- Women's HealthGeneral Page Tier 3BlogIf you’ve ever dreaded laughing at a good joke or sneezing for fear of an “oops” moment, then you know what it’s like to live with urinary incontinence. You may be hanging back from doing things you love, worried you can’t get to a bathroom and embarrassed about leakage you can’t control. Here’s a start to learning more about the condition — its causes and treatments — so you can see that it’s possible to get back to living your best life. Incontinence is more common than you think. An estimated 15 to 25 million Americans deal with incontinence. But it’s hard to put a firm number on it because so many people are too embarrassed to talk about it. We do know women are two times more likely than men to develop urinary incontinence — and that physiology plays a part. The structure of a woman’s internal organs, pregnancy, childbirth and menopause all have an effect. Aging does too because pelvic floor muscles that support the urinary tract muscles weaken as you age, making it harder to hold in urine — though it’s not necessarily a normal part of getting older. There are different types of incontinence. The most common types of incontinence in women are stress incontinence, urge incontinence, and a mix of the two. Stress Incontinence Stress incontinence makes having fun unpredictable. Things like laughing, dancing and exercise put pressure on your bladder, causing uncontrollable leakage. You don’t feel an urge to urinate; it just happens. Weak pelvic floor muscles or the bladder out of its normal position are usually the culprits. Urge Incontinence A “gotta go” feeling you can’t ignore is urge incontinence, or overactive bladder (OAB). OAB can happen when certain nerves and bladder muscles don’t work together. Your brain tells your body you need to go to the bathroom, even if your bladder isn’t full. That signals the bladder muscle to contract, and the sphincter — the muscle that controls urine flow — relaxes. The urge comes on suddenly, even if you’ve recently emptied your bladder, and you may not make it to the bathroom. Some people have a frequent urge to go — up to eight times a day — and then barely go when they get to the bathroom. Mixed Incontinence Having more than one type of incontinence isn’t uncommon. If you do, stress and urge incontinence are usually the two that combine and lead to leakage. You don’t have to live with it Too many people stay silent about incontinence, assuming events like pregnancy, childbirth and aging make it an inevitable part of life you have to get used to. Not true. It’s very treatable, and often with self-help methods you can do it yourself. Lifestyle Changes For some people, reducing the risk of leakage is as simple as making lifestyle changes, such as: Avoiding lifting heavy objects Avoiding liquids in the evening Limiting caffeine and alcohol, which make you produce more urine Losing weight to relieve pressure on the bladder Kegel Exercises Weak pelvic floor muscles — those that support the bladder — are often at the root of leakage problems. Kegel exercises involve strengthening the muscles that control urine flow by tightening and relaxing them. Doctors often recommend women do Kegels during pregnancy to prevent incontinency problems. You can work with a physical therapist to learn how to do Kegels effectively. Bladder Retraining Timing is everything when it comes to staying dry. Finding the sweet spot takes practice. It may involve making sure your bladder is empty to prevent the urge to go. Make a pit stop every two hours if you know the urge to go hits every 2 ½. But you may have to retrain your bladder if the urge to go too often is a problem. That involves gradually extending the time between bathroom visits. For instance, if you go to the bathroom every hour, stretch it to an hour and 15 minutes, increasing the time over a few weeks. Medications, Devices or Medical Procedures If self-help approaches don’t help, your provider may suggest other options, such as: Medications that can help relax bladder muscles or block nerve signals that cause an urge to go Vaginal inserts available over the counter can be used to reduce stress incontinence A pessary, a ring-like device your doctor fits you for to support pelvic floor muscles and reduce stress incontinence Injections of a bulking agent in tissues around the bladder to help keep the opening closed and prevent leaks Pelvic floor stimulation to nerves and muscles to strengthen them and to reduce the urge to go A sling is a small piece of synthetic material surgically placed to support the urethra to improve leaking from stress incontinence Incontinence doesn’t have to control your life. Yes, it can feel awkward to talk with your doctor about bathroom habits. But incontinence is a very treatable condition. A full evaluation with a pelvic medicine and reconstructive surgeon can help you determine the best treatment for you. Asking for help can get you back to a life free of worries about leakage. Authors Aparna Ramaseshan, MD, is a Female Pelvic Medicine and Reconstructive Surgeon (FPMRS), at the Women’s Center for Pelvic Health. To make an appointment, call 443-481-1199.0
- Physical Therapy, Women's HealthGeneral Page Tier 3BlogEver heard of pelvic physical therapy? Probably not. And if you have, a single word likely comes to mind: Kegels. But pelvic therapy involves much more than repeatedly contracting and relaxing your pelvic floor muscles (the muscles that control the flow of urine). In fact, many pelvic floor physical therapists are baffled that pelvic floor care for new moms is often summed up in one incomplete, oversimplified and often ineffective piece of advice: “Do your Kegels.” “Most women have never been assessed to see if they are doing Kegels properly,” says Yong Zheng, MD, urogynecologist with Anne Arundel Medical Center’s Women’s Center for Pelvic Health. Pelvic physical therapists are experts of the musculoskeletal system. “We completely examine our patients’ abdominal and pelvic muscles, and we help with bowel, bladder and sexual functioning. We use biofeedback and electric stimulation to teach the muscles to work properly.” Moving Beyond Kegels Pelvic physical therapy helps treat problems like incontinence, prolapse, pelvic pain, low libido, painful sex and constipation safely, and without medication or surgery. It can even help with that post-baby belly pooch called diastasis recti. So why isn’t it a standard treatment option for these postpartum issues? Well in some places, it is. In countries like France, Australia and the Netherlands, doctors actually prescribe pelvic physical therapy to new moms. Most women receive therapy sessions before they’re cleared to resume physically demanding activities (read: sex and exercise). “In Europe, new moms are taught, mainly by physical therapists and midwives, how to do Kegel exercises before they leave the hospital,” says Dr. Zheng. “After delivery, if a woman has a third or fourth degree tear, she’ll undergo physical therapy as a standard part of postpartum care.” But in the U.S., pelvic therapy still isn’t part of routine care for new moms. “In the United States many women, and even some doctors, are not familiar with pelvic physical therapy,” she says. Here’s why: At the six-week checkup after giving birth, doctors assess the uterus and cervix, but often ignore the pelvic floor muscles. And since most pelvic floor issues aren’t life-threatening, many women suffer in silence and wait for symptoms to go away. But symptoms don’t always go away and they can have lasting effects. “If these issues are not addressed, women can experience continued weakening of pelvic muscles, which leads to worsening of incontinence,” says Dr. Zheng. A Common Sense Solution Pelvic physical therapy after giving birth just makes sense. Think of it like this: Pushing a 5- to 9-pound child through a small canal in the body is arguably the most strenuous athletic event of a woman’s entire life. Just like triathletes and marathon runners ice, stretch and rest their legs after a big race, new moms should also heal their strained muscles. “While vaginal delivery is a natural process, it is truly very traumatic to the pelvic floor,” says Dr. Zheng. “It’s imperative to let the pelvic floor heal properly after delivery because those muscles can be your best friend but can also be your worst enemy.” Start The Conversation Until the U.S. catches up with Europe’s pelvic care standards, it’s up to women to talk to their doctor. “Talk to your health care provider about any symptoms that occur or are exacerbated after delivery,” says Dr. Zheng. “When in doubt, ask.” Asking your doctor for a referral for pelvic therapy could mean the difference between a full recovery and worsening pelvic floor issues. “Incontinence is common after birth, but not normal to extend past the six-week mark,” she says. “Although it is hard to manage a newborn, and a mother’s own needs are often put second, it is important to seek care as soon as possible.” Biofeedback: displays your pelvic muscle activity on a computer screen to better understand when you are squeezing or relaxing your pelvic muscles. This truly helps you know how to properly strengthen or relax your pelvic floor. Electric stimulation: also called e-stim. A physical therapist uses a device to deliver a weak electrical current to re-educate your muscles how to contract properly and improve sensation and awareness of the pelvic area “There is nothing better than helping a mom feel more like herself, get back to working out safely and feel more confident with her body,” says Dr. Zheng. Author Yong Zheng, MD, is a urogynecologist with AAMC’s Women’s Center for Pelvic Health. You can reach her office at 443-481-1199. Originally published Dec. 15, 2017. Last updated May 1, 2019.0
- Orthopedics, Women's Health, Patient StoriesGeneral Page Tier 3BlogThirty-four-year old Jennifer da Rosa had spent several months and visited four different doctors searching for someone to cure her unexplained hip pain. “Finally, I saw Dr. Petre and he was able to diagnose it,” says the 34 year-old college instructor from Kent Island. Jennifer had an uncommon condition in her right hip which caused the bones to grate against one another rather than slide smoothly in the hip socket. After diagnosing her condition—called FAI for femoral acetabular impingement—Orthopedist Ben Petre, MD, performed arthroscopic surgery to remove the extra bone tissue in her hip and restore the joint to proper function. The procedure is not widely available, but as one of the few hip specialists in the area, Dr. Petre has both the experience and the tools to offer arthroscopic hip surgery for FAI and a variety of conditions. “The ability to diagnose and treat this is relatively new,” he says. “It’s an uncommon condition, and diagnosing it is complicated because there are many other things that can cause hip pain, from a problem with the back or internal organs such as your bladder or ovaries to a hernia.” For Jennifer, the diagnosis came as a huge relief. The surgery eliminated her pain, and within a month she had recovered her life again. “Before the surgery, I had been afraid to take my kids to the aquarium or the zoo,” she says. “I was afraid I wouldn’t be able to walk because of the pain.” Jennifer says the experience has given her a new perspective on having surgery in general. “I know a lot of people try to avoid surgery, but I’m very pleased that I had it. The benefit far outweighs any kind of fear or downtime needed for recovery.”0
- Orthopedics, Pediatrics, WellnessGeneral Page Tier 3BlogElbow injuries in young baseball players are an increasingly common problem seen by orthopedic surgeons because the act of throwing creates substantial stress on the elbow. The elbow is protected by a combination of ligaments and muscle that help to dissipate this stress. Repetitive throwing, however, can cause significant injuries including ligament tears, cartilage loss, bone spurs, and even fractures. These injuries, whether treated conservatively or with surgery, lead to a significant amount of time spent on the sidelines. Coaches and parents must understand how to reduce the frequency of these injuries. Prevention starts with limiting the amount of throwing and allowing for proper rest. To reduce injuries, the Academy of Orthopaedic Surgeons recommends the following: Players should not throw for three consecutive months during the year. Player should not compete on more than one team during the same season. Players and coaches should follow pitch counts to prevent stress on the elbow (see chart) Players should not throw breaking balls until age 14. Resist the urge to play the same player as pitcher and catcher during the season as this can create stress on his/her elbows. Despite appropriate limits and rest, injuries can still occur. Pain, stiffness, decreased velocity, and decreased accuracy are all potential indicators of a developing elbow injury. Players should not throw through pain. Initial treatment should consist of rest, ice, and anti-inflammatory medication. If the symptoms do not resolve within seven days, consultation with an orthopedic specialist is recommended. Author By Cyrus Lashgari, MD, orthopedic surgeon at AAMG Orthopedic and Sports Medicine Specialists, a practice of Anne Arundel Medical Center. To reach him, call 410-268-8862.0
- Orthopedics, Weight Loss, Women's Health, WellnessGeneral Page Tier 3BlogFrom Zumba® to barre to breakdancing, the fitness industry has seen a growing trend in dance fitness. Whatever dance fitness trend you choose, you can lose or maintain weight, become more active and have tons of fun with this type of exercise. But dance fitness can also cause injury if you aren’t careful. Problems like shin splints, knee pain, back strains and ankle sprains can take the spring out of your step. The good news: You can take steps to prevent injuries with these tips, says Apryl Riggins, physical therapist at AAMG Physical Therapy. GO EASY. “Always start slow. Try one class, or even half of a class, and see how your body responds,” Apryl says. “Injuries don’t typically occur from a single movement or class. Injuries more often occur as a result of repetitive movements over several days or weeks, and especially when you’re tired.” If you experience pain or fatigue, take a day or two off, make sure you’re pain-free, then resume your dance class to make sure you’re comfortable. WARM UP WISELY. Warm-ups should include a cardio component. Start with gentle arm and leg movements for five to 10 minutes, gradually picking up your pace. Once your muscles are warm, try some dynamic stretches, such as high knees, butt kicks or leg swings. COOL DOWN CORRECTLY. Slow your dance movements for five to 10 minutes. Then stretch your body, including your arms and legs, holding each stretch for 30 seconds to one minute. MIX THINGS UP. Try cross-training, or doing more than one form of exercise. Doing other types of exercise in addition to dance works different muscle groups. Cross-training can help you avoid overuse injuries. “Pilates and yoga are excellent additions to dance training,” says Apryl. “They focus on core strengthening and stabilization of your abdominal, pelvic and back muscles, which helps prevent injury.” TREAT YOURSELF RIGHT. “General muscle soreness is normal after a workout, but sharp pain is not,” Apryl says. “If you experience intense pain, talk to your doctor.” Conditioning and physical therapy can help relieve pain and prevent injuries from returning. For more information, call 443-481-1140 or visit AAMGPhysicalTherapy.com. Author Apryl Riggins is a physical therapist at AAMG Physical Therapy. Originally published Feb. 15, 2017. Last updated Jan. 7, 2019.0
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