C-Section or Not? Choosing a Caesarean Section Delivery to Avoid Incontinence

Incontinence - C-Section or Not? Choosing a Caesarean Section Delivery to Avoid Incontinence IncontinenceNetwork.comIn Incontinence?In IncontinenceEntire SiteIn IncontinenceEntire Site Top Incontinence NewsUnderstanding Urinary IncontinenceCheck a SymptomIncontinence DrugsDoctors/HospitalsClinical TrialsIncontinence Web ResourcesThe First 48 HoursPreventionTreatmentTests and ResultsTypes of IncontinenceInsurance HelpOrganize your Caregiving Community! Meet Our CommunitySee All SharepostsSee All QuestionsSupport GroupsAsk the ExpertFree Newsletter.Sign up now!EmailPassword (Forgot Password?)Remember Me Thursday, August 05, 2010Incontinence Home > SharePosts > Health Professional > Jennifer Sobol, D.O. > C-Section or Not? Choosing a Caesarean Section Delivery to Avoid Incontinence Font size A A A Email MoreRSS Save to My Home This helped! C-Section or Not? Choosing a Caesarean Section Delivery to Avoid IncontinenceRelated: Stress Incontinence, Incontinence,  More Tags> pelvic floor, Incontinence, Stress Incontinence, C-Section or Caesarean Section ,  Fewer Tags> More Topics > Jennifer Sobol, D.O. Health ProfessionalUrologic Surgeon

Jennifer Sobol, D.O., is a urologic surgeon who practices general...

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Historically, a Caesarean Section or C-section for short had been performed in emergencies if a mother or baby had trouble during delivery. This procedure goes back to biblical times. In the last century, the incidence of the surgery increased profoundly. Now it accounts for at least one-third of births in this country. Some of them are performed for medical reasons including a breech delivery (which is also a relatively new trend in this country), where the baby is coming out feet first, but many of them are now elective for a variety of reasons. I have a friend who scheduled her c-section because she has a very busy job and work schedule, and for her, she felt it made sense to schedule her c-section. She discussed it with her doctor and that is what she had. When I talked to her about it, she told me that not only did she want a c-section for schedule reasons, but also because she didn't want to have incontinence from pelvic floor relaxation that we often see after a vaginal delivery.

 

This got me thinking; is it okay for women to choose to have a c-section for no other reason other than trying to prevent the risk of incontinence? Well, I know the answer for many women and obstetricians, the answer is yes! I once spoke with a female urologist who is an expert on pelvic floor dysfunction and she truly believed that all women should have a c-section to prevent the "inevitable" injury to the pelvic floor during vaginal births. I thought this was a radical viewpoint but she made a valid point. The amount of money spent nationally on incontinence is staggering!! If someone could do something to prevent this disease, then is it appropriate?

 

One thing that a woman has to keep in mind is that a c-section is surgery and is not without basic surgical risks, however low they may be. Your hospital stay is prolonged to four to five days, where vaginally delivered women usually go home in two days. In general, it is felt that overall recovery is also easier with a vaginal delivery than getting over a surgical incision, but I think that point can be debated. One of my closest friends had her second child 2 weeks ago and had to have a c-section because her baby was breech. She had delivered her first child two years ago vaginally. She was so upset that she was going to have to have a c-section, and I spent a lot of time on the phone (she lives in another city), trying to reassure her, but to no avail. Now when I talk to her she tells me that her recovery is much easier than she was anticipating, and the only big issue for her is that she cannot pick up her 2 year old for a couple of months. She says that having the incision is better than having to sit on an ice pack and deal with the episiotomy stitches, which I think is more bothersome in general than people let on.

 

The other issue to keep in mind is that there is evidence starting to be reported in medical journals that pregnancy alone increases your risk of pelvic floor relaxation and subsequent urinary incontinence. Having a c-section does not guarantee that you will not have incontinence and having a vaginal delivery will not doom you either. I have many patients that I see for stress incontinence because of pelvic floor relaxation and urethral hypermobility that have only had c-sections, or have never been pregnant. On the flip side, not everyone who has a vaginal delivery will have stress urinary incontinence.

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When Someone You Love Has Incontinence

Up until now, when discussing the social aspects of incontinence, I have addressed how to talk about your incontinence with your family and friends. But what do you do when a loved one has incontinence?

I hate to be crass, but we all know people who smell like urine, and at one time or another, we have all thought, "Don't they know what they smell like?"

For the most part, people are over-sensitive about their incontinence and worry that everyone can smell them, but most of the time, they don't. However, I am sure we all know someone like the person I am talking about.

I had a great-aunt who passed away some years ago, but in the last few years of her life, I imagine she became incontinent, or became debilitated enough that she could no longer keep herself clean enough, and she did smell like urine. I hated going to her house because everything smelled.

I think she stopped wearing pads, or at least changing them, and urine was likely soaking into some of her cushions. I said something to my mother about how we should say something but she thought my aunt would be mortified. I think she would have been mortified to know we didn't tell her. Most people don't know they have a bad odor when they do.

There is never a good way to approach something like this with someone. It is embarrassing, I know. But just imagine, if you were socially offensive, wouldn't you want someone to tell you. It's kind of like getting spinach stuck in your teeth and greeting a million people at a party, only to find the stowaway at the end of the night. Of course that has happened to me and I usually find my best friend and yell at her for not telling me. Her respond is "I didn't want to embarrass you."

So instead of being embarrassed for a minute or two from someone I know who cares about me, I was embarrassed for the whole night, and in front of some people who were very important professionally. Recognizing that incontinence is probably 10 fold more embarrassing, wouldn't you want to know?

I wish I had a good and fool proof way to approach your loved one. I try to think about what I would say to my aunt if given the chance. I run many different scenarios in my head, and few of them have a good outcome. I certainly can't title them, "and we all lived happily ever after!" I do know that if someone came to me and said that I smelled like urine, I would hope that they not only had enough intestinal fortitude to say something, but I would hope they had an answer. Pointing out something that is perceived as embarrassing is much worse when there is no perceived way to fix it.

Probably the best thing is to ask about their overall health and see how he or she is feeling. I might say that I went to the doctor recently and we talked about incontinence, and you found out there were many ways to treat it. Another option is to bring up and interesting article or Web site you just stumbled across that they may find helpful. I can promise you that it may be a bit of an uncomfortable conversation for a little bit, but in the end, I think your loved one will be grateful, and possibly thank you. More likely, they will never bring it up again, but hopefully you will notice a change, and you will know that you did some good in the end. Good luck to you if this is something you have to do, and Happy New Year!!

Is Biofeedback a Possible Incontinence Treatment for Me?

I have discussed the different types of incontinence in many other SharePosts before, and I often talk about surgical options or medications. I have briefly mentioned other options, but now there is proof!!

A study was just released out of the University of Pittsburgh that shows that biofeedback is very helpful and works well in women over the age of 60, and in particular, those who are also being treated for depression.

In general, people with depression have a sense of "learned helplessness," and those of you suffering with incontinence know that you surely often feel helpless. Imagine adding clinical depression to this. The last thing many people want is to take more medication, and that is where biofeedback becomes very important.

Biofeedback is a type of physical therapy where you learn to inhibit bladder contractions and you get sensory feedback cues until you learn to do it yourself. Biofeedback is helpful because you don't need medications and many people report having a much better sense of control of their body and of their disease.

I am currently in the process of taking care of an elderly woman who doesn't have any family and lives in a retirement home. She is quite cared for by the staff who genuinely love her very much. It took her many years to even tell the nurse who works there that she is having a problem with incontinence. My patient felt completely alone with her problem and had no idea that other people were living with incontinence too. When she came to me, she barely wanted to talk about it until I told her that she is not alone and I could help her. We tried her on several medications but the side effects were intolerable and she wasn't able to stay on them long enough to find out if they worked. I talked with her about some other options as well and she was the most interested in biofeedback because she didn't need to take any medications or go through any procedures either.

I often offer biofeedback as an option, but I really didn't know what to tell people about it's usefulness until this study. I think this study is a breakthrough for some real scientific evidence that biofeedback can work, without medications or surgery. It usually needs to be administered by a physical therapist and they just need a prescription from your doctor.

If you have been apprehensive about seeing your doctor about your incontinence because you thought all you would be offered was medications, then here you go; another option for you to try. Remember, you may not be a candidate for this, and it is important to be evaluated by a physician, but it is worth a try. You have nothing to lose!

Dating and Intimacy Concerns When You Have Urinary Incontinence

Incontinence - Dating and Intimacy Concerns When You Have Urinary Incontinence IncontinenceNetwork.comIn Incontinence?In IncontinenceEntire SiteIn IncontinenceEntire Site Top Incontinence NewsUnderstanding Urinary IncontinenceCheck a SymptomIncontinence DrugsDoctors/HospitalsClinical TrialsIncontinence Web ResourcesThe First 48 HoursPreventionTreatmentTests and ResultsTypes of IncontinenceInsurance HelpOrganize your Caregiving Community! Meet Our CommunitySee All SharepostsSee All QuestionsSupport GroupsAsk the ExpertFree Newsletter.Sign up now!EmailPassword (Forgot Password?)Remember Me Thursday, August 05, 2010Incontinence Home > SharePosts > Health Professional > Jennifer Sobol, D.O. > Dating and Intimacy Concerns When You Have Urinary Incontinence Font size A A A Email MoreRSS Save to My Home This helped! Dating and Intimacy Concerns When You Have Urinary IncontinenceRelated: Incontinence, Dating, Pelvic Pain,  More Tags> Biofeedback, Incontinence, Urinary Incontinence, Dating, Relationships ,  Fewer Tags> More Topics > Jennifer Sobol, D.O. Health ProfessionalUrologic Surgeon

Jennifer Sobol, D.O., is a urologic surgeon who practices general...

Send MessageSubscribeJennifer Sobol, D.O.Tuesday, February 26, 2008View All of Jennifer Sobol, D.O.'s Posts

Even though Valentine's Day has passed, I thought I would address an issue a very dear patient of mine recently raised; how do you date and meet someone new when you have incontinence?

 

She is recently single and ready to hit the dating scene after a bit of a hiatus. She has had problems with incontinence and has required several surgeries and medication but she reports she is 99% better than when I met her a year ago. She has gained a lot of confidence over this past year, but is still nervous about meeting someone new. Her concern is how to explain her medical condition to someone new.

 

Her concerns and worries are definitely legitimate. I mean, how do you explain it to someone you are just getting to know? It's hard enough to talk to loved ones and close friends about incontinence, what about a virtual stranger. How about when you start to get intimate? Sexy undergarments are pretty much out of the question for many, right? I really never thought about this issue that much because no one has really talked to me about it.

 

It got me thinking, and I started to think about all of the patients I see for all kinds of reasons. Being a urologist, I see people with all kinds of sensitive medical conditions. I not only see people with incontinence, but erectile dysfunction, sexual dysfunction, chronic pelvic pain and a host of other problems. Most of these people feel alone in the world with their medical problem and I always try to tell them that I see many patients with similar issues.

 

I often recommend they look online for online support groups. I think people can find a lot of comfort when they find out they are not alone, and there is a lot to be learned from other people who share similar experiences.

 

The other thing, which I think is pretty important to remember, is that this new person in your life has his or her own issues too. Like I was saying, I see so many patients with so many personal and sensitive health issues that I realized almost everyone has something going on; they just don't talk about it. This isn't meant to downplay what you may be experiencing, but remember, you don't know what the other person is going through privately either.

 

Finally, in my opinion, if this new person in your life isn't sympathetic to your MEDICAL CONDITION, then he or she wasn't the right one for you anyway!! Good luck dating out there!

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