SOTTOPELLE HORMONE REPLACEMENT AND PARKINSONS

Exciting news! Dr. Tutera, the physician who trained Dr. Ashford to perform bio-identical hormone pellet replacement, is seeing great results with early-onset Parkinson’s patients using SottoPelle® hormone replacement therapy. These patients continue to make remarkable strides in a variety of areas.

Parkinson’s patients using SottoPelle® report:

    Reduced progression of symptoms

    Decreased need for certain medications

    Improved fitness and endurance

    Improved balance and coordination

    Increased mobility and flexibility

    Reduced tremor

When Parkinson’s disease (PD) strikes, it causes the failure and death of critical nerve cells in the brain, called neurons. Parkinson’s mainly affects neurons in an area of the brain called the substantia nigra. These particular neurons produce dopamine. Dopamine, in turn, communicates with the part of the brain that controls movement and coordination. As PD progresses, dopamine production decreases. This leaves a person unable to control movement in a normal way. And this inhibits the ability to exercise and maintain fitness.

SottoPelle® hormone replacement – specifically testosterone replacement – allows those with Parkinson’s to once again exercise. It gives them the motivation, endurance and stamina to make headway in physical fitness, just as it does in those without the disease.  In addition to this, the estradiol pellets increases dopamine production and decreases inflammation in the female brain, as does the testosterone in the male brain.

The steady flow uniform supply of needed hormones in the blood stream around the clock for months at a time appears to be beneficial.  Parkinson’s patients using SottoPelle® experience significant improvements in their conditions.  Bio-identical Hormone Replacement with Hormone pellets isn’t a cure-all for the disease, but it can forestall the disease’s progression. This helps patients become more functional with less medication. 

Melvin Ashford, MD

Minnesota Women’s Care

OBGYN and Pelvic Specialty Care Center

651-600-3035

Urologist or Gynecologist for Incontinence?

     Do I go to a urologist or to a gynecologist? Bladder control issues and gynecological issues can, and usually do, overlap. That’s why Dr. Melvin Ashford, OB/GYN sought out certification in both areas. He is now one of the few, board certified, urogynecologists in the state of Minnesota.

Dr. Ashford has been a practicing OB/GYN physician for 12 years. In 2012 he launched his private practice and opened Minnesota Women’s Care in Maplewood, Minnesota to offer his patients a more welcoming environment for their visits. Incontinence and uterine prolapse are two interconnected issues that Dr. Ashford regularly treats with exceptional success.

“One of the saddest things is to have a grandmother who comes and says, ‘I don’t play with my grandkids anymore because I smell like urine,’” says Dr. Ashford. Frequently Dr. Ashford will see patients with serious pelvic floor issues that could have been averted had they seen him sooner. Generally, they’ve delayed the visit because they thought there was nothing that could be done or they thought what they were experiencing was normal.

There are much better solutions than wearing adult diapers according to Dr. Ashford. There are treatments that stimulate the pelvic muscles and strengthen them. Implants can be inserted to control the bladder and get the leakage stopped. Sometimes Botox can be injected in the bladder to stop bladder spasms stop the leakage. There are also surgical procedures that can be done and medications available.

When a situation does require surgery, in the past, you would have two or three doctors operating in the same place where the organs are connected to each other.

“The problem is, when you have issues of uterine prolapse, the bladder and uterus falling down, then you have incontinence,” explains Dr. Ashford. “They are all connected to each other with connective tissue. So what you do to the top of the bladder impacts the vagina, and what you do to the vagina impacts the rectum.”

One doctor would be handling the bladder falling down and another doctor would deal with the uterus. You had two or three doctors doing one surgery. When you combine urology with gynecology, the procedure is more fluid and outcomes are better, according to Dr. Ashford. You have the same person correcting all the defects in the bladder, vagina and uterus at once.

Of course, Dr. Ashford deals with many other issues related to the pelvic area in his practice. He utilizes the most current technology and treatments available. He was one of the first physicians in Minnesota to begin using the da Vinci® surgical robot to perform minimally invasive hysterectomies and treat endometriosis and uterine fibroids. The da Vinci system provides a much faster recovery because it requires much smaller incisions.

Part of what Dr. Ashford does is simply educate his patients on the increasing range of treatments available. Vaginal rejuvenation gynecology is a treatment for those whose vagina has loosened over time. This vaginal tightening procedure helps improve the sensation of intercourse. Recently, they began offering SottoPelle®, a revolutionary form of bio-identical hormone therapy. SottoPelle uses a unique form of low-dose pellet therapy that lasts for 3 months or longer. It is the only hormone therapy that responds when the body needs more, keeping hormone levels more balanced than applications that rely on pills, patches or creams.

When Dr. Ashford launched Minnesota Women’s Care, he had specific vision in mind for his patients; that’s why it is called a “care center” and not a clinic. Appointments are not hurried or rushed. Every patient is warmly welcomed, the same as you would welcome a friend to your home, with the offer of a beverage and comfortable seating and surroundings. Through the Uniquely Catered Pregnancy Program, expectant moms are really pampered - including a mini-massage at each appointment.

When asked what it is about Minnesota Women’s Care that truly sets them apart, Dr. Ashford doesn’t hesitate: “It’s the people that we have working here.”

Dr. Ashford says that nurses, assistants and secretaries frequently stay late or come in early. They go out of their way to do things for each patient and give patients individualized attention. It creates a culture of care that patients recognize as genuine and heartfelt.

Whether your visit to Minnesota Women’s Care is for a routine pelvic exam or to address concerns related to incontinence, menopause or intercourse, Dr. Ashford and his staff will provide you with the most up-to-date treatment available and in a personalized manner that is rare to find in many other clinic settings.

Minnesota Women’s Care is located at 2603 White Bear Avenue North, Maplewood, MN. You can call them at 651-600-3035 for an appointment or visit them online at mnwcare.com for more information.

Worried about Tightness?

Millions of women are suffering from vaginal laxity...causing loss of sensation during sexual contact and stress urinary incontinence. For those of you still listening and interested in facing facts and finding solutions.  Ponder the following questions.  Do you:

    1.  Find it challenging to grip your vagina with only your forefinger.

    2.  Notice that your vagina is unable to completely close.

    3.  It is possible to place even more than 3 fingers into your vagina easily.

    4.   Orgasm is harder to attain than previously

    5.   Receive less enjoyment from intercourse

    5.   Find it more difficult to please your partner.

Speaking plainly.  Yes child birth is natural!!!!   However a 6-10 pound baby coming though the vaginal canal naturally causes some damage to the pelvic floor.  The impact is to the nerves, the muscles and the connective tissue.  This is a fact.  Do you have to live with it?  No!  The two components essential to maintaining a tightened vagina are the muscles and connective tissues.  Kegels or augmented pelvic floor exercise offers great options for naturally strengthening the Pelvic Floor.  

However strengthening or better functioning muscles do not always correlate with bulking of the muscle.. We all know of people who work out daily and are in good shape but do not bulk.  Bulking is necessary as well as strengthening for subjective sense of a tightening of the vagina.  Until now the most consistent and reliable method of vaginal tightening has been surgery.  A new in office laser therapy results in shrinkage of the vaginal connective tissue resulting in tightening.  Femilift Laser therapy is an innovative approach to a common issue for many women without surgery or downtime.  We are excited to announce that we are offering this therapy at Minnesota Women's Care.

In addition to the Femilift option, Minnesota Women's Care also offers ThermiVA.  There painless procedure uses RF energy to treat vaginal atrophy and tighten the vagina.  We often times will use both procedures as the overlapping modalities provide even more efficacy.  

I was hesitant to address this topic from fear of backlash from feminist groups.  To be clear, I am not inferring that women should be ashamed of their bodies.  Those who know me know better.  However, I can assure you that if there was some natural occurrence that resulting in a decreased performance for a man in this regard he would be in the doctor’s office the day after it happened.  Why should women just live with it?  Again, I am well aware that some women will be offended by this message.  I’m sorry.  My intent is not to offend but rather to reach out to those women who want to address this issue.  We have solutions and help for those that desire it.   Call us at Minnesota Women’s Care 651-600-3035.  Dr Ashford

Menopause and Hormones

It has been said that nothing in life is certain except death and taxes.  For women, menopause can be added to that list. By definition, Menopause is when the ovaries have exhausted their capacity and ability to make hormones.  The result of this loss of function for 90% of women is hot flashes, vaginal dryness, emotional ups and downs, moody disposition, lack of focus, difficulty with memory, concentration, decreased sex drive, and a lack of energy.  Many women simply say, “I am not myself”.

Hormones are a vital part of wellbeing and beneficially affect a multitude of pathways in the body.  Imbalances can actually occur in various settings but the most dramatic decline occurs with menopause.  The low estrogen and testosterone levels not only results in an uncomfortable experience, but also bone loss.  This bone loss can lead to osteopenia and increased risk of bone fractures.  Furthermore, it is well known that estrogen increases HDL (good cholesterol) and decreases LDL (bad cholesterol).  Estrogen also has been shown in many studies to decrease atherosclerotic plagues (clogged arteries) and decrease the risk of colon cancer.   Before menopause, women have a lower risk of heart disease than men.  After menopause women’s risk catches up with men.  This suggests a beneficial effect of hormones.

If Hormones are so good what is all the controversy about?

In July of 2002 a study was published called the Women’s Health Initiative (WHI).  The study results indicated an increased risk of Breast cancer in 8/10,000 women.  In addition an increased risk of stroke or heart attack in 7-8/10,000.  Looking at the adverse events together in short this study indicated that women taking oral estrogen and progesterone (prempro) made from horse urine had an increased risk of an adverse event of 0.3% each year of use of Hormonal therapy.  A positive from the study was a finding of a decreased risk of colon cancer by 30%.

These results initially were a jolt to the medical community as prior studies showed a decrease risk of heart disease.  Consequently countless women were told to stop their hormones.  It wasn’t long though before these women came marching back to their doctor’s door demanding relief from the symptoms of lack of hormones.

Further evaluation found 2 major flaws in the Women’s Health Initiative (WHI) Study:

Flaw #1; All of the women in the WHI were given oral estrogen.  Furthermore synthetic oral estrogen made from horse urine.  Studies have shown that transdermal estrogen through subcutaneous pellets, patches, sprays or gels are safer and do not increase the risk of heart attack or stroke as they do not increase clotting factors as oral estrogen does.

Flaw #2: The average age of the women in the study was 63!  These are not the newly menopausal women suffering from symptoms.  The question is whether the very small risk seen for breast cancer, heart attack or strokes was secondary to the hormones OR the age of the patient. 

Another very interesting point is that the all of the above risks in the WHI study were based upon the women taking PREMPRO (estrogen and progesterone from horse urine).  In the SAME study there was another arm.  The other arm of the study was with women taking Premarin (estrogen only from horse urine).  In this arm there was no increased risk of heart attacks, strokes or breast cancer.  In fact the risk of breast cancer in the estrogen only arm trended down!

Good news!  A study released in 2012 called Kronos Early Estrogen Prevention Study (KEEPS) looking at women between the ages of 42-58 found no increased risk of blood pressure, breast cancer, heart attacks, strokes or blood clots. 

The bottom line:  While more studies are needed to provide a definitive answer most women suffering from the symptoms of menopause are likely safe in taking hormone replacement therapy.   Especially if taken for a short period of time.  In most women the vasomotor symptoms resolve by 5-7 years after the start of menopause.  It also does appear that using non oral forms of estrogen may be beneficial.  However with every medical intervention care must be individualized and take into account the individuals medical history.

Menopause is a natural aspect of life.  Why are we bothering with trying to treat it?

Yes. It is very natural.   However, consider this.  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 continues for 5-7 years AFTER menopause starts.  Quick math:  That’s a potential 20 years!  Busy women with active and healthy lives do not want to live with these symptoms for 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. 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. 

Are there alternatives to hormone therapy for menopausal symptoms?

Yes.  There are many alternatives to hormone therapy:  Black cohosh, Soy products, clonidine, and gabapentin are some commonly non FDA approved mentions alternatives.  For some women these work well but for about 70% of women they don’t cut it.

There is only one FDA approved alternative to estrogen.  A SSRI (typically used for depression) called paroxetine was rebranded and approved as Breisdelle for the treatment of hot flashes.  It was shown to be more effective than placebo in the control of hot flashes only.

What are bio identical hormones?  Are they safer?

When most refer to Bio identical hormones they are describing hormones derived from naturally occurring sources, such as yams and soy that are identical in chemical structure as the hormones that are produced naturally by our bodies.  Simply using a hormone chemically identical to natural hormones is not necessarily safer.  However mounting evidence has shown that using bio identical hormones subcutaneously, tailored to the hormonal needs of the individual, and delivered based upon physiologic demand; can be safer that traditional methods.

SottoPelle Bio identical Subcutaneous Pellet therapy is just one way to help achieve this. SottoPelle Therapy® is an all-natural bio-identical hormone replacement therapy administered with a pellet that allows for a continual release - the key to improving brain and muscle function.

In the end, hormone therapy must be individualized depending on the individual’s medical history, symptoms, risk factors and priorities.  Hormones are not poison and for the most part results in life changing beneficial effects for women.  Discussing options with a knowledgeable physician equipped with the tools to provide relief is a must for all women suffering with the symptoms of menopause.  In most cases achieving a proper hormone balance together with proper nutrition and exercise is the key to aging gracefully.

Melvin Ashford, MD

Minnesota Women's Care 

OBGYN and Pelvic Specialty Care Center

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.