Category Archives: Urinary Incontinence

Control your Bladder Incontinence with Kegel Exercises | Fullerton, CA

Pure, Natural, BeautyAn obstetrician named Dr. Arnold Kegel originally described pelvic floor muscle exercises. Their purpose is to strengthen the pelvic floor muscle supporting the urethra in order to control the accidental loss of urine during physical exertion (i.e. sneezing, coughing, laughing, running, or exercising). This type of loss of urinary control is called Urinary Stress Incontinence, and can have a considerable impact on the overall quality of life and well-being.

The pelvic floor muscle is called the ‘levator’ muscle and when contracted helps to stop urination, prevent passing gas or a bowel movement, and to tighten the vagina during intercourse. The levator muscle forms the floor of the pelvis and supports the urethra, vagina, and rectum. It consists of two types of muscle fibers: “slow-twitch” (70%) and “fast-twitch” (30%). Both muscle fiber types should be exercised to improve the muscle’s tone and ability to rapidly contract when ‘stressed’. The muscle can be identified by placing two fingers inside the vagina, tightening your levator muscle, and feeling the squeeze. You do not need to squeeze your abdominal, thigh, or buttocks muscles. Just focus on squeezing or tightening your urethra, vagina, and anus. If you can slow or stop the flow of urine, you are using the levator muscle.

A strong levator muscle improves bladder function in two important ways:

1. Improves stress incontinence: During a sudden cough or sneeze, the pelvic floor muscles contract, supporting the bladder and decreasing the accidental loss of urine. The stronger the muscle, the better the control.

2. Suppresses the ‘urge’ to urinate: When you feel an inconvenient urge to urinate contract your levator muscle (slow-twitch exercise). There is an immediate nerve impulse sent to the bladder to relax

Two types of exercise are necessary to adequately strengthen the levator muscle and should be performed the sense of urgency. The stronger your levator muscle, the greater the nerve stimulation to relieve the urge sensation.

Two types of exercise are necessary to adequately strengthen the levator muscle and should be performed every time you finish urinating. These should be used on alternating days’

‘Slow-Twitch’ Muscle Exercise

Squeeze your levator muscle and hold it tight for a slow count of five seconds, relax, and repeat again for a total of five (5) contractions. (Remember, do not tighten your thigh, abdominal, or buttocks muscles; tighten only your levator muscle). As you gradually strengthen your pelvic muscle, work your way up to twenty (20) contractions.

‘Fast-Twitch’ Muscle Exercise

Quickly contract and relax your levator muscle 30 to 50 times, relax for ten seconds, and repeat again for a total of two to three sets. You may only be able to start out with a total of 30 “quick flicks”. Over a period of a few weeks you will be able to increase the number up to a total of 200.

Within 6-8 weeks of consistently performing these exercises you will notice a definite improvement. Don’t quit. Every time you go to the bathroom and after you finish urinating (before you stand up), perform either one of the above levator muscle exercises (switch each time or each day). Remember, this is now part of your normal urinating routine. It is what you do every time you go to the bathroom. It is like any isometric exercise. If you don’t exercise this muscle regularly, it will become weak again and your symptoms will return. Many patients with urinary stress incontinence have cured their symptoms completely by performing these exercises.

Contact Dr. Gordon Gunn today at (714) 912-2211 to schedule an appointment.

Dr. Gordon Gunn also proudly serves Buena Park, La Mirada, Yorba Linda, Diamond Bar, Walnut, and surrounding areas.

Don’t Let an Overactive Bladder Take Control of Your Life. | Fullerton, CA

iStock_000014235018SmallHaving an overactive bladder can be distressing. It can ruin daily plans and interrupt sleep. Not sure if you have an overactive bladder? Below are some symptoms that can help you determine if you have an overactive bladder:

  • Sudden and overpowering urge to go to the bathroom
  • Leaking accidents if you can’t reach the bathroom in time
  • Having to go frequently day and night
  • Getting up more than 2 times a night to go to the bathroom
  • Little warning time before feeling you have to urinate
  • Have anxiety about having a wetting accident
  • Using Pads or devices to protect from wetting accidents

Does your constant urination give you fears of going on long trips or family outings? Do you find it hard to sit through an entire movie without going to the bathroom?  Don’t suffer with this affliction.

Contact Dr. Gordon Gunn to learn more about the treatment options available at (714) 912-2211 to schedule an appointment.

Dr. Gordon Gunn also proudly serves Buena Park, La Mirada, Yorba Linda, Diamond Bar, Walnut, and surrounding areas.

Timed Voiding Bladder Program | Fullerton, CA

A loving grandparentThis is an important part of your bladder-retraining program. When followed consistently you will have significantly improved control over your urgency symptoms, including any urge incontinence. This program started when you monitored the amount and the type of fluids you consumed each day in your Voiding Diary. A normal fluid intake is between 1500-2000 cc (50-70 oz.) per day, which should produce 1200-1500 cc (40-50 oz.) of urine output. The normal bladder capacity before you feel any sensation of urge is about 300 cc (10 oz.). Normal voiding volumes are 210-300 cc (7-10 oz.) with the first morning voiding usually being the largest at 400-500 cc. Your Voiding Diary record will have indicated if any modification is required in the volume or type of fluids you drink.

Timed Voiding Bladder Program

Your goal with the Timed Voiding Program is to increase your bladder’s capacity and prolong the time interval between urinating up to a minimum of three or more hours. The initial time interval between urinating will be determined by the frequency of urination as recorded in your Voiding Diary.

Attached is a “Voiding Chart for Bladder Retraining” on which you will chart your daily progress for the first week. [Please make five additional blank copies of the Voiding Chart to insure you have a total of six weekly charts.] The Chart is a daily record of your Scheduled (predetermined voiding interval), Unscheduled (when you are unable to suppress the urge without the risk of accidentally urinating), and Accidental

Follow the instructions on the chart as indicated: (incontinence) urinating episodes.

  • Fill in the following on each sheet: Your Name, Date, and Voiding Interval (Hrs.) at the beginning of each week.
  • Fill in the time for any of the types of urinating (Scheduled, Unscheduled, or Accidental) and place a check mark
  • Dark Gray Column : Urinating at the Scheduled Time.
  • Light Gray Column: Urinating at any Unscheduled Time. (when you cannot suppress the urge)
  • White Column: If you Accidentally urinate (incontinence incident), place a checkmark at the time it occurred and add a “D” for Damp or “W” for Wet beside the check mark to indicate the relative amount of urine loss.

Keep your Chart nearby along with a pencil and a clock or timer. Most importantly, maintain your determination to stay with this six-week program.

Contact Dr. Gordon Gunn today at (714) 912-2211 to schedule an appointment.

Dr. Gordon Gunn also proudly serves Buena Park, La Mirada, Yorba Linda, Diamond Bar, Walnut, and surrounding areas.

Your Bladder | Accepting Patients in Brea, CA

iStock_000008712786SmallUrinary urgency is the sudden, overwhelming feeling of the need to urinate. Urinary urgency can disrupt sleep, work, sexual activity, relationships and social interaction. Women who frequently experience urinary urgency usually knows where the nearest bathroom is located (toilet mapping). When the urge strikes they rush to the bathroom and the uncomfortable urge sensation is relieved. If they fail to get there in time, an accidental loss of urine may occur and is referred to urinary urge incontinence. The loss of urine can vary between a few drops to a large amount. Urgency and urge incontinence are often associated with the need to urinate more frequently (frequency of more than eight times per 24 hours), and the need to get up at night to urinate (nocturia). Women who regularly experience urinary urgency and frequency (with or without nocturia or incontinence) have a condition called urinary urgency syndrome (also called overactive bladder or OAB). Their daily lives are influenced, and frequently controlled, by their bladders. These symptoms can lead women to change behaviors and adopt preventive coping mechanisms, such as limit daily travel, quit exercising and dancing, reducing fluids, avoiding sexual intimacy, and wearing pads or adult diapers.

Urinary urgency can be caused by two general categories of disorders: Physical and Habitual
Physical Causes of Urinary Urgency
1. Infection in the bladder or urethra
2. Polyps or tumors in the bladder or urethra
3. Caffeine, citrus juices and alcohol
4. Diabetes Mellitus
5. Interstitial cystitis
6. Neurologic disorders (multiple sclerosis, Parkinson’s disease, spinal cord trauma)

Physical causes can usually be diagnosed with office testing called urodynamics. Actual bladder contractions (called motor urgency or detrusor instability) are usually due to a specific physical disorder. Treatment is directed at both the cause and symptoms.

The normal bladder will hold at least 15 oz. (450 cc) of urine. When your bladder is “full”, you feel the urge to urinate. However, you should normally be able to suppress that urge, until it is convenient to go to the bathroom. The brain initiates the process of urinating after you are sitting on the toilet by sending nerve impulses to the urethra to relax and to the bladder to contract. When the pressure within the bladder exceeds the pressure in the urethra, urine flows (hopefully into the toilet).

If the bladder contracts abnormally (bladder instability), a sudden increase in pressure within the bladder signals the brain to start the voiding reflex. A sense of urinary urgency may occur and if the pressure in the bladder exceeds that in the urethra, loss of urine will occur. When there is no physical cause of urgency (habit), there usually is no increase in bladder pressure. However, the brain can learn to associate specific actions, places or times with the feeling of the need to urinate. However, it is usually not associated with a bladder contraction or with a full bladder.

Most commonly, urinary urgency or overactive bladder develops gradually over time. It is frequently associated with stress urinary incontinence (loss of urine associated with sudden increases in abdominal pressure, such as coughing, sneezing, laughing, running, etc.). Patients may learn that voiding more frequently may decrease the amount or urine loss with stress incontinence episodes. Often the sudden onset of urinary urgency can be associated with a specific activity; i.e., driving into your driveway at home, inserting your house key into the door lock, putting your hands under running water, or even seeing a bathroom. In most cases, the bladder function is normal and the brain is sending false messages (sensory urgency).
Completing a Urinary Incontinence Questionnaire and a 24-hour Voiding Diary, a pelvic floor physical examination and simple office bladder testing (Urodynamics) can usually establish a definite diagnosis. Correction of habitual urinary urgency involves a bladder-retraining program. Surgery is rarely indicated.

Treatment of Habitual Urinary Urgency and Incontinence:
The goal of a bladder-retraining program is to regain control and not be a victim of your bladder. This will always include the first two listed below.
1. Awareness and Refocusing:
Bladder retraining begins with understanding the mechanism of urinating (discussed above) and reconditioning the urgency reflex. Postponing the act of urinating without leaking any urine can be achieved with changing your focus whenever the urge to urinate strikes. Consider taking the following steps:
(a) When the urge strikes, stay still and do 3-4 ‘Slow Twitch’ Kegel pelvic contractions AND
(b) Visualize walking slowly to the bathroom to perform any task other than
(c) Then, act out your visualization sitting on the toilet (i.e. adjusting the towels, sorting the medicine cabinet, etc.)
(d) After you have completed your task, proceed to use the toilet. thinking of the act of urinating.
Simply put: this mental refocusing along with the pelvic contractions will delay your brain from sending impulses to your bladder and urethra until you are actually ready to urinate.

2. Pelvic Floor (Kegel) Exercises – this program of strengthening your pelvic floor muscles should be a part of your normal urinating routine and is performed every time you finish urinating Refer to article entitled ‘Kegel Exercises – How to Strengthen Your Pelvic Muscle’.

When these two steps are not as successful as you wish, then the following programs may bring success.
1. Medications – various drugs that relax your bladder may be used to relieve the sense of urgency. These can cause a sense of dryness in your mouth. If this side effect occurs, suck on hard candy rather than drink excessive fluids. Common medications include Detrol LA 4 mg., Ditropan 5, 10, 15 mg, Vesicare 5, 10 mg,
2. Time Voiding Program – this is a program in which you will be urinating at fixed time intervals and doing your best to suppress the urge to urinate until the next scheduled time.
3. Pelvic Floor Electrical Stimulation – this is a device, which is inserted into the vagina and painlessly causes your pelvic floor muscles to contract. This program is used only after the other programs have been tried and your urinary urgency symptoms persist.
4. Biofeedback – a program designed to help you suppress the urge and postpone urinating.

Contact Dr. Gordon Gunn today at (714) 912-2211 to schedule an appointment.

Dr. Gordon Gunn also proudly serves Buena Park, La Mirada, Yorba Linda, Diamond Bar, Walnut, and surrounding areas.

There is Hope for Relief of an Overactive Bladder with InterStim Therapy | Fullerton, CA

mature woman blonde greyFinding relief from the symptoms of overactive bladder can be a long journey. InterStim Therapy is an option for patients who have not had success with, or could not tolerate, more conservative treatments. InterStim Therapy is not intended for patients with a urinary blockage.

What Is InterStim Therapy?

InterStim Therapy is a proven neuromodulation therapy that targets the communication problem between the brain and the nerves that control the bladder. If those nerves are not communicating correctly, the bladder will not function properly. The InterStim system uses an external device during a trial assessment period and an internal device for long-term therapy. We may decide to try InterStim Therapy by going through a trial assessment period. Based on the outcome of the trial assessment,we will work with you to determine the next step that is right for you.

InterStim Therapy was created by Medtronic, the developer of the pacemaker, and has been FDA approved since 1997 for urge incontinence, and since 1999 for urinary retention and urgency-frequency.

To find out if InterStim Therapy can help you,Contact Dr. Gordon Gunn to learn more about the treatment options available at (714) 912-2211 to schedule an appointment.

Dr. Gordon Gunn also proudly serves Buena Park, La Mirada, Yorba Linda, Diamond Bar, Walnut, and surrounding areas.


A Simple Explanation of Urinary Incontinence | Fullerton, CA

Senior Woman Enjoying Hot DrinkUrinary Incontinence & Pelvic Prolapse

Incontinence is the inability to control either your urine or stool until a socially appropriate time. There are multiple causes of incontinence depending upon which nerves, tissues or organs have been damaged


“Stress” Urinary Incontinence, Type I:

This involuntary loss of urine is associated with sudden increases in abdominal pressure, such as laughing, coughing or exercising. It is due to a defect in the pelvic floor support of the bladder. Mild incontinence can generally be corrected with a program of pelvic floor exercises and bio-feedback therapy. Outpatient surgery will usually correct the more severe forms.

“Urge” Urinary Incontinence, Type II:

When the bladder muscle involuntarily contracts, partial or complete bladder emptying occurs. It is usually associated with a strong urge to urinate. Frequently, this may occur with specific events, such as arriving at your home or hearing running water. Treating the underlying causes and instituting behavior modification programs will usually correct this type of incontinence. Our bio-feedback program is very helpful in treating this type of incontinence when initial treatments are not completely successful.

“Stress” Urinary Incontinence, Type III:

This type of incontinence is similar to Type I incontinence, but the cause is entirely different. Rather than due to a loss of support, there is an abnormally “low pressure” within the urethra, which may allow urine loss to occur with any physical activity. It is treated differently from Type I.

Fecal Incontinence:

This is an involuntary loss of stool, which may occur with our without the sense of the need to defecate. There are many causes of fecal incontinence and treatment varies according to the individual diagnosis.

Pelvic Prolapse

The muscles and ligaments of the pelvic floor are attached to the uterus, bladder, vagina and rectum. When these structures are weakened or damaged (often from childbirth), the pelvic organs will protrude down toward the outside of the body resulting in pressure or a “falling-out” sensation. Depending on the specific organs involved there may be abnormal bladder, bowel or sexual function.

Contact Dr. Gordon Gunn today at (714) 912-2211 to schedule an appointment.

Dr. Gordon Gunn also proudly serves Buena Park, La Mirada, Yorba Linda, Diamond Bar, Walnut, and surrounding areas.

FAQ’s About Urinary Incontinence | Fullerton, CA

iStock_000005142700SmallWhat is Female Urology?

Female Urology (referred to as Urogynecology) is a subspecialty within Obstetrics and Gynecology that focuses on disorders of the female pelvic floor such as pelvic organ prolapse (bulging out of the uterus and/or vagina), urinary incontinence and fecal incontinence.

How common is urinary incontinence among women?

It is estimated that 11 million American women currently suffer from leakage of urine. However, that estimate may be low. A study of 2800 postmenopausal women funded by the National Institute on Aging found that 56% of women experienced urinary incontinence at least weekly. Many women incorrectly assume that urine leakage is normal. While this problem may be very common, it should not be considered normal.

What causes urinary incontinence?

Urinary incontinence is the involuntary discharge of urine. There are many possible causes of urinary incontinence. The key to treatment is identifying the specific type of the incontinence a woman is experiencing through a careful medical interview and a focused physical exam. Frequently, a special test called urodynamics is recommended to accurately diagnose the problem. Urodynamics studies should always be performed when a woman is considering surgery to correct her incontinence.

The two most common types of urinary incontinence are “stress incontinence” and “urge incontinence”. Stress incontinence is accidental urine leakage that occurs during physical activities that cause a sudden pressure (or “stress”) on the bladder such as laughing, lifting, coughing, or sneezing. Urge incontinence is urine leakage that occurs before a woman has a chance to get to the bathroom in response to urge to urinate. Women with this type of leakage may also experience frequent urges to urinate, the inability to suppress the urge and frequent nighttime waking to urinate.

What treatment options are available?

Treatment for urinary incontinence varies on the type and severity of incontinence. The first step in treating the problem is determining an accurate diagnosis.

Stress incontinence can be effectively treated with pelvic floor exercises, devices that “block” the loss of urine, or surgery.

Urge incontinence is commonly treated with medication, biofeedback, or electrical stimulation to the nerves that control the bladder.

There is a wide variety of non-surgical and surgical treatment options available for all kinds of urinary incontinence.

What are the surgical options to treat stress incontinence?

When it comes to treating stress incontinence, not all surgical procedures are equal. There are many variations of anti-incontinence surgery, but the two surgical procedures that have the best results are retropubic urethropexy (Burch Procedure) and the trans-vaginal sub-urethral sling. The tension free vaginal tape (TVT) has rapidly replaced most other surgeries for stress incontinence. The TVT procedure involves the placement of synthetic sling material at the mid-urethra. The procedure takes approximately 45 minutes and may be performed on an outpatient basis. Although no surgery for incontinence has a 100% cure rate, the retropubic urethropexy or suburethral sling permanently cure 75-95% of women suffering with stress incontinence.

What are the risks of surgery to correct stress urinary incontinence?

All surgical procedures present some risks. Although rare, potential complications may include difficulty emptying the bladder and development of urge incontinence.

How can I prevent this problem?

All the factors that cause urinary incontinence are not fully understood, so it is difficult to recommend ways to prevent the problem. Pelvic muscle exercises, also known as “Kegel” exercises, help strengthen the pelvic floor and are probably the best thing you can do to help prevent stress incontinence. Refer to: Health Topics for Women, Bladder Problems on this website.

Contact Dr. Gordon Gunn today at (714) 912-2211 to schedule an appointment.

Dr. Gordon Gunn also proudly serves Buena Park, La Mirada, Yorba Linda, Diamond Bar, Walnut, and surrounding areas.

Treatment Options for an Overactive Bladder | Fullerton, CA

Grandparent and daughterSuffering from an Overactive Bladder can be life altering. The good news is an Overactive Bladder can be treated. Some of the treatment options are as follows:

  • Dietary changes
  • Fluid management
  • Pelvic muscle exercises
  • Drug therapy
  • Sacral nerve stimulation

Dietary Changes

Some symptoms of overactive bladder can be managed by changing your diet. Keeping a diary of what foods you eat and how much fluids you consume can possible help you form a correlation between consumption and urination.

Some foods and drinks to avoid are:

  • Caffeine – Increases bladder activity.
  • Alcohol – It has been shown to act as a bladder stimulant. It triggers symptoms of overactive bladder and acts as a diuretic, increasing the frequency of urination.
  • Artificial Sweeteners – Studies have shown sweeteners negatively affect bladder function. Frequency and urgency of urination were increased after consuming drinks with artificial sweeteners.

The best thing for you to drink is plenty of water. Water is a great beverage for your bladder. Some people think by not drinking water they will help their overactive bladder. However, not enough water intake leads to urine that is highly concentrated. Dark yellow and strong smelling urine actually makes you go to the bathroom more often and causes bacteria to grow.

Pelvic Muscle Exercises

These type of exercises help prevent and/or alleviate symptoms, since they strengthen the pelvic floor. They send a signal to the bladder to relax and resume filling. Through regular exercises you can build strength and endurance to help regain and maintain bladder control.

InterStim Therapy

The InterStim Therapy process works by delivering electrical stimulation directly to the sacral nerves. It is shown to be successful in 4 out of 5 patients. InterStim therapy involves two stages. First, there is a test. Then second, a permanent implant. The implant delivers electrical stimulation without having to revisit the doctor. It is an outpatient procedure. The implant is surgically placed under the skin in the upper buttock or abdomen. It stimulates the sacral nerve using electric pulses.

Contact Dr. Gordon Gunn today at (714) 912-2211 to schedule an appointment.

Dr. Gordon Gunn also proudly serves Buena Park, La Mirada, Yorba Linda, Diamond Bar, Walnut, and surrounding areas.

Bladder Incontinence, you are not alone | Fullerton, CA

mature woman blonde greyBladder incontinence or the unintentional loss of urine, is a problem for more than 13 million Americans—85 percent of them women. Even though around half of the elderly population has bladder incontinence, it is not usually a consequence of age.
Several factors cause bladder incontinence. Women are most likely to develop it during pregnancy and childbirth, or after the hormonal changes of menopause, because of weakened pelvic muscles. Older men can become incontinent as the result of prostate surgery. Pelvic trauma, spinal cord damage, caffeine, or medications including cold or over-the-counter diet tablets also can cause incontinence.

But even though urinary incontinence can be improved in 8 out of 10 cases, fewer than half of those with bladder problems ever discuss the condition with their health care professional. The condition often goes untreated.

Contact Dr. Gordon Gunn today at (714) 912-2211 to schedule an appointment.

Dr. Gordon Gunn also proudly serves Buena Park, La Mirada, Yorba Linda, Diamond Bar, Walnut, and surrounding areas.

Is an Overactive Bladder hindering your life? InterStim Therapy can help. | Fullerton, CA

iStock_000003648493Small - 28Are you suffering from an overactive bladder?  Dr. Gordon Gunn of Fullerton, CA may be able to help with the use of InterStim® Therapy.

InterStim therapy is a treatment that uses mild electrical pulses (called electrical stimulation) to stimulate nerves in your lower back, just above the tailbone. These nerves activate or inhibit muscles and organs that contribute to urinary control — the bladder, sphincter and pelvic floor muscles.

InterStim Therapy might be right for you if you have the following symptoms:

  • Urge incontinence: The involuntary and accidental loss of urine.
  • Urgency: A strong, intense and often sudden desire to urinate.
  • Frequency: Urinating more than eight times in a 24-hour period.
  • Urinary retention: the inability or failure to completely empty the bladder.

To find out more about InterStim Therapy, contact Dr. Gordon Gunn today at (714) 912-2211 to schedule an appointment.

Dr. Gordon Gunn also proudly serves Buena Park, La Mirada, Yorba Linda, Diamond Bar, Walnut, and surrounding areas.