Urinary Incontinence: Embarrassing but Treatable What is urinary incontinence? Urinary incontinence means that you can't always control when you urinate. As a result, you wet your clothes. This can be embarrassing, but it can be treated. About 12 million adults in the United States have urinary incontinence. It's most common in women over 50 years old. But it can also affect younger people, especially women who have just given birth. Be sure to talk to your doctor if you have this problem. If you hide your incontinence, you risk getting rashes, sores, and skin and urinary tract infections. Also, you may find yourself avoiding friends and family because of fear and embarrassment. What causes incontinence? Urinary incontinence can be caused by many different medical problems, including weak pelvic muscles or diabetes. See the box below for a list of common causes.     Causes of urinary incontinence For women, thinning and drying of the skin in the vagina or urethra, especially after menopause For men, enlarged prostate gland or prostate surgery Weakened pelvic muscles Certain medicines Build-up of stool in the bowels Not being able to move around Urinary tract infection Problems such as diabetes or high calcium levels     Are there different types of incontinence? Yes. There are 4 types of urinary incontinence. A brief explanation of each follows. Stress incontinence Stress incontinence is when urine leaks because of sudden pressure on your lower stomach muscles, such as when you cough, laugh, lift something or exercise. Stress incontinence usually occurs when the pelvic muscles are weakened, for example by childbirth or surgery. Stress incontinence is common in women. Urge incontinence This occurs when the need to urinate comes on too fast -- before you can get to a toilet. Your body may only give you a warning of a few seconds to minutes before you urinate. Urge incontinence is most common in the elderly and may be a sign of an infection in the kidneys or bladder. Overflow incontinence This type of incontinence is a constant dripping of urine. It's caused by an overfilled bladder. You may feel like you can't empty your bladder all the way and you may strain when urinating. This often occurs in men and can be caused by something blocking the urinary flow, such as an enlarged prostate gland or tumor. Diabetes or certain medicines may also cause the problem. Functional incontinence This type occurs when you have normal urine control but have trouble getting to the bathroom in time. You may not be able to get to the bathroom because of arthritis or other diseases that make it hard to move around. Is urinary incontinence just part of growing older? No. But changes with age can reduce how much urine your bladder can hold. Aging can make your stream of urine weaker and can cause you to feel the urge to urinate more often. This doesn't mean you'll have urinary incontinence just because you're aging. With treatment it can be controlled or cured. How can it be treated? Treatment depends on what's causing the problem and what type of incontinence you have. If your urinary incontinence is caused by a medical problem, the incontinence will go away when the problem is treated. Kegel exercises and bladder training help some types of incontinence. Medicine and surgery are other options. What are Kegel exercises? Stress incontinence can be treated with special exercises, called Kegel exercises (see the box below). These exercises help strengthen the muscles that control the bladder. They can be done anywhere, any time. Although designed for women, the Kegel exercises can also help men. It may take 3 to 6 months to see an improvement.     Kegel exercises To locate the right muscles, try stopping or slowing your urine flow without using your stomach, leg or buttock muscles. When you're able to slow or stop the stream of urine, you've located the right muscles. Squeeze your muscles. Hold for a count of 10. Relax for a count of 10. Do this 20 times, 3 to 4 times a day. You may need to start slower, perhaps squeezing and relaxing your muscles for 4 seconds each and doing this 10 times, 3 or 4 times a day. Work your way up from there.     What is bladder training? Some people with urge incontinence can learn to lengthen the time between urges to go to the bathroom. You start by urinating at set intervals, such as every 30 minutes to 2 hours--whether you feel the need to go or not. Then gradually lengthen the time between when you urinate--say by 30 minutes--until you're urinating every 3 to 4 hours. You can practice relaxation techniques when you feel the urge to urinate before your time is up. Breathe slowly and deeply. Think about your breathing until the urge goes away. You can also do Kegel exercises if they help control your urge. After the urge passes, wait 5 minutes and then go to the bathroom even if you don't feel you need to go. If you don't go, you might not be able to control your next urge. When it's easy to wait 5 minutes after an urge, begin waiting 10 minutes. Bladder training may take 3 to 12 weeks. Will medicine or surgery help? Medicine helps some types of urinary incontinence. For example, estrogen cream to put in the vagina can be helpful for some women who have mild stress incontinence. A medicine called oxybutynin (brand name: Ditropan) can be used for urge incontinence and too-frequent urination. Surgery can be helpful. It is usually done if other things haven't worked or if the incontinence is severe.

Urinary Incontinence: Kegel Exercises for Your Pelvic Muscles How do pevic muscles get weak?l Pelvic muscles help stop the flow of urine. For women, pregnancy, childbirth and being overweight can weaken the pelvic muscles. For men, prostate surgery can weaken pelvic muscles. Weak pelvic muscles can cause you to leak urine. Fortunately, pelvic muscles are just like other muscles--exercises can make them stronger. People who leak urine may have better control of these muscles by doing pelvic muscle exercises called Kegel exercises. This handout focuses on Kegel exercises for women because it is much more common for women to leak urine than for men. If you are a man who leaks urine, talk to your doctor about whether Kegel exercises can help you. Which muscles control my bladder? At the bottom of the pelvis, several layers of muscle stretch between your legs. The muscles attach to the front, back and sides of the pelvic bones. Two pelvic muscles do most of the work. The biggest one stretches like a hammock. The other is shaped like a triangle (see picture below). These are the same muscles that you would use to try to stop the flow of urine. They are the muscles you will exercise and strengthen. How do I exercise pelvic muscles? You can exercise almost anywhere and any time--while driving in a car, at your desk or watching TV. To exercise these muscles, just pull in or "squeeze" your pelvic muscles (as if you are trying to stop urine flow). Hold this squeeze for about 10 seconds, then rest for 10 seconds. Do 3 to 4 sets of 10 contractions per day. Be patient and continue to exercise. It takes time to strengthen the pelvic muscles, just like it takes time to improve the muscles in your arms, legs or abdomen. You may not notice any change in bladder control until after 6 to 12 weeks of daily exercises. Still, most women notice an improvement after just a few weeks. A few points to remember Weak pelvic muscles often lead to urine leakage. Daily exercises can strengthen pelvic muscles. These exercises often improve bladder control. Ask your doctor or nurse if you are squeezing the right muscles. Tighten your pelvic muscle before sneezing, lifting or jumping. This can prevent pelvic muscle damage and urine leakage. Continue to exercise. If the exercises work, continue to do them, just like any other exercises. Daily pelvic muscle exercise log I exercised my pelvic muscles ______ times daily. I spent _____ minutes exercising. At each exercise session, I contracted my pelvic muscles _____ times.

Urinary Incontinence: Bladder Training What is urinary incontinence? Urinary incontinence means that you can't always control when you urinate. Causes of urinary incontinence include weak pelvic muscles, certain medicines, build-up of stool in the bowels and medical problems such as diabetes or congestive heart failure. About 12 million adults in the United States have urinary incontinence. It's most common in women older than 50 years of age, but it can also affect younger people. There are 4 main types of urinary incontinence: Stress incontinence Urge incontinence Overflow incontinence Functional incontinence What is bladder training? Bladder training is a behavioral technique used to treat people who have stress incontinence, urge incontinence or a combination of the two (called mixed incontinence). Stress incontinence is when urine leaks because of sudden pressure on your lower stomach muscles, such as when you cough, laugh, lift something or exercise. Urge incontinence is when the need to urinate comes on so fast that you can't get to a toilet in time. Your doctor will help you determine which type of incontinence you have and whether bladder training can help you. How can bladder training help? Bladder training can help in the following ways: Lengthen the amount of time between bathroom trips. Increase the amount of urine your bladder can hold. Improve your control over the urge to urinate. Where do I start? Ask your doctor to help you develop a bladder training program. He or she may ask you to keep a bladder diary to record how much and how often you urinate during a 24-hour period. This information will help your doctor create a treatment program that's right for you. During your bladder training program, your doctor may have you keep track of the number of urine leaks you have each day. This will help you and your doctor determine whether bladder training is helping. Listed below are examples of several different bladder training methods. Your doctor may recommend 1 or more of these methods to help control your incontinence. Kegel exercises: These are exercises that help strengthen the muscles you use to stop the flow of urine.   Delay urination: Some people who have urge incontinence can learn to put off urination after they feel the urge to go. Start by trying to hold your urine for 5 minutes every time you feel an urge to urinate. When it's easy to wait 5 minutes to urinate, try to increase the waiting period to 10 minutes. Gradually lengthen the waiting period until you're urinating every 3 to 4 hours. When you feel the urge to urinate before your time is up, it may be helpful for you to practice relaxation techniques. Breathe slowly and deeply. Concentrate on your breathing until the urge goes away. Doing Kegel exercises may also help you control urges.   Scheduled bathroom trips: Some people control their incontinence by going to the bathroom on a schedule. This means that you plan times to go to the bathroom, whether you feel the urge to urinate or not. For example, you might start by going to the bathroom every hour. Then gradually increase the time between bathroom trips by 30 minutes until you find a schedule that works for you. Remember, bladder training often takes 3 to 12 weeks. Don't be discouraged if you don't have immediate results or if you still experience some incontinence. What else can I do? You may find it helpful to change your diet. Alcohol, caffeine, foods high in acid (such as tomato or grapefruit), and spicy foods can irritate your bladder. Talk to your doctor if you think your diet may contribute to your incontinence. Some people find that limiting how much they drink before bedtime helps reduce nighttime incontinence. Losing weight if you are overweight can also help reduce incontinence. Are there other ways to treat incontinence? Yes. Medicines or medical devices can treat some types of urinary incontinence. In some cases, surgery may be an option. Treatment depends on what type of urinary incontinence you have and what is causing the problem.

Constipation: Keeping Your Bowels Moving Smoothly What is constipation? Constipation is when you have trouble having bowel movements. Your stools may be very hard, making them so difficult to pass that you have to strain. Or you may feel like you still need to have a bowel movement even after you've had one. How often should I have a bowel movement? Not everyone has bowel movements once a day. Don't believe ads that say you must have a daily bowel movement to be "regular." A normal range is generally 3 times a day to 3 times a week. You may be getting constipated if you begin to have bowel movements much less often than you usually do.     Tips on preventing constipation Don't resist the urge to have a bowel movement. Set aside time to have a bowel movement. A good time may be after breakfast or any other meal. Eat more fiber. Drink plenty of fluids--at least 8 glasses a day. Fluids can include water, juices, soup, tea and other drinks. Don't take laxatives too often. Exercise or move around more.     What causes constipation? As the food you eat passes through your digestive tract, your body takes nutrients and water from the food. This process creates a stool, which is moved through your intestines with muscle contractions (squeezing motions). A number of things can affect this process. These include not drinking enough fluids, not being active enough, not eating enough fiber, taking certain drugs, not going to the bathroom when you have the urge to have a bowel movement and regularly using laxatives. Any of these things can cause the stools to move more slowly through your intestines, leading to constipation. How is constipation treated? The main thing in treating constipation is to be sure you're eating enough fiber and drinking enough fluids. This helps your stools move through your intestines by increasing the bulk of your stools and making your stools softer. Increasing how much you exercise will also help. Talk to your family doctor if you notice any blood in your stools, if constipation is new and unusual for you, if you're constipated for 3 weeks or more, or if you're in pain. What should I eat? Eat plenty of fiber (see the box below). Two to 4 servings of fruits and 3 to 5 servings of vegetables a day is ideal. Add extra fiber to your diet by eating cereals that contain bran or by adding bran as a topping on your fruit or cereal. If you are adding fiber to your diet, start slowly and gradually increase the amount. This will help reduce gas and bloating. Make sure to drink plenty of water too.     Foods rich in fiber Unprocessed wheat bran Unrefined breakfast cereals Whole wheat and rye flours Grainy breads, such as whole wheat, rye or pumpernickel Fresh fruits Dried fruits, such as prunes, apricots and figs Vegetables Legumes, such as chickpeas, baked beans and lima beans     Should I use laxatives? Laxatives should usually be avoided. They aren't meant for long-term use. An exception to this is bulk-forming laxatives. Bulk-forming laxatives work naturally to add bulk and water to your stools so that they can pass more easily through your intestines. Bulk-forming laxatives can be used every day. They include oat bran, psyllium (one brand: Metamucil), polycarbophil (one brand: FiberCon) and methylcellulose (one brand: Citrucel). How are bulk-forming laxatives used? You must use bulk-forming laxatives daily for them to work. Follow the directions on the label. Start slowly and drink plenty of fluids. Gradually increase how much you use every 3 to 5 days (as you get used to it) until you get the effect you want. You can help bulk-forming laxatives taste better by mixing them with fruit juice. Do bulk-forming laxatives have side effects? You may notice some bloating, gas or cramping at first, especially if you start taking too much or increase the amount you're using too quickly. These symptoms should go away in a few weeks or less. Is mineral oil a good laxative? Mineral oil should generally be used only when your doctor recommends them, such as if you've just had surgery and shouldn't strain to have a bowel movement. Mineral oil shouldn't be used regularly. If it is used regularly, it can cause deficiencies of vitamins A, D, E and K. Should I try enemas? Enemas aren't usually needed. Many people use enemas too much. It's better to let your body work more naturally. What if I've been using enemas or laxatives for a long time? You may have to retrain your body to go without laxatives or enemas if you've been using them for a long time. This means eating plenty of fiber and using a bulk-forming laxative, drinking plenty of water, exercising and learning to give yourself time to have a bowel movement. If you've used laxatives and enemas for a long time, your family doctor may suggest that you wean yourself off of them slowly to give your system a chance to return to normal. Be patient--it may take many months for your bowels to get back to normal if you've been using laxatives or enemas regularly. Talk with your family doctor about any concerns you have. Glaucoma What is glaucoma? Glaucoma is an eye disease that may cause loss of vision. It occurs as a result of a buildup of fluid in the eyeball. Imagine that the inside of your eye is like a sink, with the faucet always running and the drain always open. Like water in the sink, the fluid in your eye moves in and out. The fluid nourishes your eye and keeps it healthy. After the fluid circulates, it empties through a drain in the front of your eye. In people with glaucoma, the drain in the eye is blocked and the fluid can't run out of the eyeball. Instead, the fluid builds up and causes increased pressure in the eye. How does increased pressure damage your eye? The increased pressure in the eye destroys the nerve cells in your eye, causing you to lose your vision. At first, you may have blind spots only in your peripheral, or side, vision. If your glaucoma isn't treated, your central vision will also be affected. When glaucoma causes vision loss, the loss is permanent. Nothing can restore dead nerve cells. What are the symptoms of glaucoma? Most people with glaucoma don't have any symptoms of the disease. You might not realize that you're losing vision until it's too late. Half of all people with loss of vision caused by glaucoma are not aware they have the disease. By the time they notice loss of vision, the eye damage is severe. Rarely, an individual will have an acute attack of glaucoma. In these cases, the eye becomes red and extremely painful. Also, nausea, vomiting and blurred vision may occur. Who gets glaucoma? Risk factors for glaucoma include older age, black race, family history of glaucoma, high pressure in the eyes, diabetes, hypertension and near-sightedness. How do I know if I have glaucoma? You won't know you have glaucoma until you notice vision loss. Since glaucoma causes no symptoms other than vision loss, it is important that you have a complete eye exam by an ophthalmologist. An ophthalmologist is a doctor who is trained to provide care for the eyes, including the diagnosis and treatment of glaucoma. Your ophthalmologist can measure your eye pressure, examine your optic nerve and evaluate your central and peripheral vision. Early diagnosis and treatment of glaucoma can prevent damage to the eye's nerve cells and prevent vision loss. How often should I have an eye exam? It is generally recommended that you have a complete eye exam by age 39. After that, eye exams should be done every 2 to 4 years. After age 64, they should be done every 1 to 2 years. What is the treatment for glaucoma? Glaucoma can be treated with eyedrops, pills, laser surgery, eye surgery or a combination of methods. The purpose of treatment is to lower the pressure in the eye so that further nerve damage and vision loss are prevented. Sleep Changes in Older Adults How much sleep do older adults need? Most adults need about 8 hours of sleep at night to feel fully alert when they’re awake. This is usually true for people age 65 or older too. But as we get older, we might have more trouble sleeping. Many things can get in the way of sleeping well or sleeping long enough to be fully rested. What sleep changes are common in older adults? Older adults might get sleepy earlier in the evening. Older adults may have trouble falling asleep when they go to bed at night. They might not stay asleep all night. They might wake up very early in the morning and not be able to go back to sleep. These problems can make older people very sleepy in the daytime. What causes sleep problems? A number of things can cause sleep problems. By the time an adult is over 65 years old, his or her sleep-wake cycle doesn’t seem to work as well. Some lifestyle habits (like drinking alcohol or caffeinated drinks, or smoking) can cause sleep problems. Sleep problems may be caused by illness, by pain that keeps a person from sleeping or by medicines that keep a person awake. People of all ages can have a sleep disorder such as sleep apnea, restless legs syndrome or periodic limb movement disorder. What is sleep apnea? People with sleep apnea usually snore very loudly. Then they stop breathing for 10 to 30 seconds during sleep. They start breathing again with a gasp. This can happen hundreds of times in a night. Every time this happens it causes the person to wake up a little bit. Sleep apnea can cause daytime sleepiness. It can also make high blood pressure and heart disease worse. If you have sleep apnea and are overweight, it might help to lose weight. It will also help to sleep on your side, and to stop drinking alcohol or using sleep medicines. Many people with sleep apnea need to wear a nasal mask during the night to keep their airways open. The mask treatment is called “continuous positive airway pressure,” or CPAP. It helps you breathe normally during sleep. Surgery can help some people with sleep apnea. What is restless legs syndrome? This is a “creepy-crawly” feeling, mostly in the legs. It makes you want to move your legs or even walk around. It may be worse in the evenings when your legs are at rest. It usually happens every night and may start after you get in bed. This feeling may keep you from falling asleep. Older adults are more likely to have this problem. If you have restless legs syndrome, placing hot or cold packs on your legs or taking a hot or cold bath might help to reduce your symptoms. Some people find relaxation techniques helpful. You can also try massaging your legs, feet and toes before going to bed. Certain medicines may help people who have restless legs syndrome. Your doctor will decide if using medicine is the right treatment for you. What is periodic limb movement disorder? A person with this disorder kicks one or both legs many times during sleep. Often the person doesn’t even know about the kicking unless a bed partner talks about it. It can get in the way of good sleep and cause daytime sleepiness. Some people with restless legs syndrome also have periodic limb movements during sleep. Medicine may help both of these problems. What can I do to sleep better? Try to go to bed and get up at the same time every day. Try not to take naps longer than about 20 minutes. Don’t have caffeinated drinks after lunch. Don’t drink alcohol in the evening. It might help you fall asleep, but it will probably make you wake up in the middle of the night. Don’t lie in bed for a long time trying to go to sleep. After 30 minutes of trying to sleep, get up and do something quiet for a while, like reading or listening to quiet music. Then try again to fall asleep in bed. Ask your doctor if any of your medicines could be keeping you awake at night. Ask your doctor for help if pain or other health problems keep you awake. Try a little exercise every day. Exercise helps many older adults sleep better. Memory Loss With Aging: What's Normal, What's Not How does the brain store information? Information is stored in different parts of your memory. Information stored in the short-term memory may include the name of a person you met moments ago. Information stored in the recent memory may include what you ate for breakfast. Information stored in the remote memory includes things that you stored in your memory years ago, such as memories of childhood. How does aging change the brain? Beginning when you're in your 20s, you begin to lose brain cells a few at a time. Your body also starts to make less of the chemicals your brain cells need to work. The older you are, the more these changes can affect your memory. Aging may affect memory by changing the way your brain stores information and by making it harder to recall stored information. Your short-term and remote memories aren't usually affected by aging. But your recent memory may be affected. You may forget names of people you've met recently. These are normal changes.     Things to help you remember Keep lists. Follow a routine. Make associations (connect things in your mind), such as using landmarks to help you find places. Keep a detailed calendar. Put important items, such as your keys, in the same place every time. Repeat names when you meet new people. Do things that keep your mind and body busy. Run through the ABC's in your head to help you think of words you're having trouble remembering. "Hearing" the first letter of a word may jog your memory.     What about when I know a word but can't recall it? This is usually just a glitch in your memory. You'll almost always remember the word with time. This may become more common as you age. It can be very frustrating, but it's not usually serious. What are some other causes of memory problems? Many things other than aging can cause memory problems. These include depression, other illnesses, dementia (severe problems with memory and thinking, such as Alzheimer's disease), side effects of drugs, strokes, a head injury and alcoholism. How can I tell if my memory problems are serious? A memory problem is serious when it affects your daily living. If you sometimes forget names, you're probably okay. But you may have a more serious problem if you have trouble remembering how to do things you've done many times before, getting to a place you've been to often, or doing things that use steps, like following a recipe. Another difference between normal memory problems and dementia is that normal memory loss doesn't get much worse over time. Dementia gets much worse over several months to several years. It may be hard to figure out on your own if you have a serious problem. Talk to your family doctor about any concerns you have. Your doctor may be able to help you if your memory problems are caused by a medicine you're taking or by depression. How does Alzheimer's disease change memory? Alzheimer's disease starts by changing the recent memory. At first, a person with Alzheimer's disease will remember even small details of his or her distant past but not be able to remember recent events or conversations. Over time, the disease affects all parts of the memory.     Memory problems that aren't part of normal aging Forgetting things much more often than you used to Forgetting how to do things you've done many times before Trouble learning new things Repeating phrases or stories in the same conversation Trouble making choices or handling money Not being able to keep track of what happens each day       Other Organizations Alzheimer's Association http://www.alz.org 800-272-3900 National Institute on Aging Information Center http://www.nia.nih.gov/ 800-438-4380 Prostate Cancer: What You Need to Know What is the prostate gland? The prostate gland is part of the male reproductive system (see the picture below). The prostate makes a fluid that mixes with sperm and other fluids during ejaculation. A normal prostate is about the size of a walnut. What is prostate cancer? Cancer is when cells in the body grow out of control. Prostate cancer is a group of abnormal cells in the prostate. Prostate cancer can be aggressive, which means it grows quickly and spreads to other parts of the body. (When cancer spreads, doctors say the cancer has "metastasized.") Patients with slow-growing cancer can expect to live as long as men who do not have cancer. Most patients with slow-growing cancer will never have symptoms. Three out of four cases of prostate cancer are of the slow-growing type that is relatively harmless. Who is at risk for prostate cancer? Prostate cancer is the most common type of cancer found in American men, other than skin cancer. The American Cancer Society estimates that there will be about 179,300 new cases of prostate cancer in the United States this year, and about 37,000 men will die of this disease. For an American man, the lifetime risk of dying from prostate cancer is 3.4%. Although men of any age can get prostate cancer, it is found most often in men over age 50. In fact, more than 8 of 10 men with prostate cancer are over the age of 65. African-American men are at higher risk than Caucasian men. Men with a family history of prostate cancer are at higher risk too. Family history means that your father or a brother had prostate cancer. Possible Symptoms of Prostate Cancer Call your doctor if you have any of these symptoms: Difficulty starting to urinate Less force to the stream of urine Dribbling after you finish urinating Frequent urination Blood or pus in the urine Pain or burning feeling while urinating Pain with ejaculation Hip or back pain that does not go away over time How does my doctor check my prostate? Your doctor may examine your prostate by putting a gloved, lubricated finger a few inches into your rectum to feel your prostate gland. This is called a digital rectal exam. A normal prostate feels firm. If there are hard spots on the prostate, your doctor may suspect cancer.   What is the PSA test? Another way to check for prostate cancer is with a blood test called the PSA test. PSA is short for prostate-specific antigen. Men who have prostate cancer may have a higher level of PSA in their blood. However, the PSA level can also be high because of other, less serious causes such as infection. Who should be screened? Screening means looking for cancer before it causes symptoms. Some doctors recommend that men at high risk--African-American men and men with a family history of prostate cancer--should be screened. The National Cancer Institute, the American Cancer Society, the U.S. Preventive Services Task Force and the American Academy of Family Physicians recommend that men talk to their doctors about whether screening is needed. What are the disadvantages of screening? One of the reasons that doctors disagree about the need for screening is that although screening for prostate cancer finds many cases of cancer, it also finds conditions that aren't cancer. This means that some men may have to go through unneeded tests and worry to make sure that they don't have cancer.   In addition, PSA screening detects many cases of slow-growing cancers that cause few if any problems. Although these cancers can be treated, there's no proof that treatment helps men live longer. And treatment may be worse than the cancer itself. Treatment can cause serious problems, such as impotence (inability to get or keep an erection) and incontinence (loss of urine). How do I decide whether to be screened? Talk to your doctor. And think about whether you really would want to know if you have cancer. Since many cases of prostate cancer don't cause problems or shorten a man's life, some men would rather not have the worry of knowing they have cancer.   If you think you would want to know if you have prostate cancer, ask yourself whether you would want treatment. Talk to your doctor about the known risks and uncertain benefits of treatment. What are the treatment options for prostate cancer? One option is "watchful waiting." Watchful waiting means leaving the cancer alone and seeing your doctor regularly so he or she can track the cancer. This may be a good option for older men and those with slow-growing cancer. Even without treatment, these men typically can expect to live as long as men who don't have prostate cancer. At any time during watchful waiting, you can choose to switch to another treatment. Surgery, radiation and drugs are other treatment options. They can cure prostate cancer if it's caught early. However, these treatments can cause serious problems, such as impotence and incontinence. Surgery or radiation may help treat the more aggressive cancers that are most often found in middle-aged men.     Other Organizations American Cancer Society http://www.cancer.org 800-227-2345 (or check your local phone book) National Cancer Institute http://www.nci.nih.gov 800-4-CANCER Prostate Health Council/American Foundation for Urologic Disease http://www.prostatehealth.com 800-242-2383       Erectile Dysfunction (ED) What is erectile dysfunction? When a man can't get an erection to have sex or can't keep an erection long enough to finish having sex, it's called erectile dysfunction. Erectile dysfunction is also called impotence. Erectile dysfunction can occur at any age, but it is more common in men older than 65. Is erectile dysfunction just a part of old age?     Physical causes of erectile dysfunction Alcohol and tobacco use Fatigue Brain or spinal-cord injuries Hypogonadism (which leads to lower testosterone levels) Liver or kidney failure Multiple sclerosis Parkinson's disease Radiation therapy to the testicles Stroke Some types of prostate or bladder surgery     Erectile dysfunction doesn't have to be a part of getting older. It's true that as you get older, you may need more stimulation (such as stroking and touching) to get an erection. You might also need more time between erections. But older men should still be able to get an erection and enjoy sex. What causes erectile dysfunction? See the box to the right for some physical causes of erectile dysfunction. The following medical problems can also cause erectile dysfunction: Diabetes (high blood sugar) Hypertension (high blood pressure) Atherosclerosis (hardening of the arteries) If you can't keep your blood sugar or your blood pressure under control, you can get erectile dysfunction. It's important that you take your medicines for these problems just the way your doctor tells you. Sometimes your hormones get out of balance and this causes erectile dysfunction. Your doctor will decide if you need blood tests to check your hormones. Some medicines can cause erectile dysfunction. If this is true for you, your doctor may take you off that medicine or give you a different one. Drinking too much alcohol, smoking too much and abusing drugs can also cause erectile dysfunction. Problems in your relationship with your sexual partner can also cause erectile dysfunction. You might try therapy to see if improving your relationship helps your sex life. Therapy will probably be most effective if your sex partner is included. Couples can learn new ways to please one another and to show affection. This can reduce any of your anxiety about having erections.     Feelings that can lead to erectile dysfunction Feeling nervous about sex, perhaps because of a bad experience or because of a previous episode of impotence Feeling stressed, including stress from work or family situations Being troubled by problems in your relationship with your sex partner Feeling depressed Feeling so self-conscious that you can't enjoy sex Thinking that your partner is reacting negatively to you     How is erectile dysfunction diagnosed? Your doctor will probably start by asking you some questions and doing a physical exam. Samples of your blood and urine may be tested for diseases and disorders. Other tests may also be needed. Your doctor will determine which tests are right for you. How is erectile dysfunction treated? How erectile dysfunction is treated depends on what things are causing it. After your doctor checks you for medical problems and medicines that might cause erectile dysfunction, he or she may have you try a medicine to help with erectile dysfunction. Some of these medicines are injected into your penis. Other medicines are taken by mouth. Not everyone can use these medicines. Your doctor will help you decide if you can try them. What other options do I have? If the medicines aren't right for you, you could also try using vacuum pump devices, or you could have surgery. Your doctor may send you to an urologist to talk about these options.       Sexual Dysfunction in Women: What Can I Do If Sex Isn't Working for Me? What is sexual dysfunction? When you have problems with sex, doctors call it "sexual dysfunction." Men and women can have it. There are 4 kinds of sexual problems in women. Desire disorders ­- When you are not interested in having sex or have less desire for sex than you used to. Arousal disorders ­- When you don't feel a sexual response in your body or you cannot stay sexually aroused. Orgasmic disorders ­- When you can't have an orgasm or you have pain during orgasm. Sexual pain disorders ­- When you have pain during or after sex. What causes sexual dysfunction? Many things can cause problems with your sex life. Medicines, diseases (like diabetes or high blood pressure), alcohol use or vaginal infections can cause sexual problems. Depression, an unhappy relationship or abuse (now or in the past) can also cause sexual problems. You may have less sexual desire during pregnancy, right after childbirth or when you are breast-feeding. After menopause many women feel less sexual desire, have vaginal dryness or have pain during sex. The stresses of everyday life can affect your ability to have sex. Being tired from a busy job or caring for young children may make you feel less desire to have sex. Or you may be bored by a long-standing sexual routine. How do I know if I have a problem? Up to 70% of couples have a problem with sex at some time. Most women sometimes have sex that doesn't feel good. This doesn't mean you have a sexual problem. If you don't want to have sex or it never feels good, you might have a sexual problem. The best person to decide if you have a sexual problem is you! Discuss your concerns with your doctor. Remember that anything you tell your doctor is private. What can I do? If desire is the problem, try changing your usual routine. Try having sex at different times of the day, or try a different sexual position. Arousal disorders can often be helped if you use a vaginal cream for dryness. If you have gone through menopause, talk to your doctor about taking estrogen or using an estrogen cream. If you have a problem having an orgasm, masturbation can help you. Extra stimulation (before you have sex with your partner) with a vibrator may be helpful. You might need rubbing or stimulation for up to an hour before having sex. Many women don't have an orgasm during intercourse. If you want an orgasm with intercourse, you or your partner may want to gently stroke your clitoris. If you're having pain during sex, try different positions. When you are on top, you have more control over penetration and movement. Emptying your bladder before you have sex, using extra creams or taking a warm bath before sex all can help. If you still have pain during sex, talk to your doctor. If you have a tight vagina, you can try using something like a tampon to help you get used to relaxing your vagina. Your doctor can tell you more about this. Can medicine help? If you have gone through menopause or have had your uterus and/or ovaries removed, taking the hormone estrogen may help with sexual problems. If you're not already taking estrogen, ask your doctor if this is an option for you. You may have heard that taking sildenafil (Viagra) or the male hormone testosterone can help women with sexual problems. There have not been many studies on the effects of Viagra or testosterone on women, so doctors don't know whether these things can help or not. Both Viagra and testosterone can have serious side effects, so using them is probably not worth the risk. What else can I do? Learn more about your body and how it works. Ask your doctor about how medicines, illnesses, surgery, age, pregnancy or menopause can affect sex. Practice "sensate focus" exercises where one partner gives a massage, while the other partner says what feels good and requests changes (example: "lighter," "faster," etc.). Fantasizing may increase your desire. Squeezing the muscles of your vagina tightly and then relaxing them may increase your arousal. Try sexual activity other than intercourse, such as massage, oral sex or masturbation. What about my partner? Talk with your partner about what you each like and dislike, or what you might want to try. Ask for your partner's help. Remember that your partner may not want to do some things you want to try. Or you may not want to try what your partner wants. You should respect each other's comforts and discomforts. This helps you and your partner have a good sexual relationship. If you can't talk to your partner, your doctor or a counselor may be able to help you. If you feel like a partner is abusing you, tell your doctor. Parkinson's Disease What is Parkinson's disease? Parkinson's disease is a disorder that causes a progressive loss of nerve cell function in the part of the brain that controls muscle movement. Progressive means that you will lose more of your nerve function as time goes on. What are the symptoms of Parkinson's disease? People with Parkinson's disease experience tremors (shakiness) as a result of the damage to their nerve cells. The tremor of Parkinson's disease gets worse when the person is at rest and better when the person moves. The tremor may affect one side of the body more than the other, and can affect the lower jaw, arms and legs. Handwriting may also look "shaky" and smaller than usual. Other symptoms of Parkinson's disease include nightmares, depression, excess saliva, difficulty turning over in bed and buttoning clothes or cutting food, and problems with walking. How is Parkinson's disease diagnosed? No blood tests or x-rays can show whether a person has Parkinson's disease. However, some kinds of x-rays can help your doctor make sure nothing else is causing your symptoms. The symptoms mentioned above suggest to a doctor that a person might have Parkinson's disease. If the symptoms go away or get better when the person takes a medicine called levodopa, it's fairly certain that the person has Parkinson's disease. What causes Parkinson's disease? Doctors don't know exactly what causes Parkinson's disease. They do know some medicines can cause or worsen symptoms of Parkinson's disease. Can medicines treat Parkinson's disease? There is no cure for Parkinson's disease. There are medicines that can help control the symptoms of the disease. Some of the medicines used to treat Parkinson's disease include carbidopa-levodopa (one brand name: Sinemet), bromocriptine (brand name: Parlodel), selegiline (one brand name: Eldepryl), pramipexole (brand name: Mirapex), ropinirole (brand name: Requip), tolcapone (brand name: Tasmar) and pergolide (brand name: Permax). Your doctor will discuss with you which medicines might help you.     Other Organizations Parkinson's Disease Foundation http://www.pdf.org 710 W. 168th St. New York, NY 10032 800-457-6676 National Parkinson's Foundation http://www.parkinson.org 1501 N.W. 9th Ave., Bob Hope Road Miami, FL 33136-1494 800-327-4545 American Parkinson Disease Association, Inc. http://apdaparkinson.org 1250 Hylan Blvd., Suite 4B Staten Island, NY 10305 800-223-2732                 Fecal Incontinence What is fecal incontinence? Fecal incontinence is the loss of normal control of the bowels. This leads to stool leaking from the rectum (the last part of the large intestine) at unexpected times. This problem affects as many as 1 million Americans. It is more common in women and in the elderly of both sexes. Many people with fecal incontinence are ashamed to talk about this problem with their doctor. They think that nothing can help them. However, many effective treatments for fecal incontinence are available. What causes fecal incontinence? Bowel function is controlled by 3 things: anal sphincter pressure, rectal storage capacity and rectal sensation. The anal sphincter is a muscle that contracts to prevent stool from leaving the rectum. This muscle is critical in maintaining continence. The rectum can stretch and hold stool for some time after a person becomes aware that the stool is there. This is the rectal storage capacity. Rectal sensation tells a person that stool is in the rectum. Then the person knows that it is time to go to the bathroom. A person also must be alert enough to notice the rectal sensation and do something about it. He or she must also be able to move to a toilet. If something is wrong with any of these factors, then fecal incontinence can occur. Muscle damage is involved in most cases of fecal incontinence. In women, this damage commonly occurs during childbirth. It's especially likely to happen in a difficult delivery that uses forceps and/or an episiotomy. An episiotomy is when a cut is made to enlarge the opening to the vagina for delivery of a baby. Young women can often compensate for muscle weakness. Typically, they only develop incontinence in later life when their muscles are growing weaker and the supporting structures in the pelvis are becoming loose. Muscle damage can also occur during rectal surgery (especially surgery for hemorrhoids). It may also occur in people with inflammatory bowel disease or an abscess in the perirectal area. Damage to the nerves that control the anal muscle or that are responsible for rectal sensation is also a common cause of fecal incontinence. Nerve injury can occur in the following situations: During childbirth. With severe and prolonged straining for stool. With diseases such as diabetes, spinal cord tumors and multiple sclerosis. Fecal incontinence may also be caused by a reduction in the elasticity of the rectum, which shortens the time between the sensation of the stool and the urgent need to have a bowel movement. Surgery or radiation injury can scar and stiffen the rectum. Inflammatory bowel disease can also make the rectum less elastic. Because loose stool (diarrhea) is more difficult to control than formed stool, diarrhea is an added stress that can lead to fecal incontinence. A change in stool consistency to a looser form often causes the problem of incontinence to show up. If I have fecal incontinence, what can be done? It is important that you have a careful medical evaluation. Attempts at self-treatment are usually unsuccessful. Anorectal manometry, which tests anal pressures, rectal elasticity and rectal sensation, as well as other tests, can pinpoint the cause of your incontinence. The treatment of fecal incontinence varies and depends on the cause of your problem. Preventing diarrhea and forming a regular bowel movement pattern are usually very helpful. For sphincter weakness or injury, anorectal biofeedback strengthens the muscle. This improves continence in most persons. Biofeedback training can even end the problem of fecal incontinence.