Author Archives: Medical Associates

Urinary Incontinence: Common but not Normal

There are some body issues that no one really likes to discuss, even with their doctor. Incontinence (leakage), urinary or fecal, is one of those issues. Incontinence affects both men and women, but did you know that it is two times more likely in females than males? The National Association for Continence (NAFC) says 1 in every 4 women over the age of 35 experiences incontinence. Incontinence is common, but that does not mean it is an inevitable part of aging and it does not mean you can’t find relief.

First, let’s review how the bladder functions: your kidneys filter your blood and remove waste/toxins which creates urine. Little tubes, called ureters, take the urine from the kidneys to your bladder where it is stored. As the bladder fills, it stretches. When it reaches a certain level, a message is sent to the brain telling you it’s time to find a bathroom. When you reach the restroom the brain tells the muscles of the bladder to contract (you can’t control this part, it just happens) and your pelvic floor muscles to relax (you can control this part).. If something interrupts the communication process between the brain and bladder or if the muscles of the pelvic floor are weak (or sometimes even tense), leakage can occur. While you cannot control the contraction of your bladder, you can control your pelvic floor muscles. Strengthening these muscles with a specific type of physical therapy can help.

Incontinence is not only a physical problem, but it can affect your personal life. Every patient is unique, but incontinence is usually a bigger issue than needing to wear a pad or change your clothing. Many sufferers experience impacts on their emotional and psychological well-being. A decrease in social activity is also common. Incontinence has also been associated with a 26% increased risk of falls in the elderly population, as reported by the NAFC. Some can lose their balance when experiencing a sudden need to reach the bathroom quickly.

There are many different types of incontinence and they all mean something slightly different. Knowing the various types can help when trying to communicate the problem to your doctor or physical therapist.

  • Stress Incontinence: loss of urine with physical activity/exertion. Often individuals note this leakage is associated with cough, sneeze, laugh, jump, or exercise.
  • Urge Incontinence: loss of urine that is preceded by a strong and sudden need to empty the bladder. With this type of incontinence, you may notice every time you hear running water or pull into your garage after work you feel the need to urinate and can’t make it to the toilet.
  • Overactive Bladder: with overactive bladder symptoms of urgency, urinating frequently, and not feeling like you empty your bladder all the way tend to coincide and one may or may not have leakage along with these symptoms.
  • Mixed Incontinence: this simple means a combination of any of the above listed types of incontinence; most often a combination of stress and urge incontinence.

No matter the factors contributing to your incontinence, you can find relief. It may be embarrassing to discuss with your doctor, but it is important to speak up. Your physician can rule out larger medical conditions, assess if any of your medications are contributing to the problem, and recommend a form of treatment. Ask your doctor about a referral for pelvic floor physical therapy. Return to your beloved social activities and experience less anxiety over incontinence. Have confidence and take back control!

Gosse_B_2017_ultiproBrittany Gosse, DPT
Department of Physical Therapy
Medical Associates Clinic



Your Health is Important When Trying to Conceive

Every aspect of your health – from the drinks you consume to the exercise you do (or don’t do) – can have an impact on your fertility and on the health of your pregnancy. By looking at your healthy (and unhealthy) habits now (before the bun is in the oven) you can start off on the right foot. Our expert OB/GYN team has shared some important steps to take to ensure your health is at its best for conception, which will hopefully make conception easier and your pregnancy safer.

Habits to Break

Smoking is never good for you, so just don’t do it. But if you need a little motivation not to light up, repeat this fact to yourself: smoking (cigarettes, e-cigarettes, hookahs, vape pens, and so on) causes my 30-year-old eggs to act more like 40-year-old eggs. This results in a more difficult path to conception and a greater risk of miscarriage. Heavy smoking damages the ovaries as well as the uterus, and secondhand smoke can harm your health and fertility, too, so just choose to stay away!

Along with smoking cigarettes, smoking marijuana isn’t good for conception either. Whether you smoke, vape, or consume edibles, you can inadvertently affect the ability of your partner’s sperm to fertilize an egg – even if he doesn’t smoke marijuana! The active ingredient in marijuana, THC, gets in your vaginal fluids and reproductive organs. So to be most fertile (not to mention safe), say goodbye to marijuana. (And you should obviously also not use any illicit drugs, including cocaine, crack, or heroin, etc.).

Some studies have linked too much caffeine consumption with lowered fertility and an increased risk of miscarriage. If a baby is in your immediate plans, it’s time to put a little less coffee in your cup. You don’t have to give it up completely but moderation is the key here. Limit your caffeine intake to no more than 200 mg per day. That’s equivalent to 12 ounces of brewed coffee per day.

Another beverage to limit (or eliminate completely) is alcohol. Drinking alcoholic beverages in excess can mess with your menstrual cycle, possibly interfering with ovulation. And because you won’t necessarily know the moment you conceive, there’s a chance you might be drinking in the first few weeks of your baby’s growth. Drinking alcohol while pregnant could harm your little one in the future. Choose to reduce your drinking to less than 7 drinks a week and never more than one on any occasion when trying to get pregnant. Only you and your bartender need to know you’re drinking a mocktail.

As far as medications go, most over-the-counter and many prescription meds are considered safe while you’re trying to conceive. But because some medications may compromise fertility, you should run any medications you take by your provider before you consume them. This includes the medications you take for your chronic condition and any vitamins or herbals you may take on a regular basis. The good news is there are almost always safer alternatives. Just ask your healthcare provider before making any changes to your medication routine.

Habits to Keep

There is a strong connection between weight and fertility. Reaching a healthy weight for your body type is an important step for conception. It’s not just the scale that determines this, though. The relationship between your weight and height are factored to determine your body mass index, or BMI. Being overweight can cause diminished egg quality, decreased ovarian function, or polycystic ovarian syndrome (PCOS), a fairly common cause of fertility issues. Alternatively, women with a low BMI can also experience conception woes. Being underweight can lower estrogen levels, which can lead to irregular ovulation or periods (or even no ovulation or periods). Women who are obese or underweight when they become pregnant also have a higher risk of miscarriage.

Though it may be different for everyone, a moderate exercise program is the key. Moderate exercise can boost fertility, and you only need 30 minutes of aerobic exercise to do this. It can be walking, stretching, strength training, or anything that increases your heart rate. Remember to keep an eye on your body fat though. Prolonged, strenuous exercise can disrupt the delicate balance of hormones needed for ovulation and conception, especially if your BMI is very low. An ideal BMI for conceiving is between 18.5 and 24.9.

Before you put yourself on a diet or start packing on the carbs, it’s important to talk to your healthcare provider. Come up with a simple plan that features a well-balanced diet. Fill your meals with lean protein, veggies and fruits, and low-fat dairy. Cut down on junk foods and sugary drinks. Try water instead. Add in that moderate workout routine discussed above and you’ll be ready to kick-off your healthy path to pregnancy!

A good night’s rest is also very important. Six to nine hours of sleep per night is best. Beating the stress of the day and letting your body recuperate will only encourage fertility.

Finally, take 400 to 800 micrograms (400 to 800 mcg or 0.4 to 0.8 mg) of folic acid every day if you are planning a pregnancy or are currently pregnant. You can take a vitamin or eat a breakfast cereal containing your daily quota of folic acid. This will lower your risk of some birth defects of the brain and spine, including Spina bifida. Talk with your doctor about your folic acid needs. Some doctors prescribe prenatal vitamins that contain higher amounts of folic acid.


Whether it’s your first, second, or fifth baby, your body needs to be nurtured and cared for so that it can do the same for your future child. Both the female AND the male partner’s fertility can benefit from the advice listed above. And remember that no two bodies are exactly the same, so talk to your doctor before getting pregnant. They will discuss your medical history, any medical conditions you have, any medications you are currently taking, and any vaccinations you might need. This will help make a preconception health plan that is best for you.

For more information on preconception health, check out this conception plan template from the CDC.


The Obstetrics/Gynecology & Infertility Team at Medical Associates Clinic:
Joseph Berger, MD  |  Tara L. Holste, DO  |  Lisa A. Kramer, MD
Trupti S. Mehta, MD  |  Laura Neal, MD  |  Erika O’Donnell, MD

Call 563-584-4435 to schedule an appointment.


Men Need Pelvic Health, Too.

Sorry to break it to you, gentlemen, but pelvic health isn’t just important for women. You have a group of muscles at the bottom of your pelvis that helps support the organs of your urinary, GI, and reproductive systems, too. There are 14 muscles, several joints, ligaments, and nerves making up the pelvic floor. No matter your gender, the pelvic floor works to control the bladder, bowel, and sexual functions. And just like women, men experience issues when the pelvic floor muscles are tight, weak, or spastic.

The pelvic floor is a part of your inner core, which is used during daily tasks, workouts, and hobbies. Your pelvic floor can become affected after surgery, due to other injury/trauma, or due to lifestyle factors or disease processes. When this happens, men can experience symptoms such as urinary or fecal leakage, constipation, abdominal/pelvic/rectal/penile pain, erectile dysfunction, and prostatitis-like symptoms. (Please note, this is not an all-inclusive list.) Additionally, men may benefit from pelvic floor physical therapy before or after prostatectomy and following hernia repairs or other abdominal/pelvic surgeries. Up to 2 million men in the United States alone meet the diagnostic definition of persistent pelvic pain.1 And that’s just one of the symptoms that may stem from pelvic floor muscles that are too tight, weak, or those that have restrictions present in or around the tissue.

Many of the interventions that pelvic floor physical therapists use to strengthen these muscles can be applied to treatment of both men and women. Your provider should begin with an evaluation process to get a clearer picture of what is happening with the muscles, their strength, coordination, endurance, and tension. This may involve an internal (rectal) and external examination to better determine how your pelvic floor is contributing to your experienced symptoms. Please don’t let the thought of internal examination deter you. There may be other options to begin addressing your symptoms until you learn more and are more comfortable. Just be open and honest with your therapist.

So, men, speak up! If you are experiencing leakage, pain, constipation, urinary urgency, changes in sexual function, or are post-surgery for the pelvic or abdominal region, ask your doctor or call with questions. If you and your physician have ruled out other diagnoses or infections, pelvic health physical therapy may be a great option for you. Know that you are not alone in the symptoms you experience. Improve your quality of life with pelvic health physical therapy at Medical Associates.


Gosse_B_2017_ultiproBrittany Gosse, DPT
Department of Physical Therapy
Medical Associates Clinic





  1. Prendergast SA, Rummer EH. Pelvic pain explained: what everyone needs to know. Lanham: Rowman & Littlefield; 2016.


What is a Kegel? Are they right for you?

Your pelvic floor muscles act as a hammock at the bottom of your pelvis that supports all your abdominal and pelvic organs. Strengthening these muscles can help with problems such as urinary leakage, fecal leakage, prolapse, general weakness, pressure, pain, post-partum pain, or instability. Many physicians or therapists, friends or family members may recommend Kegels as an intervention to address your symptoms, but what are Kegels and are they right for you?

First, let’s define a Kegel. A Kegel is an isolated contraction of the pelvic floor muscles. This means that those pelvic floor muscles are the only muscles contracting in your body (lifting up towards your head and squeezing around). No other muscles come to aid in this isolated contraction. It should be a “secret” squeeze; in other words, no one else would know you are flexing them.

But when you reach for your grocery bag, move that heavy couch, lift the baby, have a bowel movement, or even sneeze – the pelvic floor doesn’t work alone. Yes, you do need to be able to isolate these muscles to help build their strength, but it needs to work together with the inner core. This allows you to anticipate movement, respond, and create a support system for stability to decrease the strain or workload to one individual group of muscles. All the muscles of the inner core need to be balanced in strength to appropriately perform actions such as these.

Kegels do have their place in Pelvic Floor therapies, however every patient is different and not everyone should do Kegels. For example, sometimes the pelvic floor is tense or in spasm, meaning the muscles are already engaged or in a contracted position. Another type of intervention or home program may be more appropriate in this case. If tension is the source of the symptoms being experienced, those muscles likely need to be lengthened and taught to relax instead. This is why it is critical to be evaluated by someone who is specifically trained in pelvic floor therapies. Knowledge of how your pelvic floor presentation relates to your symptoms and the ability to assess what the rest of the system is doing are crucial.

If you’ve tried Kegels and they haven’t helped, please contact us. There might be modifications we can make, different muscles to address, or an altogether new therapy tactic to try. Call 563.584.4465 to schedule an appointment or ask your doctor for a referral to pelvic floor physical therapy. You can also fill out our intake form here and someone from our office will reach out to you.

Gosse_B_2017_ultiproBrittany Gosse, DPT
Department of Physical Therapy
Medical Associates Clinic