Atlantic Urogynecology Associates - Summit

Bladder training can be effective in the treatment of urge incontinence, mixed incontinence and urgency-frequency syndromes. The medical team at Atlantic Urogynecology Associates teaches strategies to patients to control urgency and develop a program of scheduled urination with gradually increasing intervals. Bladder training can give women a way to reclaim control over bladder function. Another way to think of it is "potty training for adults."

Bladder diary

The first step is to keep a record of your baseline bladder control. That's done by keeping a bladder diary. A diary will establish your baseline fluid intake; number of leakage episodes; and urinary frequency (amount of time between trips to the bathroom).

Next, decide on your initial scheduled voiding interval. If your bladder diary shows that you go to the bathroom every hour or less, your scheduled voiding interval will start at 30 minutes. If your bladder diary indicates more than one hour between your bathroom breaks, then your first interval will be one hour. Once you establish your initial voiding schedule, the medical team at Atlantic Urogynecology Associates recommends that patients do the following:

• Void every morning as soon as you wake up and every evening just before going to sleep
• Void every time your schedule says you should — regardless of whether you think you need to
• Make every effort to put off urinating - even if you have a very strong urge to do so - until your scheduled time comes up
• You only need to follow the schedule while you are awake. No scheduled urination is necessary during sleeping hours
• If you absolutely have to interrupt your schedule, get back on track (with the next scheduled void) as soon as possible
• Keep a daily record of your urination and leakage episodes, so that you can track your progress
• When the initial schedule gets easy for you, increase your interval by 30 minutes
• Stay on a given interval for at least one week before increasing
• Aim for a goal of minimal to no accidents and a voiding schedule of between two to four hours. Getting there should take you anywhere from four to 12 weeks
• You may find it easier to be successful with your bladder training if you go on the “bladder diet” at the same time

If you feel as though you are about to have an accident before your scheduled time to urinate, focus on something else to make the urge go away. Some ideas: count backwards from 100 by sevens; sit down or lie down; get on the phone with a friend; perform several strong Kegel exercises.

Life’s events can weaken pelvic muscles. Pregnancy, childbirth, and being overweight can do it. Fortunately, pelvic floor muscles are just like other muscles — exercises can make them stronger. The medical team at Atlantic Urogynecology Associates teaches women with bladder control problems to regain control through pelvic muscle exercises, also called Kegel exercises.

Which are the right muscles?

The part of your body that includes your hip bones is the pelvic area. At the bottom of the pelvis, several layers of muscle stretch between your legs. The muscles attach to the front, back, and sides of the pelvic bones. Two pelvic muscles do most of the work. The biggest one stretches like a hammock. The other is shaped like a triangle.

During your pelvic exam, your doctor or nurse placed two fingers in your vagina and a hand on your abdomen. Then your doctor or nurse asked you to contract the muscles of your vagina around her fingers as if you were stopping the flow of urine. These are the muscles you will exercise.

How to exercise pelvic muscles

You can exercise almost anywhere — while driving in a car, at your desk, watching TV — and at any time — morning, noon or night. Just pull in the pelvic muscles and hold for about 10 seconds, then rest for 10 seconds. Do three to four sets of 10 contractions per day.

Be patient. Your goal is to improve muscle tone, and just as it takes time to improve muscle tone in your arms, legs, or abdomen, it takes time to tone the pelvic muscles. You may not feel your bladder control improve until after six to eight weeks. Still, most women notice an improvement after a few weeks.

Points to remember

• Weak pelvic muscles often cause bladder control problems.
• Daily exercises can strengthen pelvic muscles.
• These exercises often improve bladder control.
• Ask your doctor or nurse if you are squeezing the right muscles.
• Tighten your pelvic muscle before sneezing, lifting, or jumping. This can prevent pelvic muscle damage.

Daily pelvic muscle exercise log

• I exercised my pelvic muscles _______ times daily.
• I spent _____ minutes exercising.
• At each exercise session, I contracted my pelvic muscles _____ times.

If the exercises are a success, continue to do them, just like any other exercises.

Low-acid bladder diet

The medical team at Atlantic Urogynecology Associates recommends certain acidic foods to avoid, which are considered irritants to the urinary tract:

• Apples
• Apple juice
• Cantaloupes
• Carbonation
• Chilies/spicy foods
• Chocolate
• Citrus fruits
• Coffee (regular and decaffeinated)
• Cranberries
• Grapes
• Guava
• Mayonnaise
• NutraSweet
• Peaches
• Pineapple
• Plums
• Tea
• Tomatoes
• Strawberries
• Vinegar
• Vitamin B complex

Substitutions

Some examples of low-acid fruits:

• Pears
• Apricots
• Papaya
• Watermelon
• For coffee drinkers: kava (low acid instant), cold brew coffee
• For tea drinkers: non-citrus herbal sun brewed tea
• Vitamin C substitute: calcium carbonate co-buffered with calcium ascorbate

If bladder symptoms are related to dietary factors, strict adherence to a diet which eliminates the above food products should bring significant relief in 10 days.

Once you are feeling better, add these things back into your diet, one at a time. When you do begin to add foods back into your diet, it is crucial that you maintain a significant water intake. Water should be the majority of what you drink every day. Always consult your physician before making dietary changes.

Preparing for surgery

If surgery is your best option for you, the medical team at Atlantic Urogynecology Associates recommends the following helpful information:

Preoperative tests

An EKG and blood tests are usually ordered prior to surgery. Depending on your health, more extensive testing may be necessary to determine whether your body will tolerate the strain of surgery. Some women with serious medical conditions are asked to meet with the anesthesiologist prior to surgery as well.

Donating your own blood

Most urogynecologic procedures are performed in a minimally invasive way resulting in a less than one percent risk for needing a blood transfusion; for that reason, we don't recommend that patients donate their own blood before surgery.

Preventing infection

All doctors and hospital personnel are trained to prevent infection through techniques known as “universal precautions.”

Smoking

Smoking is not allowed anywhere inside the hospital. Smoking causes heart and lung problems and may also cause urinary incontinence and prolapse to recur after surgery. If you smoke, we would like to help you quit. Please ask about programs that can help you.

The day of surgery

Please do not eat or drink anything after midnight on the night before surgery. On the morning of surgery, you may take your regular medications with a sip of water, unless your doctor or anesthesiologist tells you otherwise. Diabetics and patients on steroids will receive special instructions from their doctor about managing their medications around the time of surgery.

The scheduling secretary will tell you what time you should check in through the Admissions Office (usually about two hours before your scheduled time for surgery). A member of the anesthesia staff will visit you. An IV will be started through a vein in your arm. Preoperative medications will be given. Some of our surgery can be performed while you are still awake, but no surgery will begin until you are completely under anesthesia.

You may find it helpful to come to the hospital with responsible family members or friends. The doctor will keep them updated as to how you are doing after your surgery.

Your hospital stay

Your doctor will tell you before your surgery if you need to stay overnight in the hospital. Most patients will go home the same day. A patient is ready to go home from the hospital when she is eating regular food without difficulty; using only oral pain medication (i.e. no need for IV pain medicine); has no fever; and is able to walk in the halls on her own. If you need to use a catheter, we will make sure you are comfortable with it before you leave.

Going home

You should be able to return home by car. Make plans to have someone drive you home from the hospital - you should not drive yourself.

Driving

As you know, driving a car requires good judgment and quick responses to changes in traffic conditions. You should never drive if you are using prescription pain medicine. We encourage you to be responsible after your surgery by refraining from driving until you feel that you could react quickly in traffic as needed.

Wound care

Do not douche or use tampons after surgery. To protect your clothing from vaginal discharge or bleeding, you may wear a mini pad or standard sanitary napkin. You may also wish to use a squirt bottle filled with saline solution to wash off after going to the bathroom. Spotting and reddish discharge after surgery is normal. Bright red bleeding, increasing pain or increasing redness around your incision are reasons to call your doctor.

Try to get your incisions as dry as possible after taking a shower. A hair dryer on the "cool" setting can be useful for this. Do not take a bath until your doctor tells you that it is okay to do so. If you have an incision on your abdomen, it is normal to feel occasional sudden "tugging" pains for several months after surgery. We encourage you to call us to ask about anything that seems out of the ordinary after your surgery.

Post-operative restrictions at Atlantic Urogynecology Associates

If surgery was the best treatment plan for your medical condition, the medical team at Atlantic Urogynecology Associates recommends the following information regarding your post-operative care:

Surgical discharge instructions: 6-week limitations

After undergoing successful extensive pelvic surgery, it takes approximately 6 weeks for the tissues that have been operated on to heal back to 80 percent of their eventual strength. It may take up to six months to achieve 90 percent wound strength and full wound strength will not be achieved until two years. We recommend that our patients be restricted in their activity for 6 weeks following major surgery. If you are only having a sling for urinary continence, you only need to follow these restrictions for six weeks.

These restrictions include:

• Use a stool softener for 6 weeks so that you do not need to strain at the time of bowel movements
• Limit activity and not allow any exercise except walking, which is strongly encouraged. Anything that increases the pressure within your abdominal cavity will tend to tear down the repair prematurely
• Refrain from lifting anything heavier than about 25 lbs.
• Avoid swimming, biking and aerobics. You should not be carrying groceries, the laundry basket, or vacuum cleaner. If you need to reach something on the floor, you should either sit down in a chair and scoop it up or slowly bend down on your knees to pick up the object.
• Routine activities such as getting dressed and shaving legs are fine. It is also fine to climb stairs as long as you take it slow.

In addition to the stool softener, you may or may not have been given medications for pain or hormone replacement. In addition to these, resume all of your medications unless we advise you otherwise.

Leaving the hospital

It is possible that you will leave the hospital with a catheter in your bladder. If so, our nurse will remove the catheter several days after you leave the hospital. This visit is called a “voiding trial.” In addition, we would like to have you come back to the office in about two weeks for an initial post-operative visit. We will then see you again at six weeks after surgery. We believe that you will have the best possible chance of healing well after surgery. This is the best way to achieve a good, long-lasting successful repair of your medical condition.

It is a typical scenario that when you are first at home, you may be more fatigued than you were prior to surgery, and it is possible that you do not have the usual stamina. This should resolve over the next four to six weeks. During the first weeks after surgery, some people become depressed. If you notice this happening, and it does not seem to be resolving on its own, you should contact our office and let us know. In addition, if you have any questions about your medication, or if there is any problem with your wound - excessive pain or a fever, or trouble emptying your bladder after the catheter is removed - you should contact our office immediately.