There are several treatment options for Stress Urinary Incontinence (SUI) including surgical and non-surgical solutions.  Depending on the severity of your incontinence and lifestyle needs, your physician will work with you to determine the best solution.

Non surgical solutions include:  absorbent pads, diapers, pessaries, other special devices,  urethral implants, and Kegel exercises. 

Kegel exercises help strengthen the pelvic floor muscles that help support the urethra and bladder during activity.  Exercising these muscles improves the tone and strength of the muscles to help close the urethra when coughing or laughing.  There are many Kegel exercises regimens, but all have one thing in common they must be done on a regular basis and indefinitely for the patient to benefit.

 Pessaries are simple plastic shapes, worn in the vagina.  A properly sized pessary can be used for incontinence to provide support beneath the urethra.  This support is needed in most stress urinary incontinence (SUI) situations.                                   

Special devices such as  urethral plugs and other devices may be available when the above strategies are unsuccessful. 

A urethral implant is an  injection into the urethra of sterilized collagen or micro-beads is directed by a telescope-like device (urethroscope) to decrease the size of the open urethra. This helps assist in the closing of the urethra during coughing or straining.  Unfortunately, more than one injection is usual.

Surgical operations are numerous to treat SUI.  

Any surgery for SUI is intended to restore support of the front vaginal wall immediately beneath the urethra. This enhances compression of the urethra against the vaginal wall. The Burch, MMK, sling, and TVT (tension-free vaginal tape) all use sutures and graft material (natural or synthetic) to provide positive outcomes as high as 95%.  These must be carefully selected for the specific type of SUI.   Your physician will discuss the best procedure for your specific condition.

Dr. Guillermo Rowe offers urinary incontinence studies in office to help determine the type and severity of incontinence.  He is also proud to offer surgical and non-surgical treatments for incontinence. Appointments are available. Contact the office at 713-795-4800. 

Diagnosis

An appropriate evaluation helps your physician or other health-care provider pinpoint the type(s) of urinary incontinence you might have. An exhaustive evaluation is not always necessary – your doctor will determine what components will be important in your case. 

Before a physical examination and other tests, your doctor  will ask you a series of questions. Your responses will assist your doctor in mapping out the tests that will be needed.  A thorough history will be taken reviewing your past and more recent medical, surgical and Ob/Gyn history. You will be asked to list your medications. A 1- 7 day diary recording the amount and time of every urination will need to be kept by you and reviewed by your provider. 

The physical examination will involve the following:

Neurologic examination:  basic testing of nerves supplying the legs and        vaginal opening; the same nerves service the bladder and urethra. 

Pelvic examination:  a typical gynecological examination of the pelvic floor effects, including those of the front (cystocele), back (rectocele) and         top walls (uterine and/or vaginal prolaspe). 

 Urine specimen:  obtained to determine how efficiently the bladder empties itself; a specimen is sent for bacterial culture (a urinary infection can cause or worsen urinary incontinence).

Cystoscope:  the physician looks into the urethra and bladder with a small, illuminated telescope-like instrument to rule out stones, growths, and     foreign objects

 Urodynamic study:  this is a test that measures pressure in the bladder  and urethra simultaneously to tell how both components are working. The test is done in office, takes 30-60 minutes, and is not painful.  

 Uroflowmetry  measures and records the amount and speed of urine during voiding. 

Cystometrogram measures how the bladder operates as it stores larger amounts of urine during filling.

Urethral  pressure profile/closure pressure measures urethra pressure to determine the urethra’s effectiveness as a closure valve. 

Leak point pressure measures how much pressure it takes to open the urethral sphincter (a valve the keeps urine inside the body) and allow urine to leak.  

Voiding study measures simultaneous pressure changes in the urethra and bladder as the bladder empties during urination.

 Please note that you may not need all of the above tests for your healthcare to determine the type or cause of your incontinence. 

Dr. Guillermo Rowe offers urinary incontinence studies in office to help determine the type and severity of incontinence.  He is also proud to offer surgical and non-surgical treatments for incontinence. Appointments are available. Contact the office at 713-795-4800. 

Female urinary incontinence can be grouped in several distinct categories, although women often have symptoms found in more than one category (i.e., mixed incontinence). 

• STRESS INCONTINENCE

Urine leakage occurs with increases in abdominal pressure (mechanical “stress”)

• URGE INCONTINENCE

Often referred to as “overactive bladder.”  Inability to hold urine long enough to reach restroom.

• MIXED INCONTINENCE

When two or more causes contribute to urinary incontinence.  Often refers to the presence of both stress and urge incontinence.

• OVERFLOW INCONTINENCE

Leakage or “spill-over” of urine when the quantity of urine exceeds the bladder’s capacity to hold it.

• FUNCTIONAL INCONTINENCE

Leakage (usually resulting from one or more causes) due to factors impairing reaching the restroom in time because of physical conditions (e.g., arthritis)

Definition of Stress Incontinence

Stress urinary incontinence (SUI) is loss of urine that occurs simultaneously with (at the same time as) physical activities that increase abdominal pressure (for instance:  sneezing, coughing, boisterous laughing, and straining when performing exercises like abdominal “crunches,” or lifting objects).  Many of the above-described activities lead to increased pressure within the abdominal cavity.  This increases the pressure within the bladder, which behaves like a balloon filled with liquid.  The rise in bladder pressure has a tendency to force the urethra open and urine loss ensues.  The amount of urine loss associated with SUI is usually small, ranging from mild seepage to drops to a large squirt.

Dr. Guillermo Rowe offers urinary incontinence studies in office to help determine the type and severity of incontinence.  He is also proud to offer surgical and non-surgical treatments for incontinence. Appointments are available. Contact the office at 713-795-4800.

Involuntary loss of urine is reportedly experienced by upwards of 95% of women in their reproductive and post-menopausal years.  This, however, does not mean that this overwhelming majority has urinary incontinence. To qualify as urinary incontinence (UI), the involuntary loss of urine must have a negative impact on the quality of the individual’s life, particularly for hygienic and/or social standpoints.  As such, the only person who can ultimately determine the presence of UI is the woman herself.

If you or someone you know is affected by loss of bladder control, you are not alone.  An estimated 15-20 million people in the United States have bladder control problems. This condition affects men and women, although it is nearly twice as common in women. The prevalence of this condition does increase with age. Fifteen to 30 percent of adults greater than 60 years of age have UI. However, this condition should not be considered a normal result of aging.

Urinary incontinence is often caused by specific changes in body function due to related or unrelated diseases and/or usage of medications that affect function of the urinary tract (e.g., diuretics or “water pills,” anti-hypertensives or “blood pressure pills”).  More often than not, UI is more of an annoyance than a sign of a life-threatening condition.  Despite the high prevalence, most people with UI are reluctant to seek help.  They might be embarrassed to acknowledge that they have a problem, even to themselves.  Or, they might have broached the issue with family members, acquaintances, and/or friends who were discouraging or suggested that no truly useful remedies exist.  Thus, many sufferers resort to dealing with the progressively worsening leakage by using the many absorbent products available, including pads and/or diapers.  This resignation often results in emotional and psychological vulnerability, including depression and social isolation. 

There is absolutely no reason for this to happen.  The good news is that 80-90% of cases can be treated successfully.  Although a complete cure may not be attainable in all cases, substantial improvement can be expected in the vast majority.  So, if you or someone you know suffers from this condition, be PROACTIVE.  Get evaluated and review treatment options appropriate to YOUR UI.  The more you know, the more confident you will be in choosing the direction of treatment. 

Below, you will find a significant amount of information on the more common causes of female urinary incontinence and associated pelvic organ prolapse (POP) conditions, including causes/predisposing factors, diagnostic evaluation, treatment options and suggestions for obtaining further information. 

Dr. Guillermo Rowe offers urinary incontinence studies in office to help determine the type and severity of incontinence.  He is also proud to offer surgical and non-surgical treatments for incontinence.  Appointments are available. Contact the office at 713-795-4800.

Risk factors include gender (100X more common in women) age (2/3 of invasive cancers are diagnosed in women over 55) genetic factors, family history, having had no children before age 30, hormone replacements, alcohol use, obesity and inactivity. 

Early detection is important! Following guidelines for screening improves the likelihood that breast cancer can be diagnosed at an earlier stage and treated successfully. Women in their 20’s and 30’s should have regular clinical breast exams. Women 40 and over should have an annual screening mammogram for as long as they are in good health and would be candidates for breast cancer treatment. Mammograms are not perfect, but they are a safe and effective screening tool. 

Being called back for additional films or tests is scary, but does not necessarily mean you have breast cancer. In fact, less than 10% of those called back are diagnosed with cancer. All mammogram facilities are required to notify you within 30 days of your results. If you don’t hear from them, call them or your doctor. Most will notify you within a week of an abnormal result. 

Mammograms are usually covered at least partially by Medicaid, Medicare or private insurance. Low cost mammograms are available in most areas, even for those without insurance. To locate these facilities, call 1-800-227-2345. 

SO, NOW WHAT’S YOUR EXCUSE!!!

Dr. Leslie Cohen

Perhaps you’ve heard Benjamin Franklin’s famous quote, “An ounce of prevention is worth a pound of cure.” Well, that’s very good advice when it comes to cervical cancer, because in fact, it’s one of the cancers that we have good ways to detect early. And, as with most cancers, survival rates dramatically increase when detected early. 

If you are 21 years old or older, you should have a Pap test, or Pap Smear as it is often called. It is a test that takes a sample of the cells from your cervix and those cells are tested for abnormalities, which could include cervical cancer. How often you should have a Pap test done? Well, that depends on several factors and it should be something we should talk through at your appointment. I don’t believe in doing tests for test sake, but I also know from my 30+ years of experience as an OB/GYN that the Pap test has detected cervical cancer in some of my patients and it has helped shape survivor stories with happy endings. Call our office today at 713-797-9171  to schedule your appointment. 

Another test now available is the HPV test. It uses the same cervical sample from the Pap test but screens specifically for the HPV virus. Maybe you’re wondering: Should I get the HPV test in addition to a Pap test? Should I receive the HPV vaccine? How often should I have a Pap test? These are all excellent questions but often have individual answers, so let’s talk about the care that best fits you when you come for your annual well woman exam. 

Finally, I’d like to share a couple of resources about cervical cancer:

• Pap Test: What to Expect
• Cervical Cancer: Causes, Risk Factors and More
• Cervical Cancer Overview and Treatments
• Survivorship tips from the American Cancer Society 

Doc

Mammograms and pap smears or maybe a follow up visit that you may not have followed up on. Whatever you should have done for yourself and did not do, let‘s get it done this year. 

We are all here to help – Dr. McBride, Sandy, Debbie, Cortney and I, Bobbie, are here to help make that happen. Give us a call 713-797-9171 and we will work with your schedule. Is this the year you have decided to start or add to your established family a baby brother or sister?  Wonderful! You can make your initial appointment on Monday Tuesday, Thursday or on a Friday morning. We set aside Wednesday appointments for our established patients who are pregnant. Once you’ve had your initial visit, we’ll schedule your follow up appointments for Wednesdays. We look forward to your excitement of hearing your baby’s heartbeat for the first time and getting your first ultrasound on a follow up visit. If you have been trying for pregnancy for a while, make an appointment to discuss this with Dr. McBride and see if further evaluation may be necessary. 

Remember: new year, new possibilities. We will talk soon! 

Bobbie

Practice Manager for Dr. McBride at Woman’s Health Group

I count it such a joy and blessing to be your physician. Thank you for choosing me as your physician and allowing me to journey with you during your days of wellness, days of pregnancy, and days of illness. That brings me to my first new year’s resolution: to remember to be thankful and to show my gratitude more. It’s a small thing that can make a big difference and I’m going to try my best not to let busyness get in the way of two small but powerful words, “thank you.” 

My second resolution is to do my part to make Texas a healthier state. I don’t know if you have seen the news stories about which states are considered healthy, but Texas isn’t one of them, in fact in 2010, we were listed as #40. It’s probably true that we like to eat food that isn’t the healthiest. The statistic that concerns me is the one about prenatal care for women – the care needed to have a healthy pregnancy and baby. That’s why my doors are open to new patients. If you have a friend or family member looking for an OB/GYN, I’d consider it an honor to care for them. If you don’t have insurance, we offer a 35% discount for eligible charges and the office staff will be happy to talk with you about the details. Also, beginning January 2012, most insurances will provide preventive care for you including an annual physical, pap smear, mammogram, and obstetric services like counseling, screening and vaccines to ensure you have a healthy pregnancy and baby. You’ll want to check with your insurance for specific details. Call the office at (713) 797-9171 to schedule an appointment convenient for you. 

My third resolution is to keep learning. You’re never too young or too old to learn something new. I think it keeps you humble. So, I hope I learn something new today and often times, I’ll pass on what I learn to you through this blog, Facebook and Twitter. If you’re not already connected with me on Facebook, I invite you to visit our page and like us and post a comment so we can all learn from each other. 

I learned a few years back that if you can sum up your resolutions in a few words you’re more likely to keep them so here it goes: Keep learning. Get healthier. Thank you. 

Doc

Once you are an established patient, our reminder service will notify you that you are due to schedule an appointment.  Also, after you have scheduled your appointment, you will receive a phone call the day before to confirm your appointment. If you realize you can’t make your appointment, let us know so we can reschedule it and let someone else have your appointment time. 

Your college student will be home during the holidays. This is a great time to have her come in for her annual exam. Teachers can take advantage of this time off as well. 

If you are due for an appointment and you are self-pay, contact our office to discuss our discount policy for uninsured persons.  We extend a 35% discount (for eligible charges). 

Here’s a suggestion for those of you who need to schedule mammograms, especially if you schedule through The Woman’s Hospital of Texas, why not make same day appointments! Have your annual exam and mammogram on the same day. We will make every effort to accommodate you. We appreciate and value your time. 

New and established patients are encouraged to visit our website and download the registration form.  Don’t forget to bring it in with you on the day of your appointment. 

We look forward to hearing from you. You can reach us at (713) 797-9171. Happy Holidays from all of us! 

Dr. McBride, Sandy, Debbie, Cortney, and Bobbie