Health Chats
Bladder Control: How to Avoid a Nursing Home
Thursday Jun 24, 2010, 03:00PM - 04:00PM (EST)
Bruce S. Crawford, MDBlank
Director, Northern Nevada Women's Incontinence Center
Women's Wellness Center - Reno
Urogynecology, Reno, NV
More than 50% of nursing home admissions are related to loss of bladder control and yet very few women do anything to prevent it. How can this be? Well for starters we have to acknowledge that we have done a poor job educating the public, women and men, about the relevance of pelvic floor fitness. Aside from the occasional suggestion to “do your Kegels” nobody hears anything about the pelvic floor. <br/><br/> The demographics are really alarming: Between 1900 and 2000, the total US population increased 3-fold, but the population of people older than 65 yr increased 10-fold. With aging, the percentage of elderly people who live at home but need assistance or who live in a nursing home increases markedly to 56% of women and 38% of men over 85.<br/><br/> As the baby boomers reach the golden years starting next year, the prevalence of pelvic floor disorders (urinary incontinence, fecal incontinence, pelvic organ prolapse) will increase dramatically along with the cost of medical services to treat these problems. Although the hour is already late we can do something now to begin to mitigate this morbid prediction. It is a two step process: first we must educate the public as to the nature of pelvic floor disorders, i.e. these are neuromuscular problems, and second we must provide a practical means to improving the performance of this specific neuromuscular system, i.e. achieve pelvic floor conditioning. This was the motivation behind the creation of the Pfilates program; a plyometric exercise program specifically created to improve pelvic floor strength, endurance, and coordination. Admittedly this is only a start. Tell someone you know about this very important, free Health Chat - Pelvic floor fitness is a very serious health concern that is rarely discussed and so easy to improve.<br/><br/> Dr Crawford is a Board Certified OB/GYN who has a special interest in the diagnosis and treatment of pelvic floor disorders including urinary incontinence, pelvic organ prolapse, female sexual dysfunction, and anal incontinence. Dr. Crawford is keenly interested pelvic floor neuromuscular restoration and is the creator of “The Pfilates Program”; a program for pelvic floor fitness training. For the last 5 years Dr. Crawford has been actively involved with the International Organization for Women and Development and has traveled to Niger West Africa each year to participate in the surgical repair of obstetrical fistula. Dr. Crawford is a frequent speaker at physician education programs across the United States.<br/><br/> Sherrie Palm is the author of “Pelvic Organ Prolapse: The Silent Epidemic”. Sherrie had never heard about the Pelvic Organ Prolapse (POP) until she needed surgery for it; she feels all women should be made aware of this common female health issue. In her book, Sherrie shares her road to knowledge and explores POP from all angles, providing the information women need to recognize the symptoms of POP and to become advocates for their own health. Sherrie is also actively involved with the local Special Olympics and donates a portion of the book’s proceeds to her local group. MedHelp is also very grateful for the tremendous outreach work Sherrie is doing in our new Urogynecology Community as our Community Leader. <br/><br/>
SherrieP:
Type here.Welcome to today’s MedHelp Health Chat, Bladder Control: How to Avoid a Nursing Home. It’s my pleasure to introduce Dr. Bruce Crawford, Urogynecologist and Director of Nevada Women’s Health Center and developer of the Pfilates program for pelvic floor fitness. I’m Sherrie Palm, community leader for the MedHelp Urogynecology Forum and author of Pelvic Organ Prolapse: The Silent Epidemic. Today we hope to share insights about urinary incontinence. UI is a health issue that many women deal with daily; studies show that anywhere from 40-75% of women will have incontinence issues at some point in their lives. Women often assume that UI is a natural part of aging but should be reporting this treatable health issue to their physicians. We hope to shed some light on this topic and answer questions that you have about how to recognize and treat incontinence. Welcome to the Health Chat Dr. Crawford!
Dr. Bruce Crawford:
Hello, It is great to be here today.  I am looking forward to your questions
MedHelp Editor:
my sister is pregnant and worried about a leaking bladder after childbirth. Can she do pelvic floor strengthening exercises during pregnancy or does she have to wait until after the baby is born? I know this isn't about nursing homes, so i understand if you can't answer it. Thanks for your help!
Dr. Bruce Crawford:
This is a very important issue.
Dr. Bruce Crawford:
The short version of the answer is YES you can, and should, do pelvic floor exercises during pregnancy.  Really this type of exercise is always a good idea.
Dr. Bruce Crawford:
I know we have a lot of concerns about what might or might not be safe during pregnanc,
Dr. Bruce Crawford:
however the pelvic floor should not be neglected.  
Dr. Bruce Crawford:
It is perhaps a good idea to avoid exercises that involve laying flat on your back after the first trimester, and perhaps a good idea to avoid "high impact" exercise, but the pelvic floor is perfectly ok.
ElizabethZ300:
Are there dietary changes that can improve urinary incontinence?  If so, what are the most important changes that can be made?  Thank you!
Dr. Bruce Crawford:
There are some things principally beverages that can be irritating to the bladder
Dr. Bruce Crawford:
caffeine,alcohol,carbonated beverages, artificial sweeteners such a nutrasweet can all be a problem
Dr. Bruce Crawford:
mostly these contribute to bladder sensitivity problems and urinary frquency
Dr. Bruce Crawford:
these beverages may also worsen urinary urgency and uncontrolled bladder contractions that lead to incontinence
Dr. Bruce Crawford:
some have suggested that non steroidal anti-inflammatories such as ibuprofen and alike may also be a problem
Dr. Bruce Crawford:
some individuals will have unique sensitivity to certain substances such as spicy foods that generally lead to more frequent urination
diz5020:
what can be done to prevent the loss of bladder control so that I won't need a surgical procedure or prescription meds?? I am 64 now and have had a total hysterectomy about 10 years ago.  Exercises? Diet?
Dr. Bruce Crawford:
This is a great question
Dr. Bruce Crawford:
Anything you can do to improve the performance of the pelvic floor will help.  Pelvic floor performance refers to the strength, endurance, and coordination of the muscles that surround and support the bladder, vagina, uterus, and rectum.
SherrieP:
Utilizing a combination of treatments is always a good idea for bladder control. Kegels are hugely important, strength in the pelvic floor muscle will help support the bladder.
Dr. Bruce Crawford:
Avoiding constipation, and frequent straining with heavy lifting is also worth consideration.  Weight loss for some individuals is helpful in reducing the risk of prolapse and can dramatically improve symptoms of stress urinary incontinence; leakage of urine with physical activity.
SherrieP:
Awareness of how strong your pc muscle contraction will give you a  better idea of when you should discuss this with your physician.
SherrieP:
You can wash your hands and insert two fingers into the vagina and squeeze your pc, see if you can feel the contraction.
Dr. Bruce Crawford:
Sherrie is correct about this.  Doing pelvic floor muscle exercises needs to be considered the same way we think about brushing our teeth or combing our hair.  We shouldn't THINK about leaving the house without doing them.  Just a few minutes a day can make all the difference.
AKJK406:
I have urinary leakage!  I'm a 38-year-old mom of 3 - full term pregnancies.  Every day I have to wear a pad because of embarrassing leakage.  Could this have been caused by pregnancies?  . Do I need surgery, or is there something else available?  Please don't tell me that this is as good as it gets!
SherrieP:
Yes, vaginal childbirth is the leading cause of POP, followed by menopause and other causes. Seek advice from a urogynecologist, they can advise you about all of your treatment options, both surgical and non-surgical
Dr. Bruce Crawford:
Thanks for the question.  Pregnancy is a major risk factor for urinary incontinence even for moms that ultimately deliver by Cesarean section.  Vaginal childbirth is a further risk factor that contributes to urinary incontinence for about 10% of women.   The good news
SherrieP:
There are many non-surgical treatment options, you may want to try a pessary prior to having surgery since you are so young.
Dr. Bruce Crawford:
is that the pelvic floor muscles can be largly restored in most cases.  Participating in a rigorous program of pelvic floor exercise within the first 6 months after dilevery is best, but the pelvic floor can be improved at any time after delivery.    
Dr. Bruce Crawford:
I would suggest making a solid effort at correcting this problem using neuromuscular techniques like Kegels or the Pfilates program.  The latter was designed specifically for pelvic floor fitness traiing and can be found on line.
SherrieP:
As a user of Dr. Crawford's Pfilates program, I can tell you it has a great impact on my pelvic floor awareness. Even though I've had surgery to repair a cystocele and other types of POP, I still do maitenance.
Walpole51:
Do Kegel exercises really work in building up the bladder muscles?  How do I know if I'm doing these properly?  Are there other exercises that work as well or better?
Dr. Bruce Crawford:
Kegel exercises do not work the bladder directly.  They do work the muscles that provide support to the bladder.  Pelvic floor exercises (Kegels) also improve the function of the nerves that supply the sensation from the bladder and the signals from the brain to the bladder.