Archive for March, 2017

Blood In Urine: Reason For Worry?

March 25, 2017

Andrew Siegel MD  3/25/17

The medical term for blood in the urine is “hematuria.”  The most common type is seen only under a microscope and is referred to as “microscopic” hematuria. This is typically discovered at the time of a routine urine test during a health exam. When one can see blood in the urine it is referred to as “gross” hematuria, although I prefer “visible” hematuria. Visible hematuria may cause red urine if the bleeding is fresh or cola or tea-colored urine if the bleeding is old. Sometimes hematuria can be accompanied by blood clots, at times so severe that they clog up the outlet to the bladder causing the inability to urinate.  Sometimes hematuria is only evident by seeing bloodstains on one’s underwear or appearing on toilet tissue.

Image below is the urinary tract; note that blood in the urine can come from any part of this tract (Attribution of image: 2010, author Jordi March i Nogue)

256px-urinary_system-svg

ANATOMY QUIZ: Test your knowledge of urinary tract and adjacent anatomy by labeling structures 1-14 (answers at end of entry)

 

3 Misconceptions Concerning Hematuria

Misconception 1: If you have visible blood in the urine and it goes away, it can be ignored.

Truth: Even if it happens only once, it can be a sign of a serious underlying problem that needs to be determined.

Misconception 2: Microscopic hematuria can be ignored since you cannot see it.

Truth: Microscopic hematuria can be a sign of a serious underlying problem that needs to be evaluated, although it is less commonly associated with a serious problem than visible hematuria.

Misconception 3: Testing can always pinpoint the cause of the hematuria.

Truth: Sometimes the precise cause of the hematuria cannot be determined, despite appropriate testing. However, testing does result in excluding all of the serious underlying causes, meaning that whatever the cause, it is not of significance.

Like a nosebleed, hematuria can be a non-significant problem due to a ruptured blood vessel.  Alternatively, hematuria can be due to serious issues such as kidney or bladder cancers, the two most concerning causes of hematuria.  It is important to know that those who use or who have used tobacco (even if they ceased use many years ago) and have hematuria have a much higher risk of having bladder cancer than non-tobacco users.

Common causes of hematuria in men and women are benign prostate enlargement and urinary tract infections, respectively.  It can occur after vigorous exercise, particularly in those who have bladder stones or other structural abnormalities of the urinary tract. Although most hematuria is painless, when painful hematuria does occur it is often caused by a kidney stone, bladder stone or urinary tract infection. Many people use blood thinners for a variety of reasons. They do not cause hematuria, but if there is an underlying abnormality within the urinary tract, can provoke and perpetuate the bleeding. Hematuria can be a side effect occurring years after pelvic radiation for cancers of the bladder, prostate, uterus, etc.

How Hematuria Is Evaluated

Imaging Tests: A variety of tests can be used to image the urinary tract, including US (ultrasound), CT (computerized tomography) and MRI (magnetic resonance imaging). Retrograde studies involve the injection of contrast into the ureters (tubes that conduct urine from the kidneys to bladder) to image the upper urinary tracts.

Urine Cytology: A Pap smear of urinary tract cells to look for abnormal cells, obtained by providing a urine specimen.

Urine Culture: A lab test to see if a urinary infection is present.

Cystoscopy: A visual inspection of the bladder with a narrow, flexible instrument performed on a monitor with magnification.

Bottom Line: Do not ignore blood in urine, whether it is visible or microscopic. It may be “nothing” (not a sign of a serious illness) or may be “something” (a warning sign of a potentially life-threatening illness), so it is always worthwhile to be properly evaluated. If you experience hematuria, do not panic since the cause can usually be readily determined and treatment initiated; if the precise cause cannot be pinpointed, serious underlying causes can be excluded.

Wishing you the best of health,

2014-04-23 20:16:29

http://www.AndrewSiegelMD.com

A new blog is posted every week. To receive the blogs in the in box of your email go to the following link and click on “email subscription”:  www.HealthDoc13.WordPress.com

Dr. Andrew Siegel is a practicing physician and urological surgeon board-certified in urology as well as in female pelvic medicine and reconstructive surgery.  Dr. Siegel serves as Assistant Clinical Professor of Surgery at the Rutgers-New Jersey Medical School and is a Castle Connolly Top Doctor New York Metro Area, Inside Jersey Top Doctor and Inside Jersey Top Doctor for Women’s Health. His mission is to “bridge the gap” between the public and the medical community that is in such dire need of bridging.

Author of MALE PELVIC FITNESS: Optimizing Sexual & Urinary Health http://www.MalePelvicFitness.com

Author of THE KEGEL FIX: Recharging Female Pelvic, Sexual and Urinary Health  http://www.TheKegelFix.com

Answers to anatomy quiz:

  1. Urinary system
  2. Kidney
  3. Renal pelvis
  4. Ureter
  5. Urinary bladder
  6. Urethra (Left side with frontal section)
  7. Adrenal gland
  8. Renal artery and vein
  9. Inferior vena cava
  10. Abdominal aorta
  11. Common iliac artery and vein
  12. Liver
  13. Large intestine
  14. Pelvis

 

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Are You “Cliterate”? (Do You Have A Good Working Knowledge Of The Clitoris?)

March 18, 2017

Andrew Siegel MD  3/18/17

The clitoris—possessed by all female mammals—is a complex and mysterious organ. Even the word itself–and the way it rolls off the tongue as it is pronounced–is a curiosity.  Many men (and women as well) are relatively clueless (“uncliterate”) about this unique and fascinating female anatomical structure.  The greatest challenge of achieving cliteracy is that so much of this mysterious lady part is subterranean–in the nether regions, unexposed, under the surface, obscured from view–and therefore difficult to decipher.  

The intention of this entry is to enable understanding of what is under the (clitoral) hood, literally and figuratively. Regardless of gender, a greater knowledge and appreciation of the anatomy, function and nuances of this special and unique biological structure will most certainly prove to be useful.  In general terms, proficiency and command of geography and landmarks on the map is always helpful in directing one to arrive at the proper destination.  Consider this entry a clitoral GPS.

 

Klitoriswurzel,_Klitoris,_Klitorisschenkel

The clitoris is mostly subterranean–what you see is merely the “tip of the iceberg.”  The white lines indicate the “rest of the iceberg.”

(By Remas6 [CC0], via Wikimedia Commons)

Mountainous and Hilly Female Terrain

The vulva (the external part of the female genital anatomy) consists of hilly terrain. It is well worth learning the “lay of the land” so that it can be traversed with finesse. The mons pubis (pubic mound) is the rounded and prominent mass of fatty tissue overlying the pubic bone, derived from the Latin “mons,” meaning “mountain.” Located beneath the lower part of the mons is the upper portion of the clitoris.  The word clitoris derives from the Greek “kleitoris,” meaning “little hill.”

Mons_pubis_jpg

Lower abdomen, mons pubis and pudendal cleft

By Wikipicturesxd (Own work) [CC BY-SA 4.0 (http://creativecommons.org/licenses/by-sa/4.0)%5D, via Wikimedia Commons

The Epicenter of Female Sexual Anatomy

The clitoris is arguably the most vital structure involved with female sexual response and sexual climax. It is the only human organ that exists solely for pleasure, the penis being a multi-tasker with reproductive and urinary roles as well as being a sexual organ. However, I would argue that nature had much more than simply pleasure in mind when it came to the design of the clitoris, with the ultimate goal being reproduction and perpetuation of the species.  If sex was not pleasurable, there would little incentive for it and pregnancies would be significantly fewer. Think about non-human mammals—what would be their motivation to reproduce if sex were not pleasurable? (Male chimps and female chimps do not sit down together and plan on having a family!)  So, pleasure is the bait and reproduction is the switch in nature’s clever scheme.

The clitoris, like the penis, consists largely of spongy erectile tissue that is rich in blood vessels. The presence of this vascular tissue results in clitoral swelling with sexual arousal, causing clitoral fullness and ultimately a clitoral “erection.”

Penile-Clitoral_Structure

Comparison of penis (left) and clitoris (right), each largely composed of spongy, vascular, erectile tissue

By Esseh (Self-made. Based on various anatomy texts.) [GFDL (http://www.gnu.org/copyleft/fdl.html), CC-BY-SA-3.0 (http://creativecommons.org/licenses/by-sa/3.0/) or CC BY-SA 2.5-2.0-1.0 (http://creativecommons.org/licenses/by-sa/2.5-2.0-1.0)%5D, via Wikimedia Commons

Clitoral size is highly variable from woman to woman—certainly as much as penile size. A very large clitoris can resemble a very small penis.

Interesting trivia: The female spotted hyena, squirrel monkey, lemur, and bearcat all have in common a very large clitoris referred to as a “pseudo-penis.”  When erect, it appears like the male’s penis and is used to demonstrate dominance over other clan members.  

The most sensitive part of the clitoris is the “head,” which is typically about the size of a pencil eraser and located at the upper part of the vulva where the inner lips meet. Despite its small size, the head has a dense concentration of nerve endings, arguably more than any other structure in the body. Like the penis, the head is covered with a protective hood known as the “foreskin.”

The head is really the “tip of the iceberg” because the vast majority of the clitoris is unexposed and internal. The clitoris (again like the penis) has a “shaft” (although it is internal) that extends upwards towards the pubic bone. The extensions of the shaft are the wishbone-shaped “legs” that turn downwards and attach to the pubic arch as it diverges on each side. Beneath the legs on either side of the vaginal opening are the clitoral “bulbs,” sac-shaped erectile tissues that lie beneath the outer vaginal lips. With sexual stimulation, these bulbs become full, plumping and tightening the vaginal opening.

One can think of the legs and bulbs as the roots of a tree, hidden from view and extending deeply below the surface, fundamental to the support and function of the clitoral shaft and head above, comparable to the tree’s trunk and branches.

vulva

Image above by OpenStax College – Anatomy & Physiology, Connexions Web site. http://cnx.org/content/col11496/1.6/, Jun 19, 2013., CC BY 3.0, https://commons.wikimedia.org/w/index.php?curid=30148635, no changes made to original

The Clitoral Response

With sexual arousal and stimulation, the clitoris engorges, resulting in thickening of the clitoral shaft and swelling of the head. With increasing clitoral stimulation, a clitoral erection occurs and ultimately the clitoral shaft and head withdraw from their overhanging position (clitoral “retraction”), pulling inwards against the pubic bone (like a turtle pulling its head in).

Interesting trivia: The blood pressure within the clitoris at the time of a clitoral erection is extremely high, literally at hypertensive (high blood pressure) levels. This is largely on the basis of the contractions of the pelvic floor/perineal muscles that surround the clitoral legs and bulbs and force pressurized blood into the clitoral shaft and head. The only locations in the body where hypertension is normal and, in fact, desirable are the penis and clitoris.

Why The Pelvic Floor Muscles Are Vital To Female Sexual Health And Clitoral Function

During arousal the pelvic floor muscles help increase pelvic blood flow, contributing to vaginal lubrication, genital engorgement and the transformation of the clitoris from flaccid to softly swollen to rigidly engorged.  The pelvic floor muscles enable tightening of the vagina at will and function to compress the deep roots of the clitoris, elevating clitoral blood pressure to maintain clitoral erection. At the time of climax, they contract rhythmically.  An orgasm would not be an orgasm without the contribution of these important muscles.

 

Bulbospongiosus-Female

Bulbocavernosus muscle (pelvic floor muscle that supports and compresses the clitoral bulbs)

 

Ischiocavernosus-female

Ischiocavernosus muscle (pelvic floor muscle that supports and compresses the clitoral legs)

(Above two images are in public domain, originally from Gray’s Anatomy 1909)

During penetrative sexual intercourse, only a small percentage of women achieve enough direct clitoral stimulation to achieve a “clitoral” orgasm, as this is usually restricted to women with larger clitoral head sizes and shorter distances from the clitoris to the vagina. Depending on sexual position and angulation of penetration, the penis is capable of directly stimulating the clitoral head and shaft, typically in the missionary position when there is direct pubic bone to pubic bone contact. However, vaginal penetration and penile thrusting does directly stimulate the clitoral legs and bulbs and the thrusting motion can also put rhythmic traction on the labia, which can result in the clitoris getting pulled and massaged.

Interesting trivia: Magnetic resonance (MR) studies have shown that a larger clitoral head size and shorter distance from the clitoris to the vagina are correlated with an easier ability to achieve an orgasm.

The clitoris plays a key role in achieving orgasm for the majority of women. An estimated 70% of women require clitoral stimulation in order to achieve orgasm. Some women require direct clitoral stimulation, while for others indirect stimulation is sufficient. Only about 25% of women are capable of achieving orgasm via vaginal intercourse alone.

With increasing sexual arousal and stimulation, physical tension within the genitals gradually builds and once sufficient intensity and duration of sexual stimulation surpasses a threshold, involuntary rhythmic muscular contractions of the pelvic floor muscles, the vagina, uterus and anus occur, followed by the release of accumulated erotic tension and a euphoric state. Thereafter, the genital and clitoral engorgement and congestion subside, muscle relaxation occurs and a peaceful state of physical and emotional bliss and afterglow become apparent.

Clitoral orgasms are often described as a gradual buildup of sensation in the clitoral region culminating in intense waves of external muscle spasm and release. In contrast, vaginal orgasms are described as slower, fuller, wider, deeper, more expansive and complex, whole body sensations. The truth of the matter is that all lady parts are inter-connected and work together, so grouping orgasm into “clitoral” versus “vaginal” is an arbitrary distinction. Most women report that both clitoral and vaginal stimulation play roles in achieving sexual climax, but since the clitoris has the greatest density of nerves, is easily accessible and typically responds readily to stimulation, is the fastest track to sexual climax for most women.

There is a clitoral literacy movement that is gaining momentum. Please visit:

http://projects.huffingtonpost.com/cliteracy for more information on the clitoris and this campaign to foster awareness of this curious organ.

Wishing you the best of health,

2014-04-23 20:16:29

http://www.AndrewSiegelMD.com

A new blog is posted every week. To receive the blogs in the in box of your email go to the following link and click on “email subscription”:  www.HealthDoc13.WordPress.com

Dr. Andrew Siegel is a practicing physician and urological surgeon board-certified in urology as well as in female pelvic medicine and reconstructive surgery.  Dr. Siegel serves as Assistant Clinical Professor of Surgery at the Rutgers-New Jersey Medical School and is a Castle Connolly Top Doctor New York Metro Area, Inside Jersey Top Doctor and Inside Jersey Top Doctor for Women’s Health. His mission is to “bridge the gap” between the public and the medical community that is in such dire need of bridging.

Author of MALE PELVIC FITNESS: Optimizing Sexual & Urinary Health http://www.MalePelvicFitness.com

Author of THE KEGEL FIX: Recharging Female Pelvic, Sexual and Urinary Health  http://www.TheKegelFix.com (much of the material from this entry was excerpted from this book)

Testicular Congestion Syndrome (A.K.A. “Blue Balls”): What You Need To Know

March 11, 2017

Andrew Siegel, MD   3/11/17

sphere-953963_640

“Blue balls,” a.k.a. “lover’s nuts,” is a commonly used colloquialism describing a malady marked by testicular and scrotal pain occurring after prolonged sexual arousal and stimulation without sexual climax.  Today’s entry explores this not uncommon situation that virtually every adult male has experienced at one point in his lifetime. The typical scenario is prolonged foreplay that ends there, with all arousal and no ejaculation. It’s like a stifled sneeze.  Thank you, Pixabay, for image above.

The sexual research by Masters and Johnson showed that the primary reaction to sexual stimulation is an increase in blood flow known as vaso-congestion (with the secondary reaction being an increase in muscle tension).  Orgasm is defined as the release from the state of vaso-congestion and muscle tension. If prolonged sexual stimulation occurs without ejaculation—congestion without decongestion—congestion does not dissipate, which can result in what is commonly known as “blue balls.”

The physiology of “blue balls” is as follows: With sexual arousal, there is increased arterial inflow of blood to the genital region, while the veins—which carry blood away from the genitals back to the heart—constrict, resulting in blood trapping that causes penile erection.  With the arousal process and the increase in genital blood flow, the testicles as well become somewhat swollen and turgid. With continued sexual stimulation in the absence of orgasmic resolution there is insufficient drainage of blood from the genitals resulting in further engorgement. The “blue” in “blue balls” describes a bluish tint that is related to venous engorgement. This tint is exactly the same as the bluish tint seen in the veins of your hand.  In addition to venous congestion, there is likely a contribution from sperm under pressure in the testicle and epididymis (structure above and behind testes where sperm are stored and mature), a condition known as “epididymal hypertension.”

Testicular congestion is a painful and frustrating condition, causing a tense, heavy, pressure-like, weighty discomfort and ache in both testicles. It feels as if someone is squeezing the testicles—a very unpleasant sensation. This situation begs for sexual release, after which the congestion and pain generally rapidly dissipate. If this does not happen with partnered sex, masturbation is the key to rapid relief.

Bottom Line (summarized poetically):   Blue balls are real…and a cure is coming.

Wishing you the best of health,

2014-04-23 20:16:29

http://www.AndrewSiegelMD.com

A new blog is posted every week. To receive the blogs in the in box of your email go to the following link and click on “email subscription”:  www.HealthDoc13.WordPress.com

Dr. Andrew Siegel is a practicing physician and urological surgeon board-certified in urology as well as in female pelvic medicine and reconstructive surgery.  Dr. Siegel serves as Assistant Clinical Professor of Surgery at the Rutgers-New Jersey Medical School and is a Castle Connolly Top Doctor New York Metro Area, Inside Jersey Top Doctor and Inside Jersey Top Doctor for Women’s Health. His mission is to “bridge the gap” between the public and the medical community that is in such dire need of bridging.

Author of MALE PELVIC FITNESS: Optimizing Sexual & Urinary Health http://www.MalePelvicFitness.com

Author of THE KEGEL FIX: Recharging Female Pelvic, Sexual and Urinary Health  http://www.TheKegelFix.com

 

 

Leaking Havoc: Diagnosing And Treating Female Stress Urinary Incontinence

March 4, 2017

Andrew Siegel, MD  3/4/17

This is the completion of a blog entry uploaded last week entitled “Leaking Havoc: Female Stress Incontinence.”

How is Stress Urinary Incontinence (SUI) diagnosed and evaluated?

Listening carefully to the patient is usually sufficient to make the diagnosis of SUI, the typical complaint being: “Doc, I leak urine when I sneeze, cough and exercise.”

After hearing the details of the patient’s problem, the next step is a pelvic examination. The issue with an exam with legs-up-in-stirrups is that this is NOT the position in which SUI typically occurs, since SUI is usually provoked by standing, exertion and physical activities. For this reason, the exam must be performed using straining or coughing forcefully enough to demonstrate the SUI.

The pelvic examination is done after the patient empties her bladder. The exam involves observation, passage of a small catheter (a narrow hollow tube) into the bladder, a speculum exam and a digital exam.

Inspection determines tissue health and the presence of urethral movement with straining. After menopause, typical changes include thinning of the vaginal skin, redness, irritation, etc. The ridges and folds within the vagina that are present in younger women (rugae) tend to disappear.

A small catheter is passed into the bladder to determine how much urine remains, to obtain a urine culture in the event that urinalysis suggests infection and to determine urethral angulation. With the catheter in place, the angle that the urethra makes with the horizontal is measured. The catheter is typically parallel with the horizontal at rest. The patient is asked to strain and the angulation is again measured, recording the change in urethral angulation that occurs between resting and straining. Urethral angulation with straining (hyper-mobility) is a sign of loss of urethral support, which often is seen with SUI. The vagina is carefully inspected for other manifestations of pelvic organ prolapse (dropped bladder, rectum, uterus) that can accompany the SUI.

urethra-rest

                                     Image above: female urethra (woman in stirrups)–note that urethra points straight ahead, like the barrel of a rifle

urethra-strain

                             Image above: female urethra (woman in stirrups)– because of urethral hyper-mobility the urethra leaks at the moment she is asked to strain or cough

Finally, a digital examination is performed to assess vaginal tone and pelvic muscle strength (rated on a scale from 0-5). A bimanual exam (combined internal and external exam in which the pelvic organs are felt between internal and external examining fingers) checks for the presence of pelvic masses.

Depending on circumstances, tests to further evaluate SUI may be used, including an endoscopic inspection of the lining of the bladder and urethra (cystoscopy), sophisticated functional tests of bladder storage and emptying (urodynamics) and, on occasion, imaging tests (bladder fluoroscopy).                   

How is SUI managed?

There are a variety of treatment options for SUI, ranging from non-invasive strategies to surgery. There are no effective medications for SUI. If there is not an adequate response to first-line, non-invasive, conservative measures, surgery becomes an appropriate consideration. However, it is always sensible to initially use a conservative approach that is cost-effective, natural, uses few resources and is free from side effects.

Kegel Exercises for SUI

Kegels have emerged from obscure to mainstream…In fact the 2017 Oscar “swag bag” included a pelvic floor device called “The Elvie,” reviewed in my book THE KEGEL FIX.

 

one-sheet-poster

Combating SUI demands contracting one’s pelvic floor muscles (PFMs) strongly, rapidly and ultimately, reflexively. The goal of Kegels, a.k.a. pelvic floor muscle training (PFMT) is to increase PFM strength, power, endurance and coordination to improve urethral support and closure.

Who Knew? PFMT has the potential to improve or cure SUI in those who suffer with the problem and prevent it in those who do not have it.

The cough reflex is an automatic contraction of the PFMs above and beyond their resting tone when one coughs. This squeezes the urethra shut to help prevent leakage. This is nature’s way of protection against incontinence with a sudden increase in abdominal pressure, a defense against cough-related SUI. An extension of this principle is to exercise the PFMs to amplify strength and power to allow earlier activation and more robust contraction.

PFMT increases PFM bulk and thickness, reducing the number of SUI episodes. Additionally, PFMT improves urethral support at rest and with straining, diminishing the urethral hyper-mobility that is characteristic of SUI. It also permits earlier activation of the PFMs when coughing, more rapid repeated PFM contractions and more durable PFM contractions between coughs.

Who Knew? PFMT can cure or considerably improve 60-70% of women who suffer with SUI. The benefits persist for many years, as long as the exercises are adhered to on an ongoing basis. PFMT is equally effective for pre-menopausal and post-menopausal women with SUI.

Who Knew? PFMT is most effective in women with mild or mild-moderate SUI. Chances are that if the SUI is moderate-severe, PFMT will be less effective. However, if not cured, the SUI can be improved, and that might be sufficient.

Once the PFMs are conditioned via PFMT, it is vital to apply the improved conditioning on a practical basis. The cough reflex can be replicated—voluntarily—when one is in situations other than actual coughing that induce SUI. In order to do so, one needs to be attentive to the triggers that provoke the SUI. By actively contracting the PFMs immediately prior to the trigger exposure, the SUI can be improved or prevented. For example, if changing position from sitting to standing results in SUI, consciously performing a brisk PFM contraction—an intense contraction for 2-5 seconds prior to and during transitioning from sitting to standing—should “clamp the urethra” and help control the problem. Such bracing of the PFMs can be a highly effective means of managing SUI and when practiced diligently can become automatic (a reflex behavior).

More Non-Invasive Strategies to Improve SUI

Manage the condition that provokes the SUI: Since discrete triggers often provoke SUI (e.g., when asthma causes wheezing, seasonal allergies cause sneezing, or when tobacco use, bronchitis, sinusitis, or post-nasal drip cause coughing), by managing the underlying condition, the SUI can be avoided.

Moderate fluid intake: With a sudden increase in abdominal pressure, there will tend to be more SUI when there are larger volumes in the bladder (although SUI can occur even immediately after urinating). Since there is a direct relationship between fluid intake and urine production, any moderation in fluid intake will decrease the volume of urine in the bladder and potentially improve the SUI. The key is to find the right balance to diminish the SUI, yet avoid dehydration. Since caffeinated beverages and alcohol increase urine volume, it is best to limit exposure (caffeine is present in coffee, tea, cola and even chocolate has a caffeine-like ingredient).

Urinate regularly: Based on the premise that there tends to be more SUI when there are greater volumes in the bladder, by emptying the bladder more frequently, SUI can be better controlled. Urinating on a two-hour basis is usually effective, although the specific timetable needs to be individually tailored. Voluntary urinary frequency is more desirable than involuntary SUI. An extension of this principle is to empty one’s bladder immediately before any activity that is likely to induce the SUI.

Maintain a healthy weight: Extra pounds can worsen SUI by increasing abdominal pressure and placing a greater load on the pelvic floor and bladder. Even a modest weight loss may improve SUI.

Who Knew? Bearing the burden of unnecessary pounds adversely affects many body parts. As much as obesity puts a great strain on the knees that support the body’s weight, so it does on the PFM.

Exercise: Being physically active can go a long way towards maintaining general fitness and helping improve SUI. In general, exercises that emphasize the core muscles—particularly Pilates and yoga—are most helpful for SUI. Unfortunately, and ironically, it is exercise that often provokes SUI.

Tobacco cessation: Tobacco causes bronchial irritation and coughing that provoke SUI. Additionally, chemical constituents of tobacco constrict blood vessels, impair blood flow, decrease tissue oxygenation and promote inflammation, negatively affecting function of the bladder, urethra and PFMs. By eliminating tobacco, SUI can be significantly improved.

Maintain bowel regularity: Achieving bowel regularity may improve SUI and prevent it from progressing. A rectum full of stool can adversely affect urinary control by putting internal pressure on the bladder and urethra. Additionally, chronic straining with bowel movements—similar in many ways to being in “labor” every day—can have a cumulative effect in weakening PFMs and can be a key factor in the development of SUI. To promote healthy bowel function, exercise daily and increase fiber intake by eating whole grains, fruits and vegetables.

The tampon trick: If SUI occurs under very predictable circumstances—e.g., during tennis, golf or jogging—a strategically placed tampon can be a friend. The tampon is not used for absorption purposes, but to support the urethra. By positioning the tampon in the vagina directly under the urethra, it acts as a space-occupying backboard. The tampon does not need to be positioned as deeply as it would be for menstruation, but just within the vagina. This may allow one to pursue activities without the need for a pad. Poise has come out with “Impressa,” a tampon available in three sizes designed specifically for SUI. It is placed via an applicator and can be worn for up to eight hours. In Australia and the UK, “Contiform,” a self-inserted, foldable intra-vaginal device that is shaped like a hollow tampon, is often used to help manage SUI.

Surgical Management of SUI: Mid-urethral sling

sling

Image above is of a mid-urethral sling in place under the urethra to provide the support necessary to cure/substantially improve the stress urinary incontinence

If conservative measures fail to sufficiently improve SUI, there are solutions. A relatively simple outpatient procedure—the mid-urethral sling—is the implantation of a synthetic tape between the urethra and vagina to recreate the “backboard” of urethral support that is defective. This creates a “hammock” to provide support and to allow compression and pinching of the urethra with any activity that increases abdominal pressure.

The sling procedure is performed via a small vaginal incision. The permanent material used for the sling is polypropylene tape, the same material as used by general surgeons to repair groin hernias. Mid-urethral refers to the placement of the sling beneath the mid-urethra, the channel that leads from the bladder to the urinary opening. Sling refers to the configuration created when the tape is firmly anchored to the soft tissues of the pelvis after being placed underneath the urethra. The sling procedure has a 85-90% cure rate for SUI.

Wishing you the best of health,

2014-04-23 20:16:29

http://www.AndrewSiegelMD.com

A new blog is posted every week. To receive the blogs in the in box of your email go to the following link and click on “email subscription”:  www.HealthDoc13.WordPress.com

Dr. Andrew Siegel is a practicing physician and urological surgeon board-certified in urology as well as in female pelvic medicine and reconstructive surgery.  Dr. Siegel serves as Assistant Clinical Professor of Surgery at the Rutgers-New Jersey Medical School and is a Castle Connolly Top Doctor New York Metro Area, Inside Jersey Top Doctor and Inside Jersey Top Doctor for Women’s Health. His mission is to “bridge the gap” between the public and the medical community that is in such dire need of bridging.

Author of MALE PELVIC FITNESS: Optimizing Sexual & Urinary Health http://www.MalePelvicFitness.com

Author of THE KEGEL FIX: Recharging Female Pelvic, Sexual and Urinary Health. Much of the content of this entry was excerpted from this book.  The book was written for educated and discerning women who care about health, well being, nutrition and exercise and enjoy feeling confident, sexy and strong.

The Kegel Fix is available in e-book format on the Amazon Kindle, iPad (Apple iBooks), Barnes & Noble Nook and Kobo and in paperback, all accessible via the following website: www.TheKegelFix.com. The e-book offers discretion, advantageous for books about personal issues, is less expensive, is delivered immediately, saves the trees, has adjustable fonts, as well as numerous hyperlinks—links to other sites activated by clicking—that access many helpful resources.