Here at Men's Liberty we're strong supporters of incontinence education. So I was thrilled to see that Dr. Anthony Komaroff of Harvard Medical School wasn't averse to addressing this issue on his blog!
But unfortunately, Dr K.'s advice is only 90% correct. So I wanted to take just a minute to supplement his answer with the missing 10%. His post is in answer to a question from a gentleman in his 70s, dealing with increasing urinary incontinence.
I’m a man in my late 70s, and I’m having trouble holding my urine. Medicines have helped somewhat, but not completely. My doctor says he’s tried every medicine and that I may have to live with my problem to some degree. Is there anything else you can suggest?
Though you may not guess it from TV ads, losing control of urine — incontinence — is not just a woman’s problem. Men, particularly older men, can have trouble too. Studies find that one in four men your age experience incontinence at least once a year — and as many as one in 10 experience it nearly every day.
If medicines are not fixing the problem completely, there are other ways to manage urinary incontinence that are specifically designed for men. But first, I should say that many commonly used medicines may actually be a cause of incontinence. I’ve included a table of such medicines at the end of this post. If you’re on any of these, talk to your doctor about whether they might be responsible in your case.
As for treatments other than medicines that might help, several pads and other absorbent products are designed for the male anatomy. Drip shields (with light protection) or guards (that absorb more) with waterproof backings slip over the head of the penis. They can be kept in place with any tight-fitting briefs. For heavier incontinence, you can wear absorbent inserts, shaped to fit men, inside your own underwear or special mesh briefs.
If you have constant leakage, devices that collect rather than absorb urine can help. A condom catheter (or “Texas catheter”) is a soft sheath made of silicone or latex. It fits over the penis like a regular condom. It attaches to a drain tube leading to a urine collection bag. The bag is strapped to your leg, underneath your pants and out of sight.
Another option is a clamp placed around the base of the penis. The device is designed as an inflatable ring or a foam-lined frame. The clamp is tightened just enough to prevent urine from leaking. Every few hours, you loosen the clamp to urinate.
Ongoing incontinence can irritate your skin. After each leak, clean the area with lukewarm water or a gentle soap or cleanser. Then apply diaper rash treatment, or a lotion or cream made for incontinence.For Dr K.'s full response, click here: What are treatment options for urinary incontinence in men?
While most doctors will tell you there are some serious drawbacks to condom catheters, there’s nothing that quite captures it for me than the story this guy, we’ll call him Bob, told about his surgery at a New York hospital in 2010.
We’ve redacted the identifying bits but here’s the bit I found most interesting… his experience of bladder management during and after surgery. We’re sharing that portion of his story below.
I went in for surgery at one of the best hospitals in New York. When I arrive, I’m immediately met; given a changing room, told were to go etc, very orderly…they put in an IV, and led to a waiting room, where I stayed for about an hour. Very well appointed, it was like the Ritz-Carlton lobby.
Finally, I’m escorted to the operating room, this turns out to be a five minute walk around hospital with my ass hanging out the back side of my “robe.” As we reach the operating room, my escort looks at me as we arrive in front of the open operating room doors; and my goodness, the look he gives me; it’s like meeting the hang man.
It’s now time to prep me…The head resident/fellow picks an intern we’ll call John. “Lucky John” the intern gets to shave me. He doesn’t look too happy. In the process he asked me, what would turn out to be, the most important question of the entire affair: what kind of catheter would I like? Would I like a standard catheter (one that is inserted into the hole of your penis), or would I like a condom catheter (one that slides over your penis)? Now I don’t know about you, but I’m thinking nothing inserted into your penis can be good! So, I go for option number two, the condom catheter. “Lucky John” finishes shaving me, puts on the condom catheter and three hours later, the surgery done, I’m rolled into the recovery room.
Exhausted, but somewhat alert, I’m told I need to lie flat for six hours and not move. This is after the above three hours and three bags of IV fluid…I really have to piss now, but I can’t move, and I can’t piss with this catheter laying flat on my back. My bladder is talking to me at this point, it’s getting painful.
Nine hours later and now 4 bags of IV fluid in me, they help stand to take the piss of life, but first we have to remove the condom catheter. Whoever invented this should be shot. Not only is it uncomfortable, it is covered with a crazy glue substance that is impossible to remove without pulling the skin off of your Johnson, it is truly, incredibly painful, I had tears in my eyes, but that wasn’t the worst part, the worst part is when you realize that “Lucky John” the intern that shaved you, didn’t do such a good job. You realize that as the pubic hair attached to your scrotum and at the bottom of your shaft is being ripped out by the roots. I no longer needed to piss, I was somewhere between wanting to eviscerate the intern, and shooting myself, it was that bad. Two days later, and one shower, the glue still has my Johnston sticking to my leg, although there’s no pain involved, I flinch every time I adjust.
I don’t know about you but that story made me cringe in sympathy. Condom catheters utilize a strong acrylic adhesive similar to what you find on duct tape or mild superglue. Now imagine ripping that off your skin 4-5 times a day, then putting a new one back on. For men who need to intermittent cath, that’s a regular occurrence. Is it any wonder doctors and patients are flocking to abandon condom catheters for a healthier, painless alternative?
Personally, for any man in his situation, I’d recommend a hydrocolloid external like Men’s Liberty that doesn’t have quite the barbaric side effects that Bob described above. Which would you choose?
We’ve talked quite a bit about how to talk about incontinence and the importance of addressing the stigma of incontinence in society. Incontinence is a symptom of a medical issue, not a standard part of life, no matter your age. So we’re thrilled to share the article below from the Mundelein Review!
They interviewed our pal, Cheryl Gartley, CEO of the Simon Foundation for Continence! See full article here: http://mundelein.suntimes.com/opinions/17855744-598/taking-stigma-off-incontinence.html
Watching daytime TV, and all of the commercials for incontinence products, one might think that incontinence is a normal part of life and aging.
While television commercials do help in decreasing the stigma attached to incontinence, it is still a very sensitive subject and experts say that is not something that individuals should just live with.
“Incontinence is a symptom of something else happening in the body,” says Cheryle Gartley, CEO of The Simon Foundation for Continence, based in Wilmette. “As we age there are changes in the body. That very fact can make [seniors] more susceptible to incontinence.”
Gartley says that talking about incontinence can be challenging for many people, but she believes that it is so important for seniors, and others, who experience symptoms of incontinence, to talk with their physicians so that the underlying reasons can be explored.
“Incontinence is a generic term for the way that the bladder is misbehaving,” Gartley said. “Specifically say what is going on to your doctor. Do you leak urine when you lift your grandchild or when you sneeze or laugh? That is one set of circumstances that indicates stress urinary incontinence.
“Do you have a sudden urge to urinate and it may or may not be associated with leakage? That’s overactive bladder and that’s caused by something different in the body.”
She also says that there is a lot of misunderstanding about issues relating to incontinence and the bladder. “Most people do not understand that the bladder is a muscle. They think of it as a vessel. That misperception leads to some things that aren’t good for the bladder.” Gartley said that when someone stops to use the bathroom when they do not have the urge, but are going “just in case,” it can actually create problems, rather than helping. “If the bladder never gets the chance to fill to its full capacity, like any other muscle that isn’t used, it doesn’t get the chance to do the job it was designed to do and you increase the chance of a misbehaving bladder.”
Gartley also understands that people may be embarrassed to talk about incontinence problems. She says although it may be difficult, it’s important to remember that physicians and nurses are used to these issues and they are trained to help.
“We’ve done work on stigma a lot in health care.” said Gartley, who started the Simon Foundation 30 years ago because of a personal experience with incontinence. She started to look for help herself, and couldn’t locate any support. Shortly after starting the organization they were featured in an Ann Landers column. A few days later they received a call from the post office: 30,000 pieces of mail from people impacted by incontinence had arrived. “The need was unbelievable,” she recalls.
The Simon Foundation just published a new book, “Managing Life with Incontinence,” to support families and individuals. Gartley says the book is unique because in addition to providing information about how to talk to doctors, family and friends and what resources are available, there are stories of individuals who actually are affected by incontinence. The Simon Foundation can be contacted online at www.simonfoundation.org or (800) 23-SIMON.
You’d think we’d run out of questions after a while, especially since we do this every week. In actuality, not really. With a growing base of new customers and healthcare professionals joining the Men’s Liberty family, there’s always someone new with questions I’ve never heard before. So I have to tip my hat to our Customer Care Reps and our Customers who so consistently think outside the box in ways I’d never expect. I salute you!
1. Why doesn't the small pouch drain into the bed bag? I have to almost lay the bag on the floor to get it to drain.
The Men's Liberty utilizes gravity drainage, meaning the bag must be below your bladder in order to drain. From your question, it sounds as though urine is draining into the small bag but not into the bed bag, which can indicate that there is an issue with the bed bag or tubing. I suggest trying a different bed bag and seeing if the same issue occurs. I would also recommend checking all your tubing to ensure that it is not twisted or kinked. If none of these resolves the issue, please call our Customer Care team and we will work with you to troubleshoot the issue and make sure we get it resolved for you!
2. You say do not remove plug on bottom. How do I empty the urine from the bag if I don't pull the plug? The bag does not hold very much fluid. My first day I had to empty the bag every two hours.
If you are regularly producing more urine than the small pouch can handle, we recommend attaching the drain plug to any standard leg or bedside bag to ensure sufficient drainage. However, if you just dribble and leak, the small pouch may be enough.
So unless it is connected to another large drainage bag, it is important to keep the plug closed in order to prevent leakage.
3. You said that it is covered by Medicare and insurance. Are all supplies needed in the future also covered and how do you receive supplies?
Yes. Once we get a letter of medical necessity and progress note from your physician, our distributors can ensure reimbursement from Medicare and/or your insurance provider. Additional documentation for future orders is obtained annually in order to ensure continued reimbursement. Our Customer Care team will take care of all this paperwork for you so that you get your supplies when you need them.
4. You asked my doctor to sign a letter of medical necessity. What is that? Is it like a prescription?
It’s similar. A Letter of Medical Necessity (LMN) is slightly different from a prescription and it is not necessary to purchase the product. If you wish to pay cash, you can do that, unlike prescription items like Viagra. However, a LMN is required in order to secure coverage for the product under Medicare or your insurance plan.
5. I’m just getting out of the hospital and will have a home health nurse helping me for the next 6 weeks. I’d like to resume using Men’s Liberty but the home health agency doesn’t want to buy the product, what can I do?
First, glad to hear you are on the mend! Second, due to Medicare regulations, only one entity can bill Medicare at a time. During a home health episode that means that they are the only ones who can bill your Medicare so they have to purchase all products you will be using, including Men’s Liberty. Unfortunately, sometimes that means they want to use products they are more familiar with, such as diapers or condom catheters. If your home health agency is reluctant, feel free to connect them to our Customer Care Team. We are happy to inform them about the product, why people use it and the benefits they can see. Once they’re bought in, it’s a lot easier to get them to supply your choice of product.
And last, but certainly not least, you can always look for a different home health service. Although sometimes it’s hard to remember, you are the customer here and you have the power to hire and fire. If your current provider isn’t providing the level and quality of service that you need, look for someone else who will!
We're thrilled to be partnering with ABC Home Medical and wanted to share a blog from one of their RNs focusing on pressure ulcers - a common malady some individuals with spinal cord injuries. Check out the full blog below:
The latest advice and helpful tip from our resident Registered Nurse.
A pressure sore is any redness or break in the skin caused by too much pressure in one area for too long a period of time. The pressure prevents blood from getting to your skin, causing the skin to die. Normally, your nerves send messages of pain or feelings of discomfort to your brain to let you know that you need to change position, but damage to your spinal cord keeps these messages from reaching your brain.
In order to prevent pressure sores, do pressure reliefs (also called weight shifting, pressure redistribution and pressure reduction) on a regular basis.
Check your skin, or have your attendant or caregiver check your skin, a minimum of twice a day (morning and bedtime). Look for changes in skin color (redness or darkening), blisters, bruises, cracked, scraped or dry skin. Feel for hardness, swelling or warmth, as these may signal skin breakdown. In some areas of the body, the bones are closer to the surface of the skin, causing increased pressure and risk for sores.
Below are some areas that the skin that is directly over bone and is at highest risk; check these areas very carefully:
Heel of the foot
The base of the buttocks ("seat bones")
Hip (from lying on side, something rubbing, or tight clothes)
Elbow (from leaning on it)
Knee (from spasms or side-lying with one knee on top of other)
Ankle (from lying on side)
Toes and bony areas of foot (from tight-fitting shoes)
Back of the head
Inspect areas of skin that are in contact with casts or braces twice daily. Use a mirror to inspect skin in hard-to-see areas. Pay attention to fingernails and toenails: an ingrown toenail or cut along your nail bed may lead to a sore which can easily be infected. As soon as you notice a discolored area, stay off the area until it returns to normal skin color.
Make sure you clean any areas in which you notice any discoloration, and keep all pressure off this area! Wash with mild soap and water, rinse well, and gently pat dry. Do not rub vigorously directly over the wound, as this will further irritate the skin. If you do notice a pressure sore and if any of the following occur, you need to seek help:
If pressure sores continuously occur, you may need to make some adjustments in your day-to-day routine. Reevaluate your diet and increase your daily exercise. You may also need to see a doctor or physical therapist to get your seating adjusted, as sliding in a wheelchair that does not fit properly can lead to pressure sores.
We’ve talked a lot about spinal cord injuries here but it’s important not to forget, that’s not the only disease that’s strongly associated with incontinence. Incontinence is often caused by other neurologic conditions such as Multiple Sclerosis, Parkinson’s Disease, Stroke and Spina Bifida. In each of these cases incontinence can have a huge economic, physical and psychological impact. So with that in mind, this week we’ve got a few questions from customers with these diagnoses!
1. Why is incontinence associated with these neurological conditions?
Many neurological conditions can cause what is known as neurogenic detrusor overactivity which basically translates to involuntary bladder contractions. There is no physical problem with the bladder or urethra. Instead involuntary muscle contractions and disrupted communication between the brain and bladder make it hard to control urinary frequency or urgency. This can lead to embarrassing accidents and potentially serious medical complications such as urinary tract infections, yeast infections or decubitus ulcers if incorrectly managed.
2. How does incontinence impact quality of life for men with neurological disorders?
Short answer here – it has a huge impact. The exact amount varies by person, by diagnosis and by their stage of illness. However, study after study has concluded that incontinence has a negative impact on health related quality of life assessments.
For example, one study indicated that 96% of individuals with MS reported bladder problems with 41% indicating they were moderately or greatly bothered by it. In addition, 31% reported that urinary problems impacted their emotional health, ability to perform household chores (22%) and physical recreation (28%).
Five different studies have suggested that incontinent stroke patients have impaired functioning, lower life satisfaction and a higher rate of institutionalization compared with stroke patients who are continent. Twelve months after their stroke, 45% of incontinent survivors were institutionalized, compared to 5% of survivors without urinary incontinence.
3. Do all men with these disorders have urinary incontinence?
No. Not everyone will have incontinence; however, a majority will, particularly as degenerative diseases like MS or Parkinson’s develop.
For Spina Bifida sufferers, urinary and fecal incontinence was very common (60.9 and 34.1%, respectively), regardless of the bladder and bowel management they used. The majority of urinary and fecal incontinent patients perceived this as a problem (69.7 and 77.0%, respectively). Spina bifida aperta, hydrocephalus and a level of lesion of L5 or above were associated with patients suffering from urinary and/or fecal incontinence.
4. I have been diagnosed with a neurological disorder which shall remain nameless and thankfully, I’m still fully continent. But I’m concerned about when that will change. How often should I get my urinary function evaluated?
Guidelines for this will vary widely based on diagnosis and the stage of the illness. However, the best guidelines I have are to get evaluated when you start experiencing symptoms or at least every three years, whichever occurs first.
There are several possible urodynamic tests your doctor can consider running to evaluate your bladder and bowel function. I’ve included a brief excerpt below from recommendations from the Agency for Healthcare Research and Quality.
Assessment of Lower Urinary Tract Dysfunction in Patients with Neurological Conditions
Assessment applies to new patients, those with changing symptoms, and those requiring periodic reassessment of their urinary tract management. The interval between routine assessments will be dictated by the person's particular circumstances (for example, their age, diagnosis, and type of management) but should not exceed 3 years.
When assessing lower urinary tract dysfunction in a person with neurological disease, take a clinical history, including information about:
Assess the impact of the underlying neurological disease on factors that will affect how lower urinary tract dysfunction can be managed, such as:
Undertake a general physical examination that includes:
Carry out a focused neurological examination, which may need to include assessment of:
Undertake a urine dipstick test using an appropriately collected sample to test for the presence of blood, glucose, protein, leukocytes, and nitrites. Appropriate urine samples include clean-catch midstream samples, samples taken from a freshly inserted intermittent sterile catheter and samples taken from a catheter port. Do not take samples from leg bags.
If the dipstick test result and person's symptoms suggest an infection, arrange a urine bacterial culture and antibiotic sensitivity test before starting antibiotic treatment. Treatment need not be delayed but may be adapted when results are available.
Be aware that bacterial colonisation will be present in people using a catheter and so urine dipstick testing and bacterial culture may be unreliable for diagnosing active infection.
Ask people and/or their family members and carergivers to complete a 'fluid input/urine output chart' to record fluid intake, frequency of urination and volume of urine passed for a minimum of 3 days.
Consider measuring the urinary flow rate in people who are able to void voluntarily.
Measure the post-void residual urine volume by ultrasound, preferably using a portable scanner, and consider taking further measurements on different occasions to establish how bladder emptying varies at different times and in different circumstances.
Consider making a referral for a renal ultrasound scan in people who are at high risk of renal complications such as those with spina bifida or spinal cord injury.
Refer people for urgent investigation if they have any of the following 'red flag' signs and symptoms:
Be aware that unexplained changes in neurological symptoms (for example, confusion or worsening spasticity) can be caused by urinary tract disease, and consider further urinary tract investigation and treatment if this is suspected.
Refer people with changes in urinary function that may be due to new or progressing neurological disease needing specialist investigation (for example, syringomyelia, hydrocephalus, multiple system atrophy, or cauda equina syndrome).
Assess the impact of lower urinary tract symptoms on the person's family members and carergivers and consider ways of reducing any adverse impact. If it is suspected that severe stress is leading to abuse, follow local safeguarding procedures.
Do not offer urodynamic investigations (such as filling cystometry and pressure-flow studies) routinely to people who are known to have a low risk of renal complications (for example, most people with multiple sclerosis).
Offer video-urodynamic investigations to people who are known to have a high risk of renal complications (for example, people with spina bifida, spinal cord injury, or anorectal abnormalities).
Offer urodynamic investigations before performing surgical treatments for neurogenic lower urinary tract dysfunction.
We’re thrilled to announce that Men’s Liberty is launching a new distribution partnership with Townsend Rep Group to sell our products in SCI clinics, VA facilities and rehab centers across the United States.
Here at Men’s Liberty we’re thrilled to be involved with a great company that shares our mission to provide innovative new products that can revolutionize the quality of life for people with spinal cord injuries.
Chief Strategy Offices, Wendy LaTorre said: “We’re thrilled to be partnering with this amazing group. TRG has impressed me with their professionalism, dedication and unswerving commitment to improving the quality of life for individuals with spinal cord injuries. We are confident we can work with Townsend Rep Group to grow both our businesses and expand the reach of the Men’s Liberty product!”
TRG Founder, Peggy Townsend said: “Men’s Liberty is a fantastic addition to our product lines targeting individuals with a spinal cord injury. We’re excited to be entering the urology market and look forward to building on this relationship in the coming months and years.”
Townsend Rep Group was founded in 2009 in San Antonio, TX. After seeing the need for medical equipment representation in other states, they quickly spread and now have many national contracts and cover all 50 states. We are constantly growing and evolving, much like the industry we're in. For more information on TRG, visit them online at: www.townsendrepgroup.com
Men’s Liberty was developed in 2006 with the goal of solving one of the most pervasive health issues today, urinary incontinence. We are inspired by the impact quality healthcare has on the lives of the people we serve and empathize with the challenges that patients face when managing activities of daily living. Men’s Liberty can help them overcome their challenges with comfort and dignity. By challenging industry standards, we challenge ourselves to maintain the leading-edge. More than 1.5 million Men’s Liberty units have been sold without a single reportable adverse event caused by Men’s Liberty, including UTI or skin injury. We are very proud of that!
We’re looking forward to getting started and we’ll be updating you all regularly on our new initiatives to spread the word!
It’s the day before Valentine’s, a day some know as Desperation Day. It’s a day for the smug couples to finalize their plans and lonely singles to visit bars in hopes of picking up an acceptable Mr/Mrs Right Now. So in honor of the spirit of both Valentine’s Day and its ignominious ‘eve we’ve got some incontinence & romance related questions from users.
1. Is there a relationship between incontinence and sexual dysfunction?
Sometimes. Because incontinence and sexual function utilize many of the same organs and similar messages to and from your central nervous system, they frequently occur together. However, according to most doctors one doesn’t usually cause the other. However, sometimes we can see a causal link because incontinence can cause men to feel less virile or sexually desirable, thereby affecting their confidence or leading to performance anxiety.
Both incontinence and sexual dysfunction are conditions you should talk to your doctor about. No matter what’s causing your incontinence, you can still experience fulfilling romantic relationships that include a sexual component.
2. How is sexuality affected by spinal cord injury?
Sexual function, as with all other human bodily systems, is controlled by the central nervous system. Thus, any injury to the central nervous system will affect sexual function. The question is to what extent function and sensation will be affected with injuries at various levels and degrees of severity. There is a growing body of information available to the newly injured about sexual function, fertility and related issues. We’ve included several links below:
For Health Care Professionals: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2941243/
3. Incontinence and sexual dysfunction after prostate cancer treatment is fairly common. Is there anything I can do to improve my function naturally?
You can do kKgel exercises to help kick start and strengthen your pelvic muscles. This can help you regain urinary control after prostate cancer treatment. Although more commonly associated with women, there are Kegel exercises out there for men. MedicineNet.com suggests the following to alleviate some forms of urinary incontinence:
To do Kegel exercises for men:
When you're first starting, it may be easier to do Kegel exercises lying down, so your muscles aren't fighting against gravity. It may also be easier to contract the muscles for just two or three seconds at first.
After a few weeks, increase the time until eventually you're contracting the muscles for a slow five or 10 seconds, and do the exercises standing up. That puts more weight on the muscles, boosting your workout and improving your control. Remember not to tense your buttock, legs, or stomach muscles while you're doing Kegels.
4. I find taking care of my husband’s incontinence difficult and sometimes I feel more like a caregiver than a partner or a lover. Is there anything he or I can do to manage his incontinence so that we can remember the fun reasons I used to touch his anatomy?
Caregiving for a loved one with incontinence can be an incredibly difficult situation and can definitely impact the intimacy in your relationship. Whether he is using adult diapers, condom catheters or using intermittent catheters – caregivers can spend up to 16 hours a week dealing with incontinence! That can include changing pads, laundry, dealing with infections and changing clothes.
The best way to get your intimacy back is to find a way to minimize the impact of incontinence on your life and your loved one's independence. Men’s Liberty is a great way to do that because it can reduce infections, eliminate accidents and laundry/clothing changes. We even have an instant remover that can help you remove the Liberty when the mood strikes!