Posts from — July 2010
Living the Life of Ripeness: Advice for the Pregnant Gardener
(c) 2010 Lauri Romanzi
- Courtesy Amy Wentz Photography, NYC
Summertime is high season for gardening. Pregnant gardeners need to take extra precautions to avoid chloasma and melasma (dark blotches) on the face and neck, protect backs, knees and pelvic support, and be extra-careful with gardening aids that may be toxic if inhaled or coming in contact with skin. For the full scoop on healthy gardening while pregnant read this piece from www.sheknows.com, including content from PHIT’s medical director, Dr. Lauri Romanzi:
PHIT tips for the Pregnant Gardener – your skin, your joints, you pelvis, your baby!
by Tracy B. McGinnis
If a fun day of shopping includes visiting your favorite home store and filling your cart with potting soil and flats of blooming plants and herbs, then chances are you’re one of the many people who enjoy gardening as a hobby. But if you’re pregnant or trying to get pregnant, does your green thumb need to go dormant until after baby arrives?
“When you’re pregnant, a little time spent working in the garden is a great way to get outdoors in the fresh air, get some light exercise and enjoy the beauty of your garden,” said Vinnie Drzewucki, CNLP of Hicks Nurseries Inc. “But remember to keep to the less strenuous activities like raking, light pruning, deadheading spent flowers and weeding.”
While you may not need to eliminate certain activities from your daily routine there are extra precautions and modifications you should make to some of your activities in order to keep yourself and baby healthy.
Toxins
“Studies show an increased rate of congenital anomalies in the babies of men and women who are exposed to pesticides, and also an increased miscarriage rate in women exposed to pesticides,” said Dr. Lauri Romanzi, Clinical Associate Professor of Gynecology at Weill Cornell Medical Center/New York Presbyterian Hospital in New York City. “Women (and the men of women) who are pregnant or trying to become pregnant should minimize or totally avoid exposure to pesticides.”
In addition to avoiding any pesticide exposure throughout your pregnancy (including interior pesticides) Andrew Pratt, Grounds Manager at Cleveland Botanical Garden also suggests women research the active ingredients in all products including “organic” or “natural” products.
”Avoid lawn care fertilizers and pesticides and consider switching to an organic program your health and the environment,” says Pratt.
If pests are a problem in your garden Drzewucki adds that, “Many problems are easily handled using organic, biological or cultural controls such as insecticidal soaps, or releasing ladybugs to control insects like aphids or using herbicidal soaps or mulches for weed control.”
Infections
Toxoplasma gondi is a common infection that is spread from animals to humans and can be acquired by ingesting or direct contact with raw or undercooked meat as well as exposure to soil. Women who are pregnant or trying to become pregnant have long been advised to avoid cleaning their cat’s litter boxes, as this also puts them at risk of getting the infection.
A fetus can get infected with the virus if the mother becomes infected both during or prior to getting pregnant. Romanzi explained that while adults who get infected usually don’t have symptoms babies with the infection are at risk of visual and neurological impairment and/or mental retardation.
Most people recover from the infection with treatment, although you’ll want to check with your healthcare provider on treatment options you may need. There are a number of things you can do to help prevent toxoplasma including: wearing solid gardening gloves, shoes with socks, practicing good hand washing habits, and fully cooking your meat.
Protect your back
“Gardening can be a relaxing and therapeutic hobby when done correctly. However, it also can lead to many types of back injuries if you are not cautious,” according to Stephen Ritter, M.D., of Methodist Sports Medicine / The Orthopedic Specialists, a Clarian Health partner.
“Yard work can be considered another great form of exercise. But, with any physical activity, it’s important to warm up and stretch your muscles. Take some time to walk around outside to prepare your muscles for any moving, lifting, digging or bending in the garden. “
Ritter suggests stretching your back muscles by leaning forward to carefully and touching
your toes. “For a seated back stretch, lean forward from your hips and reach for the floor and hold. A five to ten minute warm up for your back muscles will help prevent any strains or soreness later.”
Ritter adds that the most common mistake people make when working in the yard is lifting heavy objects inappropriately.
“You should bend your knees and use your legs to lift your body up. Instead of reaching forward to move a heavy object, walk over to the object and lift it straight up off the ground by bending your knees and keeping your spine in an upright position,” suggest Ritter. “This will help avoid placing strain on your spine and back muscles.”
Ritter also suggests kneeling instead of bending over for long periods of time when working in the yard. “By kneeling in the garden, you are putting much less strain on your back and spine. If necessary, use knee pads to protect your knees from dirt or soreness.”
Using long handed tools will help you maintain a proper postures and Ritter suggests placing a shovel directly in front of you and parallel to your hip bones if you are doing any digging.
“Don’t overdo it: Gardening can cause back pain and overuse injuries,” says Ritter. “For example, after 15 minutes of raking, change to pruning or mowing your lawn. You should also avoid all-day marathon gardening sessions. Space out your gardening tasks over the course of several days.”
Chiropractor Dr. Greg Werner, www.gregwerner.com, suggests limiting the time you spending gardening and standing up and walking around between plantings as well as using a gardening bucket or bench to sit on when planting or pulling weeds.
“Use proper gardening tools when planting: using only your arms will put undo pressure on your wrists,” adds Werner. “When you are pregnant you are more prone to overuse syndromes such as carpal tunnel or tennis elbow.”
“Do your gardening a little at a time instead of trying to knock it all out in one try, and if you’re just trying to spruce up your yard and you are far along in your pregnancy (third trimester) have your husband/partner do it.”
Meditate
Debbie Mandel, MA, author of “Addicted to Stress,” says there are things you can do to make gardening a “moving meditation, instead of a toxic experience.”
“Protect yourself from searing sun with sun block, a hat and loose clothing,” says Mandel. “Even better avoid gardening midday.”
“Melasma (aka Chloasma) is a hyper pigmentation condition that affects 50-70% of pregnant women, most commonly appearing on the forehead, cheeks and chin,” says Dr. Romanzi. “While it can be treated post-partum with bleaching agents, laser, chemical peels and topical agents such as tretionoin(Retin-A) it can also be prevented by the liberal and regular use of SPF-50 UVA-PF 28 sunscreen (2007 study University Teaching Hospital IbnRochd in Casablanca, Morocco) . Pregnant women who want to prevent hypermelanotic changes in their skin should regularly use adequate sunscreen and sunhats outdoors.”
Mandel adds that women should, “Drink plenty of water as gardeners tend to get immersed in what they are doing and forget about hydrating.” And suggests avoiding gardening during the times mosquitoes in your area fee – generally 6-8am and pm.”
July 31, 2010 No Comments
ivillage asks Dr R – what’s the deal with “sneeze and pee?”
ivillage.com asked Dr. R to help out on a piece about urinary incontinence and many other embarrassing topics of the feminine persuasion – here’s a direct link to Dr R’s portion:
ivillage asks Dr R about exert and squirt urinary incontinence
Scroll through all the other topics as well. This review has something for everyone, guaranteed.
July 19, 2010 No Comments
Ask Dr R: Sex distress in a stable but foreplay-free marriage
Dear Dr. I was reading an article in the glamour magazine and came across your name. I’m 38 years old. I’ve two kids (5, 3) and married for 6 years. During these years, I had orgasm only one time with my husband. I have other problems going on in life too. But part of the reason is that my husband can tell that I don’t have orgasms. I never had sex before so when I got married at the age of 30, you could tell I was lost. My marriage is in the verge of breaking up. I used machine (rabbit) and it works. I just don’t understand why it won’t work with my husband. He said every girl he had sex before had orgasms, except for me. I do know that he doesn’t foreplay, all he wants is sex. And I don’t enjoy it like that. He knows that women like cuddling but still he won’t do that to me. What can I do? How can I improve myself?
Hello Distressed,
Many women (most women) need foreplay to fully enjoy sex and to achieve orgasm. Your husband’s premarital record of routine female orgasms without foreplay is remarkable, unusual and almost unbelievable.
Your relationship would benefit from couples counseling with a board certified psychiatrist or psychologist specializing in sexual function.
This is not a problem about YOU. It is a problem about your relationship and conflicting expectations between yourself and your husband. If your husband won’t go, you will benefit from going alone.
Best Regards,
Dr R
July 16, 2010 No Comments
Ask Dr R: Overactive bladder and Enablex
July 16, 2010 1 Comment
Three (Unhappy) Musketeers – Prolapse, Bladder Outlet Obstruction and Overactive Bladder
Pelvic organ prolapse, difficult urination, frequency, urgency and overactive bladder – for some women, it’s all related.
(C) Lauri Romanzi 2010
Pelvic organ prolapse and overactive bladder. de Boer TA, et al. Neurourol Urodyn. 2010;29(1):30-9.
Department of Obstetrics and Gynaecology, Radboud University Nijmegen Medical Centre, Nijmegen, the Netherlands.
Medical research comes in several forms. This particular study gathered all the research already published on the topic, pooling all the data in one big group for re-analysis. Called meta-analysis, studies that pool data from other studies advance medical science by reviewing smaller clinical trials to figure out if the findings have anything in common that might thereby be considered “true”.
courtesy womensvoicesforchange.org
Look at this picture – what a mess. There’s no way bladders caught in the clutches of severe pelvic organ prolapse can function properly. The urethra, a 2-3 inch straw-shaped tube that allows urine to pass out of the bladder, is often kinked or compressed by the prolapse. The muscles in the bladder wall, normally located above the urethra, are now below the urethra, forced to fight the mighty forces of gravity and the kinked or compressed urethra, in order to empty, and as a result, the emptying is often incomplete. So the bladder fills up more quickly, starting a whole cascade of symptoms, enough to make any bladder crazy.
Not emptying fully, the bladder fills more quickly. Result? Frequency. And a propensity to bladder infections from all that stagnant urine. You used to urinate a few times a day without much thought, but now bladder management is a part-time job. Urine flow is very slow, dribbling, and sometimes stop – and – start. This condition is called bladder outlet obstruction.
Contracting extra-hard in this upside down position in order to bypass gravity and urethral obstruction from all that kinking or compression, the bladder starts to misfire, suddenly contracting without any warning of fullness, as if it can’t make up it’s mind. Result? Urgency, that horrible sensation of needing to get to the bathroom RIGHT NOW and wondering if you’re going to make it in time. Or not making it in time, literally peeing in your pants on your mad dash to the water closet (urge incontinence). This condition is called overactive bladder.
courtesy "Plumbing and Renovations"
The common findings in the studies included in this meta-analysis showed that any method of successfully managing the prolapse, be it pessary or surgery, allowed the bladder to return to normal function. Anything that un-kinks the urethra, re-positions the bladder so that it’s on top of, instead of underneath, the urethra, and repositions all the pelvic organs to their normal location will normalize bladder function in most cases. Why is this an important finding? Because it helps doctors understand that, in a woman with prolapse and bladder problems, just fixing the prolapse ought to fix the bladder problems, without overactive bladder medications or the need for constant antibiotics to fight all those urinary tract infections.
Here is a synopsis of the data (aka abstract) of this study:
Abstract
AIMS: In this review we try to shed light on the following questions: *How frequently are symptoms of overactive bladder (OAB) and is detrusor overactivity (DO) present in patients with pelvic organ prolapse (POP) and is there a difference from women without POP? *Does the presence of OAB symptoms depend on the prolapsed compartment and/or stage of the prolapse? *What is the possible pathophysiology of OAB in POP? *Do OAB symptoms and DO change after conservative or surgical treatment of POP? METHODS: We searched on Medline and Embase for relevant studies. We only included studies in which actual data about OAB symptoms were available. All data for prolapse surgery were without the results of concomitant stress urinary incontinence (SUI) surgery. RESULTS: Community- and hospital-based studies showed that the prevalence of OAB symptoms was greater in patients with POP than without POP. No evidence was found for a relationship between the compartment or stage of the prolapse and the presence of OAB symptoms. All treatments for POP (surgery, pessaries) resulted in an improvement in OAB symptoms. It is unclear what predicts whether OAB symptoms disappear or not. When there is concomitant DO and POP, following POP surgery DO disappear in a proportion of the patients. Bladder outlet obstruction is likely to be the most important mechanism by which POP induces OAB symptoms and DO signs. However, several other mechanisms might also play a role. CONCLUSIONS: There are strong indications that there is a causal relationship between OAB and POP
July 10, 2010 No Comments
Ask Dr R: overactive bladder, interstitial cystitis, and ulcerative colitis
July 8, 2010 No Comments
An obstructed bladder is a cranky bladder – the story of prolapse and the badly behaved bladder
(C) Lauri Romanzi 2010
Pelvic floor disorders include problems with urinary incontinence, pelvic organ prolapse, fecal incontinence, fistula, urinary tract infections, and mechanical sexual dysfunction. Who wants to think about this stuff? Well, for starters, women who suffer these disastrous conditions.
Pelvic organ prolapse, on which I’ve written aplenty, can sometimes induce a rather nasty condition called overactive bladder. Overactive bladder happens when your bladder muscle (yes, the bladder is a muscle, an automatic muscle, like the muscles in your intestines or your heart) decides to EVACUATE, any time it wants to, whether you’re on the toilet or riding the bus. Women with overactive bladder often report a compelling, sometimes sudden urge to void (urinate) that is difficult or impossible to defer. She may find her bladder waking her from deep sleep many times at night with this same horrible urgency. When this urgency control is “difficult”, she’s Kegeling her legs off, squeezing her thighs together and sweating bullets trying to make that horrible urge feeling stop so she can uncross her legs and dash to the nearest powder room. When the urge to void is “impossible” to defer, she wets her pants. It’s messy, horrifying, and terribly unsexy.
Urge Incontinence from Overactive Bladder
While most cases of overactive bladder are idiopathic (medicalese for “no apparent cause”), some cases are caused by prolapse. When the bladder or uterus (or both) prolapse, the urethra can be kinked or compressed, obstructing urine outflow and making it difficult for the bladder to empty completely. Obstructed bladders are cranky bladders, often becoming overactive in response to this interference with emptying.
A recent multicenter European study published in Neurourology and Urodynamics showed a distinct correlation between severe pelvic organ prolapse, bladder outlet obstuction, and overactive bladder. Prolapse can obstruct bladder outflow and if it does, the bladder tends to become overactive, reminiscent of that vaudeville song, “The head bone’s connected to the … neck bone…”. In this timely review, they also found that successful prolapse surgery often, but not always, calmed down bladder overactivity by un-blocking the urethra and normalizing bladder outflow. The connection between prolapse, bladder outlet obstruction and overactive bladder
Women with prolapse and bladder problems often want to know if surgery will fix both. This study helps us understand that it indeed may help fix both the prolapse and the obstructed/overactive bladder disorders in a large portion of women with this unhappy combination. For years, I’ve used pessaries (vaginal widgets that comfortably hold prolapse in place) to help predict whether or not prolapse surgery might also stop obstructed voiding and overactive bladder, and most of the time it correlates well to surgical outcome. And sometimes, the patient is so pleased with the pessary that she cancels the operation.
For a detailed case report on women with prolapse, obstructed voiding and overactive bladder, click on this MedScape review:
Dr R for MedScape- prolapse, overactive bladder, stress incontinence, obstructed bladder
http://cme.medscape.com/viewarticle/700135
One last note for women with prolapse and bladder problems – there is another urinary incontinence condition, called stress incontinence, that may actually increase with pessary use or prolapse surgery, because a stress – incontinent urethra may actually seal better with the kinking and compression caused by prolapse, and may therefore increase when the prolapse and kinking are mechanically corrected. Stress incontinence is caused by poor urethral closure that allows urine to leak out with strenuous physical exertion, like sneezing or coughing or opening a window or lifting heavy grocery bags. No urgency, just “exert and squirt”.
Stress Urinary Incontinence = "Exert and Squirt"
If you have prolapse and stress incontinence, your problems require therapies for prolapse and therapies for stress incontinence. Prolapse therapy options usually involve pessary use or reconstructive surgery. Stress incontinence options include Kegel exercises with pelvic floor physical therapy, medications, or procedures such as urethral bulking injections or minimally invasive sling operations. You can do prolapse reconstruction and urethral sling in one operation, for instance, taking care of both your plumbing and your renovation problems at the same time (on Plumbing and Renovations).
Prolapse or no prolapse, urge incontinence from overactive bladder and stress incontinence from a weak urethral seal can plague any woman at any age. About 13% of women with overactive bladder are under the age of 35, and up to 30% college female athletes report regular urinary incontinence of one sort or another during training and competition. It comes with the territory, and it increases in prevalence as women age.
1/3 of incontinent women suffer only stress incontinence, 1/3 only urge (overactive bladder) incontinence and 1/3 suffer a mixture of both overactive bladder / urge incontinence AND stress incontinence.
If you have incontinence, or prolapse and bladder problems, make sure you don’t undertake any therapeutic measures without first understanding if you have overactive bladder, bladder outlet obstruction, and/or stress urinary incontinence. It is absolutely possible, and not at all uncommon, to have all three conditions if you suffer severe prolapse. Take the time to sort it all out, make sure it’s clear in your mind, then work with your doctor to set a common-sense course of action to restore your core to normal anatomic and physiologic function.
July 5, 2010 No Comments
Dr R Talks About Prolapse, Part 1
(C) Lauri Romanzi, 2010
Pelvic organ prolapse, the medical term for vaginal bulges caused by damage to the connective tissues supporting the organs above and around the vagina (the uterus, bladder, rectum and vaginal opening), is a silent epidemic affecting women worldwide. Common terms include dropped bladder, dropped uterus, rectocele and vaginal laxity. Recent estimates using US Census population projections anticipate a 46 percent increase in pelvic organ prolapse among American women over the next 40 years, from 3.3 million in 2010 to 4.9 million. According to a recent study from Duke University, it is possible that the number of women with prolapse will be even greater than this, up to 9.2 million. Prolapse may occur to varying degrees in up to 50 percent of women who’ve given birth. Prolapse can even cause depression.
Childbirth contributes to most prolapse conditions, however genetics, medical disorders such as connective tissue disease, diabetes and obesity, and lifestyle habits have all been shown to contribute to pelvic organ prolapse risk. I’ve had many young women in their 30′s with prolapse who’ve never been pregnant, or found themselves suffering a dropped bladder after an easy and quick delivery of their first normal (or even low) weight baby. Even cesarean section is no guarantee against pelvic organ prolapse, with 5% of women in one recent study suffering severe, palpable and visible prolapse even though they delivered by cesarean section before going into labor. The role of Kegel fitness and Kegel exercise in the prevention of treatment of pelvic organ prolapse is just recently getting the research attention it deserves, and Kegel exercise may well play a role in prevention and treatment of prolapse. But for certain, if you suffer prolapse that looks like the image below, no amount of pelvic floor Kegel exercise, or any other kind of exercise, will pull your parts back into place.
Prolapse surgery often comes with a recommendation for hysterectomy, but the latest trends highlight new techniques that fix the prolapse just as well without removing the uterus. When the uterus prolapses it can be resuspended by one of several techniques, and the surgery holds up just as well as when a hysterectomy is included in prolapse repair surgery. This uterine resuspension concept is an exciting new option that allows many women to undergo prolapse repair surgery without removing any organs.
While many women with prolapse believe just one single body part is out of postion, most commonly, prolapse involves hernia-type displacement of several organs. When the bladder drops, formally called a cystocele (siss-toe-seal), it is often accompanied by a rectal bulge, called a rectocele (wreck-toe-seal). Laxity at the vaginal opening, called a perineocele (pear-in-ee-oh-seal) results when the perineum loses connective tissue bulk as a result of childbirth. Uterine prolapse is called, well, uterine prolapse. But behind a prolapsed uterus, it is common to find an internal small intestine hernia called an enterocele (en-tare-oh-seal).
When you put all these prolapse possibilities together at their absolute worst, it looks like this:
Courtesy WomensVoicesForChange.org
My role as guest blogger gives me the opportunity to demystify this deeply troubling malady. For more information, check out this first of 2 posts on pelvic organ prolapse done for my friends at Sweet Talk on The Spot:
Dr R covers Prolapse, Part 1 for Sweet Talk on The Spot
To review Dr R’s book on prolapse, see www.plumbingandrenovations.com
If you have any questions, send in your comments on this post or post your own question to Ask Dr R.
(C) Lauri Romanzi, 2010
July 4, 2010 No Comments