Aging Dads: Incontinence Issues Part 2– A Urologist Weighs In

Dr. Leonard Plaine, a highly respected, recently retired urologist at NYU Langone Medical Center, was a logical choice to double-check my last week’s “Aging Dads: Incontinence Issues–Part 1” post. He has treated men’s urological issues for many decades and I especially wanted his “take.”

Dr. Leonard Plaine weighs in:

1.  The links are well-chosen. They provide the important information men need. But he wanted to make a point about human nature, saying “Many people are not motivated to do Kegels regularly.” And that’s a good point. Some people certainly are; but what about those who have good intentions but won’t follow through? Is “Know Thyself” the key?

2.  Harvard’s Prostate Knowledge article,“A patient’s story: Overcoming incontinence,” is excellent–very complete– a piece every man wondering about incontinence issues and prostate surgery should read.

Coincidently, it was timely. Dr. Plaine had been consulted by a former colleague, earlier that day, about the advisability of his patient’s having the artificial sphincter procedure for overcoming incontinence. Dr. Plaine’s opinion raised an important caution. It involved radiation.

His former colleague’s patient had successful prostate surgery several years before and carried on life as usual. Then his PSA rose and another doctor ordered radiation treatments, which the patient had. Incontinence followed. The artificial sphincter procedure, detailed in Prostate Knowledgewas being contemplated. Dr. Plaine said once tissues in the area needed for the sphincter have been subjected to radiation, they are compromised–reducing the likelihood of a problem-free solution. In fact, he would not recommend the artificial sphincter procedure in that situation.

This prompted me to phone the friend mentioned in Part 1, whose husband had radiation after prostate surgery, was living with incontinence issues, and was considering the sphincter procedure. She said her husband consulted 2 doctors. One surgeon–according to her–was ready to do the sphincter procedure; her husband’s surgeon (who did his prostate surgery), on the other hand, was very hesitant–said chances were my friend’s husband “wouldn’t be happy.”

Lastly, I learned two new terms: “urodynamics ” and the “Cunningham clamp.”
The first is the sophisticated study of how the bladder works and helps diagnose reasons for incontinence. When ordinary answers aren’t the answer, urodynamic testing may be recommended. Mayo Clinic explains “urodynamics” testing in the preceding link.

The second, “Cunningham Clamp,” (see update below)* is what Dr. Plaine calls–an “old fashion” device, meaning it has been around for years, to control incontinence. Although he said he hasn’t heard much about it recently, he thinks it’s good daytime option to adult underwear, pads etc.

With hopes that some of the information in these last 2 posts will help older dads age well……..

5/2015 Update: the acquaintance mentioned in part 1, tried the Cunningham clamp for a while and, as I recall, didn’t like it. Will check on specific reasons and add those at a later date. He decided on the sphincter surgery, which took place 3 months ago after his surgeon said the tissue looked fine for the procedure. I understand he’s happy with the current result. I don’t think there was a discussion about the possibility of a later problem with the tissue. This is obviously a question to ask of the surgeon if contemplating the procedure. Note: This should not be construed as medical advice; only one person’s experience that can provide a framework for discussion.

Check out: “Newsworthy” (right sidebar). Links to current information and research from highly respected universities to help parents age well.

Aging Dads: Incontinence Issues–Part 1 Older Men

incontinence-condition

Wanting to be inclusive, this follows last Saturday’s post about women’s incontinence and the New Guidelines for dealing with it. Interestingly, a current TV ad features a group of women mapping out where bathrooms are located, before presumably going out shopping–or for lunch. Then of course we hear about the product that will make that kind of planning unnecessary.

But what about men?

Although the high rise of incontinence is in women 75 and over, and the rise is less dramatic in men, incontinence–usually temporary (3-6 months)–is common following prostate surgery. Also as men age the sphincter muscle that controls urine outflow can weaken due to more and more years of use. Doctors recommend Kegel exercises for men (with varying degrees of success depending on different factors). I’ve selected informational links from what I consider reputable sources like Mayo Clinic, as this post is intended to provide some background information before speaking with a doctor if there are issues. It should not be construed as giving medical advice, however.

Links:
—Mayo Clinic has instructions for doing Kegel exercises: http://www.mayoclinic.org/healthy-living/mens-health/in-depth/kegel-exercises-for-men/art-20045074
—Webmd weighs in: http://www.webmd.com/urinary-incontinence-oab/kegel-exercises-treating-male-urinary-incontinence
—The NY Times blog also (July 2014)–Here it’s necessary to read to the end of the article to avoid missing important information: http://well.blogs.nytimes.com/2014/07/14/ pelvic-exercises-for-men-too/?_php=true&_type=blogs&_r=0

As we get older and dine out with friends, it’s not unusual to have men get up from the table to use the bathroom. It’s a part of aging. Enlarged prostate as well as prostate cancer become problematic for many older men. That’s why PSA monitoring is important– may be the equivalent of mammograms for women.

Everyone of a certain age (boomers and older) must know men who have had surgery for prostate cancer. Whether using the DaVinci method or the traditional method, there will be some degree of incontinence for a limited time. An acquaintance is living with the same incontinence situation (following successful prostate surgery for cancer) as the person in Harvard’s Health publication–Prostate Knowledge. He is currently debating the surgery, as was the man in this very good article http://www.harvardprostateknowledge.org/a-patients-story-overcoming-incontinence#an important read for any man contemplating prostate surgery or dealing with incontinence.

Included–as always–in the current US News‘ 2014-2015 survey are the best urology departments in the US. The top 4 (all scoring at least 91.2 to /100) are: Cleveland Clinic, Mayo Clinic-Rochester, Johns Hopkins and UCLA Medical Center respectively. This does not mean they have the best urologists for men’s incontinence; but it does mean these hospitals have excellent departments, if needed. Click for the list

We try to help parents age well. While incontinence is bothersome and embarrassing and isn’t usually an ordinary topic of conversation, understandings about it may prove helpful for many.

Related: Johns Hopkins yearly “Prostate Cancer “Discovery” 2015 issue, plus site with yearly back issues.

Note: “Newsworthy” (right sidebar). Links to timely information from outstanding research institutions–and some fun stuff–to help parents age well.

 

Aging Women: Incontinence–and Diapers!?*

Just published: The American College of Physicians’ New Guidelines
re: women’s urinary incontinence–see 
Newsworthy at right–
triggers thoughts:

1.  An experience with Mother.
2.  One of this blog’s key thoughts: Is it better for parents or better for us (in this instance the caregiver)?
3.  A prejudice about the word “diapers” used in conjunction with old/older people’s incontinence.

Incontinence was never a problem for mother. But it was a concern of hers after hospitalization following a stroke that required a catheter. Her first outing after leaving the hospital, other than to a doctor’s appointment, was lunch with me at Marie Callendar’s. She needed to gain weight and loved their pies. All went well until the end of the meal when she said she needed to get to the bathroom fast. While it wasn’t far she was frail, walked cautiously, and as we got through the first door she said she didn’t think she’d make it to the stall. Mind over matter to the rescue?

(I was always fasciated by those people who could walk barefoot over hot coals. It was, I thought, an incredible example of mind over matter. I still think of it when I’m at the doctor’s or dentist’s and anticipate pain. What works for me is asking  her/him to talk to me about anything so my attention/mind is diverted from possible pain thoughts. [Surprising what you learn! I learned one doctor’s wife was in my Teachers College counseling program, among other interesting things.])

I tried this diversion tactic with Mother, suggesting that in less than a minute she’d be in the stall, seated and wouldn’t feel embarrassed. Her mind was diverted; the plan worked. Result: she felt liberated–and confident about going out. Her preference to sit near the Ladies Room lasted a few weeks then was no longer an issue….until a year later.

After a bad fall in an unlit movie theater, and resulting hospitalization, Mother came home extremely frail and weak. Although Dad was at home and had a good mind, he was old. Mom needed caregivers 24/7 for an extended period. My only request from the newly-hired, highly-recommended caregiver was that Mother get appropriate exercise, which included walking to the bathroom and back since she had no bathroom issues. I figured Dad could take care of the rest. I came back to NY, confident that things were moving forward nicely.

A month later I flew back at night to see my parents. The night caregiver “tattled.” The day caregiver (who hired the others) was using “diapers” on Mother. Made it easier for this caregiver, but was unnecessary for Mother. Saying I just happened to find  “pull-ups” in the closet, took the night caregiver off the hook and made beginning the conversation I needed to have with the day caregiver easier.

Incontinence is embarrassing enough without having people use the word “diapers” or deciding a person needs them because it means less work for the caregiver.  And wouldn’t “pull-ups” be a more respectful term than “diapers”–simply because it’s not equated with being a helpless infant?

The American College of Physicians’ new guidelines for dealing with female urinary incontinence stress trying normal (pill-free and lifestyle changes) solutions first. Doesn’t maintaining feelings of normalcy help parents–and everyone–age well?
*             *            *

Note: “Urinary incontinence (UI), the involuntary loss of urine, has a prevalence of approximately 25% in young women (aged 14 to 21 years) (1), 44% to 57% in middle-aged and postmenopausal women (aged 40 to 60 years) (2), and 75% in elderly women (aged ≥75 years)” ACP

Related: For the Guidelines as published by the ACP, click this link or link in last paragraph. They’re easily understandable and the helpfulness of the exercises is clear.

The recommended Kegel exercises–courtesy Mayo Clinic (there’s also a link within the Newsworthy article).