Botulinum Toxin A Injections
Botulinum toxin A can be injected into the sides of your bladder to treat urge incontinence and overactive bladder syndrome .
This medication can sometimes help relieve these problems by relaxing your bladder. This effect can last for several months and the injections can be repeated if they help.
Although the symptoms of incontinence may improve after the injections, you may find it difficult to fully empty your bladder. If this happens, you will need to be taught how to insert a catheter into your urethra to drain the urine from your bladder.
Botulinum toxin A is not currently licensed to treat urge incontinence or OAB, so you should be made aware of any risks before deciding to have the treatment. The long-term effects of this treatment are not yet known.
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Physiological Changes Associated With The Ageing Lower Urinary Tract
Urinary incontinence increases with rising age. Ageing is associated with changes in the lower urinary tract which predispose an elderly to UI. As we age, bladder capacity and contractility reduce, with reduced ability to defer voiding once the urge to do so arises. The post-void residual urine volume increases with age. During the storage phase, detrusor shows increased uninhibited contractility .
Among the elderly postmenopausal women, the pelvic muscles show loss of volume and tone. The ligamentous and connective tissue support for the pelvic organs gradually fail because of ageing. The weakened pelvic floor increases the risk of pelvic organ prolapse causing cystocele, rectocele and uterine prolapse. Stage 3-4 prolapse of pelvic organs can cause UI. A weakened pelvic floor also allows a hypermobile urethra to slide downwards during sudden increase in intraabdominal pressure .
What Are Treatment Options For Fainting
The treatment of fainting depends on the diagnosis.
- Lifestyle alterations: Drink plenty of water, increase salt intake , and avoid prolonged standing.
- Lifestyle alterations: Sit up and flex calf muscles for a few minutes before getting out of bed. Avoid dehydration. Elderly people with low blood pressure after eating should avoid large meals or plan to lie down for a few hours after eating.
- Medications: In most cases, medications that cause fainting are withdrawn or changed.
The treatment for cardiac syncope is very specific to the underlying illness. Valvular heart disease often requires surgery, while an arrhythmia might require medications or other treatments listed below.
- Medication and lifestyle alterations: These treatments are designed to optimize the heartâs performance while limiting its demands. Controlling high blood pressure, for example, would involve medication and lifestyle changes. In some cases, specific anti-arrhythmic medication may be prescribed.
- Surgery: Bypass surgery or angioplasty is used to treat coronary heart disease. For some valve problems, valves can be replaced. Catheter ablation is available to treat some arrhythmias.
- Pacemaker: A pacemaker may be implanted to correct the heart rate, slowing the heart in certain types of fast arrhythmias or speeding up the heart for slow arrhythmias.
- Implanted defibrillators are used to control life-threatening fast arrhythmias.
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What Is Urinary Incontinence Symptoms Causes Diagnosis Treatment And Prevention
Urinary incontinence , the involuntary loss of urine, is a very common condition that no one wants to talk about. Because of the stigma that surrounds it, many people are too humiliated to seek help. But most conditions that cause UI can be corrected with medical or alternative interventions.
Occurring much more often in women than men, UI happens when the muscles in the bladder that control the flow of urine contract or relax involuntarily, resulting in leaks or uncontrolled urination. UI itself is not a disease, but it can be a symptom of an underlying medical issue.
Impact Of Urinary Incontinence
Urinary incontinence is a largely undertreated condition. Despite the widespread prevalence of urinary incontinence, only a fraction of sufferers ever seek treatment.
Issues like stigma and embarrassment keep many from reaching out for help. Yet, despite the unwillingness to talk about it, incontinence is something that greatly impacts the people it affects.
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What Treatment Options Are Available If Urinary Incontinence Still Won’t Go Away
Seeing a urogynecologist as early as possible can help ensure that you have a complete understanding of your condition and treatments options.
“Both stress and urgency incontinence typically respond well to behavioral modifications, but if things are not improving, it’s best to get evaluated,” says Dr. Lindo. “This is why I always recommend seeing a specialist about your condition right away. You never want to play the guessing game with your health, especially when your condition affects your quality of life.”
In addition, your doctor can recommend a pelvic floor physical therapy program. While Kegels can play an important role in alleviating urinary incontinence, Dr. Lindo says they’re performed incorrectly more than 80 percent of the time.
“An incorrect Kegel will not help correct urinary incontinence,” warns Dr. Lindo. “Seeing a physical therapist who specializes in pelvic floor exercises can help ensure you’re performing Kegels and other exercises correctly and truly strengthening your pelvic floor.”
And if your condition continues to progress or worsen, your urogynecologist has expertise to perform testing and recommend a range of urinary incontinence treatment options and procedures that can help to correct your condition and address your specific situation.
The Mental Impact Of Urinary Incontinence
While the physical impact of incontinence is substantial, the effect of incontinence on a persons mental health can be truly devastating. Many people with incontinence carry an emotional burden of shame and embarrassment in addition to the physical disruption on their lives.
They learn to hide their problem from close friends and family, and even significant others for years. They shy away from social activities for fear they will have an accident in public, and stop doing things they once took joy in. Slowly, their isolation and shame may lead to depression and anxiety.
And, the impact doesnt stop there sexual function also takes a hit as many females are nervous of leaking during intercourse.
When you think about the anxiety that many feel in relation to possible incontinence during sex, its easy to see why many females with incontinence may avoid the act altogether.
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Dementia And Changes To The Lower Urinary Tract
Dementia is an umbrella of neurodegenerative disorders which cause degeneration of the CNS. The Alzheimer’s Disease Association estimated that currently, there are 46.8 million people living with dementia worldwide and this number will double every 20 years to 74.7 million in 2030 and 131.5 million in 2050. Much of this increase will be in the developing world.
Central control of detrusor activities includes the frontal cortex, basal ganglia, Pontine Micturition Centre. The central control provides an inhibitory input on the detrusor to reduce contractions during the bladder filling phase. Dementia, particularly vascular dementia, normal pressure hydrocephalus, Frontotemporal lobe dementia, Alzheimer’s Disease present with features of detrusor over-activity where urgency is the main symptom. Among the elderly with Alzheimer’s disease, urge incontinence is the commonest presentation and UI is proportional to the dementia severity and impairment of ADLs .
Diffuse Lewy Body Dementia , Multisystem atrophy, Parkinson’s Disease Dementia and AD have additional component of autonomic dysfunction, in addition to the central causes. The autonomic dysfunction presents with detrusor over-activity as the main type of UI. The synuclein deposition in PDD and DLBD is present in central nervous system and postganglionic sympathetic nerves .
Surgical Management Of Ui
Data on surgical management of UI among the frail elderly is scarce. Outcome measures are often confounded by comorbidities and postoperative complications among the elderly. Age related physiological changes like pelvic floor weakness and impaired bladder function also affect the success of surgical treatment. The elderly is at a higher risk of postop morbidity and mortality than the younger patients, and the elderly with dementia have a high risk of developing postop delirium. Recent recommendations by the American College of Surgeons and American Geriatric Society for preoperative assessment of the elderly patients include assessment of comorbidities with optimization, medication management, nutritional improvement, screening for frailty, cognitive impairment and function preoperatively .
For the elderly women with stress incontinence, options include injection of bulking agents at the proximal urethra, midurethral sling, colposuspension, transvaginal/retropubic/transobturator tension-free vaginal tape are all recognized surgical interventions for stress UI. They are effective for women well selected to enroll in large trials with good gain in quality of life, with a risk of postop complications like infection. However, the more frail, disabled elderly with cognitive impairment have not been well studied .
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What Are The Symptoms Of Bladder Control Problems
Signs and symptoms of urinary incontinence can include
- leaking urine during everyday activities, such as lifting, bending, coughing, or exercising
- being unable to hold in urine after feeling a sudden, strong urge to urinate
- leaking urine without any warning or urge
- being unable to reach a toilet in time
- wetting your bed during sleep
- leaking during sexual activity
How Will Syncope Affect My Life
With the proper diagnosis and treatment, syncope can be managed and controlled. If you have had an episode of syncope, there is about a 30% chance you will have another episode. Your risk of another episode and how the condition affects you depends on several factors, including the cause and your age, gender and other medical problems you have. If you have questions about your risks, please talk to your doctor.
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What The Doctor Does
Doctors first ask questions about the person’s symptoms and medical history. Doctors then do a physical examination. What they find during the history and physical examination often suggests a cause of the incontinence and the tests that may need to be done.
Doctors ask questions about the circumstances of urine loss, including amount, time of day, and any precipitating factors . People are asked whether they can sense the need to urinate and, if so, whether the sensation is normal or comes with sudden urgency. Doctors may also ask the person to estimate the amount of urine leakage. Doctors will also ask whether the person has any additional problems with urination, such as pain or burning during urination, a frequent need to urinate, difficulty starting urination, or a weak urine stream.
Sometimes doctors may ask people to keep a record of their urination habits over a day or two. This record is called a voiding diary. Each time the person urinates, the volume and time are recorded. After an episode of incontinence, the person also records any related activities, especially eating, drinking, drug use, or sleep.
Although urodynamic testing is important, results do not always predict response to drug treatment or assess the relative importance of multiple causes.
Causes Of Loss Of Bladder And Bowel Control
Causes of Bowel Incontinence
Causes of Urine Incontinence
It is not always necessary to have a noticeable cause of loss of bladder and bowel control, but your doctor can help you identify the best treatment in this case. Certain conditions can cause urinary incontinence. For instance, it may happen due to poor overall health, vaginal childbirth, and any damage to the nervous system.
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When To See A Doctor
People with warning signs should go to an emergency department at once. People without warning signs should call their doctor. The doctor will decide how quickly they need to be seen based on their other symptoms and other known conditions. In general, if incontinence is the only symptom, a delay of a week or so is not harmful.
Most people are embarrassed to mention incontinence to their doctors. Some people believe that incontinence is a normal part of aging. However, incontinence, even incontinence that has been present for some time or that occurs in an older person, may be helped by treatment. If symptoms of urinary incontinence are bothersome, interfere with activities of daily living, or cause people to curtail their social activities, people should see a doctor.
Bladder And Bowel Incontinence
Incontinence is a loss of control of a personâs bowels or bladder which can cause accidental leakage of body fluids and waste. Incontinence can be more than a physical problem. It can disrupt your quality of life if its not managed well.
Fear, anxiety, and anger are common feelings for people dealing with incontinence. You may avoid being intimate or having sex because you are afraid of urine, gas, or stool leakage. Fear of having an accident may keep you from being physically active, enjoying hobbies, or spending extended time outside your home.
Both men and women can have incontinence during and after surgery or some other treatments for cancer. Incontinence can also occur because of other non-cancer medical conditions. Be sure to talk to your health care team if you have difficulty controlling urination or bowels. Talking about incontinence can be embarrassing, but being open and honest with your health care team can help manage it.
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When Should You Worry About Fainting
Fainting may be caused by something serious, such as a heart problem or a seizure, or by something minor, such as laughing too hard.
Donât try to diagnose yourself seek immediate medical attention if you lose consciousness.
Fainting can be alarming, and it should be. While often the cause of fainting is something minor, fainting also can be a sign of a serious underlying medical concern. âThe problem is that you canât evaluate yourself, and you should let a physician determine if fainting is worrisome or not,â says Dr. Shamai Grossman, an associate professor of emergency medicine at Harvard Medical School, who has conducted 20 studies on fainting.
Treatment Options For Urgency Incontinence:
- Pelvic floor physical therapy This therapy helps to retrain the bladder.
- Medications A range of medications can help you hold your bladder for longer and decrease your urinary frequency symptoms.
- Botox injections in the bladder Botox relaxes the wall of your bladder in order to prevent it from contracting when it’s not supposed to.
- Peripheral nerve stimulation This treatment uses a needle to stimulate a nerve in your foot that travels up the leg to the spine, where it connects with the bladder and calms it down.
- Sacral neural modulation In this outpatient surgical procedure, a bladder pacemaker is implanted to help control how the bladder is stimulated by the sacral nerve.
“Regardless of which type of incontinence you’re experiencing, it’s important to get evaluated simply because there are so many options for treating urinary incontinence,” says Dr. Lindo. “We always start with conservative treatment approaches, but if those don’t work, you don’t have to continue to suffer. We can help to improve your quality of life.”
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Keeping A Bathroom Journal
You may be asked to keep a bathroom journal before or after your appointment. In your journal, youll log all your bathroom trips and bladder leakage or issues. It can also be helpful to record what you eat and drink in your bladder journal. This record will help your doctor get a more accurate idea of your symptoms and how often they occur. Keeping a journal can also determine what triggers your need to pee or any accidents.
What Are Kegel Exercises
Kegel exercises, also called Kegels or pelvic floor muscle training, are exercises for your pelvic floor muscles to help prevent or reduce stress urinary incontinence. Your pelvic floor muscles support your uterus, bladder, small intestine, and rectum.
Four in 10 women improved their symptoms after trying Kegels.9 Kegels can be done daily and may be especially helpful during pregnancy. They can help prevent the weakening of pelvic floor muscles, which often happens during pregnancy and childbirth. Your pelvic floor muscles may also weaken with age and less physical activity.
Some women have urinary symptoms because the pelvic floor muscles are always tightened. In this situation, Kegel exercises will not help your urinary symptoms and may cause more problems. Talk to your doctor or nurse about your urinary symptoms before doing Kegel exercises.
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Burning Or Painful Urination
People with UTI often feel a burning sensation when they urinate. This symptom is one of the key signs that a person may have a urinary tract infection.
Burning urination or painful urination is medically known as dysuria. It can be caused by infectious and noninfectious conditions.
A urinary tract infection makes the lining of the bladder and urethra become red and irritated.
In addition to the burning sensation, there is also an itchy or stinging feeling as the urine comes out. The pain can be felt at the start of urination or after urination.
Pain is often felt in the urethra. These are the tubes that carry urine to the bladder. The pain can also extend to the area around the genitals.
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Pelvic parasympathetic nerves: arise at the sacral level of the spinal cord, excite the bladder, and relax the urethra. Lumbar sympathetic nerves: inhibit the bladder body and excite the bladder base and urethra. Pudendal nerves: excite the external urethral sphincter.
Likewise, can bulging disc cause bladder problems? If the herniated disk presses on nerves in the nearby spinal canal, this can cause variety of nerve-related symptoms, including pain, numbness and muscle weakness. In the most severe cases, a herniated disk can compress nerves that control the bowel and bladder, causing urinary incontinence and loss of bowel control.
In respect to this, what nerves control the bladder and bowels?
Can a pinched nerve cause urinary problems?
Bladder Control Medication Side Effects
Many people take medication prescribed by their doctor for bladder control. Many medications for bladder control are anticholinergic. That means they also cause dizziness as a side effect.
So the side effects of bladder control medications is another way that bladder control problems cause dizziness.
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