoga 3 times per week to keep my stress at bay.
  • Deep Breathing Exercises – This is a great trick to practice if you feel yourself starting to get worked up. Practice counting to 10, while breathing in and out slowly until you start feeling relaxed.
  • Counseling – Sometimes you need someone to talk to help you work through your emotions.  You may find comfort in talking with a friend or family member, or even a professional counselor, who can help you learn how to deal better with stress.
  • Massage – This one likely doesn’t need much explanation - who doesn’t love a good massage? 

Drink Plenty Of Water. Drinking enough water just helps your body function better. And for people with IBS, it will ensure that everything moves more smoothly and minimize pain. This is especially true with those who suffer from constipation. 

Medications. 

There are several different medications used to treat symptoms of IBS. Whether you suffer from constipation, or diarrhea, OTCs and prescriptions are available. Antibiotics are also sometimes prescribed for those patients whose symptoms are caused by an overgrowth of bacteria in the intestines. And if you suffer from anxiety or depression, like me, some antidepressants and anti-anxiety agents can actually improve your IBS symptoms too. Talk with your doctor about your symptoms and work with him or her to find a solution that’s best for you. 

Other treatment options. 

Acupuncture. Despite a lack of data on acupuncture and IBS, many patients turn to this method of treatment for pain and bloating. Acupuncture, which is usually performed by a licensed acupuncturist, targets specific points in the body to help channel energy flow properly. 

Probiotics.  As research continues to emerge around the importance of gut bacteria and your overall health, probiotics may become a more common treatment option.  Consuming them can increase the “good” bacteria that live in your intestines and may help ease your symptoms. 

Hypnosis.  Hypnotherapy has been shown to improve symptoms by helping the patient to relax. Patients practicing hypnotherapy have reported improved quality of life, reduced abdominal pain and constipation, and reduced bloating. However, most of the time hypnotherapy is dependent upon a therapist, and is usually not covered by insurance plans, making it a costly form of therapy.

I’m 37 now and have had my IBS pretty much under control for the last several years. Looking back, I can’t believe I lived with it as “normal” for so long. If you suffer from this condition, there is simply no reason to not get it treated. 

Need help finding a doctor?  Use the NAFC Specialist Locator.

About the Author:  Annette Jennings lives in Oklahoma with her husband, 2 children, 2 dogs, and 1 cat. She's happy to be speaking up about her condition and hopes it will inspire more people to do so. 

Depression And Incontinence

Sarah Jenkins

Depression And Incontinence World Health Day 

Do you suffer from urinary incontinence? If you do, you are one of over 35 million Americans that live with the condition every day. Incontinence can be a mild inconvenience, or it can be a completely devastating condition that greatly restricts a person’s life. While there are many treatments that exist for incontinence, the condition holds a strong stigma and sense of extreme embarrassment and shame for those who live with it on a daily basis, which prevents them from discussing it with anyone – even their doctor.

When someone has severe incontinence, they are in constant fear of having an embarrassing accident.  Not making it to the restroom on time is always a concern and they seek out ways to ensure that they are always near a bathroom.  This can greatly restrict how much they are willing to travel from their home – even for work.  As a person becomes more and more reclusive due to their condition, they may suffer from anxiety, loneliness, and depression. Their relationships with friends, family, and work can all suffer. 

This is unfortunate since there are so many treatment options available to men and women these days. Behavioral modifications, medications, advanced therapies or surgeries can all be used to treat urinary incontinence effective.  There truly are some great tools available.

If you suffer from urinary incontinence, or depression, don’t continue to let it control your life.  Take the appropriate steps below to treat it:

Talk to your doctor.  This is really the first step. While it can be hard to open up about something so personal, doing so will put you on the path to recovery – for both incontinence and depression. 

Lose Weight. If you are carrying around a few extra pounds, it’s worth the effort to shed them, since the added weight can contribute to stress urinary incontinence, as well as weak pelvic floor muscles. 

Exercise.  Getting regular exercise is always a great idea. But, for urinary incontinence and depression it can have a doubly good effect.  Strengthening your pelvic floor muscles can give you greater control over urinary incontinence. Your pelvic muscles benefit from all types of exercises but working with a trained physical therapist can really help you to focus on them with specific moves and postural tips.  And, most exercises produce a chemical called endorphins, which can produce a positive feeling in the body. In fact, regular exercise has been shown to decrease symptoms of depression. And it doesn’t take much – just 30 minutes of an exercise like walking (or really, anything that you enjoy) 3-5 times a week can do the trick.

Look into medical treatment. There are medications that exist for both urinary incontinence and depression. Your doctor can talk with you about the different types available and work with you to find one that’s right for you. Additionally, advanced procedures like sacral neuromodulation, which uses mild electrical pulses to stimulate your sacral nerves, or Botox injections into the bladder, which can help to strengthen bladder control, may be an option for you.  There are also various surgical procedures that can be very effective in treating urinary incontinence.

Regardless of which outcome you choose, the most important thing to do is to take some sort of action. Life doesn’t have to be limited by incontinence and with the myriad of treatment options available there is no reason that it should be a source of depression.  Don’t let leaks rule your life!  Take control and get help today.

NAFC is proud to support the efforts of the World Health Organization today during World Health Day, 2017, which is focused on raising awareness of depression. If you or a loved one suffers from depression, talking about it can be a first step towards recovery.  Learn more about the 2017 World Health Day at www.who.int/campaigns/world-health-day/2017/en/

What To Expect After Pelvic Floor Reconstruction

Dawn Dingman

What to expect after pelvic floor reconstruction surgery for pelvic organ prolapse

The decision to undergo pelvic reconstructive surgery to correct pelvic organ prolapse (POP) can be difficult. Women often wait years dealing with symptoms of POP before they commit to surgery. Aside from decreasing symptoms of prolapse, a desired outcome of pelvic floor reconstruction is for the woman to be able to return to her active life. Likely, the surgeon has provided some information about do’s and don’ts, but this is usually related to immediately post-surgery.  Most pelvic floor surgeries require an initial 6 to 8 week rest period —keeping activity very light—no sexual intercourse, no heavy lifting, no running etc.

But after the initial rest period, then what? Are there activities to avoid or limit? How much is “too much” to lift?  Should anything be avoided altogether? Medical literature tells us that 30% of women may require a second surgery at some point in the future due to failure of the first or because of another pelvic problem.1 Yet, there is little information on improving outcomes in order to prevent another surgery. Most surgeons use a common-sense approach in advising their patients, and if a woman has specific questions or concerns, she is always advised to ask her surgeon. The surgeon has the best understanding of how the procedure went and in what shape the woman’s pelvic tissues are.

The primary cause of POP is trauma to the pelvic floor muscles (PFM,) connective tissue or “fascia” and ligaments. These structures become unable to support the pelvic organs. The majority of women undergoing surgery sustain tissue injury from childbirth trauma.  More rarely, women may develop severe prolapse due to extreme increases in intra-abdominal pressure (IAP) for other reasons.  Examples include illnesses that cause chronic coughing or performing frequent Valsalva maneuvers (straining) such as with chronic constipation.

In attempting to identify risk factors and make post-surgical recommendations, research has determined that indeed, the two things that increase IAP and vaginal pressure (VP) the most are coughing and Valsalva maneuvers. Most of these studies compared pressure measurements during everyday activities like supine lying, standing, lifting, running, coughing and straining. According to the research, many things increase IAP; just getting out of bed will mildly increase IAP, as will lifting moderate weight and running. One study went so far as to say that many post-surgical guidelines are “needlessly restrictive.”5 The researchers found that in subjects without pelvic floor problems tasks such as lifting eight to 20 pounds off a counter, lifting 13 pounds from the floor, walking briskly, performing crunches all produced no more increase in IAP than getting out of a chair. They summarized that “how lifting is done impacts intra-abdominal pressure.” The good news is, that the research, found that unless a woman has a chronic cough condition or habitually performs Valsalva maneuvers, everyday stressors like standing, walking, lifting normal weight, sexual intercourse and running should be okay post pelvic surgery.

Women seen by a specially trained pelvic physical therapist (PT) after surgery are taught strengthening exercises and postural strategies, as well as how to lift correctly. If risk factors are present the woman may need extra help to learn how to care for her pelvic floor during stressful activities, this may include diet counseling and information on sexual positions to limit stress to the PFM. Here is a list of some things PT’s might teach their patients post surgery:

Posture. PFM works best when the spine, pelvis and hips are in good alignment. If a woman’s back is too rounded, the normal bony structure of the pelvis can’t act to support the pelvic organs as intended. If the back is too arched, the pelvic muscles can become overstretched and strained. Normal spinal posture is a simple and effective way to support the pelvic organs. Learn how to maintain good posture with your normal daily activities, such as sitting at a computer, lifting, squatting etc.

Diet. To avoid constipation and straining (Valsalva) with bowel movements, drink plenty of water, eat a balanced, healthy diet with whole grains and fresh vegetables and learn about soluble and insoluble fiber. If constipation exists, it needs to be assessed to determine the type of constipation, and then be properly treated.Toilet Posture: We know that the vast majority of people evacuate their bowels best when in a squatting position. Most modern toilets don’t accommodate for this. Try placing a phone book or two under the feet to elevate the legs. Or try this device, which allows for a nice squatting position when on the toilet:  spine in neutral, but hips flexed and knees above the hips.

Restful Rescue Poses: There are excellent resting positions that utilize gravity to encourage organs to “reposition” back into the pelvic cavity. Here’s one: lie on your back and place a pillow or small wedge under the pelvis to invert your pelvic region. Place pillows under your knees as well and one pillow (or none) under the head. It’s a lovely position to rest in, and for those doing a strengthening program, it’s a great position for that too. If you want to go all out, place a heating pad over your tummy, turn the lights low, play soothing music and rest for a blissful 20 minutes or so. 

Biomechanical Considerations for Sexual Intercourse. Let’s face it, the majority of women going through POP surgery are sexually active. Sex must be addressed and often it’s the PT who spends the time with the patient and can make the best recommendations. For example, if a woman has pain with vaginal penetration, she may need to perform special stretching exercises to open the vaginal introitus and the PT can advise on intercourse positions that will least stress the PFM. Menopausal women may also need to discuss additional local estrogen and lubricant with your surgeon or physical therapist.

Pelvic Bracing. This is a technique of co-contracting one’s lower abdominal muscles, deep back stabilizing muscles, with the PFM. When done correctly it can limit the stress on the pelvic organs during activities of increased IAP, like lifting or squatting. It sounds complicated but it’s really not. Women should learn to do this in any position. First, attend to your PFM by giving them a gentle squeeze (feel the perineum lift) followed immediately by a relaxation (feel the perineum release down.) Starting from a relaxed place, gently draw the PFM upward as you gently draw the navel inward. Imagine you are trying to lift your vagina like an elevator as you feel your lower tummy gently flatten. Do this gently, not full force. You should be able to breathe normally as you do this. You’ll feel the two muscle groups acting together to tighten the lower belly and “brace” the pelvic floor. The deep back muscles should activate when you do this providing posterior support simultaneously. Hold this co-contraction for a few seconds then release. If you have trouble with this, seek out a pelvic floor PT in your area to help you learn. Learning how to brace during functional activities sometimes requires a bit of training, so again, seeking a specialist may be indicated if you are someone who has risk factors.

Pelvic Floor Muscle (PFM) Strengthening. Often called “Kegels,” PFM strengthening involves exercising the PFM by contracting them for short or long periods of time—usually from two to four seconds to train the “fast twitch” muscle fibers, and five to 30 seconds to train the “slow twitch” muscle fibers.  Sometimes these exercises are done in conjunction with other muscle groups. The muscle fibers of the pelvic floor are 70% slow twitch and only 30% fast twitch. This means that the PFM are much better at endurance events than brute strength activities. They act more as supportive postural muscles; however we occasionally need a quick strong contraction to avoid leaking with a sneeze. Correct PFM strengthening incorporates exercises for both types of muscle.

Some women actually do too much exercise and develop tight, painful muscles. Sometimes, after a pelvic surgery, a woman might actually feel “tight” or “tense” inside. This is from the surgery, not because the muscles magically strengthened from the procedure. If after surgery you have symptoms of pain (either at rest or with an activity like sex), urinary urgency or frequency, then tell your doctor. Kegels would not be appropriate for you. If this is the case be sure to talk to your doctor for other options, such as biofeedback.

Other women need to exercise to develop more muscle tone and strength. The trick is to ensure there is balance between strength and flexibility. If you are still leaking or feel weak, then strengthening may be helpful.

Physical therapists with a pelvic floor specialization are trained to assess the whole person to determine an appropriate exercise routine, and women are advised to be evaluated before undertaking a rigorous strength program.

Incontinence and Autism - A Treatment Guide

Sarah Jenkins

Incontinence and Autism

Incontinence is a condition that affects over 35 million Americans of all ages.  Dealing with incontinence can be difficult at any age, but helping a child with a disability, like autism, learn to manage incontinence can be especially challenging. 

As a child, learning to use the bathroom is a normal part of development. And even in children who don’t have a physical, mental or emotional disability, the rate at which they develop this skill varies greatly.  However, for some children with autism, other factors can play a part in how they learn to use the toilet.  Autism is a spectrum disorder brought on by a dysfunction of the central nervous system. It is usually diagnosed in the first three years of life. Children with autism experience impairment of common social skills (making eye contact, interacting with other people or reading social cues), communication difficulties (delayed language development or complete lack of speech), and behavioral challenges (sterotyped and repetitive body movements, extreme attachment to routines, unusually intense or focused interests, and sensory sensitivities to environments including sounds, light, smells and textures.

When looking at these characteristics of autism, it’s easy to understand how some children with autism may have challenges when potty training or learning to remain continent.

Using The 5 Ps.

 Incontinence may come in many forms, but there are some common ways to approach the situation. We call them ‘The 5 Ps,’ and they can help make treatment more tolerable for caregivers and contribute to a real opportunity for improvement:

Patience – We all know that patience is a virtue, but when it comes to incontinence, it’s often a virtue that’s hard to find. Try not to place blame for setbacks. Instead, provide positive encouragement and do your best to maintain a good sense of humor – it’ll pay off in so many ways.

Persistence – Progress may be slow, but don’t give up. Having a positive outlook and setting sensible goals can reduce frustration for everyone.

Planning – Incontinence is all about surprises, and they’re usually not pleasant ones! Take the time to schedule activities – even simple ones that you do around the house – and make sure to stick to that schedule. Communications planning is just as important – make sure that teachers, caregivers and anyone else who shares responsibility for the child knows what they need to know about the child’s situation and is able to take appropriate action if needed.

Practice – You never know what will work until you’ve tried it – and in most cases, that means trying and trying again. Test out different treatments, ask healthcare professionals for recommendations and see for yourself if there are certain products or programs that work for you.

Progress Is Possible – It may not always feel like you’re getting somewhere, but there are thousands and thousands of families who can tell you firsthand that the effort you make today really can turn into results down the road. It may not always be realistic to expect a cure, but there are things you can do – tactics, treatments and products – that can make your loved one much more comfortable and your life much easier.

It’s important to note that many children with autism have no problems with incontinence, and for those that do the severity of their condition can vary greatly. In addition, many children continue to develop over time and can improve their condition with the proper help and instruction from a caregiver. 

For more help on addressing incontinence in children with disabilities, download our brochure, Incontinence Support For Children With Disabilities.

Can Reflexology Help With #BladderLeakage?

Sarah Jenkins

reflexology #bladderleakage

What is Reflexology?

Reflexology is a therapy that focuses on the small areas of your foot or hands that correspond to different areas of the body. In reflexology, it is believed that by massaging these specific areas, you may be able to alleviate certain ailments.

What Can I Expect when I see a Reflexologist?

Reflexology is a new concept for many people so don’t be scared to ask lots of questions! Your practitioner will likely conduct a thorough health history to make sure that reflexology is for you, and also to determine what issues you may be having so that he or she knows where to focus. Likely, the focus will be on the feet, hands, or ears, or some combination of the three.

The reflexologist may ask you to lie down, and may start by gently washing or soaking your feet in warm water.  If you are seeing the reflexologist for a specific condition, he or she may focus on that area, but will also work all points of the foot or hands, as this is thought to allow the all areas of the body to relax and promote greater healing.

Reflexology is relaxing to most people and can be a great stress reliever.

Does reflexology help with bladder control?

More research needs to be done on reflexology and bladder control, but some people believe that by focusing on the areas of the foot and hands that are associated with the bladder, you may be able to reduce bladder spasms which often cause an urgent and frequent need to use the restroom (also known as overactive bladder, or OAB).

Can I try Reflexology on my own?

While reflexology may be most effective when performed by a practitioner, you may be able to feel the benefits on your own, or with a partner. Check out the pressure points on the foot in this chart, and learn some great techniques to perform the practice at home.

But You Look So Good

Maggie Zehring

A Guest Blog Post from Alice Thomas

In the early days of my MS I regularly heard ‘But, you look so good.’ While I have always been happy to have my good looks admired, rather than feeling like a true compliment, this statement often came across as one of disbelief that there could possibly be anything wrong with me.

I have even been skeptically asked ‘Are they sure you have MS? You don’t look sick.’ To which I am tempted to reply ‘You don’t look ignorant’. Because the question is inherently impudent and compels us to provide proof we actually have a disease. As patients, we don’t want pity but we do wish to be understood and we shouldn’t have to explain. So, what’s the answer?

One of the barriers to negating this confusion is that invisible symptoms can be difficult and even socially unacceptable to talk about. Amongst the many aspects of MS that aren’t obvious to the casual observer, bladder and bowel dysfunction are some of the most distressing. During my own looking so good days, this may have been the most troubling of my symptoms. I didn’t understand it so how could I talk about it and furthermore, why would I want to? It didn’t seem right to answer the old ‘But, you look so good?’ raised eyebrow with the truth that actually I was up all night doing laundry and crying because I’d peed the bed.

Adding to the frustration and confusion that looking good doesn’t necessarily equal feeling good, is that we as patients already question this ourselves and sometimes we are the most unforgiving accusers of all. We too can’t clearly see our own fatigue, nerve pain, numbness, muscle weakness or heat sensitivity. Consequently, we repeatedly set ourselves up for failure by not recognizing or respecting these unseen forces and then feel angry and defeated when we can’t accomplish what we’ve set out to do. We are the unwilling soldiers in our bodies’ civil war and it is a physical battle but also an emotional one. The physical struggle might be about the strength of our legs on any given day but the mental one is often an argument to simply will ourselves to do that which, based on how we look, we think we should be able. What we need to tell ourselves is the same thing we need to hear from others. MS is real. MS is hard.  

The answer to the dreaded ‘looking good’ statement isn’t to defensively list off every manifestation of the nasty disease that exists within us. You don’t owe anyone an explanation of something as intimate as your health. Nor should you have to prove your condition. But the question isn’t going away. Determining what is caring inquiry and what is idle curiosity can inform your response in these interactions. I’ve often found myself uncomfortably blurting out more than I wanted with someone who didn’t really care anyway. Rather than referencing my latest MRI, I’ve learned to point to some resources. Now when someone remarks on my striking countenance I say ‘Thanks, I inherited my mother’s flawless skin. MS is a complicated illness. If you want to know more, may I suggest checking out the MS Society website?’.

We are all curious from time to time. Let us act out of compassion and before we glibly assess the state of someone else’s health, of which we actually know nothing, pause a moment and instead of saying ‘but, you don’t look sick’ admit that we don’t really know much about the problem and ask how we could find out more.

Alice Thomas lives in Toronto with her husband and dog. She is an avid traveler, an arts enthusiast and a cheese fanatic. She is the author of the blog Tripping on Air - My trip through life with MS.  

Alice Thomas lives in Toronto with her husband and dog. She is an avid traveler, an arts enthusiast and a cheese fanatic. She is the author of the blog Tripping on Air - My trip through life with MS.  

The Link Between Diabetes And Neurogenic Bladder

Sarah Jenkins

diabetes and neurogenic bladder

Diabetes is a growing epidemic in our nation. More than 29 million Americans currently suffer from diabetes, and the Centers for Disease Control and Prevention estimates that by 2050, as many as 1 out of every 3 adults in the US could have the condition.

Many of us have heard the common complications associated with diabetes: heart disease and stroke, eye problems, including blindness, kidney disease and amputations due to damaged blood vessels and nerves.  But did you know that diabetes can also lead to neurogenic bladder?

Neurogenic bladder is a condition that occurs when nerve damage has occurred, preventing the bladder from emptying properly. Symptoms can include a frequent and strong urge to urinate (but in small amounts), difficulty emptying the bladder, incontinence, and urinary retention. Many people associate neurogenic bladder with conditions such as spinal cord injuries, MS, Alzheimer’s Disease, or Parkinson’s Disease. But neurogenic bladder can happen in people with diabetes too, as a result of diabetic neuropathy, which causes the bladder to lose the ability to sense when it is full.

The good news is that there are treatment options available for neurogenic bladder. Lifestyle changes, such as scheduled voiding, dietary changes, and keeping a bladder diary are a helpful start and can make a big difference.  Several drugs and procedures can help with symptoms of overactive bladder, and for those who have difficulty urinating, catheters can be a big help as well. Finally, surgery options are available. 

Of course, if you are pre-diabetic, the best course of treatment is prevention. Keeping your A1C levels in check with proper diet and exercise is essential in ensuring that you maintain a healthy weight.  Eating healthy foods at moderate portions, and getting in 30 minutes of physical activity can delay and in some cases prevent the disease.

If you are concerned about diabetes, talk with your doctor. He or she will help you assess your risk factors, and start you on a plan to combat this very prevalent disease.

Ask The Expert: What's The Best Way To Prevent UTI's When You Have A Neurogenic Bladder?

Sarah Jenkins

UTI's and neurogenic bladder

Question:  What’s the best way to prevent UTI’s when you have a neurogenic bladder?

Answer:  Unfortunately, Urinary Tract Infections are common in patients with neurogenic bladder. Patients with neurogenic bladder often have a harder time completely emptying their bladder. They also are often unable to sense that the bladder is full, resulting in them holding urine for too long.  Some patients also self catheterize, or use indwelling catheters, which can present complications leading to a UTI.

Of course, the best treatment of a UTI is prevention.  Below are 2 simple steps that patients living with neurogenic bladders can take to avoid bladder infections.

  1. Keep things clean. It stands to reason that keeping yourself, and any equipment used to assist with voiding, hygienic can help keep bacteria at bay. Be sure to properly clean your body, and any external catheters after each use. Always wash hands before and after self-catheterizing.  During a short-term infection, change indwelling catheters and be sure that the bladder fully empties to prevent urine from remaining in the bladder for too long.
  2. Develop a voiding schedule. While many things are considered when deciding when to catheterize, including patient and caregiver schedules and urine production, steps should be taken to ensure that the bladder is emptied frequently to prevent infections. Develop a schedule that works for you and stick to it.

UTI’s can cause many complications for people with Neurogenic Bladder, including decreased quality of life and other serious health concerns. If you are experiencing any common signs of a UTI, call your doctor.

Common signs of a UTI:

  • Fever
  • Urinary incontinence/leaking around the catheter
  • Cloudy urine
  • Spasticity
  • Back pain
  • Bladder pain
  • Lethargy
  • Painful or difficult urination
  • Sudden, high blood pressure

I am not MS, by Alice Thomas

Steve Gregg

MS is not a suffix at the end of my name. My life with MS, is just my life. 15 years after my diagnosis an MS-free existence is as foreign to me as all night study sessions and the days when my RDA of fruit could be met with grape jello-shots and strawberry pop-tarts. That was another life. One that would hopefully seem strange and remote to me now regardless of my health status. My life with MS is not a separate thing. My life with MS is just my life.

When I was diagnosed I expected everything I knew about myself to change. Suddenly I was a Person With A Disease. I didn’t know what that meant but I was convinced I was about to become someone else. A statistic. A sick person. Irrelevant. Nothing else about me would matter. The first and most important thing people would learn and know about me would be that I had MS. I was terrified of how others would perceive me but more importantly of how my own sense of self might be lost to a new reality. This identity crisis which threatened to convince me I was ‘less than’ for simply having a disease, was as disabling as any physical symptom I’d experienced. 

The early years of my diagnosis brought about massive changes to my life. Optic neuritis meant I was no longer able to drive a car. Weakened legs caused me to change apartments because of stairs and I was forced to leave my job. MS introduced tremendous challenges to my world. But that’s not the whole story. It seems at best cliché and at worst sacrilegious to admit but there have been some positives. Eventually I took the crisis as an opportunity to re-assess what is important to me. It helped me clarify my priorities. I do what I love.

Over time I have adapted to my changing physical body and circumstance and surprisingly I haven’t stopped being me. I didn’t become ‘less than’. In fact in some ways it could be argued I became more me. The things that are fundamentally Alice cannot be altered by a disease. I am incontrovertibly a story-teller, a traveler and a lover of life. A singer, a volunteer, an art loving, wine drinking, dog mum. I am empathetic, enthusiastic, creative and kind. I am curious about the world. I am an advocate and an ambassador. I am a foodie, a fun time, a baker and a homemaker. An optimistic, advisor, a student and a teacher. My life as an artist, a wife, daughter, sister, aunt, friend, these are the things that define me. I am not my job, my car or some stupid apartment. MS is not the most important thing about me, nor is it the most interesting. I am not MS. 

Peace didn’t arrive overnight. Every loss has been mourned. I must consider X, Y and Z each day and while it’s true most may not, they have their own alphabet soups to contend with, full of realities and problems completely foreign to me. As novelist Tom Holt says, “Human beings can get used to virtually anything, given enough time and no choice in the matter whatsoever.” We can adapt. The degree to which we are able to reconcile and coexist with calamity is the degree to which we are able to find our peace.

Grieve the changes. Adjust expectations. Live your life. 

Life with MS is complicated. We argue a lot. But it’s my life and I’m grateful for it.

Alice Thomas lives in Toronto with her husband and dog. She is an avid traveler, an arts enthusiast and a cheese fanatic. She is the author of the blog Tripping on Air - My trip through life with MS.  

Alice Thomas lives in Toronto with her husband and dog. She is an avid traveler, an arts enthusiast and a cheese fanatic. She is the author of the blog Tripping on Air - My trip through life with MS.  

Watch This Video Of How Botox Helped A Woman With MS Battle Neurogenic Bladder

Sarah Jenkins

If you're reading this article, you, or someone you know, have likely dealt with some form of incontinence before. It's a common occurrence (more common than most think!), and can be a source of daily annoyance, shame and fear in our lives. 

For those living with Multiple Sclerosis (MS), bladder dysfunction is often present and can greatly affect the quality of one's life. Symptoms such as hesitation, interrupted or weak flow, incomplete emptying, incontinence, frequency, and pain are reported by many who suffer from MS.  However, there is hope.  Many treatments are available to those living with this condition.  Watch the videos below to see how Amy, an MS sufferer, bravely describes her struggles with neurogenic bladder, and her amazing transformation after she started treating it with Botox. 

Amy's Before Video

 

Amy's After Video

Video Roundup – Four Inspiring Stories Of People Who Have Overcome Neurogenic Bladders

Sarah Jenkins

Becoming paralyzed or learning that you have MS or another neurological condition is anyone’s worst nightmare. The everyday freedoms that most of us take for granted suddenly become the main focus of life and things that were easy before become monumentally more difficult. We’ve rounded up stories from 4 inspiring people who have overcome tremendous obstacles and are determined to live life on their own terms. Watch their amazing stories in the links below.

Botox Injections For Neurogenic Bladder

Watch this self-taped video from Paralyzed Living about how he uses Botox injections to treat his neurogenic bladder.

Daniela’s Story

Watch Daniela’s inspiring story of how a freak accident left her a quadriplegic, unable to use her legs, and limited use of her arms and hands. Daniela struggled with bladder management, and finally took matters into her own hands by conducting extensive research into her options and finding a solution that has helped her regain her independence.

Audrey’s story

Audrey became paralyzed after an accident and suffered from bowel issues, but found the freedom to do what she wants from using Peristeen, a product for bowel management.

Amy’s Story

MS can wreak havoc on your bladder, resulting in urgent and frequent trips to the restroom, and in some cases, leakage. Watch this story from Amy, on how she used Botox to help her regain control.

Amy’s Video Diary – Before:  

Amy’s Video Diary – After:

Do you have your own story you’d like to share? Contact us!

Watch NAFC's Videos For Tips On Self-Catheterization

Sarah Jenkins

Being told that you have to use a catheter can be scary, but many people use a catheter to empty their bladders on both a temporary and a long-term basis.  And while you might recoil from the idea at first, once you get the hang of using one and see the benefits it can bring, it you may wonder how you were ever able to get by without it.

With a little practice, using a catheter can become second nature to you. Here are our best tips for using a urinary catheter.

  • Don’t be afraid to ask your doctor lots of questions. Catheters should be prescribed by your doctor and proper instruction should be given to you by your healthcare provider. If you are unsure of the process, speak up.
  • Be sure to keep the catheter and catheter site clean to avoid infections (UTIs are common with those using a catheter). Wash at least twice per day.
  • Use lubrication when inserting the catheter to reduce pain, discomfort, and friction – all of which may also help reduce infection.
  • Always wash your hands thoroughly prior to and after emptying the urine bag.
  • Be careful of tugging on the tubing, twisting, it, or stepping on the tubing when you are walking. It may be helpful for you to clip the tubing to your clothing to avoid this.
  • Always keep the urine bag below your bladder (below your waste) to prevent urine from flowing back into your bladder and causing an infection.
  • Drink plenty of fluid to help keep your urine flowing well.
  • Stock up on spare catheter equipment for emergencies.
  • Call your doctor if you experience any of the following
    • Trouble inserting or cleaning your catheter
    • Urine leakage between catheterizations
    • You notice any type of smell
    • Blood in the urine
    • Skin rash
    • Pain or burning in the urethra, bladder, or lower back
    • Swelling, draining, or redness in your urethra.
    • Any sign of a urinary tract infection, such as a burning sensation, a need to urinate often, a fever, or chills.

Learning how to use a catheter doesn’t have to be daunting. Watch NAFC’s videos on how to self-catheterize for both men and women here.

Self-Catheterization for Women:

 

Self Catheterization for Men:

Our Favorite Avocado Recipe: Guacamole!

Sarah Jenkins

Avocado Guacamole #BladderLeakage

It’s National MS Month and we’re celebrating by whipping up a snack that’s super good for you – especially if you have MS. Avocados are a terrific source of healthy unsaturated fat and are chock full of antioxidants. In fact, a 2013 study from Food and Function found that avocados are so good for you that they may counteract other foods that are, well, not so good for you. Subjects were fed either a plain hamburger patty, or one with avocado. Those who ate the plain burger showed a spike of IL-6 (a protein that is a measure of inflammation) four hours after it was eaten, however those who ate the burger with avocado saw little change in IL-6 over the same 4 hours. Plus, triglyceride levels (which, when elevated, can contribute to diabetes, heart disease and kidney disease) also did not rise after eating the burger with avocado (more than after eating the burger alone), despite the added fat and calories of the avocado.

There are tons of great ways to take advantage of this super food – toss some slices atop a sandwich, throw them in a salad, or, our personal favorite, whip up a delicious side of guacamole. 

Ingredients:

  • 2 large ripe avocados
  • 1/4 cup lime juice
  • 1/2 tsp cumin
  • 1 clove garlic, minced
  • dash of sea salt
  • 1 chopped tomato (seeds removed)
  • 1/2 cup chopped red pepper
  • 1 chopped jalapeño pepper (omit this if you don’t like the heat)
  • 1/4 cup chopped red onion
  • 1 tablespoon cilantro

In a large bowl, mix the chopped avocado, lime juice cumin, garlic, and salt. Then fold in the tomato, red pepper jalapeño, red onion, and cilantro. Serve with chips, on top of a burger, or as a dip for veggies.

What Is Neurogenic Bladder?

Sarah Jenkins

Neurogenic Bladder

Having a neurological condition presents many challenges, but one that few people likely think about until they are dealing with it is how the condition may affect your ability to use the restroom. Like many organs, the bladder is controlled by nerves that connect to your brain and spinal cord. When these functions are challenged due to a neurological condition, it can cause a person to have a neurogenic bladder.

What is Neurogenic Bladder?

Neurogenic bladder happens when there is a lack of bladder control due to a brain, spinal cord or nerve problem. Typically, the bladder has two functions – storing urine, and removing it from the body. These functions are controlled by communication in the spinal cord and brain. When a person’s nerves, brain or spinal cord become injured, the way they communicate with the bladder can become compromised.

There are two types of neurogenic bladder: the bladder can become overactive (spastic or hyper-reflexive), or under-active (flaccid or hypotonic). With an overactive bladder, patients experience strong and frequent urges to use the bathroom, and sometimes have trouble making it in time, resulting in urinary incontinence. In an under-active bladder, the sphincter muscles may not work correctly and may stay tight when you are trying to empty your bladder, resulting in urinary retention (producing only a small amount of urine) or obstructive bladder (when you are unable to empty your bladder at all). In either case, treatment is available.

What Causes It

Neurogenic bladder can be caused by a number of conditions. Some children are born with neurogenic bladder. Children born with spina bifida (when the fetus’ spine does not completely develop during the first month of pregnancy), sacral agenesis (when lower parts of the spine are missing), or cerebral palsy (a disorder that weakens a person’s ability to control body movement and posture) all may suffer from neurogenic bladder due to their conditions. Other medical conditions that may cause neurogenic bladder are Parkinson’s disease, Multiple Sclerosis (MS), spinal cord injury, stroke, or central nervous system tumors.

Treatment Options

Luckily, there are many treatment options for neurogenic bladder. Treatments vary depending on whether you have overactive bladder or urinary retention. To learn about treatments for these conditions, click through the links below.

Treatments for Overactive Bladder

Treatments for Urinary Retention

A neurogenic bladder doesn’t have to limit your life. Don’t be afraid to explore your options and find a treatment that works for you.

Do you have a neurogenic bladder? Tell us about your experience in the comments below – we’d love to hear about treatment options that have worked for you!

ASK THE EXPERT: Is It Safe To Have Sex With A Vaginal Prolapse?

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: Is it safe to have sex if you have a vaginal prolapse?

Answer: Yes! A prolapse occurs when a woman’s vaginal wall weakens and collapses, causing the uterus, rectum or bladder to fall into the vagina. However, in most cases, it is completely fine to have sex as long as the woman feels comfortable.  And, having sex when you have a prolapse will not cause any harm to the bladder, rectum or uterus, nor will it make the prolapse worse.

Some women with a prolapsed organ may feel some slight discomfort during sex. Using lubricant can help, as well as ensuring your pelvic floor is completely relaxed before you begin. Trying other positions may also alleviate any pain you are experiencing too. Talk with your partner about what feels best for you.

Are you an expert in incontinence care? Would you like to join the NAFC expert panel? Contact us!

Donate to NAFC

Is a Pelvic Floor Exerciser For You? Read Our Thoughts And A Review Of Three Popular Products That Claim To Improve Pelvic Floor Strength

Sarah Jenkins

Pelvic floor toner, pelvic floor exerciser

We’ve all heard the age-old advice that doing kegels are good for us.  And for the majority of people, they are. Kegels, when done along side other workout moves, can help tone and strengthen the pelvic floor, making leaks less likely.  And if that doesn’t mean much to you, consider this: experts say that a stronger pelvic floor can help make orgasms more intense, heightening sexual sensation.

The problem many people face is doing kegels correctly. The nature of kegels makes it hard to know if you’re tightening (and releasing!) the right muscles.  That’s where kegel exercisers come in. This new-ish breed of exercise equipment helps you to know exactly how you are performing in the kegel department.  Here’s a breakdown of three devices that are currently on the market:

Elvie

Elvie is a popular device that allows you to literally do your pelvic floor workout anywhere. It’s the smallest kegel tracker available and uses a combination app to track your progress. Elvie is made up of medical-grade silicone and has multiple sensors that measure force and help you see your efforts on screen, so women can visualize their kegel exercises in real-time. Elvie even corrects your lift technique, as 30% of women push down which can lead to damage. There are three levels – beginner, intermediate, and advanced. When you first set your Elvie up, you’ll run through a series of tests to gauge your strength, and then will begin advancing through the different levels as you progress, making the tool fun and challenging.  Each work out only takes 5 minutes, and as you move up in levels you unlock more games and challenges.  Elvie is priced at $199 and can be ordered online through the product’s website.

 

PeriCoach

PeriCoach is an FDA-cleared device that, similar to Elvie, uses sensors to guide you through a pelvic floor training session. Like the Elvie, PeriCoach syncs up to an app on your smartphone.  The app ques the user to squeeze and relax against the PeriCoach, and the contractions of the muscles are detected displaying activity on the smartphone app, showing your progress overtime. The tool also allows you to document your results, which may be useful if you’d like to share them with a doctor or PT. A recent report from PeriCoach showed that the device improved incontinence symptoms in up to 70% of users. PeriCoach is available for $249 at http://www.pericoach.com.

 

Yarlap

Yarlap is another pelvic floor exerciser, but this one does much of the work for you. It’s an FDA cleared pelvic floor stimulator that instructs your pelvic floor muscles to gently contract and relax in order to show you how a Kegel exercise should actually feel.  The difference between Yarlap vs. Elvie and Pericoach is that the Yarlap does the workout for you. It uses a technology called AutoKegel, which perfomrs the Kegel exercises comfortably, correctly, and easily to help you regain muscle tone.  Yarlap consists of a probe, which is inserted into the vagina, and is attached to a display unit, which you can program based on your needs. Yarlap is priced at $299 and can be purchased at http://www.yarlap.com.

A word of caution when considering an electronic device for kegels:  Kegels aren’t for everyone, and for some women who have pelvic floors that are too tight, they can even be harmful.  It’s just as important for the pelvic floor to be able to relax as it is for it to be able to contract, so use these devices with caution, and, preferably, with the guidance of a physical therapist specialized in the pelvic floor.  And, because the pelvic floor connects to many muscles in the body, they shouldn’t be done in isolation. It’s important to strengthen your entire core to ensure that everything is working together, and one muscle isn’t overly taxed during your day-to-day activities.  This is where a trained physical therapist can really help customize your workout.

Have you ever tried a pelvic floor exerciser? What were your results? 

Talking With Your Loved One About Incontinence

Sarah Jenkins

Talking With Your Loved One About Incontinence

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.