Living with Interstitial Cystitis (IC): Diet for the Painful Bladder

Interstitial Cystitis (IC) is not well understood but the link between food and the occurrence of pain episodes is very clear.  The list of foods that can irritate the bladder and thus cause pelvic pain in patients with IC is long.  The important point is that not every food on the list will be an issue for every patient.  As in the case of most situations, every person is unique and will respond differently to different foods.  I tell patients to follow the Interstitial Cystitis (IC) diet in a strict fashion for two weeks. At that point evaluate their body’s response.  If there is no change in your pain level, then diet may not have a significant impact in your case.  However, most patients with IC will notice a change.   Most patients with Interstitial Cystitis will notice a significant decrease in pain severity and episodes after following these diet rules.  If this occurs then you have confirmation of the diet link to your pain.

Once you have established that there is a dietary component to your pain, the next step is figure out which foods are the culprits.  At this point, I suggest adding one food item per week back to your diet.  Start with the food that you miss the most.  If your pain is exacerbated by this item, then you know that in your case this food item should be avoided.  If you have no recurrence of pain, then this item is likely ok for you.  Continue this process weekly until you have clearly established which foods you should avoid. 

With all that said, here is the list:

Fruits:

Allowed:  Bananas Coconuts, dates, blueberries, melons and pears

Avoid:  All other fruits and juices (especially acidic and citrus fruits)

Special note:  While Cranberry juice can help to prevent bladder infections it can worsen interstitial cystitis pain and flair ups.  Avoid cranberry juice.  The acid is a strong bladder irritant.

Vegetables:

Allowed:  Most vegetables except those listed below

Avoid: Tomatoes and tomato sauces (ketchup, pasta etc.), onions, soybeans, fava beans, tofu

Beverages:

Allowed: decaffeinated tea or coffee.  Flat soda

Avoid:  Coffee, tea, carbonated drinks, alcohol, fruit juices (especially citrus and cranberry

Dairy:

Allowed:  Milk, American cheese, cottage cheese, white chocolate

Avoid: Yogurt, sour cream, soymilk, aged cheese, chocolate

Carbohydrates:

Allowed:  Pasta (avoid tomato based sauce), rice potatoes

Avoid: Rye and sourdough bread

Meat:

Allowed:  chicken, fish

Avoid:  processed, aged, canned, cured or smoked meat

Nuts/oils:

Allowed: most oils, almonds cashews and pine nuts

Avoid: other nuts

Seasonings/condiments:

Allowed:  Garlic

Avoid:  Mayonnaise, miso, soy sauce, vinegar, spicy foods  (especially Chinese, Mexican, Indian and Thai)

Preservatives

Avoid: Benzyl alcohol, citric acid, MSG, NutraSweet, saccharin.  Any food with preservatives and artificial ingredients or colors.

Tips for dining out:

Ask for “ no tomatoes or onions”

Have a plain baked potato rather than loaded with condiments

Ask for salad dressings and other possible trigger items on the side

Look for plain non marinated steak or chicken (spices will throw you off)

Quick Synopsis:  This was a lot of information.  Here is the short and sweet version.   Avoid:

• Citrus fruits
• Tomatoes and tomato based sauces
• Coffee
• Tea
• Carbonated and alcoholic beverages
• Spicy foods

Last tip:  If you just have to have something you know will cause a problem use “Prelief”.   Prelief is an over the counter neutralizer that if taken 30 minutes before eating can help to decrease the occurrence of pain.  I hope that this helps.  Diet alone will not solve the problem and there is no known cure for Interstitial Cystitis.  Diet along with the other therapies and interventions can offer significant relief to those suffering from the pain and bladder symptoms associated with Interstitial cystitis. 

Melvin L. Ashford, MD

Minnesota Women’s Care

OBGYN and Pelvic Specialty Care Center

Rewire, Regain, Refocus, Renew: Menopause a Different Way!

Many women experience changes in their bodies in their 40s and 50s that seem to impact every part of their lives. They tell us they don’t feel like themselves. They tell us about unexplained weight gains, hot flashes, loss of interest in sex and forgetfulness. All of this is new – and very unwelcome. For many women, they believe there is only one choice: endure it and put up with a new normal. In years past it was called “The Change.” We believe in changing the way women experience “The Change”.

Are you suffering from hormone imbalance?

Take a look at this list and check which ones describe you and how you feel:

• Anxiety
• Irritability
• Fatigue
• Depression
• Lack of Interest in Sex
• Loss of Muscle Tone
• Loss of Memory
• Osteoporosis
• Hot Flashes
• Night Sweats

If you checked two or more, chances are you’re experiencing the impact of menopause. You are not alone. For many women, there is a great solution: Bio-identical hormone replacement therapy.

Isn’t all HRT the same?

In a word: NO.  Let me explain:

For many years I have struggled to balance the controversies regarding hormonal therapy with the significant and life disrupting symptoms suffered by women with hormonal imbalance. Not only do the symptoms negatively impact a woman’s life, the health concerns from hormonal imbalance are just as significant. For years, the only option has been pharmaceutical HRT.  Pharmaceutical drug therapies often are not bio identical, offers a one size fits all approach and provides hormones in a non-physiologic way.  Women’s bodies are not designed to receive huge bolus doses of hormones at once but rather slow constant release of small amounts of hormones based upon the bodies physiologic activity at the time.  I thought there had to be a better way to approach the problem and the solution.

A totally different approach.

I have found a therapy option that I feel to be safe and extremely effective to help women suffering from hormonal issues. SottoPelle Therapy® is an all-natural bio-identical hormone replacement therapy. (Often, women have heard about bio-identical HRT through TV talk shows and assumed it was a “Hollywood Thing.” It’s not.) SottoPelle therapy is administered with a pellet that allows for a continual release - the key to improving brain and muscle function. The method isn’t new. There’s more than 70 years history of its use in England and Australia. Other delivery methods result in sporadic, or a “roller coaster,” effect in the delivery and release of hormones within the body. These methods include pills, patches, injectables, and creams.

In addition, with SottoPelle, the dose for each woman is calculated based on specific factors about her and her blood analysis. This results in achieving physiologic hormonal balance - something research has shown is absolutely vital to good health and well-being. Of all hormonal replacement modalities, only pellet therapy can provide this balance 24 hours a day, 7 days a week.

Isn’t the "Change of Life" (menopause) natural?

Yes. It is very natural. Menopause occurs when the ovaries are deplete of the follicles that produce female hormones. It is usually marked in women by the cessation of menstruation.  The symptoms of menopause - hot flashes, loss of sex drive, decreased energy, loss of concentration insomnia, and vaginal dryness - can start 8-10 years before menopause actually starts. This time period before menopause is called Peri-Menopause. So, in most women the symptoms of menopause will start 8-10 years BEFORE menopause actually starts and continue 5-10 years AFTER menopause starts. Busy women with active and healthy lives can have significant disruptions in their life for upwards of 20 years!! Yes Menopause is natural, but so is appendicitis, cancer or diabetes. No one would ever suggest that these natural processes should not be interrupted by modern medicine.  Likewise a women suffering from the symptoms of menopause deserves help.

The goal is to help women suffering from the symptoms of menopause to live a better life.  It’s about providing the right care at the right time for the right patient.  Women going through menopause without significant symptoms do not need therapy.  However for those with lifestyle disruptions, therapy can be a quality of life saver.  One of my favorite quotes from a patient was “I went from existing to living”.  That quote summarizes the point so succinctly.

Why exist when you can LIVE!

SottoPelle Bioidentical Subcutaneous Pellet therapy is just one way to help achieve this.  Achieving proper hormone balance together with proper nutrition and exercise is the key to aging gracefully for women.  It rewires your desire, regains your focus and refuels your drive.  We are pleased to offer this option at Minnesota Women’s Care.  Get the facts.  A new life is a consultation away.

Melvin Ashford, M.D.

Female Urinary Incontinence: No Laughing Matter

Female incontinence is not a laughing matter. 

Female incontinence is so common among women 40 and over, people crack jokes about it. But, if you’re among the women who suffer from female incontinence, it’s really not funny. Nor are you suffering alone. It’s estimated that more than 40% of women over 40 experience some kind of urinary incontinence.

Incontinence is a condition that can really impact the quality of life for some women – making them fearful of leaving home or engaging in social activities. At Minnesota Women’s Care we make it clear to our patients that there is no need to suffer from urinary incontinence. There are treatments available that work. There’s hope and there’s help.

About Female Incontinence: Types and Causes 

Not all urinary incontinence is the same nor is it always caused by the same thing. It is more common during pregnancy, after childbirth and in post-menopausal women, but that’s not the rule. It can happen to any woman at any time.

Most women experience one of these more common types of incontinence alone or in combination: 

Stress Incontinence: Indicated by leaking of small amounts of urine while coughing, sneezing, exercising or other movements. It is often caused by a weakening of the pelvic floor muscles – the muscles that hold the bladder in place. When the pelvic floor muscles weaken or have been damaged, urine leaks from the bladder into the urethra during certain movements. Stress incontinence can also be caused by bladder prolapse – sometimes called “fallen bladder” - when the bladder descends into the vagina to varying degrees.

Overactive Bladder (Urge Incontinence): Indicated by leaking of urine at unexpected times in response to abnormal bladder contractions. Sometimes Overactive Bladder (OAB) can present without actual leakage. Some women suffer from frequent or urgent urination caused by muscle spasms in the bladder.

Mixed Urinary Incontinence: The most common type of incontinence Women with this suffer from a mixture of several forms of incontinence. Often both stress incontinence and Overactive Bladder. 

Female Incontinence: Four Things to Do Right Now 

First of all, wearing pads or special undergarments is not a solution. Our objective is to get to the root of your incontinence issues – not just to cope with the symptoms. Depending on your situation, these four solutions may have an impact on your symptoms:

Pelvic Muscle Exercises: These simple exercises – called Kegels – are used to strengthen the muscles near the urethra. Taking a few minutes each day to do these exercises can help to reduce or cure stress leakage. Ask your healthcare provider to help you isolate the correct muscles if you’re unsure.

Weight Loss: If you are overweight, the extra weight can cause bladder control problems. Talk with your health care provider about a diet and exercise program to help you lose weight.

Dietary Changes: Certain foods and drinks can cause incontinence, such as caffeine (in coffee, soda, chocolate), tea, and alcohol. You can often reduce incontinence by restricting these liquids in your diet.

Timed Voiding or Bladder Training: These techniques may help you to train your bladder to hold urine better. In timed voiding (urinating), you fill in a chart of when you urinate and when you leak urine. From the patterns that appear in your chart, you can plan to empty your bladder before you would otherwise leak.

Female Incontinence: Effective Treatments for Women 

If diet and exercise do not alleviate the symptoms, we offer a range of treatments depending on your particular needs and choices. This includes:

Urostym Pelvic Floor Rehabilitation System: This system provides biofeedback that assists patients with localization of the pelvic floor muscles necessary to strengthen the pelvic floor and provides direct electrical stimulation of the pelvic floor muscles to help strengthen them. It also helps to assess the pelvic floor function to guide therapy. We have found this helpful for women who thought they were performing Kegels, but had not isolated the correct muscles.

Intone: This new product, provided by our office for women to take home, provides biofeedback, electrical stimulation, measurement of the degree of “squeeze”, and a log of the patients exercise results. The device is used daily for 12 minutes for 9 weeks, then twice a week. During office visits, we connect the patient’s Intone device to the office computer and are supplied a detailed report of how often they exercised and how effective the routine was. This allows us to offer better coaching to improve results.

Cystoscopic Botox Injections: Though recently approved by the FDA for bladder use in the treatment of OAB, many physicians, including myself have been using this for years based upon sound evidence of the procedure’s safety and efficacy. Approximately 80% of women treated with Botox injections in the bladder with have resolution of the uninhibited bladder contractions resulting in urge symptoms and incontinence. The procedure is not permanent. The effect of Botox will last 6-9 months in most patients. Consequently it needs to be repeated. However for the woman living attached to the bathroom and suffering from embarrassing uncontrollable urinary leakage this is acceptable. This can be performed in our office or the surgery center.

Urgent PC: During this in-office procedure, a small needle is placed near the ankle to stimulate the tibial nerve. It results in satisfactory symptoms improvement for 60-80% of women. The needle placement is not painful as the need is very fine “acupuncture size”. After 12 weekly treatments maintenance treatments are performed every 1-4 months dependent upon the patient’s return of symptoms.

Interstim: This implanted device is like a pacemaker for the bladder. Once implanted, the device will work for 5 – 10 years before the battery needs to be replaced. The implantation occurs in two stages. First we’ll determine if the device will significantly improve your symptoms. If it does, we proceed with stage two. For patients who are unable to tolerate medications, Interstim has provided dramatic symptom relief.

Urethral Bulking: This procedure involves insertion of a filler product, often collagen into the urethral opening to narrow the opening of the bladder. This can be an effective option for those experiencing symptoms from Stress incontinence but is not a treatment for urge incontinence.

Medication: Certain medications can reduce many types of leakage and new drugs are frequently introduced for the treatment of OAB. One such new development is Myrbetriz, a drug that works by relaxing the bladder wall. It can be used in combination with other medications.

Female Incontinence: Surgical Treatments 

There’s been much controversy of recent about the use of mesh to repair bladder issues. Let's clarify: there is a tremendous difference between using a small amount of mesh for a sling procedure to stop urinary leakage and using more mesh for prolapse repairs. Sling procedures for the treatment of stress incontinence are considered gold standard therapies and were not called into question with the FDA letter regarding mesh. The letter was primarily pertaining to use of larger sheets of mesh for vaginal repairs secondary to prolapse. As noted above there are several other options for stress incontinence that do not require surgery. However in many patients a sling surgery is the most appropriate.

Female Incontinence: The Bottom Line 

Incontinence Therapy is an individualized decision after discussion with a physician. A board certified Female Pelvic Medicine and Reconstructive Pelvic Surgeon (urogynecologist) is the best to help guide a patient through this decision. There are 10 in the state of Minnesota. I am proud to say that I am one and can offer my patients the most current help available.

More than anything, I want women to understand this: You do not need to suffer with urinary incontinence. The impact it can have on your daily life – and on the life of your family – is much too great. There are many treatments available and they work.

Melvin Ashford, M.D.

Read this BEFORE you have a hysterectomy.

Times have changed. The surgical process for a hysterectomy is now very different. 

Just last week the FDA issued a warning about cutting tools used to remove uterine fibroids during a laparoscopic supra-cervical hysterectomy. Many women facing a hysterectomy may have questions about how this relates to them. We'll explain that in full below. It's yet another example of how things have changed for the process of hysterectomies - the second most frequent surgery for women.

In years past, when a woman had a hysterectomy she could expect a number of things. First, she often had a 5" – 7" incision across her abdomen - indicating what we now call an "open hysterectomy." Her stay in the hospital extended for a number of days following her surgery. Post-surgical pain was extreme and it often took months before she started to feel like herself again. Many activities were severely restricted during the long recovery.

During the past decade, everything about having a hysterectomy has changed. Fortunately, the experience your mom or grandmother had is a thing of the past. This is what you need to know now. 

What is a hysterectomy? 

Hysterectomy is a surgical procedure to remove the uterus. Commonly I will recommend a hysterectomy if the woman is experiencing severe abdominal pain due to endometriosis or uterine fibroids, excessive bleeding, chronic abdominal pain or if the uterus has moved from its usual position – a condition known as a prolapse of the uterus. Other less frequently encountered situations may also call for a hysterectomy as the best course of treatment.

What is minimally invasive surgery? What does it mean for me? 

While rare cases may call for an open hysterectomy, in my practice more than 99% of the hysterectomies I perform are minimally invasive procedures. This means that the surgery is performed with a much smaller incision. In real terms, for you as a patient, this means a faster recovery time and less pain. 

These are the basic types of hysterectomies that are considered to be minimally invasive:

Vaginal Hysterectomy: For several decades, physicians have been routinely performing vaginal hysterectomies. This is where an incision is made in the vagina and the uterus is removed through this incision. There is no incision visible on the abdomen.

Laparoscopic Hysterectomy: During this procedure, several small incisions are made in the abdomen. A lighted instrument with a camera is inserted through one of the incisions. The uterus is cut into small pieces and removed through the incisions. (Please note: this is a total laparoscopic hysterectomy and IS NOT the type of surgery for which the FDA has issued a warning. Please read more below.)

da Vinci® Robotic Assisted Hysterectomy: In my practice, I use the da Vinci Surgical Robot for most of the hysterectomies I perform. This system allows me to use much smaller incisions and smaller surgical tools. This is the difference in incision size between an open hysterectomy and a da Vinci hysterectomy:

For my patients, there’s less pain, less blood loss during surgery and a much faster recovery.

Benefits of Minimally Invasive da Vinci Hysterectomy: 

The da Vinci System includes a 3D high definition system which allows me to operate with an unequalled view of the abdominal area. The state-of-the-art surgical tools are controlled by me and offer more precision and control than other comparable minimally invasive procedures. The system allows me to perform highly complex surgeries without the large incision that was previously required for this kind of surgery.

Over the years I have been operating with the da Vinci system, I have found a number of benefits for my patients with this process. This includes:

 • Shorter hospital stays
 • Less post-operative pain
 • Less blood loss during surgery
 • Faster recovery
 • Minimal scarring

News flash: what does the FDA warning on hysterectomies mean? 

In a major safety advisory released last week, the Food and Drug Administration discouraged surgeons from using a powered cutting tool to remove uterine fibroids. This has a profound impact on doctors and patients relying on laparoscopic supra-cervical hysterectomy. This is NOT the laparoscopic surgery we've described above.

With laparoscopic supra-cervical hysterectomy, the surgery the FDA has warned about, the uterus in removed from the cervix but the cervix remains in place. As a result the only way to remove the uterus is through the small laparoscopic incisions. Given the small size of these incisions, the uterus has to be morcellated (cut into pieces) inside the abdomen to be removed. For more than 99% of women this is not a problem. However, for the 1/350 women with a fibroid that turns out to be an unsuspected sarcoma (cancer); cutting the uterus into pieces inside the abdomen results in worsening prognosis by spreading the cancer.

This can all be avoided by seeking out a doctor with the skills to provide a total laparoscopic hysterectomy. This provides the minimally invasive approach with fast recovery, can conserve the ovaries and remove the uterus without morcellation. Dr. Ashford has been one the first surgeons performing such procedures with and without a robot in Minnesota.

In conclusion 

If your physician has recommended a hysterectomy, I would encourage you to find out if this surgical process is right for you. My patients have been pleasantly surprised by their fast recovery and how different their experience was from their mother or grandmother. It’s really gratifying to me as a physician to be able to bring relief to women after years of suffering from painful conditions and to do so in a way that provides for a smooth recovery and a faster return to their busy lives.

Melvin Ashford, M.D.

SottoPelle Hormone Therapy

Fatigue? Poor concentration? Stubborn weight gain?

Mood changes? Night sweats? Decreased sex drive?

These are just a short list of the many changes associated with menopause. Our body systems are complex and interconnected and the changes associated with hormone shifts can impact many areas of life. The hormonal shifts of menopause can cause major upheavals in a woman’s feeling of well being. Most women are offered one-size-fits-all therapy without regard to their individual needs. SottoPelle Therapy is a reinvigorating improvement on an option studied since the 1930's.  Using bio-identical hormones tailored to the individual needs of each patient with continuous and constant release 24 hours a day, it is highly effective and extremely safe.

Consider being able to:

• Get through the day without bothersome hot flashes
• Be productive and focused
• Experience a healthy sex drive
• Maintain a high energy level throughout the day
• Sleep through the night
• “Feel” Great!

A note about hormonal therapy from Dr. Ashford:

For many years I have struggled to balance the controversies regarding hormonal therapy with the significant and life disrupting symptoms suffered by women with hormonal imbalance. Severe hot flashes decreased sex drive, lack of energy and just feeling out of place are not symptoms conducive to a happy and healthy life. Many other areas of life are negatively impacted by this. Furthermore the underlying health concerns from hormonal imbalance are just as significant. Finally I have found a therapy option that I feel to be safe and extremely effective to help women suffering from hormonal issues. 

SottoPelle Therapy is an all-natural bio-identical hormone replacement therapy that specializes in the use of subcutaneous testosterone and estradiol pellets. This method was first used in 1937 in England and Australia. The use of biologically identical, non-synthetic testosterone and estradiol is safe, and the use of pellets provides an effective delivery method. The pellet delivery method allows for the continual release of the hormone – the key to improving brain and muscle function. Other delivery methods result in sporadic, or a “roller coaster,” effect in the delivery and release of hormones within the body. These methods include pills, patches, injectables, and creams. Literature shows that the use of pellets and all natural testosterone carries less risk compared to synthetic testosterone. We use a science based approach to prescribing (dosing) the patient the appropriate amount of testosterone and/or estradiol based on specific factors about the individual and their blood analysis. This results in achieving physiologic hormonal balance-something research has shown is absolutely vital to good health and well-being. Of all hormonal replacement modalities, only pellet therapy can provide this balance 24 hours a day, 7 days a week. 

At Minnesota Women's Care we believe in providing the best care based on each woman's unique needs. We believe in finding solutions for conditions that diminish the quality of your life - solutions that are consistent with each woman's needs and her desired approach to treatment. Sotto Pelle Therapy for women symptomatic from hormone deficiency is one such therapy. Why live with constant hot flashes, emotional ups and downs, decreased sex drive, deteriorating bone conditions and all the negative consequences of hormone deficiencies. Stop Coping, Start Living!

Melvin Ashford, M.D.

Stopping Urinary Leakage Without Surgery

Acknowledging that some women despite their symptoms will prefer to avoid surgical intervention, Minnesota Women’s Care offers a intensive pelvic floor rehabilitation program to help stop urinary leakage without surgery.  Enhanced pelvic floor rehabilitation has a 30-40% increased chance over placebo in stopping urinary leakage without surgery. 

Our Urostym Pelvic Floor Rehabilitation System provides biofeedback that assists patients with localization of the pelvic floor muscles necessary to strengthen the pelvic floor.  One of the things that we do in our initial assessment is palpate the levator ani complex as the patient is asked to perform a kegel.  The overwhelming majority are not squeezing the correct muscle.  Yet the majority indicate “I’ve been performing Kegels and they don’t work”.  For most the problem is not that Pelvic floor exercise doesn’t work, but rather that they are not exercising the correct muscle.    In addition to Biofeedback to help localize the levator ani, the Urostym Pelvic Floor System provides direct electrical stimulation of the pelvic floor muscles to help strengthen the muscles.    It also helps to assess the pelvic floor function to guide therapy. 

Intone, a new product provided by our office for women to take home, provides biofeedback, electrical stimulation, measurement of the degree of “squeeze”, and a log of the patients exercise results.  The device is used daily for 12 minutes for 9 weeks, then twice a week.  At office visits, we connect the patient’s intone device to the office computer and are supplied a detailed report of how often they exercised and how effect the routine was.  This allows effective coaching and results in better compliance.

 

Melvin Ashford, MD

When to stop The Pill before trying to conceive?

How long should you be off of the birth control pill before starting to try to get pregnant?

First of all ... good for you for planning ahead for a healthy pregnancy.  In the past doctors recommended waiting 2-3 months after stopping the pills to establish normal menstrual cycles.  The Idea behind this was more to ensure that the correct due date was established upon becoming pregnancy.  However, now with the accuracy of ultrasounds this is not as important. 

Depending upon what method you are using you may want to stop a few months ahead of the month that you plan to conceive if you are over 35.  Women over 35 may have a slower resumption of normal cycles and ovulation after stopping hormonal contraception than others.  Ultimately, the time frame for stopping birth control depends heavily on you social situation. 

Some people want to try to do their best to conceive during a certain time of year (e.g. many teachers try to have summer babies).  If this is the case, then you may want more time off the birth control to start charting your ovulation and cycle length. Medically, if you have a history of: irregular periods before you began the pill, difficulty conceiving in the past, endometriosis, or are over 35, it may take longer to conceive and thus you might want to factor this in as to when you want to stop birth control. Also, remember to start a prenatal vitamin a month before becoming pregnant.  Also schedule a preconception visit with your doctor.   Avoid alcohol, tobacco and drugs, and be mindful of what prescription and over the counter medications you take before conception.

Best wishes for a wonderful pregnancy!