New and questions

In the past year leakage from incontinence has gotten worse.  I realize it's not nearly as bad as some ladies may have.  I'm thinking it's a mixed bag of types involved.  However, I don't believe that POP is involved, especially since I have to imagine it would have been noticed for the GYN part of a recent appointment.  Definitely it's stress involved, ie coughing, low situps, jumping.  There's some leakage occurring during the daytime although it's not an amount I can measure.  There is definitely a urine smell though.  For close to a year I've been wearing the light type of Poise or Tena pads.  If working out, and definitely if working on situps, have to wear a moderate type of the pad.  

This has been building up prior to the past year.  For the most part, I thought that perhaps I was just heavy and sweating a lot.  But...sweat doesn't have an odor of urine.

I spoke of this at my annual physical at the VA Hospital the other day and am being sent to Physical Therapy.

Any thoughts or suggestions?  Thanks!

[Galsal59]

Oh dear...hopefully I'm not in the wrong forum since POP isn't involved.  Thanks

[ButterBuns]

I can relate I had this too and finding the cause is a daunting task. I went through ultrasounds, to meds, to possible urethral infections, to seeing a urologist who discussed surgery then finally we found a large cyst on my ovary causing pressure on my bladder. That all took a year plus ugh. It could be caused by a number of things...have you had children, age, like you noted stress, but I would suggest to keep searching for an answer that you know is right bc the end result will hopefully be relief of this terrible occurance. One thing that helped me with the odor was keeping feminine wipes for the frequent trips to the bathroom. I've never heard of physical therapy but something to consider is practicing kegels I was told they could strengthen the muscles. Exercising is also helpful bc losing a little weight could relieve some pressure on the bladder. Last resort surgery but exhaust all resources in the search for the problem before chosing this method. Best wishes BB

[Galsal59]

Thanks.  I'm 51, not yet in menopause, with 1 child although there were multiple miscarriages before he was born.  While I do need to lose weight, when I had lost 30 lbs last year on the South Beach diet and weighed 157 is when the condition really picked up and ran off.  A good point, but it's not an ovarian cyst.  I know this because annually I've been checked by ultrasounds to ensure nothing anatomically wrong due to messed up menstruation.  For the past few years, I get too many approximately one-half of the year.  A private Dr I see (not the VA) ran hormones and thinks I shouldn't ever have my cycle again.  Well he doesn't quite know that since I've had three since then.  My Estrogen is quite low, almost bottomed out, yet I still get cycles.  Supposedly in November I had a UTI but no pain or anything.  If I did have one, it was the first in my entire life.  

The wipes is an idea I'd thought of but personally haven't ever known any one that uses them.  The therapy I'm sure is to help see if any thing can be done about the muscles without going to last resorts.

Thanks for your answer and I appreciate it.  

Sal

[sherrieP]

Hi Sal,

I'm Sher, the CL of this forum. First up I'd like to say that physicians typically don't pick up on POP, it is not screened for during a pelvic exam (although it sure should be-I've been banging the drum on that perspective!). Even when gyns do pick up on POP, they usually aren't able to tell what degree you have, you should have a definitive diagnosis of type/degree and that usually takes a urogynecologist (specialist for POP).

Urinary incontinence is the most common symptom of POP but certainly not the only one. UI is also almost always tied to POP issues. Please read the following post for POP basics, see if you recognize any other symptoms.

http://www.medhelp.org/posts/Urogynecology/Taking-Pelvic-Organ-Prolapse-Out-of-the-Closet/show/1271553

There are many treatments available for  POP and I highly recommend women try them b/4 proceeding to surgery. Many women use a pessary, others see a PT for treatment but it is important that the therapist you see is a women's pelvic floor specialist or it won't be of much benefit. I have a link I can forward to you if you need this info. Myofascial release therapy is also beneficial for many women both in early stages of POP as well as women post surgery who still have some restrictions to address. Kegels are always beneficial to all women but they have to be done properly. Here's a link to an article I posted on our health pages.


http://www.medhelp.org/health_pages/Womens-Health/KEGELS-AND-KEGEL-BREATHING/show/1133?cid=591

There is a possiblity of course that the incontinence is not related to POP but it almost always is. I am hopeful you will find a physician to address this; if you decide you want to see a urogyn and don't know how to find one let me know-I can private message info to you.

Good luck Sal,
Sher

[Galsal59]

thanks Sher!  there's definitely several of the causes that are Me.  as for the symptoms, I can't tell about any of the sex ones.  Nothing to base that on for a while.   I've no doubt the muscles have gone to hell in a hand-basket since when I began doing sit-ups and ab exercise with a Bender Ball is when I had to be certain to wear a heavier pad.  That little ball put the positioning angle just so that it had a major effect...yet regular sit-ups don't so much.  Go figure.

The information about a Gyn examination not necessarily picking up on POP is quite interesting.  I see the Gyn at the VA next month.  The physical therapist I'm seeing is at the VA too, so I highly doubt she's specialized in this.  At least they have me seeing a woman though.  :)  I've worked with her before for therapy on a bad shoulder.

[sherrieP]

Most women have more than one POP cause, personally I had 5-most women in our age pocket have at least 2, vaginal childbirth and estrogen loss. On the situp path, I noticed some time ago (I'm a big believer in maintenance post surgery for POP so I pay attention to exercises I do as far as how they impact the pelvic floor) that how I do situps makes a difference.  However it is vital in your state to be extremely careful with any ab exercises you do-since I've had surgery to repair my POP issues, I am in a different stage than you are so if you try any of these, be extremely aware of how they make your body feel. It could very well be that none of them will work right now. With lower estrogen levels impacting your muscle tissue strength and integrity, that will impact how much benefit you get as well.

When you go see the gyn, question her on POP, take a list of symptoms and bring the topic up-typically if women bring symptoms up and question POP, the drs will address it. I would shy away from any suggestions to have surgery done by a gyn however, the pelvic cavity is extremely intricate and you want a specialist to do surgery if you go that direction. Same goes with PT, bring up POP topic, if she is not famliar with POP issue, maybe someone else in her department is.

Good luck, keep me in the loop!
Sher

[Galsal59]

Thanks for the input.  Turns out the Therapist I'm seeing is the only one at this VA Hospital that is certified for PFT.  She finally convinced the Therapy group there was enough of a need for the specialty and she's permitted to see Four appointments for this weekly.  So, needless to say...she's b-o-o-k-e-d since the Women's Clinic has learned of her and sends patients her way.  She agreed that it could be missed by a pelvic exam and wasn't even by Gyn.  Just an exam for a Pap.  She was upset that the Personal Trainer I had before had remarked when I spoke of the bender ball causing the problem was like "oh, that happens with women your age and it's normal.  just keep working it and things will get better.  or better yet, use a mini tramp to work those muscles"  Said it is indeed not "normal" nor acceptable.  I suppose it doesn't help that my timing pattern of urination is rather frequent.  I was shocked when she asid the average Bladder is meant to go 3-4 hours between urination.  Holy COW...I'm every hour at times and with a large volume too and am LUCKY if I can make it through an entire movie without having an accident on the way out of the theater.  That's a race to get to the bathroom before others so I don't have to wait.  A road trip?  Oh hell...if I can last for more than an hour it's because I haven't drank much liquid.  

So I'm definitely speaking of it with the Gyn.  I do sincerely doubt that unless something were extreme that the VA would even speak of surgery.  It's just not their style if they don't have to.  

So yes, there's a few things occurring with me.  I thank you, truly!

Sal

[sherrieP]

I am so happy Sal that your PT is educated in pelvic floor, what a great stroke of luck! And from the feedback you've given on what she had to say, she will be able to guide you well. And I agree, whenever I hear comments like "it comes with aging" or "that's what happens when you have babies" it sends me through the roof. Since she is booked so far ahead, you'll have to do some work on your own to find out what helps you until you see her-I am hopeful your gyn will be of some help but.... Treatment wise, pessary, kegels, core strengthening exercises like Pilates or Pfilates, support garments, Incostress can all help. Therapist might utilize biofeedback, electrical stim, myofascial release therapy. Many options to try. Typically women utilize more than 1 treatment at once. I'm going to send you a PM (private message) with additional thoughts.

Sher

[Galsal59]

Thank you for your time Sher.  Therapist does utilize those options you spoke of btw.  Said her goal was to get me to being 80% better.  I'm sure that losing weight would be of a great help.  But...the hormones are all out of whack for me and even if at the gym 6-7 days a week combined with eating correctly, the waist and lower abdomen gets worse despite the rest of the body getting better and toned and muscled.  Sigh

Some times feels like too many issues all at once.

I'm curious though on thoughts how things work out when in the dating scene.  Rather afraid to go there with this going on.

[sherrieP]

Yes Sal, it is so hard to get your body in balance when the hormones are out of wack. I use bioidentical hormones and have been very happy with them but you do need a dr who dances on the holistic side to rx them. Until they are in balance it will be extremely difficult to get wasteline fat and bloat under control and then you add POP on top of it...if you want more info on this let me know- I know a great book that explains it well.

On the dating scene, this is a topic that I truly want to get more dialogue out there on but it is hard to find venues open to my touching it-I have conversations with women about it though. How on earth can single women be comfortable approaching the dating scene with POP issues-how on earth do you divulge such personal info? I recommend establishing a good base relationship first of course so you are more comfortable discussing this stuff and then make it clear that you are interested in intimacy but have a health issue that you are not comfortable revealing-at the point you feel the man involved is ready you could disclose. I would suggest you make sure you drink lots of water the day of intimacy to make your urine more diluted (but stop a couple of hours prior to sex so you don't need to continually run to the bathroom while with your partner) and make sure you pee prior to sexual activity to reduce risk of leakage. Being on the bottom with traditional man dominant position will help reduce risk of leakage. You might want to express that it may be uncomfortable for you to have intercourse so you want to go slow (even if you don't have pain with intercourse, it will give you the upper hand with controlling the pace). If you have tissues bulging out of the vagina that give you concern, I would just express to the man that you are not comfortable with oral sex because of discomfort, in all honesty it is doubtful that he will realize tissues are bulging unless he sees them and sensation wise it may increase his pleasure because the penis is "wrapped"more snuggly in additional tissues.

Just take it slow and if the man is a worthwhile partner, it should be fine.

Sher

[Galsal59]

Glad my questions helped get some discussion about this and dating in the open.  :)

[sherrieP]

It's brave women like you that help establish recognition of these health issues, thanks again Sal!

[Galsal59]

Seeing GYN tomorrow.  Also Gastro although that isn't part of things.  The VA scheduled both on the same day, which is incredibly unusual.  And of course GYN will say sending me for an Ultrasound as they always do.  Gastro will be reviewing to schedule a Colonoscopy...first in 10-11 years, now that I'm over 50.

I'll be asking questions of course.  I've no doubt something is occurring...whether it's a true POP or not is unknown.  I had already recognized that I either need to bend forward or lift on the lower abdomen to assist in emptying the bladder more.  After meeting with the Therapist I've recognized that Tampons do tend to wind their way down before they should but not enough to be uber obvious.

Am thankful that to a slight extent using Caffeine-Free beverages is helping slightly but not enough to make THAT big of a difference.  It's humorous that I'm supposed to hold out for two hours to void.  HA!  

[sherrieP]

I'm always so glad to meet women that have a great sense of humor (I live to laugh)!! Yep, tampons popping out is another indicator of POP. Difficulty urinating is indicator of advanced cystocele (grades 1 & 2 are leakage, stages 3 & 4 is difficulty peeing with still some leakage issues. Let me know how things turn out.

Sher

[Galsal59]

No help there...GYn says oh sure things all seem to be in place where they should.  Harrumph!

[sherrieP]

So frustrating, it's ridiculous you have to go through so much just to get a definitive answer-at least the PT has a clue. Lean on her for path, hopefully she can give you the guidance for direction to go in next.

[Galsal59]

The PT didn't observe a prolapse.  The muscles work well for quick contractions ie 2 seconds but can't sustain much endurance more than that.  This was gleaned from internal electronic monitoring.  So am working on retraining the muscles.  

[Galsal59]

The PT didn't observe a prolapse.  The muscles work well for quick contractions ie 2 seconds but can't sustain much endurance more than that.  This was gleaned from internal electronic monitoring.  So am working on retraining the muscles.  

[Galsal59]

The PT didn't observe a prolapse.  The muscles work well for quick contractions ie 2 seconds but can't sustain much endurance more than that.  This was gleaned from internal electronic monitoring.  So am working on retraining the muscles.  

[Galsal59]

oh my goodness...don't know how that posted several times.  only sent it once!

[sherrieP]

Gotta say I am shocked that the PT didn't observe prolapse; if you can't hold your pc longer than 2 seconds that is a weak pc contraction. When you do Kegels how deeply can you feel the contraction? If it is not POP what did she say was the  cause of urine loss? It is almost always POP, if it is not there has to be another cause. Typically unless a PT is trained in pelvic floor they won't be able to determine if you have it but you did mention she has pelvic floor credentials.

There are devices you can buy to check and strengthen your pc on your own (similar to what a PT does but smaller device). No matter what please continue to work on your pelvic floor. Once you recognize the proper contraction you can do Kegels anytime/anywhere (I'm Kegeling as I'm typing); I try to remember to do them every time I step on the brake in my car at stopsigns and stop lights.

What all does she have you doing?

[sherrieP]

And the multi posting made me smile, I also have some days when my fingers sit a bit heavy on the keyboard and I end up multi posting, ha!

[Galsal59]

still working on the pelvic floor muscles.  they're getting stronger and up to about 5 seconds in terms of endurance.  i can get a good reading right off the bat but it dwindles down.

how is this being measured you might ask?  we're using a vaginal emg/stimulation sensor which connects to a laptop running software that works with the sensor.  the graph displayed shows when contracting and when not as well as the dwindling downward.  we're working not only on the quick contractions controlled by those specific muscles but also the trans abdominal or is vaginal some where in that title?  she indicated those were the ones that reacted when using the Bender Ball as I'd experienced.  this is for the functional exercises.  a deep pelvic muscle contraction and then a slight pelvic tilt to work on that muscle at the same time.  then we took it a step further and let one knee sag off the side while doing the preceding actions all at the same time.  that sure requires some coordination...which i'm not big on.  also did graphing of coughing, laughing, etc to see how muscles reacted and then did the same while working on muscles.  holy COW, sensor almost came out with a medium sized cough.

PT had a good statement though...for most of our lives these muscles all worked properly.  so trying to retrain them.

you have a good point too...will ask what else other than POP could be causing this.  

[sherrieP]

Glad to hear contractions are being measured with biofeedback, sure isolates what needs to be done. And yep, all muscles can be retrained, just need to work at it a bit longer in our later years than in the younger ones. I've been an exercise nut for 30+ years and because of the MS and just general fatigue, I  have days where my contractions feel so weak-but I exerdcise anyway and on the days when I feel rested the contraction is strong. Each of us has body fluctuations.

Sounds like a good regimen.
:)