Val asks:
Why doesn't my bladder empty completely even though I urinate several times a day and night?
Lily Arya, MD, responds:
This is a common symptom and is rarely associated with real emptying problems. Most likely your bladder has become very sensitive, potentially due to an overactive bladder, interstitial cystitis or a kidney stone. It's in your best interest to see a urologist or urogynecologist who can evaluate your symptoms and determine the best course of action.
To schedule an appointment with a Penn urogynecologist, please call 800-789-PENN (7366) or request an appointment online at PennMedicine.org.
Monday, May 21, 2012
What could be the cause of my recurring UTI?
Claire asks:
I have a recurring UTI. I was given a low-dose antibiotic to take for six months, but after two months the problem continues. I did have netting put in for a leaking bladder about 10 years ago, could this be the cause?
Megan O. Schimpf, MD, responds:
Recurrent UTIs can be a frustrating and uncomfortable problem for patients, but the good news is that they rarely progress to serious infections. Sometimes they happen because the female urethra is very short and easy for bacteria to climb. Intercourse can also increase the frequency of infections, and women after menopause can be at risk because of the lack of estrogen. Taking low-dose preventive antibiotics is an accepted way of treating this problem. If you are still having infections using those medications, it’s possible that the bacteria are resistant (not treated by) to the medication. If you’ve previously had surgery for incontinence or on your bladder, it would be worthwhile to be evaluated by a physician. You want to make sure that the bladder is emptying properly and that the inside of the bladder is normal.
To schedule an appointment with a Penn urogynecologist, please call 800-789-PENN (7366) or request an appointment online at PennMedicine.org.
I have a recurring UTI. I was given a low-dose antibiotic to take for six months, but after two months the problem continues. I did have netting put in for a leaking bladder about 10 years ago, could this be the cause?
Megan O. Schimpf, MD, responds:
Recurrent UTIs can be a frustrating and uncomfortable problem for patients, but the good news is that they rarely progress to serious infections. Sometimes they happen because the female urethra is very short and easy for bacteria to climb. Intercourse can also increase the frequency of infections, and women after menopause can be at risk because of the lack of estrogen. Taking low-dose preventive antibiotics is an accepted way of treating this problem. If you are still having infections using those medications, it’s possible that the bacteria are resistant (not treated by) to the medication. If you’ve previously had surgery for incontinence or on your bladder, it would be worthwhile to be evaluated by a physician. You want to make sure that the bladder is emptying properly and that the inside of the bladder is normal.
To schedule an appointment with a Penn urogynecologist, please call 800-789-PENN (7366) or request an appointment online at PennMedicine.org.
Monday, May 14, 2012
What could contaminate urine and what would be the next step after learning this information?
Patti asks:
My mom is 71 years old and had a partial hysterectomy many years ago. She has had bleeding that includes small blood clots and her urine is dark. She had a lab test, but the lab said her urine specimen was contaminated and referred her to her physician. She is concerned and wondering what could contaminate urine and what should her next step be?
Lily Arya, MD, responds:
I would first suggest your mom be treated for a urinary tract infection. If the bleeding doesn't resolve, she needs to be seen by a urologist. William Jaffe, MD, is a Penn urologist who can help to diagnose and treat her problem. To learn more about services at Penn Urogynecology or to make an appointment with Dr. Jaffe, call 800-789-PENN (7366) or request an appointment online at PennMedicine.org.
My mom is 71 years old and had a partial hysterectomy many years ago. She has had bleeding that includes small blood clots and her urine is dark. She had a lab test, but the lab said her urine specimen was contaminated and referred her to her physician. She is concerned and wondering what could contaminate urine and what should her next step be?
Lily Arya, MD, responds:
I would first suggest your mom be treated for a urinary tract infection. If the bleeding doesn't resolve, she needs to be seen by a urologist. William Jaffe, MD, is a Penn urologist who can help to diagnose and treat her problem. To learn more about services at Penn Urogynecology or to make an appointment with Dr. Jaffe, call 800-789-PENN (7366) or request an appointment online at PennMedicine.org.
My sister-in-law suffers from pelvic floor dysfunction. Are there any support groups (specifically for younger people) who suffer from PFD?
Anonymous asks:
My sister-in-law severely suffers both physically and mentally from pelvic floor dysfunction (PFD). She has seen many doctors and physical therapists, and received internal and external shots, medications, prolotherapy, etc. The treatments seem to work at first, but not for any length of time.
This has prohibited her from participating in daily activities and as her symptoms worsen, severe depression and anxiety settle in. Her problems are physically painful, but the mental toll it is taking on her is becoming equally as severe as the PFD itself.
She attended one support group, but didn't feel they could relate because they were older women suffering mostly from prolapse. I would like to find for her a support group, online or in person.
Are you aware of any younger support groups for PFD? She needs support from women who understand what she deals with daily, and at 31 years old, she feels alone, and that no one understands what she is going through.
Lily Arya, MD, responds:
Unfortunately, we do not have any support groups to offer your sister-in-law at this time. I recommend you contact Kristene E. Whitmore, MD, medical director of the Pelvic and Sexual Health Institute at Drexel University College of Medicine.
Learn more about services at Penn Urogynecology. To schedule an appointment with a Penn urogynecologist, please call 800-789-PENN (7366) or request an appointment online at PennMedicine.org.
My sister-in-law severely suffers both physically and mentally from pelvic floor dysfunction (PFD). She has seen many doctors and physical therapists, and received internal and external shots, medications, prolotherapy, etc. The treatments seem to work at first, but not for any length of time.
This has prohibited her from participating in daily activities and as her symptoms worsen, severe depression and anxiety settle in. Her problems are physically painful, but the mental toll it is taking on her is becoming equally as severe as the PFD itself.
She attended one support group, but didn't feel they could relate because they were older women suffering mostly from prolapse. I would like to find for her a support group, online or in person.
Are you aware of any younger support groups for PFD? She needs support from women who understand what she deals with daily, and at 31 years old, she feels alone, and that no one understands what she is going through.
Lily Arya, MD, responds:
Unfortunately, we do not have any support groups to offer your sister-in-law at this time. I recommend you contact Kristene E. Whitmore, MD, medical director of the Pelvic and Sexual Health Institute at Drexel University College of Medicine.
Learn more about services at Penn Urogynecology. To schedule an appointment with a Penn urogynecologist, please call 800-789-PENN (7366) or request an appointment online at PennMedicine.org.
Monday, May 7, 2012
I underwent pelvic reconstruction surgery and have experienced vaginal bleeding for more than two years. Is this normal?
Anonymous asks:
I underwent pelvic reconstruction surgery involving synthetic mesh to lift my bladder. I have experienced vaginal bleeding for more than two years. Could this be normal? If not, what should my next step be?
Lily Arya, MD, responds:
I am very sorry to hear about this ongoing problem. I recommend you schedule an appointment to determine what the issue is and how to resolve it. Ariana Smith, MD, and I, Lily Arya, MD, specialize in this area and are available for a consult. Call 800-789-PENN (7366) or request an appointment online.
Learn more about services at Penn Urogynecology and Penn Urology.
I underwent pelvic reconstruction surgery involving synthetic mesh to lift my bladder. I have experienced vaginal bleeding for more than two years. Could this be normal? If not, what should my next step be?
Lily Arya, MD, responds:
I am very sorry to hear about this ongoing problem. I recommend you schedule an appointment to determine what the issue is and how to resolve it. Ariana Smith, MD, and I, Lily Arya, MD, specialize in this area and are available for a consult. Call 800-789-PENN (7366) or request an appointment online.
Learn more about services at Penn Urogynecology and Penn Urology.
My daughter has a large fistula that must be surgically repaired. We are looking for a surgeon with experience in this type of procedure.
Laureen asks:
My daughter is 28 years old and has a large fistula that must be surgically repaired. It developed during labor and a Cesarean-section delivery. The diagnosis was made during an exploratory procedure to install a bag to decompress her bladder and allow it repair naturally.
Unfortunately, the doctor decided natural repair would be impossible because of the size and the state of the edges of the fistula. We are looking for a surgeon with experience in this type of procedure. My daughter lives in New Mexico, but she is willing to travel.
Arianna Smith, MD, responds:
Dear Laureen,
I am very sorry to hear about your daughter's problem. Fistulas are not uncommon after gynecologic surgery. Sometimes they heal after the bag is placed, but most often surgical repair is necessary. Generally, surgery can be done through the same incision that was used for the Cesarean section. A short hospital stay after surgery is necessary. I have expertise in this type of surgery and if you would like to schedule an appointment with me, please call 800.789.PENN (7366).
Learn more about services at Penn Urogynecology and Penn Urology.
My daughter is 28 years old and has a large fistula that must be surgically repaired. It developed during labor and a Cesarean-section delivery. The diagnosis was made during an exploratory procedure to install a bag to decompress her bladder and allow it repair naturally.
Unfortunately, the doctor decided natural repair would be impossible because of the size and the state of the edges of the fistula. We are looking for a surgeon with experience in this type of procedure. My daughter lives in New Mexico, but she is willing to travel.
Arianna Smith, MD, responds:
Dear Laureen,
I am very sorry to hear about your daughter's problem. Fistulas are not uncommon after gynecologic surgery. Sometimes they heal after the bag is placed, but most often surgical repair is necessary. Generally, surgery can be done through the same incision that was used for the Cesarean section. A short hospital stay after surgery is necessary. I have expertise in this type of surgery and if you would like to schedule an appointment with me, please call 800.789.PENN (7366).
Learn more about services at Penn Urogynecology and Penn Urology.
Friday, April 27, 2012
Coping with Multiple Sclerosis: The Caregiver’s Perspective
Dorothea “Dottie” Pfohl RN, BS, MSCN, is a clinical coordinator of Penn’s Comprehensive Multiple Sclerosis (MS) Center. For more than 20 years she has specialized in caring for people with MS. She is in involved with MS research, clinical practice and community outreach and she serves as a resource with the MS Society and WAMS – Women Against MS.
Caring for a person with multiple sclerosis (MS) can be both a challenge and a gift. In some cases, facing a diagnosis of MS brings relationships together and strengthens the bond between couples. But just as every person with MS is affected in a unique way, every relationship is affected differently ─ and not all stories end happily.
While patients with MS are typically diagnosed between the ages of 20 and 40, some may be diagnosed during adolescence. When someone is diagnosed at a very young age, it can cause parents to feel fearful, anxious and guilty about their child’s future. Siblings may resent the “sick” child for getting more parental attention.
For patients diagnosed as young adults, dating and commitment issues can be difficult obstacles. And those who are diagnosed with MS after starting a family may wonder how they will meet their economic needs and if they will fulfill their dreams for the future. Marriages today face a myriad of threats, and a chronic illness can be the straw that breaks the camel’s back.
The well-being and challenges faced by patients with MS are thoroughly documented, but caregivers and the adversity they face are important too. While many of the issues they face are unique, some difficulties are shared by all caregivers. They often are learning to assist with injectable medications, coping with personality or behavioral changes and cognitive decline, and managing bowel and bladder dysfunctions that may have an impact on sexuality and intimacy.
The Well Spouse Association, based in Philadelphia, is a nonprofit organization that advocates for and addresses the needs of caregivers of chronically ill and/or disabled spouse/partners. The Well Spouse Association’s motto is "When one is sick, two need help.” And I agree.
As a health care provider and someone focused on the medical care of patients with MS, it's easy to forget the faithful partner who worries for their loved one, assumes more of their partner's roles and takes on the financial burden. Stress takes a physical and mental toll on everyone, and caregivers need to be sure to take care of themselves and get enough rest to protect their own health.
When I reflect on the needs of the caregiver, I often think of flight attendants when they advise people on the flight to put the mask to their own face first in a crisis, and then look to help people around them. It is equally as important that caregivers take care of themselves first so they are better equipped to support the person with MS. In addition to the Well Spouse Association, The National MS Society, Multiple Sclerosis Association of America and many religious organizations offer respite and support to the loved ones of those with MS.
At the Penn MS Center, I have the luxury of getting to know people over time. It is inspiring to see the way devotion and love trump the challenges MS presents to patients and their families.
No matter the issue, whether it’s finances, home help or simply the mental stress of caring for a sick person, the Penn MS Center’s comprehensive approach to care allows us to walk side by side with the patient and caregiver as a team.
The Penn MS Center has teamed up with the National MS Society for the 10th Annual Women Against MS (WAMS) Luncheon to be held May 8, 2012. Read more or register for the WAMS Luncheon.
Caring for a person with multiple sclerosis (MS) can be both a challenge and a gift. In some cases, facing a diagnosis of MS brings relationships together and strengthens the bond between couples. But just as every person with MS is affected in a unique way, every relationship is affected differently ─ and not all stories end happily.
While patients with MS are typically diagnosed between the ages of 20 and 40, some may be diagnosed during adolescence. When someone is diagnosed at a very young age, it can cause parents to feel fearful, anxious and guilty about their child’s future. Siblings may resent the “sick” child for getting more parental attention.
For patients diagnosed as young adults, dating and commitment issues can be difficult obstacles. And those who are diagnosed with MS after starting a family may wonder how they will meet their economic needs and if they will fulfill their dreams for the future. Marriages today face a myriad of threats, and a chronic illness can be the straw that breaks the camel’s back.
The well-being and challenges faced by patients with MS are thoroughly documented, but caregivers and the adversity they face are important too. While many of the issues they face are unique, some difficulties are shared by all caregivers. They often are learning to assist with injectable medications, coping with personality or behavioral changes and cognitive decline, and managing bowel and bladder dysfunctions that may have an impact on sexuality and intimacy.
The Well Spouse Association, based in Philadelphia, is a nonprofit organization that advocates for and addresses the needs of caregivers of chronically ill and/or disabled spouse/partners. The Well Spouse Association’s motto is "When one is sick, two need help.” And I agree.
As a health care provider and someone focused on the medical care of patients with MS, it's easy to forget the faithful partner who worries for their loved one, assumes more of their partner's roles and takes on the financial burden. Stress takes a physical and mental toll on everyone, and caregivers need to be sure to take care of themselves and get enough rest to protect their own health.
When I reflect on the needs of the caregiver, I often think of flight attendants when they advise people on the flight to put the mask to their own face first in a crisis, and then look to help people around them. It is equally as important that caregivers take care of themselves first so they are better equipped to support the person with MS. In addition to the Well Spouse Association, The National MS Society, Multiple Sclerosis Association of America and many religious organizations offer respite and support to the loved ones of those with MS.
At the Penn MS Center, I have the luxury of getting to know people over time. It is inspiring to see the way devotion and love trump the challenges MS presents to patients and their families.
No matter the issue, whether it’s finances, home help or simply the mental stress of caring for a sick person, the Penn MS Center’s comprehensive approach to care allows us to walk side by side with the patient and caregiver as a team.
The Penn MS Center has teamed up with the National MS Society for the 10th Annual Women Against MS (WAMS) Luncheon to be held May 8, 2012. Read more or register for the WAMS Luncheon.
Monday, April 23, 2012
Where can I find information on participating in clinical trials?
Mary Asks:
Please tell me the parp inhibitor clinical trial is still open. Penn called me to participate in the trial in the beginning of November and at that time I showed no measurable cancer. Of course it's back. Failed chemo twice and have BRCA2 gene. Thank you so much for your time.
Penn Medicine Responds:
Dear Mary,
We're sorry to hear about your recent diagnosis. Thank you for your question and interest in participating in a trial. You can contact the Gynecologic Oncology Research Program directly by calling 215-614-0234. The research coordinator for the program can offer you more insight about the trial and/or will align you with any appropriate trials. For more information on gynecologic oncology clinical trials, please visit the department of Obstetrics and Gynecology clinical trials web site.
Please tell me the parp inhibitor clinical trial is still open. Penn called me to participate in the trial in the beginning of November and at that time I showed no measurable cancer. Of course it's back. Failed chemo twice and have BRCA2 gene. Thank you so much for your time.
Penn Medicine Responds:
Dear Mary,
We're sorry to hear about your recent diagnosis. Thank you for your question and interest in participating in a trial. You can contact the Gynecologic Oncology Research Program directly by calling 215-614-0234. The research coordinator for the program can offer you more insight about the trial and/or will align you with any appropriate trials. For more information on gynecologic oncology clinical trials, please visit the department of Obstetrics and Gynecology clinical trials web site.
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