GynoFiles

Menopause and/or aging itself do, to some extent, cause the bladder, uterus and rectum to drop. This is due, in part, to the lack of estrogen, which causes a thinning and weakening of all the pelvic muscles. Other factors are more significant, and bladder problems often begin with pregnancy and childbirth. We can blame some these problems on our ancient history. The first hominid species to walk upright evolved more than 2 million years ago. The most important branch of hominids was Australopithecus . These primitive humans walked semi-upright and gave birth to small-brained offspring. Thus, the female pelvis required only slight adaptations for the increased stress of childbearing. These early hominids evolved into Homo erectus about 1 million years ago and then emerged as Homo sapiens just over 300,000 years ago. This new species had a “modern” pelvis—an awkward compromise that permitted erect and stable locomotion on two feet while allowing the birth of a (relatively) large...

All decisions with hysterectomy have risks and benefits. For some women there are over-riding reasons to have a subtotal hysterectomy. For others the decision to keep your cervix may be based on personal preference rather than scientific fact. Hysterectomy means removal of the uterus, so if you have had a removal of the uterus, but your cervix was conserved, this is called a subtotal hysterectomy. The term partial hysterectomy is not a clinical term used by gynos although women may refer to hysterectomy without taking the ovaries as a partial hysterectomy and it really doesn't refer to the taking of the uterus. In a study published in the June issue of the American Journal of Obstetrics and Gynecology showed that in fact there was no improvement in incontinence rates if the cervix was left, and preliminary studies show that the rates of incontinence could actually increase if a subtotal hysterectomy rather than a complete hysterectomy were to be performed. Other considerations...

Runners when questioned are no different than other women who create pelvic pressure during exercise, thus some runners during their running events is a time that they complain of extra strain on their bladders. Longer races, in spite of some dehydration will create extra strain not only because of pounding through those half marathons, but perhaps just plain holding their pee a bit too long. Maybe it's just a matter of it being wedding season, you want to rock out until that bouquet is flung! Doing the Watusi in the highest heals may  be a bit strenuous on an already challenged bladder. Although your gyno has cautioned that latte breaks from shopping, and just getting too much caffeine, sugars, citrus and salt can affect the causes of incontinence, even with being good on your diet you may be struggling with your bladder. Pelvic examinations and cystometric testing as well as other tests can help make a diagnosis of any medical concerns.  Pessaries can be of help as wel...

Before we treat incontinence we check for the simple things that can be fixed, such as medications, diet, lifestyle (do you drink a lot of fluid before you exercise). Then it's been down to pessaries, medication or even surgery. Many medications have, among their risks, side effects of urinary incontinence. Before you take your prescription: Know your current risk factors for incontinence and ask your gyno for strategies to decrease the potential side effects! Patients on medication may have success, but it may require long term daily medication use, and some medications for incontinence need to be taken 2-3 times a day! Researchers reporting in the NEJM have now reported a single injection of 100 u of Botox into the bladder muscle can treat incontinence. For details please read: NEJM on line.

The Episiotomy Cut: Debate 2012: In 1935 Aldridge and Watson published their theory that performing an episiotomy would protect the mother’s pelvic muscles. They felt that all sorts of protection would be conferred, including prevention of prolapsed uterus. By the 21 st century obstetricians were looking at all the factors leading to bladder incontinence and weakness of the pelvic floor muscles, and it was hotly debated as to whether these episiotomy cuts would be helpful or harmful. The subject is complicated by the fact that women have some bladder dysfunction, and prolapse, immediately after delivery that resolves relatively quickly. The dysfunction immediately after delivery probably comes from temporary weakness or paralysis of nerves of this area, secondary to the baby’s head pounding against the pelvic floor and it’s muscles. In a study published in Obstetrics & Gynecology in 2012 a group of researchers   from the Johns Hopkins School of Medicine looked at women 5 ...

Jumping Jack (Jane) Dribble? Wet from a few leaks every time you go to the gym, and feel like you can't keep up with the pounding and zumba or cumbia and salsa moves? Lose the 5K race because you stopped for a bathroom break? Terrible! Unfortunately those with bladder issues of leaking with coughing and sneezing, find it's even worse at the gym. And that sort of leaking is what gynos mean when they say you have "stress incontinence" the stress is the rumba, the incontinence, the dribble! Bearing down to strain is a medical maneuver called a valsalva, and the strain of the forces of valsalva go directly to the neck of the bladder and affect if we can hold the urine in our bladder or if it leaks. Basic strategies like peeing before you bounce should help a bit, but often more has to happen, like lots of Kegel's, eating a bladder healthy diet, and otherwise trying medical interventions like pessary devices, medication, biofeedback, neuromodulation therapy, PRP the...

For Women Having Bladder Issues, Answer These Questions For Your Gyno: 1. How often do you urinate each day? How long do you usually wait between the times you urinate? 2. Have you had a recent bladder infection? More than one? 3. Do you get up to urinate at night? How many times? And what do you think the reason is you urinate at night? How long is it from bed time until the first time you go to the bathroom at night? 4. From the first urge to urinate, how long is it before you absolutely have to go to the bathroom? Is it usually an urgent sensation, or do you gradually feel like you have to urinate? 5. Do you leak when you do exercises? Which ones? 6. Do you wear pads? Daily pad use? Wet your underwear? 7. How often do you stop your urine stream when you urinate? 8. Have you noticed any change in how or how much you urinate? 9. Do you leak urine during sex? Wet the bed? 10. Do you have to strain to urinate?

We gals have the reputation of having the weakest bladders, and it doesn't take much of a detective to realize the lines by the "Ladies" rooms are always longer than the lines by the men's rooms! But what we tend to forget, is that the syndrome of overactive bladder, and leaking because of overactive bladder does occur in men as well. In fact when we quote the studies regarding effectiveness of treatments, you should know that just about every study has about 15% men, and the medications that are used to treat this condition are approved for use in guys as well as girls. So if your guy happens to keep pace with you while you rush to stake out every bathroom in a new location: well he might have the overactive bladder problem too! And the treatments will work quickly in him as well! Now when I say quickly: it's not quickly like treating a one week bladder infection: full effectiveness may take as long as 12 weeks with the treatments. So time to have a gyno gab, ...

Persimmons Fresh from the Garden Leaking Poop. No other way to say it. If this happens regularly, for whatever reason, it becomes intolerable. So intolerable a huge percentage of women won't even discuss with their gynos. Women as they age have come to learn that reduced bladder function, and occasionally peeing in one's pants, well, just happens, and even that is often not discussed with primary care providers, but studies show some women won't even be able to muster up that conversation. Occassionallly they sneak in a mention with overactive bladder questions. And you certainly aren't admitting it's why you avoid social situations and travel! Few gyno journals ever discuss the intolerable problem of leaking poop. But one Mayo Clinic study has tried out, in a dozen patients, a treatment with Clonidine, a medication, used for hypertension, and off label hot flash treatments, and has now been shown to help a bit with diarrhea based IBS as well! IBS patients are ...