Do You Suffer From Symptoms of Incontinence?

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Fecal Incontinence after Gallbladder Surgery

Gallbladder surgery is one of the most common surgical procedures performed in the U.S. today, with more than 700,000 procedures taking place each year. While the vast majority of patients experience no postoperative complications or changes, a small percentage may develop symptoms of fecal incontinence which can range from occasional minor leakage to more significant loss of bowel control. Symptoms can develop soon after surgery; other times, they may not appear until months afterward or longer.

What Does Your Gallbladder Do?

Your gallbladder acts as a reservoir for bile, a digestive acid produced by your liver. During digestion, your gallbladder delivers bile to the small intestine in varying amounts, depending on the food that’s being digested. Once the gallbladder is removed, your liver delivers bile directly to the small intestine in smaller quantities. For the vast majority of patients, this change presents no problem. But a small percentage of patients may experience digestion-related problems like loose bowels or diarrhea, an increase in the number of their bowel movements or bowel leakage. Sometimes, these symptoms resolve by themselves over time, but other times, they may persist.

Why Does Gallbladder Removal Sometimes Cause Incontinence?

Before gallbladder removal, your liver delivered bile to the gallbladder, which regulated the delivery of bile to the small intestine. After your gallbladder was removed, bile was delivered directly to the small intestine. Because bile acts as a laxative, the removal of this extra layer of regulation sometimes makes stool so loose that it is hard to control. After a cholecystectomy, many people develop temporary diarrhea that stops soon after the surgery. However, in some cases, diarrhea does not stop on its own. In these cases, you’ll want to pursue anti-diarrheal options with your doctor.

Treatments to Control Your Fecal Incontinence

Fecal incontinence can cause significant embarrassment, anxiety and even depression, but the good news is, today there are lots of treatments that can be used to control symptoms, including medications that can help bind bile and prevent stool leakage. Some patients may also benefit by relatively simple changes in their dietary habits. For instance, because bile plays a big role in the digestion of fats, avoiding fatty foods or adopting a low-fat diet may provide relief from symptoms over time. And since bile is not being stored, eating smaller meals several times a day rather than three large meals can also help.

Studies have shown many people with fecal incontinence are too embarrassed to speak to their doctor about their symptoms. As a result, they live with unnecessary shame and inconvenience. If you suffer from fecal incontinence, remember: your doctor has heard it all before.

Incontinence Treatment in Middle Tennessee

If you live in middle Tennessee and are struggling with incontinence after a gallbladder surgery, let our experienced doctors help. Make an appointment with the Incontinence Institute today for an evaluation so you can start leading a happier, more confident life.

Urinary Incontinence in Men

Did you know that up to 11% of the male population suffers from urinary incontinence? This is a lower percentage than for women, but, this does not diminish the fact that millions of men must cope with urinary incontinence. If you are a man who suffers from UI, know that you are not alone.

Types of Incontinence

The types of incontinence in men are comprised of three main categories: Stress Incontinence, Urge Incontinence, and Overflow Incontinence. Stress Incontinence means that a person will lose urine involuntarily when their body is put under stress, possibly from lifting heavy objects, coughing, or even laughing. Urge Incontinence is when a person feels a sudden, urgent, and unstoppable urge to urinate. Finally, Overflow Incontinence means that urine leaks consistently and is characterized by frequent urination, often in small amounts. Those who suffer from incontinence may experience one, two, or all three of these types.

Central Nervous System (CNS)

Male Urinary Incontinence is often associated with nervous system problems. Diabetes has the potential to cause nerve damage over time, which can result in loss of bladder control. And, a stroke, Parkinson’s Disease, and Multiple Sclerosis can all cause urinary symptoms. The Central Nervous System (CNS) is critical to proper bladder function, so anything which interrupts nerve signals to the bladder has the potential to result in incontinence.

Prostate Related Incontinence

While nervous system related incontinence is possible for both men and women, the prostate presents a uniquely male cause for Urinary Incontinence. As a man ages, a process called Benign Prostate Hyperplasia (BPH) can occur, which simply means that the prostate has increased in size. As the prostate enlarges, it can begin to put pressure on the urethra. This pressure can result in a number of urinary symptoms, ranging from hesitancy to urge incontinence. When this happens, difficulty starting and maintaining a stream of urine is common, and, Overflow Incontinence also frequently reported. While removal of an enlarged or cancerous prostate may seem like the solution to this problem, Radical Prostatectomy, the total removal of the prostate, can result in Urinary Incontinence symptoms of its own.

As always, prior to self-diagnosis and taking symptom management into your own hands, meet with a medical professional to receive a diagnosis and implement a treatment plan. Our board-certified, industry-leading physicians address the needs of patients suffering from Urinary and Fecal Incontinence with customized treatment plans, supported by cutting-edge technology and procedures.

If you are suffering any of the above symptoms, or if bladder overactivity is drastically affecting your daily life, reach out to one of our medical professionals to see how you can restore yourself to a higher quality of life. Call 1.615.547.2938 to schedule a consultation today, and let us empower you to live the leak-free life you deserve.

Resources:

  • https://www.medicinenet.com/urinary_incontinence/article.htm#how_is_urinary_incontinence_ui_in_men_diagnosed
  • https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1476070/

What is Nocturia?

Nocturia refers to nighttime urination – people who have nocturia wake up frequently to use the bathroom. Though all incontinence is characterized by its disruption of daily life, nocturia is particularly impactful because it interrupts a key human function – sleep. So, alongside frequent urination, leaks, and the inability to control one’s bladder, individuals who wake up two or more times at night to use the restroom often suffer from lower quality sleep. Consistent sleep disturbance can translate to lethargy during waking hours and may contribute to the development of depression, dysfunctional mood regulation, as well as the incidence of type 2 diabetes (T2D), obesity, and cardiovascular disease.

What Causes Frequent Nighttime Urination?

Nocturia can be a side effect of underlying bladder issues, a medication side effect, as well as symptom of an underlying medical condition. However, causes may also be impacted by individual behavior. Nocturia may very well be a byproduct of the beverages that an individual consumes – particularly those close to bedtime. Caffeinated drinks like soda and coffee, as well as alcohol, can contribute to this problem. In some cases, individuals are simply drinking too much right before bed.

There are several different reasons people may actually make more urine at night, which can be one cause of nocturia. These are as follows:

  • Nocturnal polyuria: When the body produces greater-than-average amounts of urine at night. While you sleep, your body produces smaller amounts of more concentrated urine, in comparison to your waking hours. Ideally as a result an individual is able to sleep 6-8 hours without interruption. An individual may be diagnosed with nocturnal polyuria when their nighttime urine volume exceeds 20-30% of their total urine volume over the course of one day.
  • Global polyuria: Just like nocturnal polyuria, this is an overproduction of urine. However, this overproduction occurs during waking hours, as well.

Outside of these causes, the onset of nocturia in women may be triggered by the impacts of pregnancy or childbirth, menopause, and/or pelvic organ prolapse. In contrast, nocturia in men may be attributed to an enlarged prostate. In both men and women, it is critical to have a health care provider determine if the nocturia is from a lower urinary tract or systemic cause.

How to Stop Frequent Urination at Night

As always, prior to self-diagnosis and taking symptom management into your own hands, meet with a medical professional to receive a diagnosis and implement a treatment plan. Our board-certified, industry leading physicians address the needs of patients suffering from nocturia with customized treatment plans supported by cutting-edge technology and procedures.

If you are suffering any of the above symptoms, or if bladder over activity is drastically affecting your daily life, reach out to one of our medical professionals to see how you can restore yourself to a higher quality of life. Call 1.888.741.6403 to schedule a consultation today, and let us empower you to live the leak-free life you deserve.

 

Supplements for Incontinence

You take a multivitamin and maybe calcium or Vitamin D for your bones – but do you take anything for incontinence? Is that even possible?

If you are trying to live a more natural lifestyle, you are probably familiar with various vitamins and supplements. Millions of Americans take vitamins and supplements, from Vitamin C to ward off colds in the winter to melatonin to help them sleep. However, it is important to note that almost all vitamins and supplements are not tested or approved by the Food & Drug Administration (FDA).

The FDA states, “According to the American Academy of Family Physicians (AAFP), a doctor may recommend that you take them for certain health problems, if you eat a vegetarian or vegan diet, or if you are pregnant or breastfeeding.” The FDA continues, “The 2005 Dietary Guidelines for Americans advises that nutrient needs be met primarily through consuming foods, with supplementation suggested for certain sensitive populations.”

The FDA’s main gripe with over-the-counter vitamins and supplements is that many of them can interact with other medications including prescription medication. It can also be harmful to take many of the same supplement. Many people do get enough vitamins through a healthy diet, and certainly that is what’s recommended. But for targeting specific conditions or areas, there are vitamins and supplements available. It is vital, though, to speak with your physician before starting a vitamin regimen. You need to ensure that nothing will interact with your current medications.

Supplements for Incontinence and Overactive Bladder

Vitamin D

Recent studies found that women over the age of 20 with normal vitamin D ranges were much less likely to suffer from a pelvic floor disorder, like incontinence. If you suffer from a pelvic floor disorder it may be time to check your vitamin D levels through a simple blood test.

Gosha-jinki-gan

This is a Japanese blend of different herbs. It is actually one of the most-studied herbs used in treatment for overactive bladder syndrome. A study found that, “Gosha-jinki-gan could be a safe and effective potential therapeutic alternative in females with overactive bladder.” Another study said that its results “suggest that Gosha-jinki-gan inhibits bladder activity by maintaining the balance of the sympathetic and parasympathetic nervous systems at a low level.” This herb helps control overactive bladder symptoms by helping balance the nervous system transmission from the brain telling the bladder it has to go so often.

Buchu

Buchu extract, or Barosma betulina, is a shrub native to South Africa. The dried leaves and supplements made from them have been used to treat urinary tract infections. It is thought that Buchu helps to promote urine flow, and overall health of the urinary tract. According to an article in Reviews in Urology, no clinical trials have been done regarding Buchu and overactive bladder.

Cornsilk

Cornsilk is the fibers at the top of an ear of corn. In supplement or tea form, cornsilk has been used to treat bladder infections and prostate inflammation. It is thought to soothe the urinary tract, and was even used by the ancient Incas. There are no clinical studies on the effect of cornsilk and urinary incontinence or irritation.

Saw palmetto

Saw palmetto is a palm that grows in the southern United States. Its berries were used by Native Americans for their medicinal properties. Saw palmetto supplements are used to treat benign prostate hyperplasia (enlarged prostate) in men. This condition can lead to excessive urination, or only partial emptying of the bladder. Saw palmetto has been studied – a large analysis of multiple studies concluded that saw palmetto produced a similar benefit to finasteride, a drug for enlarged prostate, and was better-tolerated. Saw palmetto may also boost the quality of life for men with enlarged prostate.

Magnesium

Magnesium is important for proper muscle and nerve function. Some doctors believe better magnesium levels can reduce bladder spasms, a common cause of incontinence. Magnesium levels can be checked through a blood test at your next doctor’s visit.

Ganoderma lucidum

This mushroom has been used in Chinese medicine for over 2,000 years. Recently, a Japanese study showed that ganoderma lucidum helped people with urge incontinence after eight weeks of use. Why? The mushroom lowers the hormone levels associated with prostate growth, a lead cause of overflow incontinence in men.

Urinary Incontinence in Middle Tennessee

If you are suffering from urinary incontinence, overactive bladder syndrome, or enlarged prostate, it may be worth it to try natural supplements. Of course, you need to consult your physician before starting vitamins or supplements, to ensure they will not react with your medications or have any adverse effects. If you live around Nashville, Tennessee our team of expert physicians would love to help. Contact our discreet, dedicated Medical Concierge by phone or private message today.

 

Chronic Pelvic Pain in Women

chronic pelvic pain in womenPelvic pain affects one in four women.  Many women live in silence, not knowing it can be helped. And many women who do seek help may have unnecessary surgeries, such as hysterectomy.

What is pelvic pain?

Pelvic pain is pain or pressure felt anywhere in the abdomen below the navel. It may be intermittent or constant. Many women describe pelvic pain as a dull ache, sharp pains, “toothache” type pain, and/or burning. Other symptoms include pelvic pain/cramps that may be related to menses, or completely independent of a period, pain associated with sex, during or afterward. Women can also have painful ovulation, painful bowel movements, pain with urination, and low back or hip pain.

Pelvic pain in women is complex and can originate from different organ systems such as the female reproductive system, the gastrointestinal system, the urinary system, the musculoskeletal system, the neurological system, or some combination thereof.

Usually, temporary pelvic pain is not a cause for concern and can be treated with over the counter NSAIDS. For more chronic pain, there may be the need for further treatment options, which can include physical therapy, acupuncture, nerve stimulation, amniotic fluid allograft injections.  However, the first necessity is to have an evaluation and determine all the causes of the pain, and what organ systems are affected.  This will require a physical examination and may require cystoscopic and/or laparoscopic evaluation along with possible colonoscopy.

Here to discuss different types of pelvic pain and treatment options is Dr. Barry Jarnagin, urogynecologist with the Incontinence Institute and the Center for Pelvic Health in Franklin, TN:

What symptoms do most women mention when they come to see you for pelvic pain?

Most women complain that their quality of life is greatly diminished by their pain.  They have trouble doing their daily tasks, caring for their children, working, and having an intimate relationship with their partner.

Are there other conditions that bring women in to see you, and then you learn they have pelvic pain?

Many times, women will have urinary and/or gastrointestinal problems (urinary incontinence, urgency, frequency, constipation, and diarrhea) who, after questioning them, admit to chronic pelvic pain and/or pain with sex.

Can pelvic pain be an indicator of a more serious problem?

It certainly can, and a full evaluation is warranted.  And, while most of the time it is a quality of life issue, it needs a full evaluation.

What do you do to treat pelvic pain?

The first and main thing is to evaluate and determine what systems are affected, then develop a treatment plan that will treat all the issues. Many times, there are dietary/behavioral changes that the patient must do along with our treatment protocols. We utilize a multidisciplinary approach with physical therapists trained in the pelvic floor, along with innovative treatments to treat nerves that are affected which are difficult to treat.  We have had much success with the amniotic cell allograft in treating pudendal nerve pain. We also utilize Botox. There are times when laparoscopy with excision of endometriosis, remove a cyst or appendix is necessary. There are many treatment options, most of which are minimally invasive, or not invasive at all.

If you or a loved one are suffering from pelvic pain, schedule an appointment today with our qualified team of doctors at the Incontinence Institute in Tennessee.

 

Incontinence Issues? There’s an App for That!

iStock_000041888110_LargeIf you have a cellphone or a tablet, chances are you’ve downloaded a few apps. And why not? There are well over two million apps available for download for both Apple and Android devices, designed to do all sorts of tasks from playing games to counting calories to balancing your budget to saving money of goods and services – and lots more. It shouldn’t be a big surprise, then, to learn there are also apps to help people with incontinence manage their condition more effectively. From bladder diaries to apps that find the nearest restroom to videos that remind you how and when to do Kegels, there are plenty of high-tech ways to keep your incontinence under control. Here are just a few in 2018 to consider (and most are free!):

1. Sit or Squat

Available for: iPhone, Android
This app for Android and Apple is sponsored by toilet paper manufacturer Charmin and helps users find the nearest public restroom, no matter where you are in the United States.

2. BladderPal

Available for: iPhone, Android
Available for Android and Apple devices, BladderPal lets you keep track of your fluid intake and urine output, two critical measurements that are frequently used by incontinence doctors to measure your level of incontinence and track your progress with treatments.

3. UroBladderDiary

Available for: iPhone
UroBladderDiary is an iPhone only app that records liquid intake and outtake, frequency, urgency, and leakage. The app can also create a custom report that can be sent in a PDF to your doctor. This app is the perfect replacement for a paper voiding diary that is frequently recommended by physicians.

4. Kegel Trainer PFM Exercises

Available for: iPhone, Android
Also available for both types of devices, Kegel Trainer gives you 10 different exercises to practice Kegels. If you’re prone to forget, use the app to set daily reminders.

5. Tät

Available for: iPhone, Android
Tät is an Android and iPhone app with 6 basic and 6 advanced pelvic floor music training sessions. It was developed by a Swedish company who used the app in a study for stress incontinence. In the study, 9 out of 10 women who used the app improved compared to 2 out of 10 women who improved while not using the app.

In addition, YouTube has plenty of videos for Kegels and other pelvic strengthening exercises for men and women, as well as yoga videos to ease the stress and anxiety that can accompany the condition and even contribute to it.

Before beginning any at-home treatment, it’s critical you have your symptoms evaluated by an incontinence specialist. In some cases, incontinence can be a sign of a serious underlying medical condition, and having an evaluation is the best way to be sure you get the right care, right away. If you live in Tennessee, the Incontinence Institute can help! Call our discrete concierge today at 615-525-5253 to schedule your own evaluation and consultation.

Are Reusable Incontinence Pads Right for You?

The Cost of Incontinence

For sufferers of urinary incontinence, making sure you are always prepared and protected can be a costly job. The average individual with moderate urinary incontinence will use around two disposables a day. With each going for $1.30-1.50, they can expect to spend around $80 per month. However, if you are using more than two disposable incontinence pads per day or you require more expensive products with better absorption and performance, those numbers can quickly climb. In fact, if we project those numbers to a year’s time, it comes out to a total of nearly $1000 – money that could have been spent treating this problem.

What is my alternative?

Various disposable solutions exist for incontinence sufferers. Reusable incontinence pads can be purchased for a larger upfront investment but long-term cost effectiveness. Pads are made of various washable materials, some of the most popular including cloth, organic cotton and hemp.

Why reusable?

  • Health- While disposable pads are largely comprised of cotton, manufacturers of washable incontinence products frequently use cloth in its place. However, you also have the option of choosing chemical-free organic products. By choosing organic products, you protect your body from materials that may have been treated with herbicides, fungicides, and pesticides. Additionally, you don’t run the risk of exposing yourself to toxic chemical residue.
  • Environmental – Using and discarding countless disposable pads puts a real burden on the environment. By switching to reusable incontinence pads, you’re keeping plastic out of landfills and pollutants out of the environment.
  • Quality- One large benefit of reusable products is that they can be created with custom sizing. Some cloth reusable products are created to be both self-sanitizing and also fast drying. Higher quality also translates to higher comfort, with a better fit and thus better performing product.
  • Cost- Incontinence products are on average 6x more expensive than baby diapers or menstrual pads. Unlike menstrual pads which may be used a couple days out of the month, many incontinence sufferers have to wear them 24/7. It is suggested that incontinence sufferers purchase at least 6 reusable pads or briefs. While they cost about $20 each, reusable incontinence products are generally advertised to last for 300 uses. The yearly savings on reusable incontinence pads compared to disposables averages eight hundred dollars! Plus, they can be quickly and easily sanitized in your home, using just your washer and dryer.

By switching to washable incontinence products, you’ll have extra money to treat what is causing your incontinence. While incontinence issues are common, they are not just a normal part of aging – there are treatments that can help. To start treating the root cause of your incontinence, contact one of our professionals today for a consultation.

How Common is Urinary Incontinence After Childbirth?

It is not uncommon to hear of pregnant women having trouble holding their bladders. In fact, up to 53% of women report some degree of urinary incontinence during pregnancy. But what happens if at one, three, or even five years after childbirth, a mother is still struggling with the involuntary loss of urine? She may be suffering from postpartum incontinence.

What is Postpartum Incontinence?

  • There are two main categories of postpartum incontinence. Many women experience both. The first is referred to as stress incontinence, in which the loss of urine is caused by increases in pressure or stress in the body. It is frequently correlated with a weakening of the pelvic floor muscles or pelvic muscles that have lost normal function due to overuse. If running, jumping, or a sneeze, cough, or laugh sends you to the restroom, you may be experiencing stress incontinence.
  • The second category of postpartum incontinence is called urge incontinence. It is most often caused by nerve damage sustained while pregnant or delivering, which impairs the bladder’s ability to communicate with one’s brain. As a result, the bladder may signal a need to use the restroom too soon or too often. Women with urge incontinence may suddenly feel like they’ve “got to go”, even when their bladders are nearly empty. The onset of these feelings may be quick and intense, and leaks may happen before they can make it to the restroom.

Could I be Experiencing Postpartum Incontinence?

  • Women who had a vaginal delivery are most likely to be affected, with up to 25% experiencing symptoms that persist for at least 1 year postpartum. In contrast, it affects up to 16% of women having had a caesarian section delivery.
  • Furthermore, obese or women over the age of 35 are at an increased risk of postpartum urinary incontinence. Likewise, the use of forceps in delivery, smoking, and incontinence during pregnancy predict a higher likelihood of postpartum incontinence.
  • Unfortunately, even though urinary incontinence after childbirth is extremely common, 77% of women who have postpartum incontinence either do not know or never seek a formal diagnosis, and as a result never receive treatment.

What can I do about Postpartum Urinary Incontinence?

Postpartum incontinence greatly affects the daily lives of those who have it. Many women resort to always wearing pads, visiting the restroom frequently, and even drinking less to minimize fluid in the bladder. Yet none of these methods offer a permanent solution.

If you are experiencing any or all of the above symptoms and are ready to find relief, the Incontinence Institute offers cutting-edge therapies and restores confidence to women affected by this condition. Some of our treatment options include Botox®, a bladder sling, and InterStim® Therapy. In every case, our board-certified physicians work closely with patients to create customized plans that cater directly to your unique needs. Contact us today to schedule an appointment and regain control – because no one should have to live with leaks.

Urology association honors Incontinence Institute’s Dr. Kaufman

Melissa Kaufman, MD. PhD Uro. Surgery resident nf

Melissa Kaufman, M.D., Ph.D., associate professor of Urologic Surgery, received the 2017 Zimskind Award at the Society of Urodynamics, Female Pelvic Medicine, and Urogenital Reconstruction (SUFU) Winter Meeting in Scottsdale, Arizona.

The Zimskind Award, established in 1979, is awarded to an individual who, within 10 years of completing residency or fellowship, has made significant contributions to the field, primarily through basic and clinical research, and has shown great potential for continuing and progressive scholarship.

“The Zimskind award represents the highest possible achievement for a mid-career specialist in lower urinary tract and female pelvic floor dysfunction. This is a singular recognition of an outstanding individual,” said Roger Dmochowski, M.D., professor of Urologic Surgery.

Dmochowski, who serves on the SUFU board, received the Zimskind Award in 1999.

Kaufman completed her Ph.D. in Biology at the University of Tennessee and obtained her medical degree from the University of Arkansas College of Medicine.

She completed her general urology residency at Vanderbilt and a Female Pelvic Medicine and Reconstructive Surgery fellowship under the direction of Dmochowski.

She is also a past president of the Society of Women in Urology (SWUI).

Provided by Vanderbilt University Medical Center’s Reporter

Top 10 Incontinence Triggers

If you find your incontinence worsening due to increased urination, something you are consuming regularly may be having a negative effect on your bladder. Try to avoid this list of 10 things that can contribute to incontinence symptoms.

  1. Alcohol
    To help prevent incontinence, try to avoid or limit alcohol consumption.It is a diuretic and can irritate the bladder.
  2. Carbonated drinks
    The bladder does not respond well to carbonation and caffeine so limiting your intake of fizzy drinks will help minimize symptoms.
  3. Chocolate
    The small amount of caffeine found in this popular treat can also worsen your symptoms.
  4. Citrus fruits
    Grapefruits, oranges, limes, lemons and tomatoes contain acid that aggravates the bladder.
  5. Coffee or tea
    Both of these liquids contain caffeine, which is a diuretic and bladder irritant.
  6. Fluids
    If you struggle with nighttime incontinence, make sure to reduce your fluid intake well before you go to bed.
  7. Frozen foods
    Artificial foods and colorings, chemicals and caffeine contained in frozen or packaged meals contribute to increased urination.
  8. Medication
    Heart medications, blood pressure-lowering drugs, muscle relaxants, sedatives, and other drugs are often diuretics; removing fluid allows the heart and other organs to work more efficiently, but can cause increased urges to urinate in those with incontinence.
  9. Spicy food
    Meals containing curry powder, chili powder and cayenne pepper can trigger incontinence in people who struggle with it, especially women.
  10. Sugar
    Foods containing honey, corn syrup and fructose can also aggravate your bladder.

If you are concerned about your symptoms or interested in more information about incontinence, call our discreet, dedicated medical concierge at 1.888.741.6403.

Sources:

About The Incontinence Institute

At the Incontinence Institute, our team of healthcare providers understand the physical and mental trials that accompany living with urinary or bowel incontinence. Because of this, we are sensitive to your situation and treat all of our patients with the utmost respect and concern for discretion.


Individual incontinence conditions, treatment and recovery times may vary. Each patient's experience with incontinence procedures and / or surgery will differ. All surgical procedures involve some level of risk. If directed to pursue surgery by your physician, prompt action is advised, as waiting may reduce the efficacy of surgical treatment. The opinions expressed in patient testimonials are by patients only; they are not qualified medical professionals. These opinions should not be relied upon as, or in place of, the medical advice of a licensed doctor, etc.

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