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In the Field: Doctors help patients with incontinence issues

Here’s something you don’t read in the newspaper every day:

• One in four women struggle at least occasionally with incontinence.

• One in five people over 40 deal with an overactive bladder.

• One in three women over 80 are incontinent.

Uncomfortable information, to be sure. So uncomfortable, that many primary care doctors don’t raise the issue with patients during visits, and many patients wouldn’t dream of bringing up the subject themselves.

That’s a shame to Drs. Tova Ablove and Teresa Danforth, who opened the Center for Pelvic Health last year at Buffalo General Medical Center and have since opened an office in East Amherst, as well.

“A lot of women don’t even hear about us from their doctors. Three or four of them are out to lunch with their bridge club and they’re talking and discover, ‘Three of the four of us have the same thing,’ ” said Ablove, a urogynecologist who treats women with incontinence and other pelvic issues.

“You’d be surprised how many people have these problems,” she said.

Ablove and Danforth, both University at Buffalo Medical School graduates, spent recent years in Wisconsin and Los Angeles, respectively, working in fellowships to prepare for the practice they opened in the summer of 2013.

Danforth, 32, is a Corning native. Ablove, 44, is from the Bronx. Both are bullish on the Queen City.

“This was perfect timing for us, with all the growth in Buffalo,” said Danforth, who specializes in the treatment of female and male incontinence and other urinary issues.

Both doctors also deal with a female issue called prolapse, in which the vaginal canal can partially collapse during the aging process, under the weight of the nearby urinary and gastrointestinal systems.

Our valves seem to become a problem as we age. Why?

Dr. Danforth: I always tell my patients, ‘Essentially, I’m a glorified plumber.’ The body is like plumbing, essentially. You have your GI plumbing, which is where all your food goes; you have your heart plumbing, where all your blood goes; and you have your urine plumbing, which starts at the kidneys. Essentially, you get leaky valves. The quality of your tissues and the quality of the supporting tissues and structures fail as you get older. It fails as you have other types of treatments. Neurologically, things can fail. In this country, one of the problems we have is morbid obesity and that certainly increases the risk of urinary incontinence, leakage.

Dr. Ablove: For most conditions we treat, there are almost always conservative options that don’t involve surgery.

Dr. Danforth: Very simple lifestyle changes can help patients tremendously, without any invasive therapy, without any medication, without any surgeries.

Can you talk about those?

Dr. Danforth: A lot are dietary changes. You can look at diets and see what foods are irritative. The biggest ones are alcohol, caffeine, spicy food, acidic food.

Dr. Ablove: Doing pelvic floor exercises, kegel exercises, for both men and women, can be helpful.

Are there medical and surgical options and when do those come into play?

Dr. Ablove: Most times for incontinence, when patients come to see us, they’ve already started to alter their diet. They’re wearing pads. They’ve already seen their primary doctor. A lot of times, I’ll offer behavioral things in conjunction with a medication so they don’t become discouraged. They will start to see results right away. There are some types of incontinence where medications aren’t appropriate and there are other types of therapies that we would offer them. Surgical options are something we offer patients after they’ve failed conservative therapies.

Your website, PelvicHealthWny.com, talks about helping to improve physical and emotional health.

Dr. Ablove: It comes down to how we interview our patients and figure out what’s wrong. The most important thing in this population is improving quality of life, and in order to get at that, you need to look at the entire person. I have long conversations with some of my patients on how they need to get involved in long-term exercise routines. We’re still going to treat their incontinence but sometimes you have to get at it from a different perspective. Sometimes, the thing that’s really bothering them isn’t the incontinence. A lot of these conditions are related to other things.

Dr. Ablove: Most of incontinence and prolapse is not life-threatening, but if people leak and they can’t see, and they’re up in the middle of the night and they fall, the mortality rates are high. So if I see an elderly woman who’s unstable, I’m going to be talking to her about a bedside commode. That could save her life.

email: refresh@buffnews.com

On the Web: Find out more about bladder-related issues at nafc.org; read refresh.buffalonews.com to find out how those who ignore diabetes face the prospect of serious bladder problems.