Tonight we’re going to talk about bowel and bladder control primarily, so Dr. Graves and I both actually trained together at the University of Pennsylvania in Philadelphia. And we’ve been each practicing for close to ten years and we’ve had five years of urology training in residency and med school before that. And the topic tonight is something that we do have a lot of focus in and enjoy taking care of and have specialty in.
So really we’re going to be dealing with two main things: that’s problems with number one and number two, so issues with urinary control and bowel control today. And actually I still remember one of the main reasons I went into urology was because I wanted to help people with quality of life issues. And often having issues controlling either urination or your bowels can be embarrassing and difficult to talk about. And a lot of patients I’ll even deal with for other reasons and they just don’t want to talk about it because they’re just embarrassed. But it’s very common and as patients even young patients can have issues but as we get older they can become more prevalent, but we want to create awareness about it and let you know that you can talk to your physicians, doctors and urologists about it and there are solutions and it’s not something you have to live with.
So just a quick outline of what we want to talk about today is understanding the bladder and bowel control better today, the care pathway for these different treatment options. And then we can also talk about how medtronic has different treatment options such as inner stem, another type of treatment called neuro, and we’ll discuss those in detail and then we’ll open it up for some questions. So if you’re having bowel and bladder issues you’re not alone, it’s very common and one in six adults can have an overactive bladder. And we’ll discuss what that means so OAB is often referred to as overactive bladder.
So you have about 37 million Americans who have an overactive bladder and that’s where you have urinary frequency, urgency, difficulty with controlling urination when you want to, and that can even have incontinence where you actually can have urinary incontinence and lose control of your urine. And then one in 12 adults can have fecal incontinence and that’s loss of control of having a bowel movement so that can be very distressing for patients. And this is quite common just to compare there’s 12 million patients in the U.S with vision problems and 17 million patients with asthma so it’s even more prevalent than that.
The frequency of peeing can be used to monitor overall health and anticipate certain problems. A regular peeing rate and volume occur when a person is well-hydrated and there is no undue pressure on the pelvic floor, bladder, and kidneys. A normal range is 5-8 voids in 24 hours and no more than twice at night if over 60 years old.
Nocturia, or frequently peeing at night, can be caused by decreased production of anti-diuretic hormone (ADH) with age or a lack of production in children. It can also be caused by drinking too much water, taking diuretic medications, untreated diabetes, urinary tract infections, or an overactive bladder.
It is important to speak with a medical professional if experiencing frequent or urgent peeing as it can be a symptom of underlying health issues.
Peeing can be an inconvenience when it gets more frequent and urgent.
The good news is that you can use your frequency of peeing to monitor how your body works. You can use it to assess your overall health and anticipate certain problems.
What is considered normal when it comes to peeing?
A regular peeing rate and volume occur when you are well-hydrated. There is no undue pressure on your pelvic floor, bladder, and kidneys. It means that you can anticipate when and how frequently you visit the bathroom.
When healthy, a good peeing range is 5-8 voids in 24 hours. At night, you shouldn’t wake up more than twice to pee if you are over 60 years old. When you pee more than eight times in 24 hours, that could mean that you have an overactive bladder.
The amount of urine you pass depends on how much fluid you drink, how big your bladder is, and how much urine your body produces.
Your body makes roughly 3 liters of urine each day. If you have a normal, healthy bladder, you can hold 300-400 ml of urine (approximately 2 cups). The urge to pee should generally start when your bladder has 150ml of urine (just over half a cup).
What is nocturia?
Peeing frequently at night is called nocturia. It means you have to wake up more than once a night to go to the bathroom.
The body usually produces more anti-diuretic hormone (ADH) at night, which prevents your kidneys from filtering and releasing water until you wake up. With normal ADH, you shouldn’t have to struggle to hold urine through your sleep.
However, ADH production decreases with age. That is why older adults are at higher risk of nocturia than younger adults.
ADH takes more time to be produced in children. That is why children below six years tend to wear diapers at night because they can’t hold pee overnight.
What causes peeing too much?
Drinking too much water
The more fluid you drink, the more urine you make, and the more frequently you need to pee. You can tell if you are drinking enough by checking the color of your urine. If your pee is light yellow to clear, then you’re taking in enough fluid.
But if your pee is always clear and you spend a lot longer in the bathroom, then you are probably drinking too much. Though drinking too much fluid isn’t dangerous, you can ease the amount to reduce your visits to the toilet.
Accidental or therapeutic use of diuretics
Diuretic medications help your body to get rid of excess fluid. The drugs work by prompting the kidney to be more permeable to sodium. This allows more sodium in the urine, which draws more water out of the blood into urine, lowering your blood pressure.
Diuretics are used as medications for high blood pressure. You should expect to pass urine a lot more when on these medications.
Drinks such as coffee, tea, and soda can act as diuretics, increasing your peeing frequency.
Untreated diabetes
Untreated diabetes means a continually high level of glucose in your blood. Since your kidneys can’t handle the re-absorption of this extra glucose, it is excreted in the urine.
The presence of glucose in your urine draws additional fluids along with the glucose, resulting in an increased peeing rate. And as you lose more fluids, your body becomes dehydrated, and you feel thirstier than usual. You will end up drinking and peeing a lot more.
Urinary tract infections
Urinary tract infections occur when bacteria enter via the urethra and multiply anywhere in your urinary tract. As the bacteria multiply, usually in the bladder, inflammation, and irritation increase the urge to pee.
In some cases, the bladder can become inflamed without an infection. This type of inflammation results in a chronic condition called interstitial cystitis or painful bladder syndrome, which is more common in women.
Overactive bladder
Characterized by a sudden urge to pee that you can’t control, an overactive bladder occurs when signals from the brain fail, causing bladder muscles to want to squeeze out urine when it isn’t full.
This condition is an urge-related form of urinary incontinence, wherein suddenly you feel the need to pee, but not much comes out.
Overactive bladder is more common in people with neurological disorders, such as multiple sclerosis, stroke, Parkinson’s disease, dementia, or a bladder abnormality like bladder tumor.
These diseases tend to cause damage to the nerves that tell the bladder muscles when to contract.
Urinary incontinence
Urinary incontinence is a condition where muscles that close off the urethra become weak, causing stress-inducing urinary leakage. The leaks may occur when you’re sneezing, coughing, or during strenuous exercise.
Incontinence may be due to pregnancy and childbirth, which weaken pelvic floor muscles.
Additionally, lower estrogen levels after menopause can also cause tissues to deteriorate in the urinary tract, resulting in incontinence.
An enlarged prostate
For men with an enlarged prostate, there may be a constant feeling of needing to pee.
The growing prostate puts pressure on the urethra. It blocks the flow of urine, making the bladder work harder to expel the urine. The leftover urine can become a breeding ground for bacteria and lead to inflammation, further messing with the bladder.
Pregnancy
When pregnant, blood volume increases, and the kidneys have to work through the excess fluid. This means that more fluid ends up in the bladder, and you can pee too much.
Increased frequency of peeing starts in the first trimester and gets worse in the subsequent trimesters.
What are the solutions to frequent peeing?
Frequent peeing can be reduced by cutting out bladder irritants from the diet. You can do so by avoiding alcohol, caffeine, artificial sweeteners, citrus, and spicy foods.
You should also quit smoking and lose weight. And drink most of your fluids earlier in the day to avoid trouble at night.
Peeing too much can be treated using medications. You can take medications that relax the bladder and its nearby muscles, such as antidepressants imipramine (Tofranil) and duloxetine (Cymbalta).
You can also get a Botox injection into your bladder. This will give temporary relief by paralyzing the muscles and blocking the chemical messenger acetylcholine, which sends signals to your brain to trigger abnormal bladder contractions associated with an overactive bladder.
Anti-cholinergic drugs, such as Oxybutynin, also block acetylcholine.
Pelvic floor physiotherapy is also ideal for stress-related incontinence, like pregnancy-linked incontinence.
But when incontinence occurs after menopause, estrogen creams may help by restoring the tissues near the urinary tract.
Bladder training is effective in controlling frequent peeing. It involves trying to go longer and longer without peeing over time.
For instance, if you go every hour, you can extend that time by 10 minutes for some days. Then keep adding on 10 minutes until you find yourself holding your pee for a longer period.
Safe, effective treatment of urinary incontinence
If you are peeing too much, you should see a urologist to determine the cause and degree of incontinence you have.
At St Pete Urology, we’ve helped many patients recover from leaky bladders through our tailored treatments.
Our solutions include behavioral therapies, pelvic muscle rehabilitation, incontinence devices, medication, Botox injections, and surgery. Our doctors have vast experience in diagnosing urinary incontinence and in providing the most appropriate treatments.
ST PETE UROLOGY IS FIRST TO OFFER NEW MEDICAL TECHNOLOGY FROM MEDTRONIC TO TREAT PEOPLE SUFFERING FROM INCONTINENCE
The New FDA Approved InterStim™ Micro is the Smallest and Fastest Rechargeable Bladder and Bowel Control System with Conditional Full-Body MRI
Full-Body MRI Conditional InterStim™ II and InterStim™ Micro Systems Give Patients a Choice Between Sacral Neuromodulation Devices to Suit Their Lifestyle
ST PETERSBURG, FL – JUNE 28, 2021 –St Pete Urology is one of the only medical providers in St. Petersburg, FL to offer new solutions to the millions of people who suffer from incontinence thanks to technology advancements from Medtronic — the world’s leading provider of therapy for bladder and bowel control issues.
More than 37 million adults in the United States – almost one in six – suffer from overactive bladder (OAB) and nearly 18 million Americans – about one in 12 – have fecal incontinence (FI).1-4 It is life-altering because many sufferers limit their lives socially, professionally, and personally,5 but it is treatable. The new InterStim™ II and InterStim Micro systems provide patients with safe, effective relief from OAB and FI. The InterStim™ II recharge-free system offers patients freedom from a recharging routine, the hassle of recharging components, and a reminder they have a disease. The rechargeable InterStim™ Micro system, the smallest device available in the sacral neuromodulation (SNM) market, benefits patients who want a smaller, longer lasting device. Both systems are full-body* conditional MRI and deliver the same therapy with long-term relief.
“Effective long-term bladder and bowel control is an unmet medical need by many in the St. Petersburg area who experience regular accidents and/or frequency issues associated with OAB and FI. It can significantly impact all aspects of a person’s quality of life – self-confidence, exercise, activities and even intimacy,” said Adam Oppenheim, DO. “By partnering with Medtronic, the trusted leader in SNM therapy, my goal is to help give patients a life without limits.”
Known as sacral neuromodulation (SNM), the therapy is delivered by the InterStim™ system – an implanted medical device that provides gentle stimulation to the sacral nerve and is thought to normalize the brain-bladder connection to alleviate symptoms. Medtronic developed SNM therapy more than 25 years ago in partnership with physicians who specialize in treating incontinence. Recent technology advancements from Medtronic now gives patients lifestyle-friendly choices in the type of InterStim system they choose; improved battery technology; conditional full-body MRI; and the smallest and fastest charging device on the SNM market.
“I must say, I was very impressed with EVERY aspect of my visit with Dr. Oppenheim. His knowledge goes without saying. Top notch. I was taken aback, though, by his patience and kindness. He took the time to listen patiently to the questions I had. I didn’t feel rushed. He answered those questions in a way that was very easy for me to understand. The staff that I encountered were friendly and assistive. I was also glad that any procedures/tests that he recommended I need are done right there at the office, not a hospital. His office and the building in which it’s in is very easy to find. Overall, a great experience. Should the need arise for anyone I know to need a urologist, I’m definitely recommending Dr. Oppenheim and his staff.”
“For much too long, my life revolved around where I would find the next bathroom,” said Wes Linkovich. “I’m so glad I finally sought help and was open-minded about sacral neuromodulation. My therapy fits well with my lifestyle and, finally, I can focus on the things I love. To anyone suffering in silence, please ask your doctor or urologist about the InterStim™ system from Medtronic. I wish I done this sooner.”
Not every patient receives the same benefit, and there are potential risks, which may include surgical, device and stimulation risks.6 St Pete Urology will explain the benefits and risks and help each patient find their best treatment.
About St Pete Urology
Drs. Reid Graves, Nicholas Laryngakis and Adam Oppenheim are dedicated to serving the urological needs of the Tampa Bay and surrounding communities. We strive to provide state-of-the-art diagnosis and treatment and believe in rendering the least invasive, most efficacious treatment of urological disorders in a kind, empathetic, manner. We treat each patient as a partner in his or her medical care and make patient education a central component of our care. Because many urological conditions are accompanied by social discomfort or embarrassment, we emphasize sensitivity and discretion when dealing with all of our patients’ concern
-end-
*Under certain conditions; see approved labeling for details. Patients with InterStim™ SureScan™ MRI leads only References:
Stewart WF, et al. Prevalence and burden of overactive bladder in the United States. World J Urol. 2003 May;20(6):327-336.
United Nations, Department of Economic and Social A airs, Population Division (2011). World Population Prospects: The 2010 Revision, CD-ROM Edition.
United States Quick Facts. United States Census Bureau Web site. Available at: https:// www.census.gov/quickfacts/table/ PST045215/00. Accessed July 19, 2016.
Whitehead WE, Borrud L, Goode PS, et al. Fecal Incontinence in US adults: epidemiology and risk factors. Gastroenterology. 2009;137(2):512- 517.
Dmochowski RR, Newman DK. Impact of overactive bladder on women in the United States: results of a national survey. Current Medical Research and Opinion. 2007;23:65-76.
Overactive bladder (OAB) is an uncomfortable and stressful condition. Characterized by a sudden involuntary bladder contraction that triggers a compelling urge to pass urine, OAB may lead to urine leakage or the need to pass urine several times during the day or night. As a result, having an overactive bladder makes it difficult to go through the day without several visits to the bathroom.
Bothersome Symptoms
While the symptoms of OAB may be less troublesome when you are at home, they can be a problem in a public or unfamiliar place. No one wants to rush out of meetings with important clients or friends for fear of not making it to the restroom in time.
The fear instilled by overactive bladder can interfere with your ability to go out with friends, work, exercise, and even sleep. It can also disrupt your sex life, leave you tired and short-tempered, or cause rashes or infection due to the leaks. And the whole experience may leave you feeling unhappy and hopeless.
Strategies for Overcoming Overactive Bladder
The good news is that overactive bladder can be controlled. In fact, many patients overcome OAB without the need for invasive medical and surgical procedures. The key to successful treatment is seeing a urologist early to assess your condition and identify steps to help you manage the symptoms and regain control over your bladder.
Lifestyle measures may include changing what you eat or drink, pelvic floor exercises, and pre-planned bathroom visits. When lifestyle changes are unsuccessful, medical and surgical interventions may be necessary.
Behavioral Changes
1. Reducing fluid intake
Restricting fluid intake reduces your urinary output and helps control OAB symptoms. Since the symptoms of overactive bladder usually occur after a certain critical urinary volume is reached in the bladder, limiting fluid intake ensures it takes longer to reach this critical volume.
By consuming most of your fluid before 7 PM, you can lessen your nocturnal frequency. If you are on diuretic medications, you can check with your urologist to see whether they can be changed.
2. Limiting foods and drinks that trouble your bladder
Alcohol and caffeine (present in coffee, tea, colas, chocolate and some energy drinks) irritate the bladder and increase urinary output. By reducing the intake of these beverages and foods, you can improve your bladder control.
Foods such as fruits and vegetables have hidden water content, so you can limit additional beverages when eating healthy fresh produce. You might also want to reduce or abstain from spicy foods, citrus fruits, and artificial sweeteners, foods made with tomatoes, soda, and other fizzy drinks.
Because the chemical constituents of tobacco constrict blood vessels, impair blood flow, decrease oxygenation, and promote inflammation—affecting the bladder, urethra and pelvic floor muscles—quitting cigarette smoking will improve your OAB symptoms.
3. Keep a bladder diary
Writing down the time and triggers for your trips to the bathroom can help you understand your body better. After a few days, your diary will show you the things that make your symptoms worse. For instance, you may realize that your symptoms get worse after you eat or drink a certain food. This helps you to decide what changes to make in your diet.
4. Weight loss and regular exercise
Excess weight puts pressure on the urinary bladder and worsens overactive bladder. Even modest weight loss may improve your overactive bladder symptoms.
Lower impact exercises, such as yoga, cycling, Pilates, and swimming, can help to alleviate pressure on the urinary bladder by boosting core muscle strength and tone. As a result, OAB symptoms improve.
Due to the proximity of the rectum to the bladder, a full rectum can put pressure on your bladder, resulting in worsening of urgency, frequency and incontinence. Taking steps to avoid constipation will improve bladder control.
Voiding Measures and Bladder Retraining
You can overcome overactive bladder by managing how and when you void. Ways to manage voiding include delayed (inhibited) voiding, timed voiding, and double voiding. Bladder retraining gradually imposes increased intervals between voids and establishes a more normal pattern of urination.
Delayed voiding means you practice waiting before you can go into the bathroom, even when you feel the urge. At the beginning, you may try waiting a few minutes, then gradually increase your waiting time to achieve a delay of up to 2-3 hours.
By timed voiding, you follow a daily pre-planned bathroom schedule. That is, instead of going to the bathroom every time you feel the urge, you go at set times during the day. For example, you may try to pass urine every 2-4 hours regardless of whether you have the urge to go or not. The goal of doing this is to prevent an urgent uncontrollable feeling and to regain control over your bladder.
Double voiding (emptying your bladder twice) helps if you have trouble emptying your bladder. After you go to the bathroom, try again a minute later.
Pelvic Floor Muscle Training
Pelvic floor muscle exercises, also called Kegel exercises, help to stimulate inhibitory reflexes between the bladder and the pelvic floor muscles. By exercising your pelvic floor muscles rhythmically, you can inhibit involuntary contraction before and after it begins.
Kegel exercises target muscles that relax the bladder. To perform the exercises, you should begin by mastering the presence, location, and nature of the pelvic floor muscles. A simple means of identifying the muscles is to start urinating and then, when about halfway completed, to abruptly stop the urine stream.
Once you locate the muscles, squeeze them just before and during the trigger for urgency or incontinence. This will diminish the urgency and help avoid the incontinence. When performing Kegel exercises, always squeeze and relax the muscles repeatedly when you feel the urge to pass urine.
Medications
Bladder relaxant medications can help you suppress overactive bladder symptoms, although you may need several trials of different medications or combinations of medications to achieve optimal results.
Your urologist will prescribe medication either in conjunction with behavioral modification or after behavior modification has been tried unsuccessfully. The drugs prevent involuntary contractions of the bladder muscles by relaxing and stabilizing them.
Biofeedback and Botox injections
Biofeedback is an adjunct to training pelvic floor muscles in which electronic instrumentation is used to transmit feedback information about pelvic floor muscle contractions. It enhances awareness and strength of pelvic floor muscles.
In other cases, your urologist may opt for Botox—a simple procedure usually done in the doctor’s office—where it is injected directly into the bladder muscle to help reduce OAB symptoms. Once injected, Botox helps to relax areas of the bladder where it is injected. Botox injections generally last 6-9 months and are covered by Medicare and most insurance companies.
Percutaneous Tibial Nerve Stimulation (PTNS) and Interstim
PTNS is a minimally invasive form of neuro-modulation. A tiny acupuncture-style needle is inserted near the tibial nerve in the ankle and a hand-held stimulator used to generate electrical stimulation with the intent of improving OAB symptoms. The procedure is performed once every week for 12 weeks.
In some cases, your urologist may opt for the more invasive form of neuro-modulation, called interstim. During the interstim procedure, electrical impulses are used to stimulate and modulate the sacral nerves in the effort to relieve OAB symptoms. A battery-powered neuro-stimulator (bladder “pacemaker”) is used to provide the mild electrical impulses that are carried by a small lead wire to the stimulated sacral nerves affecting bladder function.
Surgery for Overactive Bladder
Treating OAB with surgery is not common and is usually reserved for cases where other treatment plans have failed. Surgery may increase the physical size of the bladder by using portions of the bowel to replace and expand a section of the bladder.
At St Pete Urology, our approach to helping you overcome overactive bladder includes lifestyle changes and medical treatments such as prescription drugs, bladder Botox treatment, nerve stimulation, and surgery. Our specialist team of urologists is experienced at dealing with overactive bladder through proper diagnosis and treatment. You can be sure your consultation will lead to a recommendation of the best possible treatment options for you. Schedule your appointment with us and begin your journey to freedom from overactive bladder. For more information on overcoming overactive bladder and other urologic conditions, visit the St Pete Urology website.
The bladder’s function is to store urine and allow urination to be infrequent and controlled. Bladder problems may lead to bothersome issues such as incontinence, infections and overactive bladder. While you may not be able to prevent every possible bladder problem, taking appropriate measures can help to lessen many of them.
What should you do to keep your bladder healthy?
1. Drink plenty of fluid
Drinking plenty of fluid increases the volume and frequency of urination, which in turn helps to flush out bacteria from your bladder. Water is the best fluid for your bladder and should be at least half of your daily fluid intake.
Ideally, you should drink 6-8 eight-ounce glasses of water every day. But if you engage in intense exercise or activity, you may need to drink more to compensate for fluid loss. On the other hand, if you have a condition such as heart disease or kidney failure, you may need to drink less. Speak with your doctor about how much fluid is right for you.
2. Avoid smoking
Smokers are more likely to develop bladder control issues than non-smokers. Cigarette smokers also tend to have more severe bladder symptoms. For heavy smokers, there is a tendency to develop a chronic cough, which exerts added pressure on the bladder and worsens urinary incontinence. Plus, tobacco smokers are three times more prone to bladder cancer than non-smokers. Avoiding cigarette smoking is good for your bladder health.
3. Get active
Physical activity not only relieves bladder problems but also prevents fluid buildup in the legs. Fluid retention in the legs—usually due to heart disease or a sedentary lifestyle—can lead to bladder control issues. You can reduce fluid retention through low-impact moderate activity such as biking, swimming or walking briskly for at least 30 minutes at least 5 days a week.
4. Do Kegel exercises
Weak pelvic floor muscles are a common cause of urine leakage (incontinence). Kegel exercises target and strengthen pelvic floor muscles and keep urine from leaking when you sneeze, laugh, lift or have a sudden urge to urinate. Speak with your urologist about what kind of exercise will benefit you the most.
5. Avoid bladder irritants
Certain foods and beverages can irritate the bladder and trigger bladder problems. Known bladder irritants include alcoholic beverages, apples, apple juice, bananas, brewer’s yeast and carbonated drinks. Others are chilies, chocolate, citrus fruits, coffee, cranberries, grapes, nuts, raw onions, raisins, soy sauce, tomatoes and vinegar.
While you don’t have to stop eating your favorite foods and drinks entirely, reducing the amounts can improve your bladder symptoms.
6. Maintain a healthy weight
Being overweight is a risk factor for incontinence, particularly stress incontinence. The excess weight exerts more pressure on the abdomen and bladder and weakens pelvic floor muscles. In fact, nearly 50-percent of older people who are overweight struggle with bladder incontinence.
By losing weight in the abdominal area, you can reduce pressure on the bladder and pelvic muscles and improve bladder control. In many cases, weight loss improves incontinence symptoms or gets rid of them completely. Make healthy food choices and engage in regular exercise to achieve and maintain a healthy weight.
7. Prevent constipation
Bladder problems are quite common in people with constipation because a full rectum presses the bladder wall causing either outflow obstruction or increased spasm. Also, constipation makes pelvic muscles overactive, which causes dysfunction in stool and urine elimination and leads to an overactive bladder. You can reduce constipation by drinking enough water, eating high-fiber foods (like whole grains, fruits, and fresh vegetables), and being physically active.
8. Manage medications
Some medications can trigger bladder control problems. For example, high blood pressure prescriptions tend to increase urine output and relax bladder muscles resulting in urine leakage. Drugs such as antidepressants, muscle relaxants, antihistamines, sedatives, and tranquilizers may hinder bladder contraction and reduce awareness of the need to urinate.
You should not stop taking your medications just because you suspect they are responsible for your bladder issues. Instead, and before making any change, speak with your doctor about your concerns. The doctor may adjust the dosage or offer a different medication. In cases where the benefits of the medications far outweigh the related bladder issues, your doctor will work with you on alternative ways to ease symptoms.
9. Flush out bacteria
Proper cleaning of the genital area before and after sexual intercourse helps to reduce bacteria and prevents bladder infections. Passing urine before and after sex helps to flush out bacteria and stops their entry into the urethra during sex.
Since holding urine in the bladder for too long increases the risk of infection and can weaken bladder muscles, make sure to pass urine as often as possible. Use the bathroom at least every 3 to 4 hours, and when urinating, don’t rush. Take your time to fully empty your bladder.
At St Pete Urology, we provide expertise in the diagnosis and treatment of urinary disorders. Our urology specialists will work with you to develop an individualized treatment plan for your problems. We value our multidisciplinary and compassionate approach to caring for our patients. For more information on the prevention, diagnosis and treatment of urinary disorders, visit the St Pete Urology website.
Urinary incontinence is basically the loss of bladder control or leaking urine. Women experience urinary incontinence twice as frequently as men. One reason for this difference is that childbirth and pregnancy, as well as menopause, can contribute to making urinary incontinence more likely. There are two common types that affect women, stress incontinence or urge incontinence (or overactive bladder, also known as OAB).
Urine is made by the kidneys and is stored in the bladder. There are muscles in the bladder that tighten, causing a need to urinate. When these muscles tighten, urine is forced out of the bladder through the urethra. Urination happens when the sphincter muscles surrounding the urethra relax, letting urine out of your body. Urinary incontinence can make you leak small amounts of urine, or release larger amounts of urine suddenly.
For women, urinary incontinence may happen regardless of age, but it’s most likely to occur in older women. Almost half of women 65 and older have some type of urinary incontinence.
Signals that you have an incontinence issue that merits seeing a urologist include spasms or pressure in the pelvic area, causing an urgent need to urinate. Also frequent trips to the bathroom, for example, more than eight times per day or more than two per night while you sleep.
Your doctor will give you a plan of treatment, starting with steps that you can do at home. If these activities don’t improve symptoms, your doctor might recommend seeing a urologist or recommend other treatments, depending on whether you have urge incontinence or stress incontinence, or both.
What You Can Try at Home
Your doctor, nurse or urologist may suggest exercises that you can do at home. These preventative activities may stop urinary incontinence, or help you leak less.
Here are some of the activities that may be prescribed:
Kegel exercises. Kegel exercises targeted to strengthen the pelvic floor can help. However, some women’s pelvic floor muscles remain tightened all the time. In those cases, Kegel exercises not only will not help your urinary symptoms but they may cause more problems.
Bladder training. Going to the bathroom at regular times can help control an overactive bladder and help urge incontinence. You will be asked to keep a bladder diary to track how often you make a trip to the bathroom. You then will add 15 minutes to the intervals between bathroom visits. You should urinate each time, regardless of whether or not you feel an urge to go. You will be incrementally increasing the time between visits. Eventually your can train your bladder to retain more urine before it needs to be emptied.
Losing weight. Having extra pounds adds pressure to the bladder and surrounding muscles, which can cause bladder control problems.
Changing eating habits. Drinks with carbonation, alcohol or caffeine may aggravate incontinence.
Treating Constipation. Try eating more fiber because constipation can worsen urinary incontinence.
Urinary incontinence does not need to be a normal part of aging. It is sometimes a signal of another health problem, such as weak pelvic floor muscles. There are different types of treatment available to help ease the problem. Our team of specialists at Advanced Urology Institute have years of experience working with patients with urinary incontinence and can develop the best plan for the individual’s needs. For more information, visit the Advanced Urology Institute website.
Like the name suggests, an overactive bladder is a bladder that does more than it should. The normal functioning of a bladder is that as urine drains from the kidneys to fill the bladder, nerve signals in the brain communicate the need to discharge the urine. The urge to urinate grows gradually so a person can delay the passage of urine for a while. During the discharge of urine, the bladder contracts, letting out the urine through the urethra.
An overactive bladder contracts suddenly and involuntarily, so a patient cannot hold the urine. It also contracts often, even when it contains just a little urine. This forces the patient to take numerous bathroom breaks. Due to the frequency and suddenness of the contractions, an overactive bladder is known to cause the leaking of urine, otherwise known as urine incontinence. It affects both men and women.
Causes of an Overactive Bladder
An overactive bladder cannot be attributed to one single cause or factor. In most cases, it is caused by a combination of factors. These include:
1. Serious case of a urinary tract infection;
2. A neurological disorder that damages the communication of nerves in the brain and in the bladder;
3. Bladder complications such as bladder stones or tumors;
4. Stroke and multiple sclerosis;
5. Acute urine retention. When urine is retained in the bladder for long, there is no longer space for storage of urine. This may result in an overactive bladder;
6. Pelvic organ prolapse in women and benign prostate hyperplasia in men; and
7. Diabetes.
Social and Emotional Impact of an Overactive Bladder
Patients with an overactive bladder often worry a great deal about stigma. They find the frequent bathroom visits embarrassing and the fear of leaking urine in any social or work environment can be debilitating. These fears affect the normal day to day life of a patient and make it necessary to seek treatment as soon as possible.
Treatment of an Overactive Bladder
A patient can receive treatment in the form of medication, injections and in few cases, minimally invasive surgical procedures. Very often these treatment options are combined with physical therapy and behavioral modifications. Such modifications include:
1. Kegel exercises. These are administered to help strengthen the muscles of the pelvic floor;
2. Exercise aimed at achieving and maintaining a healthy weight;
3. Going on scheduled bathroom visits; and
4. Use of absorbent pads.
An overactive bladder is manageable and treatable. In order to avoid the difficulties that accompany the condition, it is advisable to seek the help of a qualified urologist for a proper diagnosis followed up by efficient treatment. Our team of experts at St. Pete Urology can help with any questions, as well as diagnosis and treatment of an overactive bladder. For more information, visit the St Pete Urology website.
Urinary diversion is a solution to any urological problem that prevents the passage of urine in the ordinary way. It is basically a rerouting of the urinal path through surgery.Ordinarily urine flows from the kidneys to the bladder through the ureter. It is stored in the bladder until the individual lets it out by urinating. The tube that drains urine out of the bladder is called the urethra. Sometimes the bladder can no longer function as a storage for urine or it has to be removed. This is common when a patient has cancer of the bladder or has suffered serious injury to the bladder. Urine flow is rerouted to follow another path out. Sometimes the procedure may be performed to provide temporary relief while in other instances it is permanent.
Types of Urinary Diversions
1. Continent Diversion
A continent urinary diversion is created by making a urine reservoir from parts of the bowel, mostly the small intestine. A surgeon can choose to attach the ureters and the urethra to the new reservoir, placing it in the position of the bladder that has been removed. That reservoir is referred to as a neobladder or a continent urinary diversion. A patient who has a neobladder is able to pass urine the normal way.
The alternative for a neobladder is creating a stoma as an outlet for the reservoir. A patient has to connect a catheter to drain urine from the stoma a number of times a day. This form of reservoir is also referred to as a continent catheterizable diversion.
2. Incontinent or Non-continent Diversion
An incontinent diversion connects the ureters that drain urine out of the kidney into an opening of the abdominal wall. The patient then is required to wear an ostomy bag into which the ureters drain the urine.
Performing a urinary diversion is a precise procedure and its complexity depends on the reasons why it is performed. A patient requires strict medical attention both before and after undergoing the procedure. Even after one has recovered, the advice of a urologist is necessary in the management of the various forms of diversions. A patient should insist on receiving the attention of a specially trained urologist if they require a urinary diversion. St. Pete Urology over the years has developed an outstanding staff of specialists in the area and it is a good place to start. For more information, visit the St Pete Urology website.
Urge incontinence is often a symptom of an unstable or overactive bladder. Characterized by a sudden strong desire to pass urine that can’t be postponed (urgency), urge incontinence usually comes with frequency (more often than normal) during the day and several times at night. Some women may even experience urine leakage during sex, particularly during orgasm. Although many women may avoid leakage by urinating frequently, they find the continual need to visit a bathroom quite restrictive to their lifestyles.
How do you know you have urge incontinence?
With urge incontinence, you will have urine loss because bladder muscles squeeze or contract at the wrong times. These contractions occur repeatedly, regardless of how much urine is in the bladder. There are 3 main indicators that you have urge incontinence:
Inability to control when you urinate
Having to pass urine frequently during the day and night
Needing to pass urine suddenly and urgently
Causes of urge incontinence
There are two principal causes of urge incontinence. Irritation within the bladder may trigger incontinence. Or it may be loss of the nervous system’s inhibitory control on bladder contractions. For example, neurological conditions such as multiple sclerosis, spinal cord injuries, Parkinson’s disease and stroke may diminish bladder control and cause urge incontinence. Likewise, cardiovascular disorders, diabetes, bladder cancer, bladder stones, alcohol consumption, infections, diuretic medicine and inflammation that irritate the bladder or damage its nerves may cause incontinence. Urge incontinence also may indicate a more serious problem. For instance, when the urgency to pass urine is accompanied by blood in urine, recurrent urinary tract infections (UTIs) or an inability to empty the bladder completely, these may be red flags for a more serious issue than just urinary incontinence.
How is urge incontinence treated?
Generally a few lifestyle adjustments may help a woman cope with urge incontinence. For instance, making it as easy as possible to get to the bathroom, avoiding caffeine (tea, cola and coffee), avoiding alcohol, reducing amount of fluid intake per day and losing weight can help relieve symptoms. Secondly, bladder training (also called bladder drill) and pelvic floor muscle exercises can be combined to treat urge incontinence. A third solution may be treating urge incontinence with medicines called anticholinergics (antimuscarinics) such as oxybutynin, solifenacin, tolterodine, trospium chloride, propiverine, darifenacin and fesoterodine fumarate. And if the urge incontinence is associated with the lining of the vagina after menopause, applying estrogen cream directly inside the vagina may help.
Urge incontinence is also treated using Botulinum Toxin A (Botox), a prescription-only medication that relieves the incontinence when other options such as bladder training and other medication have failed. When these treatments are not successful, the urologist may suggest surgery. Surgical procedures for treating urge incontinence include sacral nerve stimulation, percutaneous posterior tibial nerve stimulation, augmentation cystoplasty and urinary diversion.
At St Pete Urology, our doors are open to all women troubled by incontinence. We are a recognized name in the urological community and boast of a team of highly innovative, experienced and certified physicians who deliver leading-edge urology and patient-centered care. We know there are many women who live with severe urological problems and we do our best to help those who come to us. We are good at treating these disorders. For more information, visit the St Pete Urology website.
While a man with urinary incontinence needs to see a urologist for proper and timely treatment, there are certain things he can do on his own to manage the symptoms. In fact, taking these actions will not only prevent and relieve symptoms, but also will help overcome incontinence.Ways of managing urinary incontinence in men include:
1. Keeping a diary
Keeping track of how much fluid you drink, how frequently you have to go to the bathroom, when and how often you leak urine, and anything that triggers your symptoms, such as drinking a lot of coffee, coughing or bending your body in a certain way is an effective way of monitoring your incontinence. Using the diary, your doctor can get a better grip of your symptoms and how they affect your life, and find the right tests necessary for correct diagnosis.
2. Regular double-voiding
Double-voiding is a great way to minimize dribbling. So when you finish urinating, you should wait for a minute or so and then try voiding again. If you succeed to pass urine in the second attempt, you’ll seldom dribble afterward.
3. Cutting down on caffeine and alcohol
Caffeine and alcohol irritate the bladder and often worsen incontinence symptoms. By cutting down the amount of tea, sodas, coffee and alcohol you drink, you’ll make a massive difference with your urinary incontinence symptoms.
4. Quitting smoking
Smoking tobacco aggravates urinary incontinence in men. So the sooner you quit tobacco the better for you.
5. Spacing apart your drinks
Staggering your fluid intake can help to ease the symptoms. For instance, if you are having a lot of trouble at night, drinking less fluid before going to bed might help. And when you have problems during the day, it might help to drink less fluid many hours before you travel or leave home for an event.
6. Avoiding foods that trigger symptoms
Certain foods trigger urinary incontinence symptoms in men. For example, spicy foods and acidic foods such as tomatoes and citrus fruits are common culprits. Likewise, artificial sweeteners and chocolate may trigger incontinence. While everyone is different, it’s wise to identify the foods that worsen your symptoms and avoid them.
7. Training the bladder
Training your bladder can help you to control urinary incontinence. You can do this by starting to take scheduled bathroom breaks whether you are feeling the urge to go or not. Then gradually extend the time you take between your bathroom trips, making a conscious effort to tame your symptoms and push yourself to only pass urine every 3 or 4 hours. Bladder training may not give immediate results, but if you persist, you’ll get positive results within a few months.
8. Flexing your bladder muscles
Exercising the right muscles will help strengthen them and improve your bladder control. Because exercising the wrong muscles may increase pressure on your bladder, you should correctly identify the ones you exercise. The right muscles to focus on are those you would use to stop yourself from passing gas.
So how do you flex them? Apply tension on the muscles for 3 seconds, then allow them to relax for another 3 seconds. Build up gradually until you’re able to do three sets of ten repetitions. You can perform these exercises anywhere — at your desk, in bed or when watching TV, but don’t do them when urinating as that can lead to infections. You should do the exercises for 15 minutes per day. While it usually takes 3-6 weeks to achieve the desired effect, positive results may be noticed soon by men who are doing the right exercises frequently.
9. Lose weight and stay hydrated
Excess weight increases pressure on the abdomen and makes urinary incontinence worse. By shedding a few pounds, you can reduce symptoms. Likewise, while it seems a good idea to drink less water in order to prevent leaks, drinking less only makes urine more concentrated and increases bladder irritation, resulting in more urinary incontinence. Therefore, if you’re thirsty, drink some water.
10. Treat constipation
Constipation, together with the strain that comes with it, can negatively affect the nerves that control bladder function. By eating a high-fiber diet and taking the necessary actions to prevent constipation, you may help your incontinence.
11. Speak with your doctor about any medication adverse effects
Some medications and supplements can cause or worsen your incontinence. For instance, sedatives, antidepressants, diuretics and various allergy and cold medicines may elicit urinary problems. So make sure your doctor is aware of the medicines and supplements you’re using and of any adverse effects you’re experiencing.
12. Planning ahead
A lot of men with urinary incontinence are anxious whenever they have to travel, fearing accidental urine leaks. To ease your anxiety when going on a road trip, make sure to map out the route and identify the places you’ll stop at regular intervals to use the bathroom. Going out with a plan will make you confident and less prone to accidental urine leaks.
13. Get support
Urinary incontinence can be both stressful and embarrassing and you may even feel lonely and hopeless. So you should make an effort to remain connected with your family and friends. Joining a support group also may be beneficial. Your doctor can help you find any support groups in your area.
Applying these techniques may help relieve urinary incontinence symptoms. But because on their own these techniques are inadequate for managing urinary incontinence, you should work closely with your doctor to find the best solutions for your condition, particularly if the symptoms are adversely affecting your life. It’s also prudent to always speak with your doctor before you try any of these techniques for managing urinary incontinence. If you’re looking for a urologist near you, then you can always see one of our urologists at Florida’s St Pete Urology in St. Petersburg. For more information on the right treatment plan for urinary incontinence in men, visit the “St. Pete Urology” site.
Tonight we’re going to talk about bowel and bladder control primarily, so Dr. Graves and I both actually trained together at the University of Pennsylvania in Philadelphia. And we’ve been each practicing for close to ten years and we’ve had five years of urology training in residency and med school before that. And the topic tonight is something that we do have a lot of focus in and enjoy taking care of and have specialty in. 
Peeing can be an inconvenience when it gets more frequent and urgent.
Overactive bladder (OAB) is an uncomfortable and stressful condition. Characterized by a sudden involuntary bladder contraction that triggers a compelling urge to pass urine, OAB may lead to urine leakage or the need to pass urine several times during the day or night. As a result, having an overactive bladder makes it difficult to go through the day without several visits to the bathroom.
The bladder’s function is to store urine and allow urination to be infrequent and controlled. Bladder problems may lead to bothersome issues such as incontinence, infections and 
