Gynecology


 
Talking About Bladder Control

Why Is It So Hard To Talk About Bladder Control? You may feel embarrassed to talk about such a personal thing. Or, like many women, you may feel ashamed about loss of bladder control.

But when you learn it’s a medical problem, you know it’s not your fault. Millions of other women have the same problem.

Your health care team can help you. Nearly everyone with a bladder control problem can be helped.

You need to ask the doctor questions. And the doctor needs to ask you questions. By talking, you will learn:

Why you have a bladder control problem

Which treatment is right for you

How Can You Tell Your Doctor About a Bladder Control Problem? 

Even if you feel shy, it is up to you to take the first step. Some doctors don’t treat bladder control problems, so they don’t ask about it. Others might expect you to bring up the subject.

Because bladder control problems are common, your doctor has probably heard many stories like yours. If your doctor does not treat bladder problems, ask for help finding someone who can help you.

The good news is that most people with bladder control problems can get better, with the help of their health care team.

What Questions Should You Ask? 

These questions can help your health care team find the cause of your bladder control problem.

Could my usual food or drinks cause bladder problems?

Could my medicines (prescription or over-the-counter drugs) cause bladder problems?

Could other medical conditions cause loss of bladder control?

What are the treatments to regain bladder control? Which one is best for me?

Can you help me, or can you tell me whom I should see instead?

What can I do about the odor and rash caused by urine?

What Information Should You Bring to Your Doctor? 

Before going to see your doctor, print out the following form and answer the questions. Check off the statements that apply to you. Fill in dates and other information. Show this form to your doctor at your next visit.

What Your Doctor Needs to Know:

I take these prescription medicines:

_______________________________________________

_______________________________________________

_______________________________________________

I take these over-the-counter drugs (such as Tylenol, aspirin or Maalox):

_______________________________________________

_______________________________________________

_______________________________________________

If you take more medicines, please list them on a separate paper.

I started having bladder trouble:    Recently   /    1 to 2 years ago  /   _____ years ago

Number of babies I have had:_____________________

Dates: _________________________________________

My periods have stopped (menopause).

Date: __________________________________________

I recently had an operation.

Date: __________________________________________

Type of operation: ________________________________

I recently hurt myself or have been sick.

Date: _________________________________________

Type of injury or illness: ____________________________

I recently had a bladder (urinary tract) infection.

Date: _________________________________________

I am often constipated.

I have pain or a burning feeling when I go to the toilet.

I often have a really strong urge to go to the toilet right away.

Sometimes my bladder feels full, even after I go to the toilet.

I go to the toilet often, but very little urine comes out.

I don’t go out with friends or family because I worry about leaking urine.

The first thing I do at new places is check the bathroom location.

I worry about being put in a nursing home because of bladder control problems.

I have (or had) these medical problems:

Cancer

Constipation

Crippling arthritis

Depression

Diabetes

Diverticulitis

Interstitial cystitis

Multiple sclerosis

Spinal cord injury

Stroke

Urinary infection

I smoke cigarettes.

Does Treatment Work? 

Treatment usually works. Many people greatly improve their bladder control. Regaining control helps people enjoy healthier and happier lives.

________________

Additional Resource National Kidney and Urologic Diseases Information Clearinghouse

National Institute of Diabetes and Digestive and Kidney Diseases

3 Information Way

Bethesda, MD 20892-3580

E-mail: nkudic@info.niddk.nih.gov

Updated: August 2003

Source: National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health

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Menopause and Bladder Control

Bladder Control for WomenAbstract

Second trimester maternal serum screening provides a method to identify pregnancies at high risk for fetal Down’s syndrome, trisomy 18, open neural tube defects, and a variety of other chromosomal and nonchromosomal fetal anomalies. Results are presented for a regional program to identify high-risk pregnancies using alpha feto-protein (AFP), human chorionic gonadotropin (hCG), and unconjugated estriol (uE3) analyses (triple marker testing). A total of 27,140 women received screening. Using a midtrimester Down’s syndrome risk of 1:270 to define the high-risk group, 5.26% of women of all ages were screen-positive for Down’s syndrome resulting in the eventual detection of approximately 72% of the affected fetuses. The detection rate for patients under 35 at estimated date of delivery was 61% and for women 35, or older, the detection rate was 100%. A separate protocol to screen for trisomy 18 identified 0.2% of pregnancies, with 38% of the trisomy 18 cases present in this group. Over 3% of women screen-positive for Down’s syndrome or trisomy 18 had a serious fetal chromosome anomaly. In addition, 2.89% of women had an elevated AFP (greater or equal to 2.0 multiples of median). This component of the screening resulted in the identification of 86% of the neural tube defects, 75% of the ventral wall defects, and also some of the other various fetal anomalies present in the screened population. Since both laboratory and clinical data are combined to generate patient-specific risks, there is a need for quality control elements that go beyond that normally required for a clinical laboratory alone. We stress the need for comprehensive follow-up programs to evaluate screening programs and maintain high quality.

PMID:

8706425

[PubMed – indexed for MEDLINE]The intrauterine device (IUD) is a type of birth control. It is a small, plastic device that is inserted and left inside the uterus to prevent pregnancy.

Cancer of the Ovary

Cancer of the ovary is a disease that affects one or both ovaries, the two organs on either side of the uterus.

What Is Cancer? 

Sometimes, cells develop abnormally and begin to grow out of control. When this happens, too much tissue is made and begins to form growths or tumors.

Tumors can be benign (not cancer) or malignant (cancer).

Some tumors of the ovary are less likely to spread to other parts of the body. These are called borderline tumors or tumors with low malignant potential.

Epithelial cancers are the most common. About 90 percent of all ovarian cancers arise from epithelial cells. These are the cells that cover the surface of the ovaries.

About 10 percent of ovarian cancers are germ cell tumors. The rest are sex cord-stromal tumors. Both types tend to occur in women under 40 years old.

Who Is at Risk? 

Women of any age can have cancer of the ovary, but the risk increases with age. It occurs most often in women who are between 50 and 75 years old. It is less common in women under 40, and more common in white women.

Symptoms 

Cancer of the ovary often does not have any symptoms in its early stage. There are few symptoms of the disease. As a result, the cancer may not be found until it’s in an advanced stage. This makes it harder to treat.

Screening 

The best way to detect ovarian cancer at an early stage is by a pelvic and rectal exam. The doctor may be able to feel a tumor or cyst on one or both of the ovaries.

Other tests used to screen for ovarian cancer include ultrasound exam, chest X-ray and laparoscopy.

Treatment 

If a woman is thought to have ovarian cancer, surgery is needed. The surgeon will explore the extent of the disease, remove the cancer, and decide what other treatment is needed.

Treatment is based on how fast the cancer is spreading.

Surgery for most patients includes removing the uterus (hysterectomy) and the ovaries and fallopian tubes (salpingo-oophorectomy).

The surgery often is followed by chemotherapy or radiation.

Finally … The key to fighting ovarian cancer is finding it early. The best way to do this is to have routine exams. Be alert to changes in your body and point them out to your doctor. These changes could be as simple as an increase in your waistline or indigestion that seems to have no cause and does not respond to medicine.

________________

This excerpt from ACOG’s Patient Education Pamphlet is provided for your information. It is not medical advice and should not be relied upon as a substitute for visiting your doctor. If you need medical care, have any questions, or wish to receive the full text of this Patient Education Pamphlet, please contact your obstetrician-gynecologist.

To ensure the information is current and accurate, ACOG titles are reviewed every 18 months.

Copyright April 1999 The American College of Obstetricians and Gynecologists

Evaluating Infertility

Many couples who want to have a child are not able to do so. About 15 percent of couples in the United States are infertile. Couples may be infertile if they have not been able to conceive after 12 months of having sex without the use of birth control.

Conception 

For healthy, young couples, the odds are about 20 percent that a woman will conceive (become pregnant) during any one menstrual cycle. This figure starts to decline in a woman’s late 20s and early 30s and decreases even more after age 35.

Testing 

Infertility may be caused by more than one factor. Some causes are easily found and treated, while others are not. In some cases, no cause can be found in either partner.

The basic workup of an infertility evaluation can be finished within a few menstrual cycles in most cases. Ask your doctor about the costs involved. Find out whether they are covered by your insurance.

Basic Workup for the Man

A semen analysis is a key part of the basic workup. It may need to be done more than once. The sample is obtained by masturbation.

Basic Workup for the Woman

The workup begins with a physical exam and health history. The health history will focus on key points:

Menstrual function

Pregnancy history

Sexually transmitted disease (STD)

Birth control

Tests. There are many ways to see if ovulation occurs. Some tests are done by the woman, and others are done by the doctor.

Urine Test. A way to predict ovulation is by using a urine test kit at home. This test measures luteinizing hormone (LH), a hormone that causes ovulation to occur.

Basal Body Temperature. After a woman ovulates, there is a small increase in body temperature.

Blood Test. After a woman ovulates, the ovaries produce the hormone progesterone. A blood test taken in the second half of the menstrual cycle can measure progesterone to show if ovulation has occurred.

Endometrial Biopsy. The lining of the uterus (endometrium) changes at ovulation. Sometimes a biopsy (a sample of the tissue) is done in this area to find out whether and when ovulation has occurred.

Procedures. Other tests may be done to look at a woman’s reproductive organs.

Hysterosalpingography (HSG). This test is an X-ray that shows the inside of the uterus and fallopian tubes.

Transvaginal Ultrasound. Ultrasound uses sound waves to produce images of pelvic organs.

Hysteroscopy. A thin telescope-like device, called a hysteroscope, is placed through the cervix. The inside of the uterus may be filled with a harmless gas or liquid to provide more information.

Laparoscopy. A small telescope-like device, called a laparoscope, is inserted through a small cut (about 1/2 inch or less) at the lower edge of the navel. The doctor can look at the tubes, ovaries and uterus.

Treatment 

Infertility often can be treated with lifestyle changes, medication, surgery or assisted reproductive technologies. It depends on the cause.

Finally… If you have not been able to conceive after 12 months of having sex without the use of birth control, you may want to think about having an infertility evaluation.

________________

This excerpt from ACOG’s Patient Education Pamphlet is provided for your information. It is not medical advice and should not be relied upon as a substitute for visiting your doctor. If you need medical care, have any questions, or wish to receive the full text of this Patient Education Pamphlet, please contact your obstetrician-gynecologist.

To ensure the information is current and accurate, ACOG titles are reviewed every 18 months.

Copyright June 2000 The American College of Obstetricians and Gynecologistsving a baby is a joyous time for most women. After childbirth, though, many mothers feel sad, afraid, angry or anxious. Most new mothers have these feelings in a mild form called postpartum blues. Sometimes these feelings are called “baby blues.” Postpartum blues almost always go away in a few days.

About 10 percent of new mothers have a greater problem called postpartum depression. Postpartum depression lasts longer and is more intense. It often requires counseling and treatment. Postpartum depression can occur after any birth, not just the first.

Baby Blues 

Many new mothers are surprised at how weak, alone and upset they feel after giving birth. Their feelings don’t seem to match the feelings they thought they would have. They wonder, “What have I got to be depressed about?”

In fact, about 70 percent to 80 percent of women have baby blues after childbirth. About two to three days after birth, they begin to feel depressed, anxious and upset. For no clear reason, they may feel angry with the new baby, their partners or their other children.

These feelings may come and go in the first few days after childbirth.

Postpartum Depression 

Women with postpartum depression have such strong feelings of sadness, anxiety or despair that they have trouble coping with their daily tasks. Without treatment, postpartum depression may become worse or may last longer.

Postpartum depression is more likely to happen in women who lack the support of a partner or who have had:

Postpartum depression before

A psychiatric illness

Recent stress, such as losing a loved one, family illness or moving to a new city

Reasons for Postpartum Depression 

Postpartum depression is likely to result from body, mind and lifestyle factors combined. No two women have the same biologic makeup or life experiences. This may be why some women have postpartum depression and others don’t.

Body Changes

The postpartum period is a time of great changes in the body. These changes can affect a woman’s mood and behavior for days or weeks.

Levels of the hormones estrogen and progesterone drop sharply in the hours after childbirth. This change may trigger depression in the same way that much smaller changes in hormone levels can trigger mood swings and tension before menstrual periods.

Many women feel very tired after giving birth. It can take weeks for a woman to regain her normal strength. Some women have their babies by cesarean birth. Because this is major surgery, it will take them longer to feel strong again.

Emotional Aspects

Many emotional factors can affect a woman’s self-esteem and the way she deals with stress. This can add to postpartum depression.

Feelings of doubt about the pregnancy are common

The baby may be born early. This can cause stressful changes in home and work routines that the parents did not expect.

Lifestyle Factors

A major factor in postpartum depression is lack of support from others. The steady support of a new mother’s partner is a comfort during pregnancy and after the birth.

Breastfeeding problems can make a new mother feel depressed. New mothers need not feel guilty if they cannot breastfeed or if they decide to stop.

The Role of Myths

Women who have an idea of the “perfect mother” are more likely to feel let down and depressed when faced with the needs of day-to-day mothering. Three myths about being a mother are common:

Myth #1: Motherhood Is Instinctive. First-time mothers often believe that they should just know how to care for a newborn. In fact, new mothers need to learn mothering skills just as they learn any other life skill.

Myth #2: The Perfect Baby. Most women dream about what their newborn will look like. When the baby arrives, it may not match the baby of their dreams.

Also, babies have distinct personalities right from birth. A new mother may find it hard to adjust to the baby.

Myth #3: The Perfect Mother. For some women, being perfect is a never-ending goal. A mother may think she is not living up to the ideal. She may feel that she is a failure.

What You Can Do

If you are feeling depressed after the birth of your child, there are some things you can do to take care of yourself and your baby:

Get plenty of rest.

Ask for help from family and friends.

Take special care of yourself.

Spend time with your partner.

Call your doctor if your feelings do not lessen after a few weeks and you have trouble coping. Blues that don’t go away after a few weeks may be a sign of a more severe depression.

Finally… Many new mothers feel sadness, fear, anger and anxiety after having a baby. This is normal. It does not mean that you are a failure as a woman or mother or that you have a mental illness. Having these feelings means that you are adjusting to the many changes that follow the birth of a child.

________________

This excerpt from ACOG’s Patient Education Pamphlet is provided for your information. It is not medical advice and should not be relied upon as a substitute for visiting your doctor. If you need medical care, have any questions, or wish to receive the full text of this Patient Education Pamphlet, please contact your obstetrician-gynecologist.

To ensure the information is current and accurate, ACOG titles are reviewed every 18 months.

Copyright © March 1999 The American College of Obstetricians and Gynecologists

Your Medicines and Bladder Control

Do You Have a Bladder Control Problem? If so, one cause of your problem may be sitting in your medicine cabinet. Medicines (drugs) can cause people to lose bladder control.

Do not stop taking any medicine without talking to your doctor. If your medicine is causing your bladder problem, your doctor may find another medicine. If you need to keep taking the same medicine, your doctor can help you find another way to regain bladder control.

How Does Bladder Control Work? 

Your bladder is a muscle shaped like a balloon. While the bladder stores urine, the muscle relaxes. When you go to the bathroom, the bladder muscle tightens to squeeze urine out of the bladder.

Two sphincter muscles surround a tube called the urethra. Urine leaves your body through this tube.

The sphincters keep the urethra closed by squeezing like rubber bands. Pelvic floor muscles under the bladder also help keep the urethra closed.

When the bladder is full, nerves in your bladder signal the brain. That’s when you get the urge to go to the bathroom.

Once you reach the toilet, your brain tells the sphincter and pelvic floor muscles to relax. This allows urine to pass through the urethra. The brain signal also tells the bladder to tighten up. This squeezes urine out of the bladder.

Bladder control means you urinate only when you want to.

For good bladder control, all parts of your system must work together:

Pelvic muscles must hold up the bladder and urethra.

Sphincter muscles must open and shut the urethra.

Nerves must control the muscles of the bladder and pelvic floor.

How Can Medicines Cause Leaking? 

Leaking can happen when medicines affect any of these muscles or nerves. For instance, medicines to treat high blood pressure may make the sphincter muscles too tight or too loose. Medicines to treat colds can have the same effect.

You may take medicine to calm your nerves so that you can sleep or relax. This medicine may dull the nerves in the bladder and keep them from signaling the brain when the bladder is full. Without the message and urge, the bladder overflows. Drinking alcohol also can cause these nerves to fail.

Water pills (diuretics) take fluid from swollen areas of your body and send it to the bladder. This may cause the bladder to leak because it fills more quickly than usual. Caffeine drinks such as coffee and cola have the same effect. Some foods such as chocolate also can cause bladder problems.

What Can You Do About Your Bladder Control Problem? 

Before your next doctor visit, make a list of all the prescription medicines you take. Also list medicines you buy without a prescription. Or you can bring all your medicines with you to show the doctor. Ask your doctor if any of the medicines could cause your bladder problem. Your pharmacist also can give you information about your medicines.

You may have to continue taking a medicine that causes a bladder control problem. Ask your doctor to help you find another way to control your bladder.

Other ways might include:

Exercises for the muscles that close the bladder

Devices to stimulate the muscles

Training the bladder to hold more urine

________________

Additional Resource National Kidney and Urologic Diseases Information Clearinghouse

National Institute of Diabetes and Digestive and Kidney Diseases

3 Information Way

Bethesda, MD 20892-3580

E-mail: nkudic@info.niddk.nih.gov

Updated: April 2002

Source: National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health

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Talking About Bladder Control

Bladder Control for WomenA healthy diet and daily exercise will increase your energy level and help you get in shape at any time of life. Having a baby and taking care of a newborn are hard work. It will take a while to regain your strength after the strain of pregnancy and birth. You should allow your body time to recover.

Benefits of Exercise 

Daily exercise can help restore muscle strength and firm up your body. Exercise can make you less tired because it raises your energy level and improves your sense of well-being.

When Can I Start? 

Check with your doctor before starting an exercise program. You should start when you feel up to it and know you will keep it up.

If you didn’t exercise during pregnancy, start with easy exercises and slowly build up to harder ones.

Getting Started 

Walking is a good way to get back in shape. Brisk walks will prepare you for more vigorous exercise when you feel up to it.

As you feel stronger, think about trying more vigorous exercise. You will want to decide on exercises that meet your needs.

Your Exercise Program

Your workout should always include time for you to warm up and cool down.

Warm Up

Before you begin each exercise session, always warm up for five to 10 minutes.

Target Heart Rate

You should exercise so that your heart beats at the level that gives you the best workout. This is called your target heart rate.

Cool Down

After exercising, cool down by slowing your activity. This allows your heart rate to return to normal levels. Cooling down is like warming up. Cooling down for five to 10 minutes and stretching again also helps prevent sore muscles.

Finally… Exercising after you have your baby can help you get back in shape. It can improve your physical and mental well-being. Before you begin your exercise program, talk to your doctor.

________________

This excerpt from ACOG’s Patient Education Pamphlet is provided for your information. It is not medical advice and should not be relied upon as a substitute for visiting your doctor. If you need medical care, have any questions, or wish to receive the full text of this Patient Education Pamphlet, please contact your obstetrician-gynecologist.

To ensure the information is current and accurate, ACOG titles are reviewed every 18 months.

Copyright © January 2000 The American College of Obstetricians and Gynecologists

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