rtb2008-02

Medical Care

Recovering from a Hip Fracture

What is a hip fracture?

A hip fracture is a break in the bones of your hip (near the top of your leg). It can happen at any age, although it is more common is people 65 and older. As you get older, the inside of your bones becomes porous from a loss of calcium. This is called losing bone mass. Over time, this weakens the bones and makes them more likely to break. Hip fractures are more common in women, because they have less bone mass to start with and lose bone mass more quickly than men.

What are the symptoms of a hip fracture?

Hip fractures usually are caused by a fall. If you fracture your hip, you may experience the following symptoms:

Severe pain in your hip or pelvic area
Bruising and/or swelling in your hip area
Inability to put weight on your hip or difficult walking
The injured leg may look short than the other leg and may be turned outward

Any time you fall and are unable to get up or stand, call your doctor right away. He or she may take an X-ray to check for hip fracture.

How is a hip fracture treated?

Most people who have hip fractures will need surgery to make sure the leg heals properly. Your doctor will discuss your surgery options with you.

Some people are unable to have hip surgery because of an illness or poor health. If your doctor doesn't think it's safe for you to have surgery, you will be put into traction to help your hip heal. Traction keeps you immobile for a long period of time.

What can I expect after surgery?

Your doctor can tell you when you should try to stand or walk after surgery. It may be painful to walk at first. You may need a walker or cane for assistance for several months after surgery.

You may need to see a physical therapist as part of your recovery. In physical therapy, you'll learn to sit, stand and walk without reinjuring your hip. You'll also do exercises to help you get stronger.

When you return home after your surgery, you may need some help from a home nurse or family member. Daily tasks may be difficult to perform while you aren't able to move around very well. A family member or nurse can help you with your daily tasks, such as bathing, cooking and shopping.

What about complications?

A hip fracture is a serious injury, but the complications from a hip fracture can be severe or even life-threatening. If you are immobile for a long period of time after your surgery, or if you are in a traction, you are at risk of developing deep vein thrombosis. Deep vein thrombosis (also called DVT) is a blood clot in a vein deep inside your body. These clots usually occur in your leg veins. If the blood clot breaks away and travels through your bloodstream, it could block a blood vessel in your lungs. This blockage (called a pulmonary embolism) can be fatal.

Other complications from immobility after hip surgery can include:

Pressure sores
Pneumonia
Muscle wasting
Urinary tract infections
Bedsore

How can I prevent another hip fracture?

To help prevent a hip fracture, you should:

Get regular physical activity to keep your bones and muscles strong.
Don't drink or smoke.
Eat and drink more products with calcium (for example: milk, cottage cheese, yogurt, sardines and broccoli) to keep your bones strong.
Take vitamin D each day, which helps your body absorb calcium. Your doctor can tell you how much vitamin D is safe for you.
If your doctor suggests that you use a cane or a walker to help you walk, be sure to use it. This will give you extra stability when walking and will help you avoid a bad fall.
See your eye doctor once a year. If you can't see well because of cataracts or other eye diseases, you are more likely to fall.
Ask your doctor about medicines that can keep your bones strong and about products that can protect your hips if you fall.
Make your house safer. Make sure that you have good lighting in your home, which will help you avoid tripping over objects that are not easy to see. Put night lights in your bedroom, hallways and bathrooms. Rugs should be firmly fastened to the floor or have nonskid backing. Loose ends should be tacked down. Electrical cords should not be lying on the floor in walking areas. Put hand rails in your bathroom for bath, shower and toilet use. Have rails on both sides of your stairs for support. Be sure the stairs are well lit.

Restless Legs Syndrome

What is restless legs syndrome (RLS)?

Restless legs syndrome (also called RLS) is a condition in which your legs feel very uncomfortable when you are sitting or lying down. It affects both men and women and can occur at any age, including during childhood, but often worsens with age and becomes a problem for older adults. RLS can make sleeping and traveling difficult and uncomfortable. Some cases of RLS are related to other conditions, such as pregnancy, iron-deficiency anemia or kidney failure. Other cases of RLS have no known cause. RLS may be hereditary, which means it can run in your family.

What does it feel like to have RLS?

People who have RLS say it's difficult to describe their symptoms. If you have RLS, you may have a "creepy-crawly" feeling in your legs that makes you want to move around. You may experience achy, tingly or burning sensations in your legs, which can make it difficult to sleep or sit for long periods of time. Moving your legs makes the feeling go away for a few minutes, but it comes back after you sit or lie still again. Your legs may also twitch when you try and sleep (also called periodic limb movements of sleep or PLMS).

How does my doctor know I have RLS?

Tell your doctor about the restless sensations. He or she will ask you questions about your symptoms, such as when they start and whether you're able to do anything to make them go away. He or she may also ask if any other people in your family have similar symptoms.

Tell your doctor about any medications (including over-the-counter medication) that you're taking. Certain medications can make RLS symptoms worse. Your doctor can recommend another medicine if this seems to be happening to you.

What is the treatment for RLS?

Treatment for RLS includes medications and lifestyle changes. See the box below for a list of things that you can do at home to help relieve your symptoms.

Medications used to treat Parkinson's disease can help reduce tremors and twitching in the legs. If your iron levels are low, your doctor may prescribe an iron supplement. Sleep aids, muscle relaxants (called benzodiazepines) and pain medications (called opioids) may also relieve symptoms. In some cases, an anticonvulsant medicine (usually used to stop seizures) can be helpful. For many cases of RLS, a combination of medications is usually needed to best treat the condition. Your doctor may prescribe several trials of medication before finding one that works best for your case of RLS.

Lifestyle changes to treat RLS

For mild symptoms, use an over-the-counter pain reliever to reduce twitching and restless sensations.
Cut back on alcohol, caffeine and tobacco.
Try taking a hot bath and massaging your legs before bedtime to help you relax.
Relaxation techniques, such as meditation and yoga, can help you relax before bed.
Apply warm or cool packs, which can help relieve sensations in your legs.
Try to distract your mind by reading, doing a crossword puzzle or playing a video game while you wait for sleep to come.
Moderate exercise may help, but don't overdo it--exercising vigorously or late in the day may make symptoms worse.
Try to go to bed at the same time every night and arise at the same time every morning. Also try to get a sufficient amount of sleep each night.

What else can I do?

Keep your doctor posted on how you're feeling. He or she can suggest different relaxation techniques and can change your medicine if it's not helping. You may want to join a support group to talk to other people who are suffering from RLS. Also, because RLS tends to run in families, you may want to talk to your relatives about your RLS and see if they have similar symptoms.

Deep Vein Thrombosis: What You Should Know

What is deep vein thrombosis?

Deep vein thrombosis (also called DVT) is a blood clot in a vein deep inside your body. These clots usually occur in your leg veins. While DVT is a fairly common condition, it is also a dangerous one. If the blood clot breaks away and travels through your bloodstream, it could block a blood vessel in your lungs. This blockage (called a pulmonary embolism) can be fatal.

Am I at risk for DVT?

You are at higher risk for DVT if you:

are older than 60 years of age;
are inactive for a long period of time, such as when you are flying in an airplane, taking a long car trip or recovering in bed after surgery;
have inherited a condition that causes increased blood clotting;
have an injury or surgery that reduces blood flow to a body part;
are pregnant or have recently given birth;
are overweight;
have varicose veins;
have cancer, even if you are being treated for it;
are taking birth control pills or hormone therapy, including for postmenopausal symptoms; or
have a central venous catheter.

Your risk for DVT increases if you have several risk factors at the same time.

How can I prevent DVT?

Frequently exercise your lower leg muscles if you'll be inactive for a long period of time.
Get out of bed and move around as soon as you can after having surgery or being ill.
After some types of surgery, take medicine to prevent blood clots as directed by your doctor.

What are the symptoms of DVT?

Some people have no symptoms at all. Most have some swelling in one or both legs. Often there is pain or tenderness in one leg (may happen only when you stand or walk). You may also notice warmth, or red or discolored skin in the affected leg. If you have any of these symptoms, call your doctor right away.

If your doctor thinks you might have DVT, he or she will do one or more tests. These may include an ultrasound (uses sound waves to check the blood flow in your veins) or venography (a doctor injects dye into your vein, then takes an x-ray to look for blood clots).

What medicines are used to treat DVT?

The following are the main goals in treating DVT:

Stopping the clot from getting bigger.
Preventing the clot from breaking off and traveling to your lungs.
Preventing any future blood clots.

Several medicines are used to treat or prevent DVT. The most common are anticoagulants (also called blood thinners) such as warfarin (brand name: Coumadin) or heparin. Anticoagulants thin your blood so that clots won't form. Warfarin is taken as a pill, and heparin is given intravenously (in your veins). If you can't take heparin, your doctor may prescribe another kind of anticoagulant called a thrombin inhibitor.

What are the side effects of anticoagulants?

Anticoagulants can cause you to bleed more easily. For example, you might notice that your blood takes longer to clot when you cut yourself. You might also bruise more easily. If you have any unusual or heavy bleeding, call your doctor right away.

Warfarin can cause birth defects. Women who are pregnant shouldn't take warfarin.

Some other medicines can affect how well an anticoagulant works. If you're taking an anticoagulant, ask your doctor before you take any new medicine, including over-the-counter medicines or vitamins. Certain foods rich in vitamin K, such as dark green vegetables, can also affect how well an anticoagulant works.

What other treatments are used for DVT?

If you can't take medicine to thin your blood, or if a blood thinner doesn't work, your doctor may recommend that you have a filter put into your vena cava (the main vein going back to your heart from your lower body). This filter can catch a clot as it moves through your bloodstream and prevent it from reaching your lungs. This treatment is used mostly for people who have had several blood clots travel to their lungs.

Elevation of the affected leg and compression can help reduce swelling and pain from DVT. Your doctor can prescribe graduated compression stockings to reduce swelling in your leg after a blood clot has developed. These stockings are worn from the arch of your foot to just above or below your knee. They cause a gentle compression (pressure) of your leg.

Arthritis: How to Stay Active and Independent

What is arthritis?

Arthritis means inflammation of the joints. It causes pain and usually also limits movement of the joints that are affected. There are many kinds of arthritis. A type called osteoarthritis (also called degenerative joint disease) is the most common.

What causes osteoarthritis?

The exact cause isn't known. A person may be at increased risk of osteoarthritis because it runs in the family. Osteoarthritis seems to be related to the wear and tear put on joints over the years in most people. But wear and tear alone don't cause osteoarthritis.

What happens when a joint is affected?

Normally, a smooth layer of cartilage acts as a pad between the bones of a joint. Cartilage helps the joint move easily and comfortably. In some people, the cartilage thins as the joints are used. This is the start of osteoarthritis. Over time, the cartilage wears away and the bones may rub against one another.

Bones may even start to grow too thick on the ends where they meet to make a joint, and bits of cartilage and bone may loosen and get in the way of movement. This can cause pain, joint swelling and stiffness.

Who gets osteoarthritis?

Osteoarthritis is more common in older people because they have been using their joints longer. Using the joints to do the same task over and over or simply using them over time can make osteoarthritis worse.

Younger people can also get osteoarthritis. Athletes are at risk because they use their joints so much. People who have jobs that require the same movement over and over are also at risk. Injuries to a joint can increase the risk of arthritis in the joint later on. Excess weight also can accelerate arthritis in the knees, hips and spine.

Is there a treatment?

No cure for osteoarthritis has been found. But the right plan can help you stay active, protect your joints from damage, limit injury and control pain. Your doctor will help you create the right plan for you.

Tips on staying active

Lose weight if you're overweight.
Exercise regularly for short periods.
Go to a physical therapist if you can.
Use canes and other special devices to protect your joints.
Avoid lifting heavy things.
Avoid overusing your joints.
Don't pull on objects to move them--push them instead.
Take your medicine the way your doctor suggests.
Use heat and/or cold to reduce pain or stiffness.

Will my arthritis get worse?

Osteoarthritis does tend to get worse over time. But you can do many things to help yourself.

It's important to stay as active as possible. When joints hurt, people tend not to use them and the muscles get weak. This can cause contractures (stiff muscles), and it can make it harder to get around. This causes more pain and the cycle begins again. Ask your doctor to discuss pain control with you so that you can stay active and avoid this problem.

Will medicine help?

Medicines you can buy without a prescription that reduce inflammation, such as aspirin, ibuprofen (one brand name: Motrin), ketoprofen (brand name: Orudis) or naproxen (brand name: Aleve), or pain relievers, such as acetaminophen (one brand name: Tylenol), can help you feel better. Your doctor can also prescribe medicine for you, such as prescription pain relievers or nonsteroidal anti-inflammatory drugs (NSAIDs) used to treat certain types of arthritis. NSAIDs can help by reducing inflammation, swelling and pain in the joints, but not everyone can take them.

Medicine should be used wisely. You only need the amount that makes you feel good enough to keep moving. Using too much medicine may increase the risk of side effects.

Can special devices really help?

Yes. Special devices (see box below) and different ways of doing things can help people with arthritis stay independent for as long as possible. These devices help protect your joints and keep you moving. For example, if you learn to use a cane the right way, you can help reduce the amount of pressure your weight puts on your hip joint when you walk by up to 60%. Talk to your doctor if you think a special device may help your arthritis.

Special devices for people with arthritis

Canes, walkers and splints
Shoe inserts, wedges or pads
Special fasteners (such as Velcro) on clothing
Large grips for tools and utensils (wrap foam or fabric around items with narrow handles, like pens)
Wall-mounted jar openers
Electric appliances, such as can openers and knives
Mobile shower heads
Bath seats and grab bars for the bathtub

Will special exercises really help?

Yes. Exercise keeps your muscles strong and helps you stay flexible. Exercises that don't strain your joints are best. To avoid pain and injury, choose exercises that can be done in small amounts with rest time in between. Dancing, weight lifting and bike riding are good exercises for people with arthritis.

Try tightening your muscles and then relaxing them a number of times. You can do this with all of your major muscle groups. You could also try an "aquacise" program available through your local swimming pool or community center. These programs involve special movements in the pool, with much of your body's weight held up by water.

Talk to your doctor before starting a new exercise program.

Should I use heat to ease pain?

Using heat may reduce your pain and stiffness. Heat can be applied through warm baths, hot towels, hot water bottles or heating pads. Try alternating heat with ice packs.

Osteoporosis in Women: Keeping Your Bones Healthy and Strong

What is osteoporosis?

In osteoporosis, the inside of the bones becomes porous from a loss of calcium (see the picture below). This is called losing bone mass. Over time, this weakens the bones and makes them more likely to break.

Osteoporosis is much more common in women than in men. This is because women have less bone mass than men, tend to live longer and take in less calcium, and need the female hormone estrogen to keep their bones strong. If men live long enough, they are also at risk of getting osteoporosis later in life.

Once total bone mass has peaked—around age 35—all adults start to lose it. In women, the rate of bone loss speeds up after menopause, when estrogen levels fall. Since the ovaries make estrogen, faster bone loss may also occur if both ovaries are removed by surgery.

Normal bone versus bone affected by osteoporosis

What are the signs of osteoporosis?

You may not know you have osteoporosis until you have serious signs. Signs include broken bones, low back pain or a hunched back. You may also get shorter over time because osteoporosis can cause your vertebrae (the bones in your spine) to collapse. These problems tend to occur after a lot of bone calcium has already been lost.

Am I at risk for osteoporosis?

Risk factors for osteoporosis

Menopause before age 48
Surgery to remove ovaries before menopause
Not getting enough calcium
Not getting enough exercise
Smoking
Osteoporosis in your family
Alcohol abuse
Thin body and small bone frame
Fair skin (caucasian or Asian race)
Hyperthyroidism
Long-term use of oral steroids

See the box to the right for a list of things that put you at risk for osteoporosis. The more of these that apply to you, the higher your risk is. Talk to your family doctor about your risk factors.

Will I need a bone density test?

Check with your doctor. For many women, osteoporosis (or the risk of it) can be diagnosed without testing. When testing is appropriate, doctors use equipment that takes a “picture” of the bones to see if they are becoming porous.

What is calcitonin?

Calcitonin (some brand names: Calcimar, Miacalcin) is a hormone that helps prevent further bone loss and reduces the pain that some people have with osteoporosis.

Calcitonin can be taken as a shot or as a nasal spray. Its most common side effect is nausea.

What is ibandronate sodium?

Ibandronate sodium (brand name: Boniva) is a new drug that is taken once a month. It is not a hormone, but it slows bone loss and increases bone density. Some of the possible side effects include upset stomach, heartburn, nausea and diarrhea.

What are alendronate and risedronate?

Alendronate (brand name: Fosamax) and risedronate (brand name: Actonel) are not hormones, but are used to help prevent and treat osteoporosis. These drugs help reduce the risk of fractures by decreasing the rate of bone loss. Their most common side effect is an upset stomach.

What is raloxifene?

Raloxifene (brand name: Evista) is a drug used to prevent and treat osteoporosis by increasing bone density. It is not a hormone, but it mimics some of the effects of estrogen. Side effects may include hot flashes and a risk of blood clots.

What is teriparatide?

Teriparatide (brand name: Forteo) is a new injectable synthetic hormone used once a day for the treatment of osteoporosis. It causes new bone growth. Common side effects may include nausea, dizziness and leg cramps.

How much calcium do I need?

Before menopause, you need about 1,000 mg of calcium per day. After menopause, you need 1,000 mg of calcium per day if you're taking estrogen and 1,500 mg of calcium per day if you're not taking estrogen.

It’s usually best to try to get calcium from food. Nonfat and low-fat dairy products are good sources of calcium. Other sources of calcium include dried beans, sardines and broccoli.

About 300 mg of calcium are in each of the following: 1 cup of milk or yogurt, 2 cups of broccoli, or 6 to 7 sardines.

If you don’t get enough calcium from the food you eat, your doctor may suggest taking a calcium pill. Take it at meal time or with a sip of milk. Vitamin D and lactose (the natural sugar in milk) help your body absorb the calcium.

Menopause: What to Expect When Your Body is Changing

What is menopause?

Menopause is a normal part of a woman's life. It is when the menstrual periods permanently end. This happens because as a woman ages, her ovaries make less of the female hormones estrogen and progesterone. These are the hormones that regulate your menstrual cycle.

When does menopause occur?

The average age for women to have their last period is about 51. But it's normal for menopause to occur any time from age 40 to 59. A woman often goes through menopause at about the same age as her mother.

Women who have both ovaries removed will go through "surgical menopause" at the time of their surgery. If the uterus is taken out but the ovaries are not, a woman will stop having periods, but she will not go through surgical menopause.

If you stop having periods early (before age 40) your doctor can do a blood test to see if you're actually going through menopause or if there is another cause for your missed periods.

Menopause is a gradual process that can take several years. You're not really through menopause until you haven't had a period for 12 months. (During this time, keep using birth control if you don't want to become pregnant.)

Talk to your doctor if you have:

A change in your monthly cycle
Heavy bleeding
Bleeding that lasts longer than usual
Bleeding more often than every 3 weeks
Bleeding after sexual intercourse
Any blood spotting between periods

What are the common signs and symptoms of menopause?

Help for hot flashes

Turn your thermostat down. Sleep in a cool room.
Dress in layers, so you can remove clothing when you get too warm.
Wear cotton and other natural fabrics that "breathe" so you don't get overheated. Use cotton sheets on your bed.
Drink cool water or other beverages when a hot flash starts.
Get plenty of exercise.
Find out what triggers your hot flashes and avoid them. Spicy foods, alcohol, tight clothing and hot humid weather are some common triggers.

Some women just stop having periods. Most women experience some symptoms, such as the following:

A change in your menstrual cycle. This is one of the first signs of menopause. You may skip periods or they may occur closer together. Your flow may be lighter or heavier than usual.

Hot flashes. Hot flashes are the most common symptom of menopause.

When you have a hot flash, you'll feel warm from your chest to your head, often in wave-like sensations. Your skin may turn red and you may sweat. You may feel sick to your stomach and dizzy. You may also have a headache and feel like your heart is beating very fast and hard.

Vaginal dryness. During and after menopause, the skin of your vagina and vulva (the area around your vagina) becomes thinner. Your vagina also loses its ability to produce as much lubrication (wetness) during sexual arousal. These changes can lead to pain during sex.

You can use an over-the-counter water-based sexual lubricant (such as K-Y Jelly) or moisturizers for the vaginal area (such as Vagisil) to make sex less painful. You can also talk to your doctor about the benefits and risks of using prescription estrogen cream for vaginal changes.

Urinary tract problems. You're more likely to have bladder and urinary tract infections during and after menopause. Talk to your doctor if you have to go to the bathroom often, feel an urgent need to urinate, feel a burning sensation when urinating or are not able to urinate.

Headaches, night sweats, trouble sleeping and tiredness are other symptoms. Trouble sleeping and feeling tired may be caused by hot flashes and night sweats that keep you from getting a good night’s rest.

Weight gain. Many women gain weight during menopause. A healthy diet and exercising most, if not all, days of the week will help keep you fit.

Does menopause have emotional symptoms?

Many women experience emotional symptoms during menopause. These symptoms may include sadness, anxiety and mood swings. For some women, symptoms can be severe. If you find that you're having emotional problems, talk to your family doctor.

What is hormone replacement therapy?

Hormone replacement therapy (HRT) is a treatment for menopause that involves taking synthetic hormones (which are made in a laboratory rather than by the body). HRT can be estrogen taken alone or estrogen combined with another hormone, progestin. Some women have found that HRT can relieve symptoms such as hot flashes, vaginal dryness and some urinary problems. However, HRT is not for everyone. New information from recent studies suggests that for many women, the risks of using HRT may outweigh the benefits. Talk to your doctor about the risks and benefits of HRT.

Are other treatments available?

Yes. Medicines such as estrogen cream, low-dose antidepressants, soy products and certain herbal supplements may help ease some menopausal symptoms. Discuss these options with your doctor.

Urinary Incontinence

What is urinary incontinence?

Urinary incontinence is the loss of bladder control. This means that you can't always control when you urinate. Urinary incontinence can range from leaking a small amount of urine (such as when coughing or laughing) to having very strong urges to urinate that are difficult to control. This can be embarrassing, but it can be treated.

Millions of adults in the United States have urinary incontinence. It's most common in people over 50 years old, especially women. 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, skin infections 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 and stretched pelvic muscles after childbirth
Certain medicines
Build-up of stool in the bowels
Overweight and obesity, which increases pressure on the bladder and muscles that control the bladder
Urinary tract infections
Vascular disease
Diseases such as diabetes, Alzheimer's disease and multiple sclerosis

Are there different types of incontinence?

Yes. There are 5 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 very suddenly, often 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 a urinary tract infection or an overactive bladder.

Overflow incontinence
This type of incontinence is the uncontrollable leakage of small amounts 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.

Mixed incontinence
This type involves more than one of the types of incontinence listed above.

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 through strengthening the pelvic muscles. 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.
Repeat this 10 to 20 times, 3 times a day.
You may need to start slower, perhaps squeezing and relaxing your muscles for 4 seconds each and doing this 10 times, 2 times a day. Work your way up from there.

What is bladder training?

Some people who have 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 (fore example, 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 it is time to go to the bathroom. 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. Several prescription medicines are available to treat urge incontinence. For men, prescription medicine is available to shrink the prostate and improve flow of urine through the prostate. Talk to your doctor about possible medicine options for your type of incontinence.

Surgery can sometimes be helpful, especially in stress incontinence in women and in overflow incontinence in men due to an enlarged prostate. It is usually only performed if other treatments haven't worked or if the incontinence is severe.

Kegel Exercises for Your Pelvic Muscles

How do pelvic muscles get weak?

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 my 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 sets of 10 to 20 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 a heavy object or jumping. This can prevent pelvic muscle damage and urine leakage.

Urinary Incontinence: Bladder Training

What is urinary incontinence?

Urinary incontinence means that you can't always control when you urinate. Urinary incontinence is caused by weak pelvic muscles, certain medicines, build-up of stool in the bowels and problems such as diabetes and 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 happen to younger people.

There are 4 main types of urinary incontinence:

Stress incontinence
Urge incontinence
Overflow incontinence
Functional incontinence

Your doctor will help you determine which type of incontinence you have and whether bladder training can help you.

What is bladder training?

Bladder training is a way of learning to manage urinary incontinence. It is generally used for 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. Some bladder training techniques are explained below.

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 about starting a bladder training program. He or she may ask you to keep a diary to record how much and how often you urinate. This information will help your doctor create a plan that's right for you.

Three bladder training methods are listed below. 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 when they feel the urge. You 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, you try to increase the time to 10 minutes until you're urinating every 3 to 4 hours. When you feel the urge to urinate before your time is up, you can try relaxation techniques. Breathe slowly and deeply. Concentrate on your breathing until the urge goes away. Kegel exercises may also help control urges.
Scheduled bathroom trips: Some people control their incontinence by going to the bathroom on a schedule. This means that you go to the bathroom at set times, whether you feel the urge or not. For example, you might start by going to the bathroom every hour. Then gradually you increase the time until you find a schedule that works for you.

Keep in mind that bladder training can take 3 to 12 weeks. During your 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 see if bladder training is helping. 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 make some changes in 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 it.

Fecal Incontinence

What is fecal incontinence?

Fecal incontinence is the inability to control of the bowel movements. This leads to stool (feces) leaking from the rectum (the last part of the large intestine) at unexpected times. This problem affects as many as more than 5.5 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.

Why does fecal incontinence occur?

Bowel function is controlled by 3 things: anal sphincter pressure, rectal sensation and rectal storage capacity. The anal sphincter is a muscle that contracts to prevent stool from leaving the rectum. This muscle is critical in maintaining continence. This is the rectal storage capacity. Rectal sensation tells a person that stool is in the rectum and that it is time to go to the bathroom. The rectum can stretch and hold stool for some time after a person becomes aware that the stool is there.

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.

What causes fecal incontinence?

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 or an episiotomy. An episiotomy is when a cut is made to enlarge the opening to the vagina before delivery. Muscle damage can also occur during rectal surgery such as surgery for hemorrhoids. It may also occur in people with inflammatory bowel disease or a perirectal abscess.

People can often compensate for muscle weakness. Typically, incontinence develops later in life when muscles are growing weaker and the supporting structures in the pelvis are becoming loose.

Damage to the nerves that control the anal muscle or regulate 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 diarrhea is more difficult to control than formed stool, it is an added stress that can lead to fecal incontinence.

If I have fecal incontinence, what can be done?

Fortunately, effective treatment for fecal incontinence is available, so it's important that you talk to your doctor about it. Attempts at self-treatment are usually unsuccessful. Along with a physical exam, your doctor may want to do other tests such as an anorectal manometry, which tests anal pressure, rectal elasticity and rectal sensation. These tests can pinpoint the cause of your incontinence.

The treatment of fecal incontinence varies and depends on the cause of your problem. Your doctor may recommend one or more of the following treatments:

Dietary changes: Preventing diarrhea and constipation are usually very helpful in controlling incontinence. Changes in your diet such as adjusting the amount of fiber you eat, drinking more fluids, or changing the amount of food you eat can often prevent diarrhea and constipation.
Medicine: Your doctor may prescribe laxatives, anti-diarrhea drugs or stool softeners to treat incontinence. Talk to your doctor before you take any over-the-counter incontinence medicines.
Bowel training: Developing a regular bowel movement pattern can be very helpful. This may involve going to bathroom at specific times of the day such as after you eat, or a treatment called anorectal biofeedback. This procedure measures your sphincter contractions while you do special exercises--called Kegel exercises. Biofeedback training can strengthen your sphincter muscles and give you more control over bowel movements.
Surgery: Several different surgical procedures can treat fecal incontinence. Often these surgeries repair or replace sphincter muscles.

Constipation

What is constipation?

Constipation is a common digestive problem. It may be difficult for you to have a bowel movement, or your bowel movements may be infrequent. 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. It's not true that you must have a daily bowel movement to be considered "regular." A normal range is anywhere between 3 times a day to 3 times a week. You may be getting constipated if you start having bowel movements much less often than you usually do.

Tips on preventing constipation

Don't resist or ignore 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 (8 glasses a day is a good goal). Fluids can include water, juices, soup, tea and other drinks.
Don't take laxatives too often. Overuse of laxatives may damage your bowels and may actually make constipation worse.
Exercise more often.
Limit foods that are high in fat and sugar (such as sweets, cheese and processed foods). These foods may cause constipation.

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 medicines, not going to the bathroom when you have the urge to have a bowel movement and regularly using laxatives. Constipation is also common in pregnant women. Any of these things can cause the stools to move more slowly through your intestines, leading to constipation.

How is constipation treated?

Eating enough fiber and drinking enough fluids are key to treating constipation. They help your stools move through your intestines by increasing the bulk of your stools and making your stools softer. Increasing how often you exercise will also help.

Talk to your family doctor if:

Constipation is new and unusual for you
You have constipation for 3 weeks or more despite at-home treatment (such as diet changes)
You have abdominal pain
You notice any blood in your stools
You lose weight without reason

What should I eat?

Eat plenty of fiber. At least 2 cups of fruits and 2 1/2 cups of vegetables per day is recommended. It is suggested that men age 50 and younger consume at least 38 grams of fiber per day, while women age 50 and younger should consume at least 25 grams per day. 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, also.

Foods rich in fiber

Unprocessed wheat bran
Unrefined breakfast cereals
Whole-grain bread and brown rice
Fresh fruits
Dried fruits (such as prunes, apricots and figs)
Vegetables
Beans (such as navy, kidney and pinto 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 your body gets used to it) until your stools are softer and easier to pass.

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 it, 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 necessary to relieve constipation. It's better to let your body work 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 period of time. This means eating plenty of fiber, possibly 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 gradually reduce the use of them to give your body a chance to return to normal. Be patient because 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. 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 destroys the nerve cells in the eye, which leads to vision loss. 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. Vision loss caused by glaucoma is permanent.

What are the symptoms of glaucoma?

Most people who have glaucoma don't have any symptoms. 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 (sudden or short-term) attack of glaucoma. In these cases, the eye becomes red and extremely painful. Nausea, vomiting and blurred vision may also 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 regularly. 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 7 or 8 hours of sleep each night to feel fully alert during the day. This is usually also true for people age 65 or older. 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 or they might not stay asleep all night (called insomnia). They might wake up very early in the morning and not be able to go back to sleep.

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 may not seem to work as well as it did when he or she was younger. As we age, our body makes less of the chemicals and hormones that help us sleep well (growth hormone and melatonin). Some lifestyle habits (such as smoking and drinking alcohol or caffeinated drinks) 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. However, people of all ages can have a sleep disorder such as sleep apnea. Restless legs syndrome or periodic limb movement disorder are also conditions that can cause problems with sleep.

What is sleep apnea?

Sleep apnea is a disorder in which a person stops breathing repeatedly while asleep. People who have sleep apnea usually snore very loudly. They stop breathing for 10 to 30 seconds during sleep and then 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, which disrupts sleeping patterns and makes it hard for the person to get a good night's rest. It can also cause high blood pressure and increase the risk of heart attack.

If you have sleep apnea and are overweight, it might help to lose weight. If you smoke, you should quit. It will also help to sleep on your side, stop drinking alcohol or using sleep medicines. Many people who have 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 is an option for people who have severe cases of sleep apnea.

What is restless legs syndrome (RLS)?

RLS is a condition in which your legs feel very uncomfortable when you are sitting or lying down. RLS can make it hard for you to sleep.

What is periodic limb movement disorder (PLMD)?

PLMD is a condition in which a person 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 prevents good sleep and causes daytime sleepiness. Some people who have restless legs syndrome also have periodic limb movements during sleep. Medicine may help both of these problems.

What can I do to sleep better?

Go to bed and get up at the same time every day, even on the weekends.
Do not take naps longer than about 20 minutes.
Don't read, snack or watch TV in bed. Use your bedroom for sleep and other rooms for other activities
Avoid caffeine about 8 hours before bedtime.
Avoid nicotine and alcohol in the evening. Alcohol might help you fall asleep initially, 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 in a different room, such as 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. Medicines that can disrupt sleep include antidepressants, beta-blockers and cardiovascular drugs.
Ask your doctor for help if pain or other health problems keep you awake.
Try to exercise a little every day. Exercise helps many older adults sleep better.

CPAP Devices for Sleep Apnea

What is sleep apnea?

In some people, the windpipe that brings air into the body is blocked during sleep. This keeps the lungs from getting enough air. This is called obstructive sleep apnea. People who have sleep apnea stop breathing for 10 to 30 seconds at a time while they are sleeping. These stops can happen up to 400 times every night. The consequences of these disturbances can be serious and sometimes life-threatening.

What is a CPAP device?

One way to treat people who have sleep apnea is a continuous positive airway pressure (CPAP) device. A CPAP device includes a mask, tubes and a fan. It uses air pressure to push your tongue forward and open your throat. This allows air to pass through your throat. It reduces snoring and prevents apnea disturbances.

You should put your CPAP device on whenever you sleep, even for naps. A CPAP device does not cure sleep apnea. But, when you use the device correctly, your sleep problems should get much better.

Do I need a CPAP device?

Talk to your doctor if you think you have sleep apnea. Your doctor may ask you to go to a sleep center for a sleep study. During your sleep study, you may try different levels of air pressure with a CPAP device to see which level helps. In general, heavier people and people who have severe apnea need higher air pressures. If you need a CPAP device, your doctor will help you choose one that is right for you.

What if I have problems with my CPAP device?

Many people have problems with their CPAP device, especially at first. Don't give up. Often, the problems go away when you get used to wearing the device. It may also be helpful for you to find a support group in your area so that you can talk with other people who also have sleep apnea.

The following are some common problems you may have with your CPAP device, and some possible solutions:

The mask feels uncomfortable. Because everyone's face has a different shape, you may need to try different masks to find one that fits you well.
Your nose feels dry and stuffy. You can try using a humidifier to moisten the air from the CPAP device.
Your nose feels blocked up. Some people who have sleep apnea also have nose problems. Ask your doctor if you have a nose problem that can be treated with a nasal spray. Surgery is sometimes also an option. People who breathe through their mouths don't do as well with CPAP nose masks. In this case, a full-face mask that covers both the nose and the mouth may help (see the picture below).
The mask bothers your skin and nose. Because the mask must fit firmly over your nose and cheeks, it may irritate your skin. A different size or kind of mask may help. There are also special skin moisturizers made for CPAP device users. Some petroleum-based products can damage the mask, so ask your doctor for more information. Some people also benefit from using nasal pillows that fit into the nostrils and relieve pressure on the bridge of the nose (see the picture below). Using a regular CPAP mask one night and nasal pillows the next night may help you feel more comfortable.
The mask leaks air. Some people can't keep their jaw closed while wearing the mask. A chin strap can help hold up your jaw to keep the air in (see the picture below).
You don't like the pressure. You may find that breathing out against the air pressure keeps you from sleeping deeply. Your doctor may ask you to use a bi-level machine that lowers the air pressure when you breathe out. The same mask may be used with CPAP and bi-level machines.
You take the mask off during your sleep or don't wear it every night. Most people can't wear the mask all night long, every night, right from the start. Keep trying, even if you can only use the mask for an hour a night at first. Once you solve your comfort problems, you should be able to increase the time you wear the mask.
You just can't get used to the mask. Some people find that wearing a dental device that pushes their tongue forward helps. You may want to talk with your doctor about whether throat or jaw surgery could help.

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?

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 the 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. For example, 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, dementia (severe problems with memory and thinking, such as Alzheimer's disease), side effects of drugs, strokes, head injury and alcoholism.

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.

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.

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

Prostate Cancer

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?

The body is made up of many types of cells. Normally, cells grow, divide and then die. Sometimes, cells mutate (change) and begin to grow and divide more quickly than normal cells. Rather than dying, these abnormal cells clump together to form tumors. If these tumors are cancerous (also called malignant tumors), they can invade and kill your body's healthy tissues. From these tumors, cancer cells can metastasize (spread) and form new tumors in other parts of the body. By contrast, noncancerous tumors (also called benign tumors) do not spread to other parts of the body. Prostate cancer is abnormal cells in the prostate gland.

Like many types of cancer, prostate cancer can be aggressive. This means it grows quickly and can spread to other parts of the body. (When cancer spreads, doctors say the cancer has "metastasized.") Prostate cancer can also grow more slowly.

If you have prostate cancer, it is important for your doctor to monitor the growth of your cancer carefully. If left completely unchecked, the cancer can grow quickly and spread to other organs in your body. This makes treatment much more difficult.

Who is at risk for prostate cancer?

Prostate cancer is the most common type of cancer found in American men, other than skin cancer.

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.

For unknown reasons, African-American men are at higher risk than Caucasian men. Men with a family history of prostate cancer are at higher risk, too. In this case, family history means that your father or a brother had prostate cancer.

Men who are obese and eat a diet high in fat are also at a higher risk for prostate cancer.

Possible Symptoms of Prostate Cancer

Prostate cancer, especially in its early stages, often does not have any symptoms. Symptoms are more likely to appear as the cancer grows.

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, especially at night
Blood or pus in the urine
Pain while urinating
Pain with ejaculation
Hip and lower back pain that does not go away over time
Pain in the lower part of your pelvis
Unintended weight loss and/or loss of appetite

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 suggest additional testing to check for prostate 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 less serious causes, such as infection.

What are the treatment options for prostate cancer?

If prostate cancer is caught early and before it has spread to other parts of the body, it can often be treated successfully.

For early stages of prostate cancer, one option is "watchful waiting." Watchful waiting means seeing your doctor often so he or she can track the cancer. This can include frequent blood tests and rectal exams to check the growth of the cancer. This may be a good option for those with slow-growing cancer, or men who are elderly and/or in poor health. At any time during watchful waiting, you can choose to switch to another treatment.

It is important to realize that watchful waiting does not involve medication or treatment that will kill the cancer. It is just an observation period. If the cancer suddenly starts to grow more quickly or begins to cause symptoms, you may need to switch to a more aggressive treatment option.

Surgery, radiation and drug therapy are options that can treat your prostate cancer. These treatments can cause side effects, such as impotence and incontinence, but these side effects usually disappear after treatment.

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 or 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. Improving your relationship may help your sex life. If you decide to seek therapy, it 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 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 is 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 is sexual dysfunction?

When you have problems with sex, doctors call it "sexual dysfunction." Both 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 in your sex life. Certain medicines (such as oral contraceptives and chemotherapy drugs), diseases (such as diabetes or high blood pressure), excessive alcohol use or vaginal infections can cause sexual problems. Depression, relationship problems or abuse (current or past abuse) can also cause sexual dysfunction.

You may have less sexual desire during pregnancy, right after childbirth or when you are breastfeeding. After menopause many women feel less sexual desire, have vaginal dryness or have pain during sex due to a decrease in estrogen (a hormone in the body).

The stresses of everyday life can also affect your ability to have sex. Being tired from a busy job or caring for young children may affect your sexual desire. You may also 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 in their relationship. Most women will have sex that doesn't feel good at some point in her life. This doesn't necessarily 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. Discuss your concerns with your doctor. Remember that anything you tell your doctor is private and that your doctor can help you find a reason and possible treatment for your sexual dysfunction.

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 or sexual lubricant 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, you may not be getting enough foreplay or stimulation before actual intercourse begins. 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. Masturbation may also be helpful, as it can help you learn what techniques work best for you.

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 lubrication or taking a warm bath before sex all may help. If you still have pain during sex, talk to your doctor. There are a variety of causes of pain during sex, so talk with your doctor. He or she can help you find the cause of your pain and decide what treatment is best for you.

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 do not 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 (called Kegel exercises) and then relaxing them may also 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 each of you 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, and 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 feel you can't talk to your partner, your doctor or a counselor may be able to help you.

If you feel like your partner is abusing you, tell your doctor.

How can my doctor help?

Your doctor can suggest ways to treat your sexual problems or can refer you to a sex therapist or counselor if needed.

Parkinson's Disease

What is Parkinson's disease?

Parkinson's is a disease that causes a progressive loss of nerve cell function in the part of the brain that controls muscle movement. Progressive means that this disease's effects get worse over time.

What are the symptoms of Parkinson's disease?

People who have Parkinson's disease experience tremors or shaking as a result of the damage to their nerve cells. Tremors caused by Parkinson's get 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 walking or buttoning clothes, or cutting food.

How is Parkinson's disease diagnosed?

A doctor may diagnose a person with Parkinson's disease based on the patient's symptoms and medical history. 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. If symptoms go away or get better when the person takes a medicine called levodopa, it's fairly certain that he or she 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. However, symptoms often disappear when the patient stops taking the medicines.

Can medicines treat Parkinson's disease?

There is no cure for Parkinson's disease. But medicines 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), and tolcapone (brand name: Tasmar). Your doctor can recommend the best treatment for you.

Sleep Changes in Older Adults

How much sleep do older adults need?

What sleep changes are common in older adults?

What causes sleep problems?

What is sleep apnea?

What is restless legs syndrome (RLS)?

RLS is a condition in which your legs feel very uncomfortable when you are sitting or lying down. RLS can make it hard for you to sleep.

What is periodic limb movement disorder (PLMD)?

What can I do to sleep better?

Go to bed and get up at the same time every day, even on the weekends.
Do not take naps longer than about 20 minutes.
Don't read, snack or watch TV in bed. Use your bedroom for sleep and other rooms for other activities
Avoid caffeine about 8 hours before bedtime.
Avoid nicotine and alcohol in the evening. Alcohol might help you fall asleep initially, 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 in a different room, such as 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. Medicines that can disrupt sleep include antidepressants, beta-blockers and cardiovascular drugs.
Ask your doctor for help if pain or other health problems keep you awake.
Try to exercise a little every day. Exercise helps many older adults sleep better.