URINARY INCONTINENCE

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Urinary incontinence--the loss of bladder control causing unintended leaking of urine—is a common problem seen more often in women than men.  Up to a third of American adults have urinary incontinence that affects their quality of life.  

Temporary causes can include drinks (alcohol, caffeine, carbonated beverages), foods (chocolate, chili peppers, and other very spicy foods), medications (heart and blood pressure medications and sedatives) and medical conditions including urinary tract infections and constipation.

Persistent causes include pregnancy, childbirth, aging changes, menopause, hysterectomy, enlarged prostate, prostate cancer, obstruction, and neurological disorders such as multiple sclerosis and Parkinson’s disease.

Common Types of Urinary Incontinence

 Overactive bladder (OAB) is also called urgency incontinence, affecting 30% of men and 40% of women.  Neurologic signals may tell the bladder to empty even when it isn’t full, or in other cases, the bladder muscles may be too active.  The main symptom of OAB is the sudden urge to urinate.  OAB is common in men with prostate problems and in women after menopause.

In stress urinary incontinence (SUI), common in older women, the pelvic floor muscles have weakened, allowing urine to leak due to coughing, sneezing, laughing, exercising and lifting something heavy.

Mixed urinary incontinence combines OAB and SUI, resulting in urine leaking with activity and frequent urges to urinate. With overflow urinary incontinence, the body makes more urine than the bladder can hold, causing the bladder to leak urine.  This type of incontinence is more common in men who have prostate problems or have had prostate surgery.

Prevention Strategies

To decrease your risk of incontinence you should maintain a healthy weight, avoid bladder irritants (caffeine, alcohol and acidic foods), increase dietary fiber to help prevent constipation, and refrain from smoking or seek help to quit smoking.

Treatment

Treatment for urinary incontinence depends upon the type of incontinence, its severity, and the underlying cause.  Sometimes a combination of treatments may be needed.

Behavioral techniques including bladder training (briefly holding urination after the urge to urinate), scheduled toilet trips and fluid and diet management are the bedrock of therapy.

Pelvic floor muscle exercises such as Kegel’s exercises, in which the patient imagines that they are trying to stop urinating by contracting pelvic muscles, have been recommended for years.  

Physical therapists who specialize in pelvic health and rehabilitation can provide individualized programs that help patients to strengthen weak muscles, relax tight muscles, retrain brain-muscle connections, and provide pain-relieving techniques.  Edgar LeClair, professor of Urogynecology & Reconstructive Pelvic Surgery at the University of Oklahoma in OKC, strongly endorses this treatment for women who are in need of additional help.

Electrical stimulation using temporarily-inserted electrodes can strengthen pelvic floor muscles.

Medications such as tolterodine (Detrol) and oxybutynin (Ditropan)can calm overactive bladders and reduce urge incontinence.  Mirabegron (Myrbetriq) treats urge incontinence by relaxing the bladder and increasing the amount of urine voided at one time.  Alpha blockers help men with prostate enlargement.  Women may respond to topical vaginal estrogen.

Botox injections into the bladder muscle may help overactive bladder.

Nerve stimulators, similar to pacemakers, can be implanted under the skin to deliver painless electrical contractions that help control urge incontinence.

Surgery can also be very effective.  Urethral sling procedures help keep the urethra closed and are effective in treating stress incontinence.   The more complex bladder neck suspension adds support to the urethra and bladder neck.  And in some men, an artificial urinary sphincter can be implanted.

The links below provide many details. For more information, please contact my office at 918-986-7979.

https://www.mayoclinic.org/diseases-conditions/urinary-incontinence/symptoms-causes/syc-20352808?p=1

https://www.urologyhealth.org/urologic-conditions/urinary-incontinence

ARE X-RAYS SAFE?

X-rays were discovered in 1895 by Conrad Roentgen, who received the first Nobel Prize for physics in 1901. X-rays are a naturally-occurring form of ionizing, high-energy radiation that can be used in medical diagnosis as well as for radiation treatment of cancers such as prostate and breast. X-rays can damage the cells of the body and potentially cause mutations in DNA and even cancer.

Madam Curie, who won the Nobel Prize in Chemistry in 1935, was an early pioneer in the field of radiation and she helped stimulate safety-related advances in radiology and radiation exposure. Common safety practices today include limiting the length of time exposed to ionizing radiation, using shielding materials in walls and equipment, and using lead aprons such as those typically found in dental offices. Pregnant or potentially-pregnant women should avoid x-ray examinations whenever possible.

There is natural environmental exposure to radiation that amounts to 0.003 rems (the basic unit of radiation exposure) per year. The maximum permissible yearly radiation exposure in minors and adults is 5 rems. An exposure of approximately 50 rems is required before harmful changes can be identified, though children may be affected to a greater degree than adults. Women are at a somewhat higher lifetime risk than men

Let’s look at how much various x-ray exams contribute to your yearly dose of radiation exposure:

The National Academy of Science concludes that low doses of radiation from medical and dental x-rays, natural and other manmade exposures pose some risk of cancer but the risk is small. Technicians and radiologists wear badges to measure radiation exposure. Patients may wish to keep a medical x-ray history, with the names and dates of radiology procedures and where they were performed.

Some other imaging techniques involve no radiation exposure. Ultrasound uses high-frequency sound waves and is safe for pregnant women. Magnetic resonance imaging (MRI) scans use powerful magnetic fields and advanced computer analysis, not x-rays.

  • The benefits of x-rays include:

  • No remaining radiation after x-ray examinations.

  • No side effects within the diagnostic range.

  • Easily available equipment for use by patients and physicians.

  • Fast results helpful in emergency diagnosis and treatment.

  • Experts agree that the health benefits of using x-rays for medical diagnosis far outweigh any harmful effects.

P IS FOR POSTURE

A recent story in the Washington Post story suggests that cellphone use by teens and younger children may by causing horns and bone spurs to grow from their skulls due to poor posture and leaning down while looking at cellular devices.  While 2016 and 2018 research in Australia has shown some possible back-of-the-head and upper-neck bony changes in Australian youth, there is nothing in the research connecting cell phone use and changes in skeletons.   The researchers made no claim of a relationship between bony changes and device use.  The Washington Post reporter originated this idea.

Posture does matter, however.  Poor posture can lead to malalignment of the spine, resulting in chronic pain in the neck, upper and lower spine, hips and knees.   Fatigue, depression, cognitive (thinking) changes and even impaired breathing are other possible outcomes of chronic poor posture.

Many Americans have very poor posture due to such activities as flying, driving, and using computers or cellular devices.  It’s important to be mindful about posture and to practice techniques to improve it in order to avoid the outcomes just mentioned.   

Helpful exercises include:

  • Stand, up elongate your spine with your head held high, perform shoulder rolls and pinch your shoulder blades together

  • Perform back extensions while resting and while watching TV

  • Perform “wall angels” to strengthen the muscles between your shoulder blades

WHAT IMMUNIZATIONS DO ADULTS NEED?

According to the Center for Disease Control,

  • Seasonal influenza (flu) – Everyone 6 months and older should get a flu vaccine every year as the best way to reduce the risk of flu and its potentially serious complications.

  • Pertussis, also known as whooping cough – The Tdap (tetanus, diphtheria, and pertussis) vaccine is recommended for women during each pregnancy and once for all adults who have not previously received it.

  • Tetanus and diphtheria – The Td vaccine is recommended every 10 years.

  • Shingles – The herpes zoster vaccine is recommended for adults 50 years and older.

  • Pneumococcal disease – Two pneumococcal vaccines are recommended for adults 65 years and older. One or both vaccines may be recommended for adults younger than 65 who have specific health conditions, such as diabetes, or who smoke cigarettes.

CALCIUM: DO WOMEN REALLY NEED A SUPPLEMENT?

Calcium and vitamin D are found in your diet, dietary supplements and, in the case of vitamin D, sunshine.  

For years the standard recommendation for calcium intake for adult women was 1,200 mg daily, but recent studies suggest that taking 500 mg of calcium daily—the amount in just 2 servings of dairy products a day--helps promote bone health without causing side effects.  So diet alone can supply enough calcium for many women.

1,000 units of vitamin D3, easily available over-the-counter, remains the standard for vitamin D supplementation. 

But, while taking these amounts of vitamin D and calcium leads to healthier bones, doing so DOES NOT reliably prevent hip fractures.  Exercise against gravity, such as walking, running and lifting weights, and certain prescription medications, however, do help prevent a variety of fractures, including hip fractures. .

SLEEP APNEA

Obstructive sleep apnea occurs when throat muscles relax while sleeping and the airway becomes temporarily obstructed.  Symptoms include loud snoring, episodes when you stop breathing during sleep, awakening with a dry mouth, insomnia and excessive daytime sleepiness.

Risk factors include excessive weight, increased neck circumference and a thick neck, a narrow throat, male sex, smoking and the use of alcohol, tranquilizers, and sedatives.

The consequences of sleep apnea, such as daytime fatigue, elevated blood pressure (hypertension), diabetes, and liver problems, can be lessened with effective treatment.   Weight loss and smoking cessation can help, as can the medical therapies CPAP (continuous airway pressure while sleeping) and oral appliances that pull the tongue away from the back of the throat, both of which open the airway. Surgery is not usually recommended.