Urinary Incontinence Naturopathic Treatment
The most frequent urinary complaints in PD patients are frequency, urgency, urge incontinence, and nocturia. Hobson et al. (58) performed a community-based questionnaire survey in Wales, U.K., and found that bladder problems were reported in 51 of 123 PD patients returning the survey compared to 31 of 92 controls. The calculated relative risk of developing bladder symptoms in PD patients compared to controls was 2.4. Lemack et al. (59) performed a similar questionnaire-based assessment of bladder problems in PD patients, but selected early-stage patients (Hoehn and Yahr stage 2.5 or lower) to determine if bladder problems occur early in the disease. Men with early PD assessed using the American Urological Association Symptom Index had a mean score of 12 compared to the community sample of normal male volunteers whose mean score was 4.8. Significant differences were seen on questions for frequency, urgency, and weak urinary stream. Women completed the Urogenital Distress Inventory-6...
Urinary incontinence is defined as the involuntary loss of urine in amounts or with sufficient frequency to constitute a social and or health problem. The prevalence of urinary incontinence is 15 to 35 percent in community-dwelling individuals older than age 60. Urinary Incontinence Types, Signs and Symptoms, and Causes In women history of surgery for urinary incontinence, estrogen deficiency, aging
Normal-pressure hydrocephalus occurs when the CSF is not absorbed by the arachnoid villi. It may occur secondary to posttraumatic meningeal hemorrhage. Clinically, it is characterized by the triad of progressive dementia, ataxic gait, and urinary incontinence. (Remember wacky, wobbly, and wet.)
To understand the magnitude of HRQL issues among cancer survivors, we have classified these concepts into discrete domains, however it is understood that they represent a highly interrelated and dynamic system. Adhering to this model of self-reported health, the late effects of cancer can have wide spread ramifications. For example, many of the late physical effects (e.g., pain, fatigue, urinary incontinence, infertility) can also have significant emotional and social consequences. Since those with increasing age also represent a large segment of cancer survivors, it is sometimes difficult to determine whether physical changes are predominantly age or cancer related (e.g., fatigue, decreased libido, weakness). Apart from the observed physical changes, the psychosocial and existential issues acknowledged by survivors
Chemotherapy, particularly alkylating agents like cyclophosphamide, can induce infertility and, in women, premature menopause, with its attendant problems of hot flashes, mood swings, vaginal dryness, and urinary incontinence. Cyclophosphamide is commonly used in breast cancer, but management of the menopausal symptoms is complicated by the fact that hormone replacement therapy is considered contraindi-cated in patients with a history of breast cancer. Consequently, other treatments must be used for hot flashes, such as antidepressants.52 This example illustrates the importance of both recognizing the symptoms related to ovarian failure in a cancer patient in which it would be otherwise unexpected, and having knowledge of the oncologic considerations of the therapies being chosen.
Prostate cancer (PCA) has become the most commonly diagnosed cancer among men in the USA, with an estimated 189,000 cases diagnosed in 2002 (1). Encouragingly, over the past several years, increased use of serum prostate-specific antigen (PSA) screening has increased the fraction of men diagnosed with PCA confined to the prostate gland, leading to more effective use of surgery and radiation therapy for treatment, and to a decline in PCA mortality (2, 3). Despite these improvements, some 30,200 men will likely died of progressive metastatic cancer in 2002 (1). Furthermore, even though men with early PCA can be cured using surgery or radiation therapy, the side effects of treatment frequently include erectile dysfunction, urinary incontinence, or rectal irritation (4-6). New insights into the etiology of PCA are needed so that new strategies for its prevention can be developed.
A significant portion of the time spent in the evaluation and treatment of the obese patient can be expedited by use of protocols and procedures. A self-administered medical history questionnaire can be either mailed to the patient prior to the initial visit or completed in the waiting room. In addition to standard questions, sections of the form should inquire about past obesity treatment programs, a body weight history, current diet and physical activity levels, social support, and goals and expectations. The review-of-systems section can include medical prompts that are more commonly seen among the obese, such as snoring, morning headaches and daytime sleepiness (for obstructive sleep apnea), urinary incontinence, intertrigo, and sexual dysfunction, among others.
Give some indication of neurological impairment. The best milestones to check are those which mothers tend to remember clearly (smiling, sitting, standing, walking, first words, feeding self, and bladder control), and the experienced mother should be asked to make comparisons with her other children. Discrepancies may have diagnostic value, because delay in a single area nearly always indicates a localized rather than a generalized defect.15 Table 2-8 is a summary of some of the more common neurological milestones and their time of occurrence.
This major operation has surprisingly low postoperative mortality (0.2 ) or serious morbidity. Urinary incontinence, possibly due to distal urethral sphincter dysfunction or bladder neck contracture, is often the most troublesome side effect. Loss of erectile function is now less of a problem thanks to modern surgical alternatives.
The newcomer to nutritional gerontology might feel overwhelmed by the prospect of obtaining valid and reliable measures of dietary intake. There appears to be a huge potential for confounding by impaired cognition, sensory loss, appetite changes, acquired poverty, impaired mobility, access to fresh food, and failure to complete cooking (Jorissen and Riedel, 2002). As individuals mature and establish personal independence, each is expected to take more responsibility for their own basic needs, such as warmth, shelter, food, and companionship. With aging, many require support to maintain this independence, and the reasons for this are extraordinarily varied. Take, for example, a woman living alone who rarely leaves the house and for whom food shopping has become hugely effortful. Her circumstances may have arisen because she has suffered sensory loss (above all, of sight or hearing), or she has problems with mobility and fears falling, or her bladder control is unsure and she is anxious...
Menopause hormone therapy (MHT), however, is very effective for treatment of hot flashes and night sweats and by secondary gain can be useful for treating sleep disturbances that result from waking related to hot flashes. Prior to 2002 when the Women's Health Initiative (WHI) was halted because of increased risk for women taking estrogen and progestin therapy for breast cancer (anticipated) and for increased risk for heart disease, stroke, and other thromboembolic events (unanticipated), MHT was recommended for all postmenopausal women to protect against osteoporosis and heart disease as well as for treatment of symptoms including hot flashes, vaginal dryness, mood changes, sleep disturbances, and sexual dysfunction. Subsequently, the estrogen-only arm of the WHI was discontinued as well, because of the increased risk of stroke (RR 1.4 for women on estrogen alone). In addition, data from the WHI demonstrated increased risk of dementia and urinary incontinence with use of MHT (Hendrix...
Subfalcine herniation, also known as cingulate herniation, occurs when the medial part of the hemisphere is pushed beneath the edge of the falx cerebri. This action generally results in damage to or ischemia of the cingulate lobe and medial motor cortex and therefore manifests itself with contralateral lower-limb weakness and urinary incontinence.
Declining estrogen levels lead to atrophy of the urogenital tissues and vaginal thinning and shortening, resulting in dyspareunia and urethral irritation. Urinary tract infections and urinary incontinence may develop. Estrogen treatment (oral or intravaginal)
Sleep benefit is a common phenomenon of variable duration ranging from 30 minutes to 3 hours in PD and implies improvement in mobility and motor state in the morning and after drug intake at night (98). The mechanism of sleep benefit is unknown, and possible causes include (i) recovery of dopaminergic function and storage during sleep, (ii) a circadian rhythm-related phenomenon, or (iii) a pharmacological response to dopaminergic drugs (7,30). Good sleep hygiene is also useful. Activities such as a hot bath a couple of hours before bedtime, maximizing daytime activity, ensuring bright light exposure, having a hot sweet drink or a light snack at bedtime, use of handrails in bed and or satin sheets to enable easier turning in bed, flexible bed times, a reclining armchair for some, and avoiding stimulants such as tea or coffee at bedtime are part of good sleep hygiene (81). Nocturia remains one of the most common causes of sleep disruption in PD and can be reduced by avoiding diuretics,...
This operation is reserved for BPH where the prostate weighs over 50-75 g. It is also appropriate where there is concomitant benign bladder disease requiring treatment such as a symptomatic diverticulum or a large stone. Potential risks are urinary incontinence, erectile dysfunction, retrograde ejaculation and urinary tract infection. The advantages over TURP are complete removal of the gland (therefore no recurrence) and no risk of dilutional hyponatraemia. However, there is an increased risk of intraoperative haemorrhage and a longer hospital stay. Previous prostatectomy, prior pelvic surgery and prostate cancer are contraindications to the operation.
Medications that May Contribute to Urinary Incontinence Urinary retention (sphincter contraction stress urinary incontinence symptoms improve in women) Urethral relaxation (urinary incontinence symptoms improve in men with benign prostatic hypertrophy) A. Cough stress test is performed when the woman's bladder is full, but before she has the urge to void. If there is an instantaneous, involuntary loss of urine with increased intra-abdominal pressure (cough, laugh, sneezing, exercise, Valsalva's maneuver), then stress urinary incontinence (SUI) is likely. If the loss of urine occurs after a delay or continues after the cough, then detrusor instability (DI) is suspected.
Routine, or scheduled, voiding requires urinating at regular intervals (two to four hours) on a fixed schedule. In bladder training, the patient schedules voiding. This method can be very effective for stress, urge (DI) and mixed urinary incontinence. B. Pelvic muscle exercises (PMEs), eg, Kegel exercises, are recommended for women with SUI. They may also help urge urinary incontinence. PMEs may be performed alone or with biofeedback, vaginal weights, and electrical stimulation of the pelvic floor. The patient is trained to gradually increase the duration of sustained pelvic muscle contractions to at least 10 seconds. Gradually, the number of repetitions is increased to 30 to 50 times per day for at least eight weeks.
Considering the frequency of urinary disorders in older men, it is not surprising that the majority of urology patients are in their fifties or older. Shrinkage of the kidneys, loss of elasticity and capacity by the bladder, and enlargement of the prostate gland combine to increase the frequency of urination, cause urination to be less complete and bladder control to be lost, as well as other urological disorders. Reductions in the number of functioning excretory units (glomeruli) and, consequently, lower renal blood flow and a lower filtration rate of the kidney's result in body toxins and wastes being excreted less efficiently. Not only is less urine excreted and excreted less efficiently with aging, but it also contains more creatine. Like older men, older women sometimes experience problems with bladder control and incontinence. Urinary problems are not as common in older women as in older men, but cancer of the genitourinary tract is no respecter of gender. Prostate cancer occurs...
Clinically, CADASIL is a subcortical form of VaD that begins in early adulthood with recurrent ischemic episodes, usually transient ischemic attacks (TIAs) or lacunar strokes, in the absence of risk factors for vascular disease, culminating in VaD and death usually about 20 years after onset of symptoms. Migraine with aura and depression are also common. The dementia is subcortical, frontal in type, accompanied by gait disturbances, urinary incontinence, and pseudobulbar palsy, clinically identical to that of sporadic Binswanger's disease. Striking white matter changes and lacunar strokes can be demonstrated by brain CT and MRI in symptomatic and asymptomatic members of families affected by CADASIL.
It is common practice to surgically remove many cancerous prostates, even though subsequent pathological examination of the excised tissues suggest that some surgeries could have been avoided 13,68 . Radical prostatectomy is a challenging procedure because of anatomical variability and the presence of adjacent vital structures, including the external urinary sphincter and neurovascular bundles. There is significant risk of serious morbidity in the form of urinary incontinence and impotence. The crux of the practice dilemma 13 is the need for improved noninvasive preoperative techniques that can more accurately measure tumor volume and extent, and thereby more clearly indicate the need for surgery. Several measures of the pathologic state of prostate cancer have been proposed to allow stratification of patients into either treat-
Gait analysis has demonstrated improvements in hip and knee range of motion, stride length, and speed of ambulation 25,26 , and in joint motion and foot placement 5,20,27-30 . Foot-floor contact pattern evaluation frequently demonstrates a change from primarily forefoot only at initial contact during ambulation to a heel or flatfoot position 28 . Occasionally excessive knee flexion, likely related to decreased calf muscle strength, requires orthotic intervention however, selective posterior rhizotomy has been shown to decrease the overall rates of orthopedic procedures required in children with spastic cerebral palsy 31 . Other unexpected benefits, so-called distant effects,'' such as decreased seizure frequency 32 , greater bladder control 32,33 , improved speech, and greater upper extremity range of movement have been observed 2,3,32 . Improvements in cognitive function 34 , behavior, and emotional control 32 have also been reported.
Patients who have a positive cough test and consistent symptoms probably have SUI. This is the second most common type of urinary incontinence in women. A history of sudden urination of large amounts of urine suggests DI (the most common type of urinary incontinence in women), or urge incontinence. A PVR volume of more than 100 mL suggests a neurogenic bladder, especially in patients with diabetes or neurologic disease.
To CSF flow, intraventricular pressure rises above convexity pressure and results in ventricular enlargement. Over time, the ventricular and convexity pressures equilibrate, and a chronic state of ventricular dilatation with normal pressure develops. Although opening pressure is normal when measured randomly by lumbar puncture, sophisticated continuous pressure monitoring reveals mild, episodic elevations in intraventricular pressure (Crockard, Hanlon, Duda, & Mullan, 1977). These episodic pressure elevations and a decrease in ventricular compliance may contribute to the maintenance of ventricular enlargement. Nerve fibers mediating cognition, lower extremity motor function, and bladder control surround the frontal horns of the lateral ventricles. The clinical symptoms of NPH are due to either stretching of these fibers or their vascular supply.
Enuresis, more commonly called bed-wetting, is a disorder of elimination that involves the voluntary or involuntary release of urine into bedding, clothing, or other inappropriate places. In adults, loss of bladder control is often referred to as urinary incontinence There are two main types of enuresis in children. Primary enuresis occurs when a child has never established bladder control. Secondary enuresis occurs when a person has established bladder control for a period of six months, then relapses and begins wetting. To be diagnosed with enuresis, a person must be at least five years old or have reached a developmental age of five years. Below this age, problems with bladder control are considered normal. The symptoms of enuresis are straightforward a person urinates in inappropriate places or at inappropriate times. The causes of enuresis are not so clear. A small number of children have abnormalities in the anatomical structure of their kidney or bladder that interfere with...
Play therapy is used to treat problems that are interfering with the child's normal development. Such difficulties would be extreme in degree and have been occurring for many months without resolution. Reasons for treatment include, but are not limited to, temper tantrums, aggressive behavior, non-medical problems with bowel or bladder control, difficulties with sleeping or having nightmares, and experiencing worries or fears. This type of treatment is also used with children who have experienced sexual or physical abuse, neglect, the loss of a family
The bladder can be scarred from radiation, resulting in persistent irritative symptoms or decreased capacity. These complications can actually sometimes worsen with time.39 Medications for urge incontinence like oxybutynin or tolterodine may be helpful. Brachytherapy, increasingly used in early stage prostate cancer, is less likely to cause bladder problems than is external beam radiation. Radiotherapy can also leave the vagina dry and scarred, requiring vaginal lubricants and dilatation procedures to ameliorate.