Urinary Incontinence Naturopathic Treatment
Because fecal impaction has been linked to urinary incontinence, a history that includes frequency of bowel movements, length of time to evacuate and whether the patient must splint her vagina or perineum during defecation should be obtained. Patients should be questioned about fecal incontinence. D. A complete list of all prescription and nonprescription drugs should be obtained. When appropriate, discontinuation of these medications associated with incontinence or substitution of appropriate alternative medications will often cure or significantly improve urinary incontinence.
Pharmacologic agents may be given empirically to women with symptoms of overactive bladder. Tolterodine (Detrol) and extended-release oxybutynin chloride (Ditropan XL) have largely replaced generic oxybutynin as a first-line treatment option for overactive bladder because of favorable side effect profiles. Oxybutynin transdermal may cause less dry mouth than the oral formulation. 3. ERT is also an effective treatment for women with overactive bladder. Even in patients taking systemic estrogen, localized ERT (ie, estradiol-impregnated vaginal ring) may increase inadequate estrogen levels and decrease the symptoms associated with overactive bladder. 4. Pelvic floor electrical stimulation is also effective in treating women with overactive bladder. Pelvic floor electrical stimulation results in a 50 percent cure rate of detrusor instability.
The artificial urinary sphincter (AUS), a device used to treat urinary incontinence, has undergone five revisions since first being described in use in 1972. All types of artificial sphincters perform similar functions to open partially when bladder pressure exceeds physiologic limits, to equalize pressures of stress, to open fully when operated, to fail in the open position, and to allow catheterization without further operations on the device. 8 The most current model, the AS-800 (American Medical Systems, Minnetonka, MN), introduced in 1982, consists of three parts an inflatable cuff, a pressure-regulating balloon, and a pump. The cuff is typically placed around the urethra and is filled with fluid, via a pump reservoir mechanism, providing continence through encircling compression of the urethra. For a patient to urinate, the fluid is pumped from the cuff to the reservoir. The fluid may then be pumped back into the cuff to provide continence or left in the reservoir leaving the...
A variety of disorders in women can be repaired with robotic assistance, such as stress urinary incontinence, uterine prolapse, and pelvic floor weakness. Thus, there is a potential for reconstructive surgery for pelvic floor weakness with robotic assistance in women. Another interesting indication is myomectomy, in which an incision is essential if one wants to perform conventional surgery. In a limited experience at our center, robot-assisted hysterectomy, myomectomy, and pelvic floor repair were feasible, safe, and effective.
Diagnosis of epilepsy is fundamentally a clinical judgment. Clinical history should elicit details of seizure semiology, seizure provoking factors, and seizure frequency in the preceding five years.7 At times there can be discrepancy in the diagnosis of epilepsy when it is based only on a screening questionnaire. In a recent epidemiological survey in Togo of the 9,155 subjects screened by a screening questionnaire, 285 subjects (3.1 ) reported loss of consciousness, 263 (2.9 ) had seizures and 142 (1.5 ) had foaming and urinary incontinence during the seizure 74 (0.8 ) had absence seizures, 68 (0.7 ) had focal symptoms. During case ascertainment of the 304 subjects studied, diagnosis of epilepsy could be established in only 170 pa-tients.8 Documenting seizure provoking factors like sleep deprivation, photic stimulation, and hyperventilation, helps the clinician in the management of people with epilepsy.9
Apy using a modified peripheral seed loading technique. Although these authors observed no cases of urinary incontinence, the four-year incidence of superficial urethral necrosis was 16 . As noted above, patients with preexisting urinary obstructive symptoms are more likely to experience acute urinary morbidity after seed implantation and need to be appropriately counseled regarding this possibility.
Feline dysautonomia is a polyneuropathy of unknown cause that affects autonomic ganglia, resulting in failure of the autonomic nervous system. The disease was first reported in the UK in the 1980s but has since been uncommon until increased numbers of cases were diagnosed in the early 2000s. There is usually a rapid onset of clinical signs, developing over 48 h, but slower progressive development can occur. Clinical signs include dilated pupils, prolapsed nictitating membranes, bradycardia, dry mucous membranes, megaoesophagus, regurgitation, constipation, bladder atony, dysuria, urinary incontinence, loss of anal tone and reflex, and anorexia. Cats become dehydrated and without nursing support and fluid replacement will deteriorate rapidly. Figure 7.17 Lateral radiograph showing a fracture of the sacrococcygeal vertebrae. The cat had faecal and urinary incontinence. Figure 7.17 Lateral radiograph showing a fracture of the sacrococcygeal vertebrae. The cat had faecal and urinary...
Enuresis is defined as the involuntary discharge of urine after the age at which bladder control should have been achieved, in most cases 5 years of age. Enuresis can occur at night (nocturnal enuresis NE ) or daytime (diurnal enuresis), or both. NE can be further subdivided as primary (continuous), and secondary (discontinuous). The term primary NE is applied to children who have never achieved urinary continence for at least 6 continuous months. Secondary NE refers to those children who achieved dryness only to later relapse to wetting. The majority of NE cases, some 90 , are primary enuretics.
Urethral catheterization is a useful procedure for the surgical patient. One of the more important indications for this procedure is to accurately measure urine output. Urine output is a critical parameter for the patient's hemody-namic status. Another indication is the relief of urinary retention, which could be due to medications, neurologic injury, or loss of bladder tone. Temporary treatment of urinary incontinence, collecting urine for bacterial culture, and treatment of perineal wounds are also reasons to use urethral catheterization. Urethral catheterization may also be necessary for the treatment of urinary obstruction, which may lead to hydronephrosis. Lastly, the chronically bedridden patient may require a urinary catheter for hygiene.
Individuals in the vegetative state require a multi-disciplinary approach to patient care. Their course is frequented by extended hospital stays and multiple complications, such as pneumonia, decubiti, urinary incontinence, and urinary infection. In addition, patients may experience disordered neuroendocrine dysfunction with elevated profiles of growth hormone, prolactin, luteinizing hormone, and cortisol.
The procedure is irreversible, with associated risks of paralysis, permanent loss of bowel and bladder control, leakage of spinal fluid, infection, loss of sexual function, and permanent loss of sensation. Temporary side effects, which usually disappear after several weeks, include sensory loss, numbness, or an uncomfortable sensation in the limbs supplied by the severed nerve. Postsurgical treatment involves months of intensive physical therapy to strengthen weak muscles and to develop new movement patterns. Contraindications to SDR suggested by some surgeons include muscle tendon contractures, a history of orthopedic surgery, and hip displacement. The following are guidelines for SDR (from www.ccmckids.org depart-ments orthopaedics orthoed4.htm)
Tethering of the spinal cord can occur as the child grows. Tethering may present as ataxia, rapid progression of scoliosis, loss of functional motor level, a change in urinary continence (new-onset incontinence in a child who had previously been dry on a bladder program), or new-onset orthopedic deformities of the lower extremities. For the child who presents with increasing urinary incontinence with no evidence of an acute urinary tract infection, a neurosurgical consult should be considered. This is generally not an emergency, although it should be evaluated promptly in an office setting.
A urinary tract infection should be suspected when a spinal-cord-injured patient presents with fever, discomfort over the kidney or bladder, change in spasticity, development of urinary incontinence, an episode of autonomic dysreflexia, cloudy or foul-smelling urine, a change in energy level, or a feeling of apprehension. 67 Unless there are confounding factors, the urinalysis shows pyuria and significant bacteruria. In a patient with the abovementioned symptoms and signs and pyuria, empiric treatment for urinary tract infection should be started. Absence of pyuria makes the diagnosis less likely but does not completely exclude it. Conversely, pyuria in an asymptomatic patient with spinal cord injury does not warrant treatment. Pyuria without infection can occur from irritation of the bladder wall in patients with indwelling catheters and in those who use intermittent catheterization.8
Enterocystoplasty is a commonly utilized technique within pediatric urology as a method of both increasing vesical storage capacity and decreasing pressure transmission to the upper urinary tracts in children with inadequate bladder volumes and abnormal bladder wall dynamics. The most frequent indications for augmentation include a poorly compliant, high-pressure, low-capacity bladder secondary to spina bifida (or other spinal cord anomaly or insult), posterior ure-thral valves (PUV), or bladder exstrophy. Augmentation is inherently associated with significant risks and therefore should only be recommended in select patients following an exhaustive trial of medical therapy. Only those with ongoing risk of renal deterioration or socially unacceptable urinary incontinence, despite maximal medical treatment and clean intermittent catheterization (CIC), should be considered for augmentation. Furthermore, vigilance and selection of patients and their families in whom compliance with CIC is...
A similar application has strong scientific support the retraining of pelvic floor muscles using a vaginal or anal EMG sensor. Feedback from the pelvic floor muscles can help the physical therapist and physician diagnose problems such as muscle weakness, spasti-city, or poor motor control. Then exercises using visual displays of muscle activity are designed and practiced until mastered. This is another rehabilitation model use of biofeedback, but it appears that the feedbackassisted exercises improve motor control and this leads to a series of positive gains for urinary incontinence or painful intercourse (vulvodynia). A similar application can be used for fecal incontinence. The patient can often regain control of his or her bowel function in a few sessions using an anal probe pressure device with instructions to normalize the pattern of contraction and relaxation of the anal sphincters.
Prostate cancer treatment with curative intent can also predispose to urinary retention. Although the true incidence of bladder neck contracture following radical prostatectomy is not known, 1.3 -27 of patients will develop symptomatic BNC requiring treatment (Anger et al. 2005). Surgical technique remains a critical determinant of BNC development however, risk factors for microvascular disease such as smoking, hypertension, and diabetes mellitus also appear to play a role (Borboroglu et al. 2000). Simple dilation appears to be effective however, some authors question the long-term patency rates with such treatment. Transurethral incision of the contracture using cold knife, electrocautery, or the holmium YAG laser is the most commonly recommended treatment for severe BNC and those cases involving urinaryretention (Anger et al. 2005 Salant et al. 1990). Great care must be taken when performing transurethral incision since deep incision may cause sphincteric damage and, in turn, stress...
In severely obese people, the excess visceral fat is thought to increase intraabdominal pressure. Animal research shows that experimentally induced acute increases in intraabdominal pressure to the levels seen in the abdomens of very obese people cause increases in pleural pressure, intracranial pressure, and central venous pressure. The investigators postulated that in humans, increased intraabdominal pressure may contribute to hypertension, insulin resistance and type 2 DM, obesity-hypoventilation syndrome, pseudotumor cerebri, incisional hernia, and urinary incontinence. Massive weight loss following obesity surgery normalizes the increased intraabdominal pressure and reduces or eliminates all the symptoms listed previously.
In adults and children older than 1 year, hydro-cephalus may present with either a high-pressure or normal pressure syndrome. The high-pressure syndrome includes headache, nausea, and vomiting. The normal pressure syndrome includes gait disturbance with a broad base and small steps, memory loss, urinary incontinence, and slowing of action.
Seizure disorders are frequently listed as a cause of syncope, and although they often cause a brief loss of consciousness, they do not share the same pathophysiologic mechanisms as syncope. Seizure is the most common event mistaken as syncope. History is very important in differentiating seizure from syncope. 16 Brief tonic movements of extremities may accompany syncope but do not represent true seizure activity. Urinary incontinence, which is often seen with seizures, may also occur with syncope. The most reliable differentiating factor is the postictal confusion period, which is commonly seen after a generalized seizure but is rarely associated with syncope. However, syncope itself may trigger a seizure, so that a seizure presentation does not exclude a syncopal origin.
Both of these behavioral approaches use the theoretical underpinning of conditioning to increase the child's self-control of nocturnal bed-wetting behaviors. The basic assumption behind this approach is that lack of bladder control is a learned response. Arousal training, using either classical or operant conditioning, is designed to reverse change these behaviors.
Urinary incontinence is the inability to maintain control over urinary functions. The goal of biofeedback treatment is to alter both smooth and striated muscle activities related to bladder control. The following methods are employed reinforcement of bladder inhibition, pelvic muscle recruitment, and stabilization of intra-abdominal and bladder pressures during the recruitment of pelvic floor muscles. In order to accomplish these goals, bladder pressure is manipulated and measured while simultaneously measuring pelvic floor muscle activity with EMG sensors. The EMG sensors are specially designed vaginal and anal probes. Fecal incontinence biofeedback is similar, yet different from urinary incontinence biofeedback. Fecal incontinence is the inability to maintain control over bowel movements. During normal anal functioning, when a bolus of feces moves into the rectum, two sphincters are involved in keeping the feces internal. The internal sphincter, which is smooth muscle and controlled...
Still unable to void after this and will go into AUR. For this reason, it is part of good practice to ensure any patient undergoing surgery for stress urinary incontinence is counseled on the possible need for CISC pre-operatively, and has the technique demonstrated so that she is able to perform it should the need arise. Consequently, most patients presenting in AUR after this sort of surgery should be able to perform CISC.
Mild to moderate TCA toxicity may present as drowsiness, confusion, slurred speech, ataxia, dry mucous membranes and axilla, sinus tachycardia, urinary retention, myoclonus, and hyperreflexia. Antimuscarinic syndrome is classically associated with decreased bowel tones and ileus. However, bowel function is fairly resistant to inhibition and active bowel sounds can be present even in seriously ill patients. Therefore, the presence of active bowel tones does not rule out the possibility of antimuscarinic syndrome. Mild hypertension is observed occasionally and rarely requires treatment. Nontolerant individuals occasionally develop coma and respiratory depression after relatively small overdoses without obvious peripheral antimuscarinic effects and without QRS widening. Overflow urinary incontinence may be mistaken for normal micturition in pediatric (diaper-dependent) patients.
If conservative treatment of intractable idiopathic constipation fails, then subtotal colectomy with ileorectal anastomosis may be considered however, this has a high failure rate and is associated with significant morbidity. A colostomy may relieve symptoms but it is an unattractive option for most patients, and abdominal pain and bloating may persist. Sacral nerve stimulation has been shown to produce a clinical benefit for patients with idiopathic constipation with improvements in symptoms of abdominal pain and bloating, plus improvement in overall quality of life scores. Almost all patients with spinal injury experience constipation and, along with bladder control, bowel control is the function that individuals with spinalcord injury would most like to regain. All spinal-injured patients should have dedicated bowel continence regimes initiated by their carers but sacral nerve stimulation has also been shown to be of benefit in this group of patients.
The central cord syndrome is usually seen in older patients with preexisting cervical spondylosis who sustain a hyperextension injury. The injury preferentially involves the central portion of the cord more than the peripheral. The centrally located fibers of the corticospinal and spinothalamic tracts are affected. The neural tracts providing function to the upper extremities are most medial in position. The thoracic, lower extremity, and sacral fibers have a more lateral distribution. Clinically, patients present with decreased strength, and to a lesser degree, decreased pain and temperature sensation, more in the upper than the lower extremities. Spastic paraparesis or spastic quadraparesis can also be seen. The majority will have bowel and bladder control, although this may be impaired in the more severe cases. Prognosis for recovery of function is good however, most patients do not regain fine motor use of their upper extremities. J.0
Grimm et al. 25 summarized the tolerance outcome in 310 patients who received I-125 or Pd-103 for localized disease. During the first 12 months after the procedure, approximately 90 of the patients had grade 1 or 2 acute urinary symptoms, which included urinary frequency, urinary urgency, and obstructive symptoms. Grade 3 acute toxicity was reported in 8 of patients, and 1.5 experienced a grade 4 toxicity. Late grade 3 and 4 toxicities were noted in 7 and 1 , respectively. These authors also documented urinary incontinence rates ranging from 6 to 48 among patients with a prior history of TURP. Among those patients without a history of TURP and with modest gland volumes, the incidence of chronic urethritis and incontinence was found to be less than 3 .
Thoracic spine fractures occur most commonly at the T10-L2 levels and can occur from direct trauma as well as forced hyperflexion of the trunk, as in lap-belt injuries. Vertebral fractures resulting from spinal osteoporosis occur in 8 percent of women over 80 years of age. Such compression fractures are usually wedge-shaped and stable. The presenting symptom is usually severe pain, and accompanying myelopathy is rare. However, when long tract signs, such as hyperreflexia, Babinski's sign, and urinary incontinence are present, a malignancy metastatic to the spine must be suspected. An epidural metastasis may present similarly as an acute myelopathy with or without pain or abnormal x-rays. Myelography, computed tomography (CT), or magnetic resonance imaging (MRI) is needed to differentiate the relatively rare thoracic disk protrusion (1 percent of all disk herniations) from a spinal cord tumor. Pain from thoracic root lesions is usually worse while reclining at night and is relieved by...
And its capsule at open operation (radical prostatectomy). This technically demanding procedure can be performed via a standard open lower abdominal approach, a perineal approach or laparoscopically. It requires the urethra and bladder neck to be joined together when the gland has been removed. Side effects are significant and include erectile dysfunction (ED), urinary incontinence, bladder neck stric-turing and damage to the rectum.
It is an important diagnosis because it is a treatable cause of dementia and gait disorder in the elderly. It is classically characterized by the triad of progressive gait disorder, dementia, and urinary incontinence. The gait disorder is usually shuffling with a broad base. Dementia is a recent memory disorder.
Epidural abscess is characterized by a chronic course of 1 to 15 months in most patients. However, a more acute course with pain, paraplegia, and urinary incontinence developing over several hours to days can occur. The earliest and most prominent symptom is localized pain, which may develop a radicular component. Cerebrospinal fluid (CSF) analysis often demonstrates a mononuclear pleocytosis and increased protein. Myelography, computed tomography (CT), and magnetic resonance imaging (MRI) can help to define the extent of infection. S. aureus and Pseudomonas aeruginosa are the most commonly reported bacterial isolates. M. tuberculosis also has been reported in those concurrently infected with HIV. Emergent neurosurgical evaluation should be obtained for adequate drainage and decompression of these lesions.
Movements when running to the mailbox. These movements, described as arm extensions and toe curling, would last for 30 seconds. At times during these paroxysmal episodes she might not be able to speak, but retained full consciousness. There was no postictal period and no loss of bowel or bladder control. After examination by a pediatric neurologist, with negative results on electroencephalogram and MRI, she was finally diagnosed as having PKD. She was again started on phenobarbital, but this medication caused depression and had to be suspended. Her therapy was changed to Tegretol (carbamazepine) 100 mg day, which successfully prevented further episodes. When she reached puberty at the age of 12, the Tegretol was increased to a twice-a-day dosing. Most recently, she was taking Tegretol-XR 200 mg once a day. She noticed that if she missed more than 1 dose, she experienced paroxysmal dystonic episodes. She believed that her episodes were now stronger and could occur more frequently. If...
Wetting in children can be caused by anatomic incontinence (ectopic ureter, bladder obstruction, extrophy), neurogenic incontinence (spinal dysraphism, trauma, tumours), functional incontinence (urge syndrome, fractional voiding), enuresis (nocturnal, diurnal), and other conditions (urinary infection, polyuria). Incontinence is characterized by failure of voluntary bladder control and incomplete emptying whereas in enuresis emptying is complete and the child is often unaware when wetting occurs. Neurogenic bladder can result from a variety of causes which interfere with the innervation of the bladder, the commonest congenital anomaly being a neural tube defect (myelomeningocele or spina bifida). Urinary incontinence and infection are the main problem. Evaluation is achieved by urodynamic studies. Intermittent self-catheterization is the most important ingredient in its treatment. Bladder augmentation, urinary diversion and artificial urinary sphincters are procedures which may be...
The urethral sphincter, which provides the secondary defense to urinary incontinence and about 50 percent of total urethral resistance. Stress urinary incontinence occurs when urine is involuntarily lost as a result of increased intraabdominal pressure, i.e., when the intraurethral pressure is less than the intraabdominal pressure. It is caused by multiparity, vaginal delivery, pregnancy, menopause, chronic cough (i.e., chronic obstructive pulmonary disease), or other forms of pelvic relaxation. Symptoms include leaking of urine during cough, straining, laughing, sneezing, running, or other causes of increased intraabdominal pressure. Diagnosis involves ruling out infection, neurologic disease, medications, or other systemic illness as possible causes of stress urinary incontinence. A thorough history and physical examination are required, including full vaginal examination with inspection of all the vaginal walls. Further workup by the consulting gynecologist includes stress testing...