Bladder Control Ebook

Reclaim Bladder Control

Urinary Incontinence affects people world wide, and can cause people to avoid social contact and not want to deal with others. This ebook by Alice Benton gives you the best way to avoid the embarrassment and discomfort that is associated with urinary incontinence. Why would you want to deal with annoyance of being unable to control your own bladder when you could find a far better way to help heal yourself? This ebook gives you natural methods of taking back control of your bladder, without having to worry about the dangers associated with surgery or medications that can cause harm to your kidneys. You can learn the best natural way to heal yourself from urinary incontinence and give yourself the life that you deserve; start living the way that you deserve to live, without all of the problems that come with urinary incontinence. Take your life back now!

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The writer has done a thorough research even about the obscure and minor details related to the subject area. And also facts weren’t just dumped, but presented in an interesting manner.

When compared to other ebooks and paper publications I have read, I consider this to be the bible for this topic. Get this and you will never regret the decision.

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What happens if storage overactive bladder symptoms persist after successful treatment ofthe voiding symptoms

In males with LUTs in whom the voiding (BPH) symptoms have been successfully treated, but whose overactive bladder symptoms persist, a trial of antimuscarinic therapy can be tried if there is no contraindication to the use of antimuscarinic agents. Your doctor will want to make sure that you are emptying your bladder well before using an antimuscarinic. There are a variety of antimus-carinic agents available (Table 13). They all are effective in decreasing urinary frequency, urgency, and urgency

Urinary Incontinence The Solutions

Holistics Antiandrogen

The good news about urinary incontinence caused by treatment for prostate cancer is that in most cases the problem improves over time. This is especially true of incontinence due to surgery, which initially may be a serious difficulty. Most studies suggest that incontinence continues to be a long-term major problem for approximately 5 to 10 percent of men treated for prostate cancer but can be improved with help. Despite all of the above suggestions, urinary incontinence will continue to be a problem for 5 to 10 percent of men following prostate cancer treatment. Injections of collagen through the urethra may strengthen the sphincter for approximately half of the men who try it, but it is expensive and the effects are usually not lasting. Out of desperation, some men use a foam rubber penile clamp, which can be released when the man wishes to urinate, or a condom catheter (widely known as a Texas catheter), which is worn on the penis and collects the urine, but both solutions bring...

Stress Urinary Incontinence Related to Urethral Underactivity4

In stress urinary incontinence (SUI), the urethra and or urethral sphincters cannot generate enough resistance to impede urine flow from the bladder when intra-abdominal pressures (that are transmitted to the bladder, which is an intra-abdominal organ) are elevated. Intra-abdominal pressures are elevated by exertional activities like exercise, running, lifting, coughing, and sneezing. The amount of urine lost is generally small with each episode. Nocturia and enuresis are rarely seen. The factors responsible for

Overactive Bladder

Overactive bladder describes a clinical syndrome characterized by lower urinary tract voiding dysfunction. The International Continence Society has defined overactive bladder as urgency, with or without urge incontinence, usually with frequency and nocturia (Wein and Rovner, 2002). The lack of specificity inherent in this definition creates potential for overlap with other urinary tract symptom complexes (e.g., LUTS) and diseases. The pathogenesis is uncertain, and urinary tract abnormalities that could cause symptoms should be ruled out. The primary dysfunction revolves around improper detrusor muscle activity and functional reductions in bladder volume. However, the definition does not exclude patients with the symptoms who do not have objective bladder hypercontractility. Furthermore, voluntary control of bladder contraction may be impaired so that the urge to void cannot be controlled (Herbison et al., 2003). Neurologic conditions may contribute. For example, patients with...

Effectiveness of Early Detection and Intervention

Screening with PSA and DRE can detect prostate cancer in its early stages, but it is not clear whether early detection improves health outcomes. Screening may result in several potential harms, including frequent false-positive results, biopsies, and anxiety. Treatment side effects may include erectile dysfunction, urinary incontinence, and bowel dysfunction. Treatment of all cases detected by screening is likely to result in many interventions for men who would never have experienced symptoms from their cancers (Harris et al., 2001).

What is a radical prostatectomyAre there different types

Laparoscopic radical prostatectomy is a procedure that has the advantages of the retropubic approach but, because there are several small abdominal incisions as opposed to the longer midline incision, the discomfort is less and the recovery is quicker with this approach. The disadvantage of this procedure is that it is relatively new and requires a urologist with advanced skills in laparoscopy. It may take longer to perform than an open radical retropubic prostatectomy. The outcomes of laparoscopic prostatectomy, such as urinary incontinence, erectile function, and positive margin rates are similar to open surgery. Robotic-assisted radical prostatectomy has surpassed laparoscopic radical prostatectomy in terms of the number of procedures being performed. Just because you are a candidate for a radical prostatectomy does not mean that this is the best form of treatment for you. You must look carefully at your lifestyle, the risks of the surgery, and what is most important to you...

Kidney Disease Urinary Disease and Diseases of the Reproductive Organs

Because symptoms of diseases of the urinary bladder are conspicuous and painful, they were the subject of considerable medical interest. The Hyangyak chipsong pang discusses dysuria, ischuria, pol-lakiuria, urinary incontinence, hematuria, gross hematuria associated with high-fever diseases, and enuresis. Various symptoms of urinary problems are also discussed in connection with gonorrhea. Some of the disorders of urine might have been caused by tuberculosis of the urogenital system.

What is cryotherapycryosurgery Who is a candidate What is the success rate What are the risks

Common side effects of cryotherapy include perineal pain, transient urinary retention, penile and or scrotal swelling, and hematuria. Urinary retention occurs in roughly 3 of individuals. Anti-inflammatories seem to help, but individuals may require a catheter or suprapu-bic tube for a few weeks post-treatment. Penile and or scrotal swelling is common in the first or second post-procedure weeks and usually resolves within 2 months of cryotherapy. Penile paraesthesia may occur and usually resolves within 2 to 4 months postprocedure. Long-term complications of cryotherapy include fistula formation, incontinence, erectile dysfunction, and urethral sloughing. The risk of permanent incontinence (i.e., need to wear a pad) is reported to range from < 1 to 8 . However, in individuals undergoing salvage cryotherapy after radiation failure, the incidence of urinary incontinence may be as high as 43 . Similarly, with total prostate gland cryotherapy, the ice ball extends beyond the capsule of...

Spinal Neurons As Targets

Where descending inputs to the dorsal and ventral horns make their connections. Over what expanse, rostrocaudal and mediolateral, do incoming axons normally join interneurons and sensory and motoneurons How many targets can one axon effectively reach and activate What are the neurotransmitters that drive and inhibit these pools Which descending inputs and which target cells would give new axons the greatest behavioral effects for restoration of movement, sensation, and bowel and bladder control Which inputs would prevent or eliminate at-level spinal pain The mechanisms that regulate target recognition within the cord have been shown in a few studies of the injured CNS to be intact, so regenerating axons may recognize appropriate attractive and inhibitory signals once axons penetrate the gray matter.311 Behavioral retraining strategies may aid target recognition, as well as the functional incorporation of new axonal inputs.

What Practitioners Say It Does

Biofeedback therapies were developed to treat a wide range of symptoms and problems, including stress, urinary incontinence, sleep disorders, Raynaud's disease, migraine headache, hypertension, addictions, vascular disorders, and many others. The procedure involves focusing the mind on a biological function and mentally visualizing or picturing the desired change. This might be warming the temperature of one's hands, tightening blood vessels to eliminate headaches, or inducing other physiological events to help relieve the particular disorder. According to practitioners, biofeedback creates a greater awareness of specific body parts and their functions. With training, increased awareness of physiologic functions enables the patient to regulate these functions.

Research Evidence to Date

Well-controlled studies report positive effects of biofeedback in treating Raynaud's disease. Biofeedback can also help people overcome urinary incontinence by developing more effective control of their bladder muscles. It can assist the retraining of body muscles after an accident or surgery, and help train new muscles to take over the function of those that are irreparably damaged.

What are the symptoms of BPH

Stream, a sensation of incomplete bladder emptying, and terminal dribbling. Storage irritative symptoms include frequent urination, nocturia (getting up at night to urinate), and urgency, the sudden compelling need to urinate that is difficult to defer. These storage symptoms are overactive bladder symptoms. Other conditions that may be a sign of prostatic enlargement are urinary retention or the inability to void, urinary tract infection, urinary incontinence, and hematuria or blood in the urine.

What damage can BPHcause

Enlargement of the prostate, BPH, increases the resistance to the flow of urine out of the bladder. Thus the bladder needs to work harder to push urine beyond the resistance. In order to accomplish this, the bladder pressures must increase. As a result of this need for increased force there is hypertrophy of the bladder muscle. The increased work that the bladder muscle needs to do to empty the bladder may lead to the development of overactive bladder (Questions 41 and 42). This increased pressure that the bladder needs to generate can be transmitted backwards from the bladder to the kidneys, and in some individuals it may impair the drainage of the kidneys, causing swelling of the kidneys hydronephrosis and a decrease in kidney function. If the bladder cannot create enough pressure and or cannot maintain the elevated pressure, then the bladder may not

Can alphablocker drugs and 5alpha reductase drugs be used together

This study was a double-blind (neither the investigator or study participants knew who received drug(s) or placebo) trial that involved more than 3,000 men who were followed for an average of 4.5 years. The men were divided into four groups placebo (control group), doxazosin (an alpha blocker) alone, finasteride alone, and doxazosin and finasteride together. These four groups of patients were then followed for signs of progression of BPH. Progression was defined as an increase of urinary symptoms, as measured by the American Urological Association symptom score, acute urinary retention, urinary incontinence, renal insufficiency, or recurrent urinary tract infections. The risk reduction of signs of progression of BPH was 39 with doxazosin, 34 with finasteride, and 66 with combination therapy.

What Clues To The Diagnosis Of Nonepileptic Seizures May Be Provided By The Patients History

Generally, there are many differences between the histories of patients with NESs and those of patients with epilepsy. NESs may occur only in the presence of others or, conversely, may never have been observed. In the latter case the clinician is dependent on the patient's description, which may be fragmentary and incomplete. Indeed, only loss of consciousness may be reported. If such a patient has a history of epilepsy, the probability of misdiagnosis is high. It is often said by clinicians that tongue biting and urinary incontinence do not occur with NESs. Unfortunately, many patients with documented NESs have reported these symptoms.

Bodyworn products for lightly incontinent men

Only one evaluation of absorbent products for men with light urinary incontinence has been published (Fader et al., 2005). It compared the four main absorbent designs of products disposable insert pads, pouches, leafs (a variant on the pouch which is positioned over the penis and scrotum) and washable pants with integral pad. All six leaf products (five disposable and one washable) and all six pouches (all disposable) on the UK market in 2003 were evaluated, together with a selected disposable insert pad and a selected washable pant with integral pouch (chosen to represent their respective designs). Seventy men with light urinary incontinence evaluated the products. The pouch design performed significantly worse than the leaf and the insert design. The most common problems with the pouch were staying in place and difficulties re-inserting the penis in the pouch once the pouch was wet. The leaf designs had the best leakage scores. The disposable insert was also effective for leakage...

Predictors of Functional Gains

Urinary incontinence is about as good a predictor of a poorer outcome as any grouping of impairments.197 Indeed, one classification tree approach to predicting outcome for inpatient rehabilitation found that the level of independence in toilet and bladder management and toilet transfers, along with adequacy of financial resources, best predicted community discharge, survival for more than 3 months after discharge, and no more than minimal physical asistance for ADLs.198 For patients under age 75 years who have rehabilitation admission FIM scores less than 37, 3 FIM items on admission (bladder management, toilet transfers, and memory), and 3 discharge FIM variables (upper body dressing, bed chair transfers, and comprehension) predict discharge placement with 75 accuracy.74 Another study, which did not include an impairment measure, employed the BI to determine the average pattern of gains over weeks after the stroke.199 The presence of prestroke disability, urinary incontinence,...

Examination and Test Findings

Mental status assessment may reveal dysfunction in multiple cognitive domains. Executive dysfunction may be more prominent than dysfunction in other domains. The neurological examination will reveal cranial nerve dysfunction and focal pyramidal and extrapyramidal abnormalities. Gait and balance abnormalities are frequently seen. Urinary incontinence is also seen in many VaD patients.

Interstitial Cystitis

The main impact of interstitial cystitis is on quality of life. Patients often express somatization and depression or anxiety as with other somatic pain syndromes, its pathogenesis is unclear. Differential diagnosis includes other somatic syndromes such as fibromyalgia, irritable bowel, and chronic pelvic pain, as well as UTI, overactive bladder, uterine fibroids, and endometriosis. Interstitial cystitis should be considered in any patient presenting frequently with UTI symptoms. There may also be association with autoimmune disorders.

Brief Overview of Nanotechnology

Urology as a specialty is in a key position to benefit from nanotechnology. The combination of functional abnormalities (e.g. overactive bladder), reconstruction (e.g. hypospadias repair, bladder reconstruction), and oncology (e.g., staging of prostate or penile cancer) all lend themselves to the development of these novel technologies. Currently, the three main areas of integration of synthetic nano-technology with potential availability to urologists are either for the delivery of pharmaceuticals, for tissue engineering, or as an adjunct to conventional imaging. A summary of the current nanotechnology development in urology is included in Table 13.1.

Hypoactive Sexual Desire Disorder

Female sexual desire is a complex interaction among biologic, psychological, social, interpersonal, and environmental components. Ovarian function, especially ovarian androgens, may play an important role. In women age 20 to 49, HSDD is almost threefold more likely in surgical postmeno-pausal women than premenopausal women. However, no significant difference in HSDD exists between naturally or surgical postmenopausal women over age 50 (Leiblum et al., 2006). Medical illnesses, such as thyroid disease, chronic pain conditions, urinary incontinence, and depression anxiety, may negatively impact sexual desire. Medications can affect sexual drive, especially selective serotonin reuptake inhibitor (SSRI) antidepressants, antihypertensives, antipsy-chotics, and narcotics. Fear of pregnancy or sexually transmitted infection and discord or communication difficulty in a couple's relationship may diminish sexual desire. The clinician must explore all aspects of the biopsychosocial model when...

Clinical Features Symptoms and Signs

Normal-pressure hydrocephalus is characterized by memory loss, gait ataxia, and urinary incontinence. Occurrence of colloid cysts with this syndrome generally is confined to adults in whom age-related atrophy or chronicity of hydro-cephalus has resulted in ventriculomegaly without increased pressure. I was unable to find any cases with this symptom in the pediatric population.

Clinicopathologic Correlations

Decubitus ulcers result from prolonged pressure over bony prominences. A pressure ulcer starts as reddened skin but gets progressively worse, forming a blister, then an open sore, and finally a crater. The most common places for pressure ulcers are over bony prominences (bones close to the skin) such as the elbows, heels, hips, ankles, shoulders, back, sacrum, and back of the head. It is thought that this pressure causes a decrease in perfusion to the area, leading to the accumulation of toxic products, with subsequent necrosis of skin, muscle, subcutaneous tissue, and bone. Moisture, caused by fecal or urinary incontinence or by perspiration, is also implicated because it causes maceration of the epidermis and allows tissue necrosis to occur. Shearing force is also a factor. Shear is generated when the head of a bed is elevated, causing the torso to slide down and transmit pressure to the sacrum. Poor nutritional status and delayed wound healing are other widespread contributing...

Autonomic Dysfunction Secondary to Focal Central Nervous System Disease

Has been associated with cardiac arrhythmias and contralateral hyperhidrosis. When the cingulate and paracentral cortices are involved, urinary incontinence may occur because of uninhibited bladder contractions. Disturbances at different levels of the bladder control system result in the development of neurogenic bladder. Neurogenic bladders can be subdivided into two types the reflex or upper motor neuron type, and the nonreflex or lower motor neuron type. The terms reflex and nonreflex denote the presence or absence, respectively, of bulbocavernosus and anal reflexes. The reflex type of neurogenic bladder includes the uninhibited bladder associated with lesions of the medial frontal region that results in urinary incontinence but not urinary retention because the detrusor-sphincter synergy is preserved. The automatic bladder results from lesions of the spinal cord that interrupt the pathway from the pontine micturition centers. An automatic bladder is associated with urgency,...

Basic Principles of Geriatric Medicine

A third principle is the underreporting of illness. When an interviewer asks a geriatric patient about various symptoms, the patient may fail to report blindness caused by a cataract, deafness caused by otosclerosis, pain in the legs at night, urinary incontinence, constipation, confusion, and so forth. The geriatric patient may believe that these symptoms are normal for a 75- or 80-year-old person. Abdominal pain and other gastrointestinal complaints such as increased gas are commonly mistaken by geriatric patients as a normal part of aging. Sometimes a patient may say, ''Nothing can be done about it, so I don't want to bother anyone by mentioning it.''

Adrenergic Receptors in the Urogenital Tract

Healthy human bladder expresses few a1-adrenergic receptors these are predominantly of the a1D-subtype, but their physiological role remains to be determined (61). Some data obtained with experimental animals raise the possibility that bladder dysfunction is accompanied by enhanced action of these receptors, and that such regulation may involve a subtype switch (62). Human bladder also expresses a large number of -adrenergic receptors, largely belonging to the -subtype, for which no physiological postjunctional function has as yet been identified (63). P-Adrenergic receptors are considered the main physiological mediator for relaxation of bladder smooth muscle, hence allowing accommodation of increasing volumes of urine at acceptable pressure during the filling phase of the micturition cycle (64). In humans, this appears to occur predominantly, if not exclusively, through a P3-subtype (65). The finding that few other human tissues are so enriched in p3-adrenergic receptors makes these...

What happens when hormone therapy fails

Still believed to have organ-confined disease. Individuals in this group include those who have a Gleason score < 6, a low pretreatment PSA level (< 10 ng mL), and low clinical stage tumor (T1c or T2a). At the time of the salvage prostatectomy, they should still have a favorable Gleason score, a low clinical stage, and, ideally, a PSA that is < 4 ng mL. Salvage prostatectomy is a challenging procedure, and if you are considering this option, you should seek out an urologist who has experience with it because there is an increased risk of urinary incontinence, erectile dysfunction, and rectal injury with this procedure. Rarely, because of extensive scarring, it is necessary to remove the bladder in addition to the prostate, and a urinary diversion would be necessary. A urinary diversion is a procedure that allows urine to be diverted to a segment of bowel that can be made into a storage unit similar to a bladder or allows urine to pass out of an opening in the belly wall into a...

The Prevention And Management Of Pressure Sores

Release The Pressure Sore With Equipment

Friction occurs when two surfaces rub together. The commonest cause is when the patient is dragged rather than lifted across the bed. It causes the top layers of epithelial cells to be scraped off. Moisture exacerbates the effect of friction. Moisture may be found on a patient's skin as a result of excessive sweating or urinary incontinence. Incontinence of urine can contribute to maceration of the skin and thus increase the risk of friction. Constant washing removes natural body oils, drying the skin. In a pressure sore prevalence survey of Greater Glasgow, Jordan and Clark (1977) found 15.5 of patients with pressure sores to be incontinent of urine and 39.7 to have faecal incontinence. Schnelle et al. (1997) found incontinence to be related to blanching erythema, an early indicator of pressure damage. Factors that may be associated with urinary incontinence include the use of diuretics or sedatives. Diarrhoea may cause incontinence in the elderly or immobile patient. It is a...

Levocarnitinein Libido

In allergic rhinitis, 1049-1050 in cirrhosis, 394 in constipation, 373 in erectile dysfunction, 885 in GERD, 317, 319, 320t in hyperlipidemia, 234, 236t, 240, 958 in hypertension, 58-59, 59t, 957-958 in ischemic heart disease, 117-118 in musculoskeletal disorders, 1027-1028 in osteoarthritis, 1000 in Parkinson's disease, 557 in urinary incontinence, 914 Lifting, in enuresis, 9231 Lifting techniques, 1028 Ligament, 1020, 1020

Transurethral Resection of the Prostate Skills A Potential Training Crisis

Transurethral resection of the prostate is potentially dangerous. Within this small amount of space, there are also many potential anatomical hazards, where an error in judgment, visual-spatial or psychomotor skill could potentially result in devastating consequences such as total urinary incontinence, rectal injury, ureteral injury, dorsal vein injury with profuse blood loss, erectile dysfunction, and life-threatening levels of hyponatremia. Historically, such a small margin of error coupled with the disconnect that exists between the operators and the patient that inherently exists with all endo-scopic procedures has made training this skill set challenging.

What are externalbeam and conformal externalbeam radiation therapies What are the side effects of EBRT

Ams Artificial Urinary Sphincter

Urinary incontinence, the uncontrolled loss of urine, is one of the most bothersome risks of prostate cancer treatment. Although it is more commonly associated with radical prostatectomy, it may also occur after interstitial seed therapy, EBRT, and cryotherapy. Urinary incontinence may lead to anxiety, hopelessness, and loss of self-control and self-esteem. Fear of leakage may limit social activities and participation in sex. If you are experiencing these feelings, you should discuss this with your doctor and spouse or significant other. If you experience persistent urinary incontinence after surgery or radiation therapy, your doctor will want to identify the degree and the type of incontinence. You will be asked questions regarding the number of pads you use per day, what activities precipitate the incontinence, how frequently you urinate, if you have frequency or urgency, how strong your force of urine stream is, if you feel that you are emptying your bladder well, and what types...

Myxopapillary Ependymoma

On occasion, the filum may be sectioned above and below the tumor and the lesion lifted out en bloc with minimal subarachnoid dissection. Not uncommonly, there are dense adhesions between the lesion and surrounding nerve roots, making determination of origin and safe resection difficult. If the lesion is integrated within the conus medullaris, judgment should be exercised. Gross-total excision may cure the patient but may be inadvisable to undertake given the substantial risk of bowel or bladder problems postoperatively.

Cranial and Spinal Epidural Abscess

The initial symptom, which is followed by radicular pain in the extremities or pain in an intercostal thoracic dermatomal pattern within 2 to 3 days. As the disease progresses, paresis of appendicular muscles is associated with loss of sensation below the level of the lesion and the loss of bowel and bladder control. Finally, there is complete paralysis of appendicular muscles and a loss of all sensory modalities below the level of the lesion.

What is brachytherapyinterstitialseed therapy Who is a candidate What are the risks

Greek Word Prostate

Bladder outlet obstruction, urinary incontinence, and rectal ulceration and bleeding. In addition, in some patients a benign increase in the PSA may occur after interstitial seed therapy. Urinary symptoms occur earlier with palladium because it releases high energy earlier than iodine. Individuals may develop urinary frequency, dysuria, or urinary retention. Urinary symptoms, if they are not associated with urinary retention, are often treated with nonsteroidal anti-inflammatories and an alpha-blocker, such as doxazosin (Cardura), terazosin (Hytrin), alfu-zosin (Uroxatral), tamsulosin (Flomax) and silodosin (Rapaflo). They often resolve over 1 to 4 months, but may persist for 12 to 18 months. bladder on a regular schedule (usually every 4 to 6 hours) throughout the day. The advantages of clean intermittent catheterization are that it allows you to know when you are able to void on your own, it minimizes bladder and urethral irritation, and it has less risk of infections and bladder...

What are the risks of surgery How are they treated

All surgical procedures have risks, and the common ones are infection, bleeding, pain, and anesthetic complications. Larger surgical procedures, which involve lengthier operative times and decreased postoperative mobility, have the risk of blood clots in the legs (deep venous thrombosis), pulmonary embolus, pneumonia, and stress-related stomach ulcers. Complications of radical prostatectomy include hernia, significant bleeding requiring blood transfusion, infection, anesthetic-related complications, impotence, urinary incontinence, bladder neck contracture, deep venous thrombosis, rectal injury, and death. Urinary incontinence Urinary Incontinence Urinary incontinence is another risk of radical prostatectomy. Incontinence may vary from none to persistent incontinence, such that every time you move you leak urine. The more common type of incontinence is stress-related incontinence, leakage that occurs when you increase the pressure in your abdomen, such as when you bear down, pick up...

General Approach to Treatment

The following are four ChE inhibitors tacrine, donepezil, rivastigmine, and galan-tamine. The use of tacrine is limited due to its propensity for hepatotoxicity, difficult titration schedule, four times daily dosing, poor bioavailability, and increased adverse events of nausea, diarrhea, and urinary incontinence. There is only one NMDA antagonist, memantine. Psychiatric and behavioral symptoms that occur during the course of the disease should be treated as they occur.

Review of Systems and Examination of the Young Child

A child 1 to 5 years of age is becoming verbal and, if in pain, can tell you where it hurts. They may start to report nausea, sore throat, chest pain, fatigue, or headache. Note that headache in a preschool child is unusual and probably indicates a serious intracranial pathologic process. Other questions to add to the infants' review of systems include questions about snoring and loss of bowel or bladder control in a child who has been toilet trained. Most children have achieved daytime control by 4 years of age, although only about half of children are dry at night by then. Restless sleep, including nightmares, night terrors, and sleep walking are not uncommon at this age.

Medical Interventions

A 31-year-old woman slipped and fell down a flight of stairs, landed on her back, and was unable to move her legs. She recovered the ability to walk but had mild residual leg weakness, a drop foot, and dyses-thesias of the feet. At age 42, she suddenly felt pain in the upper back and urinary incontinence while cheering at a basketball game. Upper thoracic, cervical, and right arm pain recurred with sneezing. At age 44, her left hand became dry and walking and urinary urgency and constipation worsened. The MRI scan shows a wide sy-ringomyelia from T-12 to C-2 in the (A) sagittal and (B) axial planes. She had kyphotic angulation of the spine at T-12 L-1 and an L-1 fracture. A staged decompression of the subarachnoid space was carried out with an anterior spinal decompression and partial extradural vertebrec-tomy of L-1, followed by a T-12 and L-1 laminectomy with intradural lysis of adhesions and placement of a dural graft. The (C) sagittal and (D) axial scans a few months...

Population And What Tests Best Distinguish One Disorder From Another

Tion.47 It is important to realize that in the vast majority of cases, convulsive syncope does not represent a cortical electrical seizure but occurs with cortical depression, usually manifested on the EEG by diffuse flattening.48 The release of brainstem mechanisms from cortical inhibition is the hypothesized mechanism. Unlike a generalized tonic-clonic seizure, syncope, even if convulsive, is usually followed by little or no confusion or somnolence. Urinary incontinence and tongue biting are rare but may occur.

Behavioral Interventions

Pelvic floor muscle (Kegel) exercises remain one of the mainstays of behavioral therapy in the treatment of urinary incontinence. The exercises involve repetitive contractions and relaxations of the pelvic floor muscles. They have been found effective in stress, urge, and mixed incontinence (Hay-Smith and Dumoulin, 2006). A simply way to teach women to identify and isolate the pelvic floor muscles is by having the patient squeeze the examiner's finger during vaginal examination. Squeezing the examiner's finger by contracting the anal sphincter during a rectal exam can help both men and women isolate the pelvic floor muscles. Pessaries in many different forms have been used for hundreds of years for the treatment of pelvic organ prolapse and urinary incontinence in women. The support offered by the pessary helps in correcting the angles and contacts between adjacent organs, thus minimizing bladder irritation and spontaneous contractions that lead to incontinence. Pessaries come in a...

Normal Pressure Hydrocephalus

Clinical Findings and Associated Disorders. The triad of progressive dementia, gait disturbance, and urinary incontinence was originally described by Adams and colleagues. In most instances, gait disturbance is the first sign, followed by dementia, and, later, urinary dysfunction. The gait is slow, unsteady, and wide based. Steps are usually short, and patients have difficulty picking their feet off the ground to ambulate (so-called magnetic gait). Turning is difficult and takes several steps. On examination, there is bradykinesia, and the legs may be spastic with increased reflexes. Patients may have difficulty in handwriting and dressing, and may appear to be mildly parkinsonian, but their tremor, if present, is usually postural, not resting. One particular feature is the discrepancy between leg function during walking and simulated walking when sitting. Patients can usually move their legs well and imitate walking while in a chair, but they become awkward and severely impaired as...

Associated Neurological Findings

With regard to CN XI or XII, bihemispherical lesions may result in significant weakness of the SCM, trapezeii, or extrinsic tongue muscles. Other features that confirm the presence of bihemispherical lesions are urinary incontinence, gait apraxia, pseudobulbar palsy (i.e., dysarthria, dysphagia, and emotional incontinence), cognitive deficits, and alterations in personality.

Pharmacologic Therapies

Various medications have been used to treat the different forms of urinary incontinence. However, most current medications are used for urge or mixed incontinence, because there is little evidence that adrenergic agonists help stress incontinence (Alhasso et al., 2005) (Table 4-18). The anti-cholinergic, antimuscarinic medications prescribed for urge incontinence work by blocking cholinergic receptors in the bladder, which in turn diminishes bladder contractility. This class of medications is effective but has adverse side effects (e.g., dry mouth, constipation) related to the cross-reactivity with muscarinic receptors in the salivary glands and colon (Alhasso et al., 2006). Additional side effects include dry eyes, blurry vision, and risk of urinary retention. Anticholin- Table 4-18 Drug Treatment for Urinary Incontinence

Evaluation

The initial step in the clinical evaluation is the identification of patients with urinary incontinence. Many older patients do not complain about incontinence to their health care provider because they are embarrassed or believe their symptoms are just part of normal aging. Direct questioning during the review of systems can help identify urinary incontinence Do you have trouble with your bladder Do you lose urine when you do not want to Do you find that you have to wear pads or adult diapers for protection (Fantl et al., 1996 Kane et al., 2004). A thorough history and physical examination are important in the clinical evaluation of older patients with urinary incontinence. The main objectives of the workup are to diagnose and treat reversible causes, establish the principal type of urinary incontinence to help guide treatment, identify patients who may need subspecialty referral, and improve overall quality of life for the patient. Once urinary incontinence has been identified, the...

Complications

The three most common complications of all treatments for prostate cancer are urinary incontinence, impotence, and bowel dysfunction. Incontinence rates after surgical removal of the prostate vary widely and are a source of spirited debate among urologists. Some of the differences are due to variable levels of skill among surgeons. Some result from different definitions of incontinence for example, some researchers use ''frequent leakage'' as a definition, whereas others use ''wears pads.'' One man's definitions of ''frequent'' and ''leakage'' may differ substantially from another man's definitions, and one man may wear a pad for occasional, minimal leakage while another may not wear one despite having copious leakage. The lowest rates of urinary incontinence following prostate surgery have been claimed by the Johns Hopkins University group who, for a small group of fifty-nine patients, reported that only 7 percent were wearing pads eighteen months after surgery. This was a highly...

Pelvic Diaphragm

VThe complex organization of overlapping muscles and fascia cause the pelvic diaphragm to be susceptible to injury and damage, especially in women. Repetitive stresses, such as those that occur during labor and delivery, can stretch and damage the levator ani muscles and cause pelvic floor insufficiency and its associated clinical problems (e.g., uterine prolapse urinary incontinence).

Root Implantation

Given the remarkable plasticity demonstrated by these experiments, a surgical approach to reinstating proximal leg movement and bowel and bladder control may be feasible after a conus or cauda equina lesion. For example, at the time of surgery after an L-1 burst fracture to clean out bone fragments and stabilize the spine, the neurosurgeon could open the dura and reimplant one or more lumbar and sacral roots that have been torn or avulsed back into the ventrolateral cord. If the animal studies are correct, the motoneurons will regenerate axons into the implant and out to the periphery to the hip and knee flexor and extensor muscles and to the bladder. The peripheral nerve and its Schwann cells are still intact and will offer regenerative signals for these growing axons. An avulsed cervical root could be reimplanted as well, placed just above the level of the SCI.

How is BPH diagnosed

This procedure is totally painless, and a medical assistant, a nurse, or a physician performs this in a physician's office. Bladder scanner ultrasound postvoid residual determination is often performed in those men who present with a complaint of the feeling of incomplete bladder emptying and or those men with urinary incontinence. Urinary incontinence Urinary frequency Urgency

What are LUTs

LUTs include storage and voiding symptoms. Storage (overactive bladder) symptoms include urinary frequency (voiding eight or more times per day), urinary urgency (a sudden compelling desire to void that is difficult to defer), nocturia, and urgency urinary incontinence. A significant number of men presenting with voiding symptoms suggestive of underlying benign prostatic hypertrophy will also have storage symptoms, thus the term LUTs would be more appropriate in these individuals. Medical therapy designed to treat the voiding phase symptoms may or may not lead to improvement in the storage symptoms. Men may have underlying overac-tive bladder in addition to BPH and studies have demonstrated that with relief of the outflow obstruction associated with BPH there may be improvement in the overactive bladder symptoms. However, in men undergoing transurethral prostatectomy for BPH, 30 of men after relief of their bladder outlet obstruction, had persistent overactive bladder symptoms.

Urinary Studies

If you have urinary symptoms, your doctor may order a urinalysis or a urine culture (or both) to check for a urinary tract infection. If you have noticed involuntary leakage of urine (urinary incontinence), you should alert your doctor to this symptom. Involuntary loss of urine is sometimes related to anatomic changes at the bladder neck. Urinary stress incontinence is the most common type of urinary incontinence, occurring in up to 20 percent of women. Stress incontinence is the inadvertent loss of urine that occurs when there is an increase in intraabdominal pressure, such as when you sneeze, cough, laugh, or exercise. It is more likely to happen when the bladder is full and happens more frequently and inconveniently when the normal mechanism of the bladder and urethra is impaired. Often stress incontinence is also associated with genitourinary prolapse, a relaxation and dropping of the pelvic or urinary organs (or both). A cystometrogram is a study to evaluate urinary incontinence....

Plain language title

Drugs versus other medications for overactive bladder syndrome in adults' might have a plain language title 'Drugs for overactive bladder syndrome'. Where the review title is easily understood, this should simply be restated as the plain language title, e.g. 'Interventions to reduce harm from continued tobacco use'.

Incontinence

Abstract This chapter focuses on the current place of washable, textile-based absorbent products in the management of urinary incontinence. It opens by describing the principal categories of products available, summarises the functional requirements of users, and reviews the clinical literature to establish how well existing products meet current needs. It then reviews the very limited work that has been published to characterise the fluid-handling properties of such products in the laboratory and relates the results to clinical data. It concludes by focusing on future trends, suggesting where improved products are needed.

Ependymoma

Clinical Features and Associated Disorders. Patients with ependymomas have symptoms corresponding to the part of the neuroaxis affected by the tumor. For example, tumors arising in the spinal cord can lead to localized back pain, sensory disturbances with a demonstrated dermatomal line, weakness of both legs, or disturbances of bowel or bladder control. Ependymomas arising in the fourth ventricle, brain stem, or lateral ventricles can present with evidence of headaches or other symptoms of hydrocephalus (especially nausea and vomiting), ataxia, and increasing head circumference. Neck pain and behavioral changes also are common presenting complaints in children. Because ependymomas may be present for as long as 3 to 6 months before they come to clinical attention, symptoms may sometimes be labeled chronic.

Mountain Sickness

Clinical Features and Associated Disorders. AMS, which usually occurs above 8200 feet, is defined by the presence of a headache and at least one of the following symptoms GI (anorexia, nausea, or vomiting), fatigue or weakness, dizziness or lightheadedness, and difficulty sleeping. y The headache is usually bilateral but may be unilateral. HACE, which is uncommon below 12,000 feet, is defined by the presence of a change in mental status and or ataxia in a person with AMS or the presence of both mental status change and ataxia in a person without acute mountain sickness. HACE, which can lead to coma and death, may be associated with urinary incontinence, papilledema, cranial nerve palsies, tremor, and abnormalities in limb tone.

Quality Of Life

Other methods include tools focusing on a single aspect such as pain, anxiety as well as individualised measures in which patients themselves define and rate the most important aspects of their quality of life.35 A number of condition-specific tools, which can be used either independently or to supplement generic measures, have been developed.36 Examples include the King's College Questionnaire for Urinary Incontinence37 Patients themselves can find it difficult to distinguish between quality of life and health status or to rate their health without a point of reference. At the same time, the effects of age and changing expectations need to be adjusted for when interpreting QOL scores. Overall, QOL offers a superior way of assessing treatment success in trials involving general gynaecology (such as menorrhagia, urinary incontinence, menopause, pre-menstrual tension) where interventions are targeted at women with benign but debilitating illnesses that compromise several key areas of...

Patient Satisfaction

The sum total of a number of patient-related factors, including expectations, characteristics and psychosocial determinants.44 Over the past few years, patient satisfaction has become increasingly accepted as a measure of quality in health services and a valid outcome in randomised clinical trials.45 This is particularly significant in the current climate of delivery of health care which aims to provide a patient-centred service with greater public involvement in planning.46 The purpose of patient satisfaction measurement is to describe health care services from the patient's point of view, measure the 'process' of care and evaluate health care.44 The particular strength of using satisfaction as an outcome is related to the unique circumstances of certain gynaecological trials such as those used for menorrhagia where not only the interventions but also the clinical outcomes may be dissimilar. In a trial of hysterectomy versus endometrial ablation, women would be expected to be...

Why Cancer Hurts

Radiation therapy can cause a variety of symptoms, usually related to the area that is being treated. In addition to fatigue, bleeding problems, skin injury, nausea, and diarrhea, there may be pain in the skin, bone, or near nerves. Pain can result from actual injury to these structures or may be due to indirect causes, such as scarring and fibrosis (excessive and thickened connective tissue) or injury to blood vessels that supply these structures. The spinal cord is very sensitive to radiation, and occasionally injury here may produce bizarre pain in the lower half of the body, sometimes accompanied by numbness and even paralysis or bladder problems (incontinence). Occasionally, years later, radiation therapy can even produce new tumors on nerves that are included in the treatment field.

Neurosyphilis

Dementia paralytica is manifest as a slow deterioration in cognitive functioning with impaired memory, loss of insight and judgment, language abnormalities, loss of appendicular strength, tremor of the tongue and hands, pupillary abnormalities, and loss of bowel and bladder control. The syndrome of dementia paralytica typically occurs 10 to 20 years after primary infection. Examination of the CSF at this stage demonstrates one or a combination of the following (1) a positive VDRL test, (2) lymphocytic pleocytosis, (3) an elevated protein concentration. y

Invasive Procedures

S-2 to S-4 can reduce urine residual volumes, increase bladder capacity, and reduce fecal impaction and constipation. This approach requires a laminectomy, a posterior rhizotomy, and an implantation of a radio receiver. As described in Chapter 4, a commercial stimulator for an upper motoneuron neurogenic bladder is now available.34 The S-3 root is most critical for bladder control. A test trial of stimulation is necessary, since some patients do not respond. Not all patients have the same underlying mechanism for detrusor hyperactivity, so stimulation of somatic afferents that then inhibit bladder reflexes in the cord may not al

Nonmotor Symptoms

As the autonomic system is disturbed in patients with PD, orthostatic hypotension and GI, urinary, sexual, and dermatologic symptoms are common. Patients with orthostatic hypotension may experience dizziness, lightheadedness, fainting upon standing, or fall-related injuries. GI symptoms include constipation and dysphagia due to a slowing of the automatic pattern of contraction and relaxation of the throat muscles. These swallowing difficulties may lead to weight loss, sialorrhea, and aspiration. Genitourinary symptoms include urinary incontinence, urgency, and frequency related to over activity of the bladder emptying reflex. Symptoms may be worse at night, causing nocturia. Sexual dysfunction includes decreased libido, erectile dysfunction, and delayed ejaculation. Skin symptoms include sweating and intolerance to heat and cold.6-8,11,12

Defining Outcomes

Pragmatic trials usually require the evaluation of more than one outcome measure in order to come to a decision about the effectiveness, risks, costs and acceptability of an intervention. For example, in surgical trials of menorrhagia outcomes should include satisfaction with treatment, menstrual flow, pain, premenstrual syndrome and period of recovery. Sometimes when the impact of a disease spreads beyond the individual to a wider group such as the family, GPs or carers, outcomes may need to be expanded to include a wider group. This may be relevant in trials of urinary incontinence or HRT. It is however important to remember that it is the primary outcome on which the power calculation is usually based, and the one that the trial is best designed to address.

Paravaginal Repair

Paravaginal herniation is commonly associated with urinary incontinence. The defect is suspected on pelvic exam when, on the Valsalva maneuver, the lateral sulcus bulges out, causing a cystocele with prominent vaginal rugae. The diagnosis is confirmed if both lateral sulci are supported and, on maximal Valsalva, the cystocele is no longer present. The defect can be unilateral or bilateral (33,107). It is caused by the tearing away of the pubocervical fascia from the arcus white line. The defect can be complete from the ischial spine to the pubic bone or partial, usually starting in the proximal portion. To start the repair, the pelvic floor is elevated with the vaginal hand and the bladder is mobilized medially. Interrupted permanent sutures are placed through the torn edge of the pubocervical fascia and then through the arcus white line. The first suture is placed proximally just above the ischial spine with the obturator canal directly above. Interrupted sutures are continued...

Diagnosis

Postsurgical vesicovaginal fistulas usually present 7 to 21 days after surgery. Most patients have urinary incontinence or persistent vaginal discharge. If the fistula is very small, leakage may be intermittent, occurring only at maximum bladder capacity or with particular body position. Other signs and symptoms include unexplained fever hema-turia recurrent cystitis or pyelonephritis vaginal, suprapubic, or flank pain and abnormal urinary stream (11).

Comparative Studies

It has been almost a decade since Ulmsten et al. (76) described the tension-free vaginal tape suburethral sling procedure and reported on his early successes. The rapid rise in popularity of the tension-free vaginal tape procedure has coincided with the rise in popularity of the laparoscopic Burch colposuspension as minimally invasive procedures for the cure of genuine stress urinary incontinence. Both procedures have their cadre of proponents, with laparoscopic Burch colposuspension advocates noting the longer track record of the Burch procedure, the ability to visualize the surgical field, and the lack of concern over erosion, while tension-free vaginal tape advocates point to shorter duration of surgery, slightly shorter recovery, relative ease of the procedure, and perceived lower cost. To date, there have been two prospective, randomized controlled trials published comparing the two procedures and one large prospective randomized controlled trial comparing tension-free vaginal...

Clinical Summary

Uterine prolapse is defined as the propulsion of the uterus through the pelvic floor or vaginal introitus. In first-degree prolapse, the cervix descends into the lower third of the vagina in second-degree prolapse, the cervix usually protrudes through the introitus whereas in third-degree prolapse, or procidentia, the entire uterus is externalized with inversion of the vagina. Symptoms include a sensation of inguinal traction, low back pain, urinary incontinence, and the presence of a vaginal mass. Uterine prolapse can occasionally be confused with a cystocele (discussed below), enterocele, or soft tissue tumor.

Urinary obstruction

The presence of urinary calculi may or may not cause clinical signs. Where clinical signs do occur, the patient will show varying signs of local pain and discomfort, haematuria, urinary tenesmus, dysuria or possibly anuria or urinary incontinence. Urinary calculi may obstruct the urethra, often at the ischial arch in male dogs, or they may cause irritation of the lining of the bladder.

Spinal Cord Tumors

Often patients are brought to medical attention because of weakness of the legs, loss of bowel or bladder control, back pain, or, rarely, loss of sensation. In children, these symptoms may be confused with regression of the child's development, growth pains, or muscle disease. Often a child's lesion is discovered incidentally during evaluation for a minor injury such as a sledding accident, when studies are performed to calm the fears of worried parents. Cervical or foramen magnum lesions may present with torticollis or nuchal rigidity.

Storage

Prominent are storage and voiding symptoms (Box 40-3). Voiding symptoms imply obstruction, but physical obstruction may not be responsible. In men with BPH, for example, detrusor overactivity, neurologic disorders, or age-related smooth muscle dysfunction may be the cause. Thus, LUTS should shift attention toward a larger symptom complex with many potential causes. This is particularly important when dealing with urinary tract disorders such as BPH, incontinence, and overactive bladder.

Spinal Stenosis

Signs or symptoms of muscle atrophy and loss of bowel and bladder control. Physical examination is frequently normal but may include loss of lumbar lordosis, impairment of spinal mobility, asymmetric knee or ankle reflexes, and muscle weakness. Results of straight-leg raising are characteristically negative.

Presentation

Urinary incontinence presentations can be divided into acute (transient) or chronic. Sudden onset of incontinence by potentially reversible and treatable conditions is referred to as acute urinary incontinence. Conditions contributing to acute incontinence include lower urinary tract conditions, stool impaction, delirium, fluid imbalance, impaired mobility, and medications (Table 4-15). These conditions not only precipitate acute urinary incontinence, but can also contribute to chronic incontinence.

Mind Body Medicine

Ocean Energy Pyramid Rq5

The area of CAM with perhaps the most extensive research base is mind-body medicine, which encompasses a diverse array of practices that overlap many traditions and whole systems of care. Astin and colleagues (2003) concluded, There is now considerable evidence that an array of mind-body therapies can be used as effective adjuncts to conventional medical treatment for a number of common clinical conditions. They found strong evidence to support mind-body approaches in the treatment of low back pain, coronary artery disease, headache, insomnia, preparing for surgical procedures, and in the management of disease-related symptoms of cancer, arthritis, and urinary incontinence.