The Urology Wellness Center specializes in the non-surgical treatment
of urinary incontinence, interstitial cystitis, impotence, urinary urgency/frequency
(overactive bladder), vulvodynia, post-prostatectomy urinary incontinence, chronic
constipation and other conditions of the bladder and bowel.
Urinary Incontinence (UI) - This condition is
signified by the involuntary leakage of urine. The Agency for Health Care Policy
and Research in the Guidelines for the Treatment of Urinary Incontinence in Adults
says that the initial treatment of choice for Urinary Incontinence should be non-surgical
behavior modification techniques. The Guidelines also state that these techniques
are successful in 70% of the patients.
Initially, an evaluation of the patient's
general health history and the history of the condition is necessary. Then, a physical
examination should be performed to check the patients abdomen, back, pelvic area
and reflexes for information pertaining to the condition and function of the bladder
and bowel. Once this information is obtained, it is possible to decide what type
of incontinence the patient has and to initiate specific treatment.
types of urinary incontinence are:
Urinary Incontinence - This type of Urinary Incontinence occurs when the
patient is under physical stress and the pressure inside the abdomen is greater than
the pressure that closes the urethra (urine tube from the bladder to the outside
of the body). This causes urine leakage which occurs when the patient coughs, sneezes,
picks up something heavy, jumps up and down, etc. It may be caused by a "dropped"
bladder or by weakness of the urethral closing mechanism. It can be treated by special
exercises, diet, special devices to support the bladder, medications, and/or surgery.
The non-surgical treatments should be tried first according to the Guidelines
for the Treatment of Urinary Incontinence in Adults (AHCPR).
Urge Urinary Incontinence - This
kind of Urinary Incontinence is associated with a strong need to urinate and an inability
to prevent urination until the appropriate time and place is reached. Urge Urinary
Incontinence occurs when the bladder contracts without the person's permission. People
who have this problem find that when they get home and put the key in the door, they
may have an extreme need to urinate and may leak urine. Some people find they leak
a little urine on the way to the bathroom, when they turn on the shower or when they
put their hands in water. It may be caused by bladder irritants such as certain foods
or drinks, medications, constipation etc. It can also be caused by a neurological
condition such as back injury, multiple sclerosis, congenital causes, stroke, etc.
Overflow Urinary Incontinence
- This type of Urinary Incontinence occurs because of the bladder's inability to
empty itself completely. When the bladder fills and can not empty, it frequently
mounts a contraction that squirts out small amounts of urine at a time. This can
be caused by obstruction of an enlarged prostate or a "fallen bladder",
neurological conditions, some medications, spasms of the pelvic floor, uncoordination
of bladder/sphincter (muscle that closes the urethra) mechanism, etc. It can be treated
by treating the cause, ie. surgery to remove obstruction, changing medications, lifting
the bladder either by surgery or pessary, etc. Sometimes it is treated by self catheterization
to remove the excess urine.
Functional Urinary Incontinence
- In this type of Urinary Incontinence there is nothing wrong with the bladder. This
type of incontinence is caused by the patients inability to get to the bathroom in
time. This may be caused by mobility problems from injury or arthritis. It may be
caused by dementia or alzheimer's disease that causes the patient to forget where
the bathroom is. Medication may also cause a person to miss the cues to toilet. There
may be obstacles in the way. There may be unavailable caregivers, etc.
Interstitial Cystitis (IC) -
People with interstitial cystitis experience significant urgency and frequency of
urination. They continuously feel as if they have to urinate and only urinate a small
amount at a time. There is usually pain in the lower abdomen or the urethra. Pain
is also frequently associated with intercourse. The Urology Wellness Center specializes
in alternative treatments for this condition. We have found that the pain may be
caused by infection with fastidious organisms (those which do not show up on standard
cultures). The pain may also be caused by muscle spasms and trigger points that refer
pain to the abdomen and bladder. Allergies, food substances, and the effects of yeast
infections can also cause the problems. Our studies show that most of our patients
experience a major lessening of pain and pressure, urinary frequency, and depression,
and an increase in level of functioning and quality of life. We use bladder training,
bowel training, special diet, treatment of trigger points and muscle spasms, biofeedback
for pelvic floor muscle rehabilitation, special antibiotics, and treatments for yeast,
and Frequency (Overactive Bladder) - This condition is similar to Interstitial
Cystitis, however, it has not been diagnosed by a physician. It is treated in similar
ways. Antibiotics are used for infection and treatment of fastidious organisms. Bladder
training, bowel training, special diet, special exercises, medications, and treatment
of muscle spasms and trigger points are also major parts of the treatment.
Vulvodynia - This condition is signified by
chronic pain in the vulva and vagina. Frequently the patient feels that the area
is red and swollen. Sexual intercourse is painful. The patient with vulvodynia may
also find that wearing blue jeans, stockings or even underpants causes excessive
pain. The Urology Wellness Center has found that vulvodynia patients respond to conservative
measures. These include diet, bowel training, medication, specific exercises, and
treatment for muscle spasm and trigger points.
Post - Prostatectomy
Urinary Incontinence - This condition is caused by the damage to nerves and
tissue by operations on the prostate, most specifically by removal of the prostate
for cancer. Treatment involves rehabilitating the pelvic floor muscle to compensate
for damage to the sphincter mechanisms and nerves. Medication, avoidance of bladder
irritants, and product support are also utilized.
Impotence - Impotence or sexual dysfunction is
the inability to achieve and maintain an erection to the satisfaction of both partners.
Impotence has a major effect on the quality of life of many people both male and
female. There are many reasons why men suffer from the the effects of impotence.
The Urology Wellness Center provides initial evaluation and treatment utilizing patient
education, counseling, medications (including Viagra and/or Yohimbine), vacuum erection
devices, etc. The Urology Wellness Center does not do injection therapy or surgery.
Philosophy of Treatment - The Philosophy
of Treatment for Interstitial Cystitis and Vulvodynia is to teach the patient to
heal herself or himself with guidance. It includes prescribing medications if necessary,
and some treatments such as biofeedback, treatment of trigger points with ice and
stretch and massage, but mostly it involves techniques and treatments that the patient
does herself/himself, such as diet and fluid management, special exercises, and special
treatments. This empowers the patient and allows her/him to have control of the condition.
The patients find that this decreases their fear (which is a pain magnifier) and
allows them to control relapses without spiraling down into the depths that they
had previously reached.
B.J. Reid Czarapata, CRNP, CUNP - B.J. is
the founder and President of the Urology Wellness Center. She is certified as an
Adult Nurse Practitioner and is also certified as a Urology Nurse Practitioner and
has been in Urology since 1986. She was part of the Division of Urology at Georgetown
University Medical Center in Washington, D.C. prior to starting the Urology Wellness
Center in 1992. She has previous experience in geriatrics, women's health, and orthopedics.
She is also Past President of the Society of Urologic Nurses and Associates, a member
of the Medical Advisory Board of the National Vulvodynia Association, the Nurse Practitioner Associations of
Maryland, D.C., and Virginia. She has written many articles
for professional journals, and speaks locally, nationally, and internationally.
As of January 1, 2000 the Urology Wellness Center joined with the Fairfax Urology Ltd., in Association with Wm. Lloyd Glover, M.D. a board certified urologist. The association with Dr. Glover has greatly increased the services available to our patients as well as making insurance more available.
What is a Nurse Practitioner -
A nurse practitioner is a registered nurse with extra medical education. The State
of Maryland allows nurse practitioners to: diagnose and treat stable chronic or simple
acute diseases, order or perform treatments, order testing, and prescribe medication.
American Academy of Nurse Practitioners defines a nurse practitioner as:
"a registered nurse (RN) who has advanced education and clinical training in
a health care specialty area. Nurse Practitioners work with people of all ages and
their families, providing information people need to make informed decisions about
their health care and lifestyle choices
Nurse Practitioners practice under
the rules and regulations of the Nurse Practice Act of the state in which they work.
Most nurse practitioners are also nationally certified in their specialty area. They
are recognized as expert health care providers.
Nurse Practitioners may be
found in all fifty states. Research studies since 1965 have documented that Nurse
High quality care Cost-effective care A unique approach to health care "Care
that results in a high level of patient satisfaction" From "The Nurse Practitioner
A Primary Health Care Professional" American Academy of Nurse Practitioners. http://www.aanp.org.
Contact us for information: insurance
or billing information, to have a brochure mailed to you, to obtain directions, to schedule appointments, etc.
Serving IC patients and providers in 69 countries.
Agency for Health Care Policy and Research To receive information on
the treatment of urinary incontinence in adults. Guidelines were published in
1992 and 1996. website:http://www.ahcpr.gov
National Kidney and Urologic Diseases Information Clearinghouse To
receive monographs on assorted urologic conditions. They also have information and
pamphlets on urinary incontinence in women. e-mail: firstname.lastname@example.org
National Association for Continence (formerly HIP - Help for Incontinent
People) To receive a Resource Guide for products and services for people with
incontinence or to receive their Quarterly Newsletter, visit their website www.nafc.org.
The Simon Foundation for Continence 847-864-3913 800 23-SIMON (800-237-4666) For
information on urinary continence. Also has programs and videos available for small
Society of Urologic Nurses and Associates (SUNA)(formerly AUAA) For
information on urologic nursing subjects. Continuing education available. Bi-annual
conference on continence. For referral to Continence Nurses in your area e-mail:
National Vulvodynia Association For information on Vulvodynia and to
receive newsletter. www.nva.org
Interstitial Cystitis Association To become a member and to receive
information on Interstitial Cystitis. http://www.ichelp.com
Interstitial Cystitis Information Center To receive information on
Interstitial Cystitis, particularly alternative therapies. Also available is a packet
that includes three articles by B.J. Czarapata, CRNP, CUNP and the diet used by the
Urology Wellness Center. There is a small charge for shipping and handling. http:\\www.moonstar.com\~icickay
The Wellness Interactive Network http://www.stayhealthy.com.
University of Connecticut Health System/UConn Health Center The clinical
web site for the John Dempsey Hospital in Farmington, CT. They offer current information
on disease, wellness, clinical trials and research as well as clinical content on
health topics such as Cardiac Care, Orthopaedic Surgery, Urology, Behavioral/Mental
Health, Women's Health and more. http://www.uconnhealth.org.