Tag Archives: Orange County

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.

Urinary Tract Infections: Diagnosis, Treatment and Prevention | Fullerton, CA

Branch of dogwood blossoms against a dark backgroundEvery year, over 11 million women develop a urinary tract infection, (also known as a UTI, a bladder infection or acute cystitis). These infections are more common in women than men, primarily due to the normal female anatomy, with the urethra (tube leading from the bladder to the outside), located very close to the vaginal opening. This allows bacteria from the vagina, and especially the rectum, to enter the bladder, and subsequently cause an infection. Sexual activity is the most common cause for developing a UTI, but pregnancy, advancing age, lack of estrogen, and diabetes are common contributing factors for developing these infections.

Typical symptoms from a UTI, are pain with urination, frequent urination with the urgency to void, and possibly pelvic pain or pressure. More severe symptoms are a general ill feeling with fever, and possibly even confusion. However, it may be possible not to have any symptoms at all, which is why your urine is usually tested at the time of your routine office visit.

To properly diagnose a UTI, a urine sample can be quickly assessed in the office to confirm the presence of bacteria or its by-products. The healthcare practitioners will presumptively treat an infection with antibiotics, but a culture of your urine is required to determine the exact type of bacteria present, as well as to ensure that the bacteria has not developed resistance to the antibiotic prescribed. This test usually requires 48 hours for the laboratory to complete. If the practitioner determines that you need to be placed on a different antibiotic, you will be notified as soon as possible. The length of treatment is determined by the severity of the infection, or if you have any underlying medical conditions which could make curing the problem more difficult. You may also be given another medication along with the antibiotic, which acts as a “bladder anesthetic” to relieve the discomfort as the antibiotics begin to work. Another option is to add a teaspoon of baking soda to half of a glass of water, and drink this twice a day.

The risk of not treating a bladder infection can result in the infection ascending into your kidneys, and possibly damaging these vital organs. Treatment of these serious infections may require hospitalization for intravenous antibiotics.

Recurrent UTI’s (more than 3 per year) can be a symptom of a more serious problem that will require further investigation. However, even after an extensive evaluation, some women are simply more prone to infections, and “prophylactic” antibiotics may be used to limit the return of an infection.

For women who are more prone to bladder infections, prevention is key:

• Women who are sexually active should void both before and after intercourse to limit the amount of bacteria in the bladder. Also, some lubricants, oils and spermicidal jelly may also make an infection more likely.

• Voiding regularly throughout the day (every 2 to 3 hours), will limit the amount of bacteria in the bladder. You should also ensure that you empty your bladder completely, and if needed, by “double voiding” (urinate normally, stand up, then sit down again and attempt to finish emptying your bladder)

• Drinking an adequate amount of liquids will continually wash out the bladder. Water is preferred, as soda, coffee and tea may make it more likely to get an infection.

• After a bowel movement or urinating, wipe from the front of the vagina to the back toward the rectum, away from the urethra.

• Frequent changing of sanitary napkins or tampons can limit infections.

• Avoiding hot tubs or highly chlorinated pools, as well as removing your wet swimsuit as soon as possible, can also limit bacterial exposure.

• Cranberry juice and cranberry pills (no calories) have been proven to reduce UTI’s.


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.




Women at a Greater Risk for Heart Disease than Men | Fullerton, CA

iStock_000004537186SmallMost people think that heart disease is a problem only for men. However, more woman than men dies from heart disease every year. Woman need to understand their risks and symptoms to reduce their chances of heart diseaseDr. Gordon Gunn of Fullerton, CA wants you to be aware of the risks heart disease and the things you can do to reduce that risk.

Besides the common risks for heart disease like high cholesterol, high blood pressure and obesity, other factors may play a role in the development of heart disease in women.

  • Low levels of estrogen after menopause.
  • Smoking – greater risk factor than in men
  • Stress and depression – affects woman’s heart more than men’s
  • Metabolic syndrome – fat around your abdomen, high blood pressure and high blood sugar shows a greater impact on woman’s hearts than men.

What you can do to reduce your risk of heart disease.

  • Maintain a healthy weight
  • Quit smoking
  • Exercise
  • Eat a diet low in saturated fat and cholesterol

Woman’s health differs from that of a man’s and requires its own special attention with proper diet, exercise and overall health and wellness.

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.

Menopause and Hormone Replacement The Verdict is In! | Fullerton, CA

iStock_000014235018SmallAccording to Dr. Gordon Gunn in Fullerton, CA, menopause is a natural occurring event that all women will experience, usually in their early 50’s, when their ovaries cease producing estrogen. Post-menopause is diagnosed when a woman has not menstruated for one year and marks the end of the reproductive period of her life.

Peri-menopause is diagnosed when the menstrual cycles vary in frequency and length and may be associated with psychological, emotional and/or physical symptoms (discussed later). These disturbances are due to a declining ovarian production of estrogen, progesterone and testosterone that may be periodic or continuous.

Women born prior to the 1930’s had a life expectancy of about 50 yrs. Today, a woman can expect to live well into her 80’s with over one-third of her life occurring after menopause.

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.