Health Chats
Bladder Control: How to Avoid a Nursing Home
Thursday Jun 24, 2010, 03:00PM - 04:00PM (EST)
1212320?1273790879
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/>
Dr. Bruce Crawford:
The first line of therapy for stress urinary incontinence, leakage with physical activity, is improved performance of the pelvic floor.  That means improved strength, improved endurance, and improved coordination.  This requires daily attention; but just a few minutes.
Dr. Bruce Crawford:
Give this a good solid try for 6 - 8 weeks.  Surgery will still be available.  I have many patients who came to me for an operation that after 1 to 2 months no longer need it.  
Dr. Bruce Crawford:
You should be aware that sustained improvement from fitness training of the pelvic floor depends on ongoing (daily) attention to pelvic floor exercise.
slightlybroken:
I had a urodynamics test that reveiled normal results besides stress incontinence. My bladder spasmed through out the filling stage. I had surgery to fix the stress incontinence issue but I'm still suffering from incontinence when I wake in the morning, I will urinate without the urge, and without warning. I do this 2-3 times a month. Why kind of incontinence is this, and why wasn't this caught on the urodynamics test?
Dr. Bruce Crawford:
Sometimes urodynamic testing needs to be repeated to understand the mechanism of incontinence.  I encourage you to follow up with your surgeon to discuss this if it remains a significant quality of life problem.  Good luck
Dr. Bruce Crawford:
Thanks to all for your great quesitons.  I really enjoyed participating in this chat.  Any one interested in getting more information about our pelvic floor exercise program can find it at www.pfilates.com.  Good luck to all
SherrieP:

I’d like to thank everyone who attended today’s Health Chat; both Dr. Crawford and I are so happy to have been able to shed some light on UI. Any questions that did not get addressed during the health chat will be answered and posted within a week so check back to the health chat archive for that additional information.
Dr. Bruce Crawford:
Anyone interested in seeing me for consultation can reach my office here in northern Nevada at 775 352-9355 (0).  Thanks again!  
SherrieP:
I can address individual POP questions at the Urogynecology Forum.
SherrieP:
Thank you all so much for joining us today, and thanks so much Dr.Crawford for joining us!!