A Simple Guide to Urinary Incontinence

A Simple Guide to Urinary Incontinence
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What is Urinary Incontinence?
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Urinary incontinence is a symptom and means the the uncontrollable leakage of urine.
It can cause a lot social discomfort to patients having this problem.
Men are more prone to it than women.

What are the Causes of Urinary Incontinence?
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Urinary Incontinence is a medical condition which may be temporary or permanent.

There are many causes of urinary incontinence:
Temporary urinary incontinence
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1.Drinking too much tea, coffee or carbonated drinks can irritate the bladder and cause or contribute to incontinence.
Coffee and other drinks containing caffeine can be a particular problem as caffeine is a diuretic, i.e. it increases the urge to pass urine.

2.Excessive alcohol. Alcohol is also a diuretic. Because it has deppresant effect on the the brain, it may affect the person's judgement temporarily, hence resulting in accidental leakage of urine.

3.Some medications like diuretic pills, heart medications and antidepressants can cause or contribute to incontinence.

4.Urinary Tract Infection may cause sufficient irritation to the bladder to stimulate incontinence.

5.Constipation result in impaction of the stools in the rectum. This irritates the nerves to the bladder resulting in incontinence.

Permanent urinary incontinence
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In both sexes there are many conditions which can cause or contribute to chronic or persistent urinary incontinence:

1.Aging
With age there is a decrease in the bladder capacity to store urine.

2.Enlarged prostate in men
BPH or benign prostatic hypertrophy is associated with aging and can obstruct the urethra and block urinary flow resulting in urge or overflow incontinence.

3.Prostate Cancer in men
Prostate cancer can cause incontinence if untreated. However the incontinence in prostate cancer patients may be a side effect of treatment e.g. surgery, radiation therapy.

4.Prostatitis in men
Inflammation of the prostate gland sometimes can cause constriction of the urinary flow and incontinence.

5.Gynecological problems such as prolapsed uterus, enlarged utrue due to fiboids, ovarian cysts or tumours can pulled on the muscles of the perineum causing weakness of the muscles and poor constriction of the bladder opening

5.Surgery involving the organs near the bladder
Any operations involving organs such as the ovary, uterus, prostate, rectum can cause inadvertent damage to muscles or nerves of the urinary tract, resulting in incontinence.

6.Urinary tract obstruction
Any enlarged tumours along the urinary tract can obstruct the normal flow of urine and cause incontinence. Bladder stones can do the same.

7.Neurological conditions
Stroke, Parkinson's disease, tumours in the brain or spinal cord and injury to the nerves in pelvis or spinal cord can can affect the nerves to the bladder and weakening of the bladder opening muscles.

What are the Types of urinary incontinence?
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Urinary incontinence may be categorised into 4 main types. It is possible however to have more than one type of urinary incontinence

1.Stress incontinence
Leakage of urine occurs because of weakness of the pelvic floor muscles. When there is pressure exerted on the bladder - e.g. from laughing, sneezing, coughing, exercising or heavy lifting, pregnancy, the muscles at the opening of the bladder comes under stress and opens to allow leaking of urine.


2.Urge incontinence
There is an uncontrollable leakage of urine while suddenly feeling the urge to urinate.

3.Overflow incontinence
There is a constant dribbling of urine even after finishing urination. There is an inability to completely empty the bladder.

4.Functional incontinence
There is physical or mental impairment resulting in the failure to realise the need to urinate.As a result the person fail to get to the toilet in time and pass out the urine. Examples are people who suffer from dementia, parkinson or is incapacitated by poor physical movement.

Other types of urinary incontinence include enuresis(bed wetting ) which is common in chilldren,
Transient incontinence which is temporary and sometimes caused by medications.

What are the symptoms of urinary incontinence?
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The main symptom of urinary incontinence is leakage of urine. This leakage may be frequent and heavy, or it may be small and rare.
Some other symptoms of urinary incontinence include:

Urgency - a strong desire to urinate even when the bladder is not full together with pelvic discomfort or pressure

Frequency - urinating more than once in a two-hour period or more than seven times a day

Nocturia - the need to wake up and urinate at least twice during sleep

Dysuria - painful urination

Enuresis - bed-wetting or urinating while sleeping

How do you make the Diagnosis of urinary incontinence?
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1. history taking is important especially the pattern of urine leakage. Other history include symptoms of straining and discomfort, use of drugs, surgery, and illness.

2. physical examination will look for signs of medical conditions causing incontinence, such as pelvic tumors, stool impaction, and poor reflexes or sensations.

3. measurement of bladder capacity and residual urine for signs of poor functioning bladder muscles.

4.Stress test - the patient coughs vigorously as the doctor watches for loss of urine.

5.Urinalysis - urine is tested for infection, urinary stones.

6.Blood tests - for PSA( in case of Cancer of prostate) or alphafoetoprotein (in case of cancer of the ovaries)

5.Ultrasound -to visualize the kidneys, ureters, bladder, and urethra.

6.Cystoscopy - a thin lighted tube is used to see the inside of the urethra and bladder.

7.Urodynamics - measurement of pressure in the bladder and the flow of urine.

What is the Treatment of urinary incontinence?
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Elderly patient tend to believe that the only way to prevent embarrassment is to wear absorbent pads or padded undergarments like adult Pampers. However the wetness may lead to rashes, sores, or infections.

Treatment involves:
A. making certain lifestyle changes.

1.Timed Voiding
Timed voiding (urinating) means writing a chart of your urination and leakage patterns for several days. This will then tell you which times of day you normally need to empty your bladder before leakage may occur.

2.Bladder training
This involves training your bladder to control the urge to urinate.

3.Changing Fluid Intake
Restricting your fluid intake, or changing the timing of fluid intake will help you to gain more control over the bladder. Restriction of alcohol, tea, coffee and other caffeinated beverages can reduce the amount of urine from your body

4.Exercises
Exercising the muscles of the pelvis(Kegel exercises) may strengthen the muscles of the affected area.

5.Vaginal cone therapy
This exercise for women involves the use of a set of five small vaginal cones of increasing weight. The patient simply places the small plastic cone within her vagina and hold it in by a mild reflex contraction of the pelvic floor muscles. This exercise is done twice a day for fifteen to twenty minutes.As the pelvic floor muscles becomes stronger, cones of increasing weight can be used, thereby strengthening the muscles gradually.

6.Electrical stimulation
Electrodes are temporarily placed in the vagina or rectum to stimulate nearby muscles and strenthen the pelvic muscles.
This can reduce stress and urge incontinence.

7.Biofeedback
Using electronic devices or diaries to track when the bladder and urethral muscles contract, the patient can slowly control movement of these muscles.

B.Treating the cause of the incontinence:

1.Medications:
drugs may be given to treat urinary tract infections or inhibit contractions of an overactive bladder.

2,Pessaries
A pessary is a ring shaped medical device that is inserted into the vagina. It compresses the urethra against the pubic bone and elevates the bladder neck.

3.Surgery
Surgery to reduce the size of your prostate gland ( transurethral resection of the prostate or TURP) helps to reduce urinary incontinence in men.

Bladder repositioning
In older women incontinence results from the bladder dropping down toward the vagina. Surgery involves pulling the bladder up to a more normal position. Using an incision in the vagina or abdomen, the surgeon raises the bladder and secures it with a string attached to muscle, ligament, or bone.

Marshall-Marchetti-Krantz
This procedure also known as retropubic suspension or bladder neck suspension surgery, is performed using an incision across the abdomen. Stitches are placed in these tissues near the bladder neck and the urethra is then lifted, and the stitches are attached to the pubic bone or to tissue behind the pubic bone. The bladder neck is supported helping the patient to control the urine flow.

Slings
The sling procedure uses synthetic mesh material in the shape of a narrow ribbon that is placed under the urethra through one vaginal incision and two small abdominal incisions. The purpose is to provide support under the urethra. There are the Transobturator Tape Sling, the Tension-free Transvaginal Sling, and the Minisling.

Artificial urinary sphincter
Rarely the surgeon implants an artificial urinary sphincter a doughnut-shaped sac surrounding the urethra. To close the urethra A fluid fills and expands the sac. Pressing a valve implanted under the skin, the artificial sphincter can be deflated allowing urine from the bladder to pass.

4.Catheterization
A catheter may be inserted to drain the urine if your bladder never empties completely or if your bladder cannot empty because of poor muscle tone, post surgery or spinal cord injury. This can be done on a if required basis.Prolonged catherisation may lead to infection of the urinary tract.

5. Botox injections
Botox injection has been tried to reduce the sensitivity of the nerves at the opening of the bladder. It appears more successful for women than in men.

How do you prevent urinary incontinence?
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Reduce your risk of urinary incontinence:

1.Maintain a healthy weight.

2.Obesity can lead to urinary incontinence.

3.Avoid constipation by drinking sufficient amounts of fibre and fluids in your diet.

4.Avoid drinks which can irritate your bladder such as coffee, tea, carbonated drinks and alcohol.

A Simple Guide to Benign Prostatic Hyperplasia

A Simple Guide to Benign Prostatic Hyperplasia
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What is Benign Prostatic Hyperplasia?
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Benign Prostatic Hyperplasia or BPH is a common condition where older men over fifty years of age have enlargement of the prostate.

What are the Causes of Benign Prostatic Hyperplasia?
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The prostate is a gland present only in males which produces the secretions nourishing the sperms in the semen.

It is a walnut size gland encircling the lower urinary outlet of the bladder.

With age, the prostate gland enlarges and squeezes the bladder outlet and the urinary passage like a clamp. An enlarged prostate gland can obstruct the urethra and block urinary flow resulting in damage to the bladder and kidneys.

The cause of the enlarged prostate gland is usually due to age and the prolonged exposure to the male hormones from puberty causing hyperplasia(overgrowth) of the prostatic cells.

What are the symptoms and signs of Benign Prostatic Hyperplasia?
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The symptoms of BPH varies from person to person.
Sometimes an enlarged prostate may cause little or no problem while a smaller prostate may may compress the the neck of the bladder giving to problems in passing urine.

Symptoms:
1. difficulty in starting urination

2. straining at urination to produce a weak flow of urine

3. dribbling of the urine after urination

4. feeling of incomplete emptying of bladder even after urination.

5. nocturia -getting up at night more frequently to pass urine

6. frequency of urination

7. interrupted urine flow

8. urgent need to pass urine immediately with uncontrolled leakage(incontinence)

Signs:
1.physical examination
A rectal examination may show the enlargement of the prostate

2.urine examination to exclude infections

3.blood tests to check on kidney function

4.an ultrasound to have a better look at the prostate and also any damage to kidneys

5.a urine flow test(Uroflow) to see how fast you can pass urine

6. a blood test for prostatic specific antigen(PSA) to exclude prosate cancer

7. Cystoscopy - a ligted tube to examine the inside of the bladder especially to find where the blockage is or if there is blood in the urine

8.Urodynamics test - to measure the voiding pressure(pressure in the bladder)

What are the complications of Benign Prostatic Hyperplasia?
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Prolonged blockage of the urine by BPH can cause serious complications:

1.Acute retention of urine( sudden inability to pass urine ) with enlargement of the bladder and abdominal pain

2. Urine leakage or incontinence

3. recurring urine infections

4. bladder stone formation

5. blood in the urine

What is the treatment of Benign Prostatic Hyperplasia?
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BPH sufferers may be referred to an Urologist for review. As lonas Prostate Cancer has been ruled out, treatment depends on the severity of the BPH.

In mild BPH,there is no significant blockage of the bladder. Symptoms are usually not bothersome. Treatment is by :
1.adjustment of fluid intake

2.regular exercise,

3.proper diet with less red meat , more vegetables and fruits.

In moderate BPH, if the blockage is not severe but the symptoms are bothersome, treatment include the above as well as :

4. medications to relax the bladder outlet or help shrink the the prostate, to improve the flow of urine.

In Severe BPH. if the blockage is severe and the person is unable to empty bladder completely,

5.catherisation and drainage of the urine may be necessary in acute retention of the urine

6.Surgery may be necessary.
This operation called TURP or transUrethral Resection of the Prostate removes the obstructing part of the prostate using a resectoscope inserted via the urinary tract.
Recovery usually takes 3-4 days.
TURP is usually safe and low risk. Less than 10 % may have some bleeding and infection. Less than 1% may have loss of urinary control.
Less than 4% will have impotence or erectile dysfuction problems.

7. Antibiotics may be given for urinary infections

What are the preventive measures taken in Benign Prostatic Hyperplasia?
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1.Changing Fluid Intake

You may need to increase or reduce your fluid intake, or change the timing of fluid intake to gain more control over the bladder. Restricting intake of alcohol and coffees can also help by reducing the amount of urine.

2.Bladder training & periuretharal muscle exercises
This involves training your bladder to control the urge to void.

3.Maintain a healthy weight.

4.Avoid constipation by including sufficient amounts of fibre and fluids in your diet.

What is the prognosis of Benign Prostatic Hyperplasia?
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Very good after treatment.

A Simple Guide to Urethritis

A Simple Guide to Urethritis
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What is Urethritis?
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Urethritis is an acute infection of the urethra(the tube which allows passage of urine from the bladder to the outside).

What are the causes of Urethritis?
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Urethritis is usually caused by the following:

1.sexually transmitted disease like gonorrhea and chlamydia.

2.Urinary infection such as cystitis

3.In males associated with prostatitis

4.Urinary stone stuck in the urethra may cause urethitis

6.urinary catheterisation

7.Injury to the urethra

8.Important component of Reiter's Syndrome

What are the symptoms and signs of Urethritis?
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Persons who has Acute Urethritis has the following

Symptoms:
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1.painful urination

2.purulent discharge from penis in males or vagina in females

3.frequency of urination

4.cloudy and unpleasant smelling urine, sometimes blood in the urine

5.fever and chills

6.Polyathritis and conjunctivitis in Reiter's Syndrome

Signs:
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1. pussy discharge can be seen in male's urethra or in female vagina

2.redness and inflammation of the opening of the urethra

How do you diagnose Urethritis?
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Diagnosis can usually be made by :

1.History of sexual activity followed by frequency of urination, painful urination or pussy discharge from urethra or vagina

2.Urine test shows the presence of pus cells, leucocyte, red blood cells and micro-organisms

3.Urine culture for bacteria and sexually transmitted organisms and the antibiotic most appropriate for it.

4. cystoscopy may be necessary to exclude urinary stones,tumours of the bladder in the case of blood in the urine

What is the complications of Urethritis?
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Upward infections from the urethra can lead to infections of the bladder and kidneys.

What is the treatment of Urethritis?
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Analgesic medicine for pain

Approprate Antibiotics for infections especially after urine bacterial culture

Lots of fluids

What is the prognosis of Urethritis?
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Prognosis is usually good with medication.

Sexual partner may need to be treated.

Recurrence is quite common.

A Simple Guide to Prostatitis

A Simple Guide to Prostatitis
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What is Prostatitis?
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Prostatitis is an acute or chronic infection of the prostate gland.

What are the causes of Prostatitis?
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Prostatitis is usually caused by the following:

1.enteric Gram negative organism from intestinal or bladder infection

2.tuberculosis occasionally

What are the symptoms and signs of Prostatitis?
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Persons who has Acute Prostatitis has the following:

Symptoms:

1.frequency of urination and nocturia

2.urgency of urination

3.hematuria(blood in urine)

4.low back pain

5.perineal pain

6.slow initiation of urine

Signs:

Tenderness on palpation of the prostate per rectum

How do you diagnose Prostatitis?
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Diagnosis can usually be made by :

1.History of frequency of urination, urgent urination

2.Tenderness on palpation of the prostate per rectum

3. Culture of the expressed prostatic fluid by prostatic massage

4.Urine and prostatic fluid culture will determine the micro-organism involved and the antibiotic most appropriate for it.

What is the complications of Prostatitis?
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Infections from the prostate can lead to infections of the bladder and up to the kidney.

What is the treatment of Prostatitis?
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Analgesic medicine

Antibiotics for infections especially after urine and prostatic fluid bacterial culture

Lots of fluids

What is the prognosis of Prostatitis?
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Prognosis is usually good with medication.

Recurrence is quite common.

A Simple Guide to Cystitis

A Simple Guide to Cystitis
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What is Cystitis?
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Cystitis is an acute or chronic infection of the urinary bladder.

What are the causes of Cystitis?
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Cystitis is usually caused by the following:

1. ascending infection of the urinary bladder from the urethra.

2. in females frequently associated with sexual activity eg. honeymoon cystitis

3.In males with enlargement of the prostate or infection of the prostate

4. In children, the bacteria E.coli of the same type as the child's bowels

5.More frequently present in Diabetic patients

6.procedures such as urinary catheterisation

7.cystitis is more common in the female,especially those on contraceptive pills or with intrauterine contraceptive devices.

8. may be associated with congenital abnormalities of the urinary tract such as bladder neck obstruction,urethral reflux,neurogenic bladder,and urinary incontinence.

What are the symptoms and signs of Cystitis?
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Persons who has Acute Cystitis has the following symptoms:

1.frequency of urination and nocturia

2.painful urination

3.suprapubic discomfort

4.cloudy and unpleasant smelling urine, sometimes blood in the urine

5.fever and chills especially in children

Signs:
Tenderness on palpation in the suprapubic region

How do you diagnose Cystitis?
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Diagnosis can usually be made by :

1.History of frequency of urination, painful urination

2.Urine test shows the presence of pus cells, leucocyte, red blood cells and micro-organisms

3.Urine culture will determine the micro-organism involved and the antibiotic most appropriate for it.

4. cystoscopy may be necessary to exclude tumours of the bladder

What are the complications of Cystitis?
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Upward infections from the bladder can lead to infections of the kidneys and kidney failure.

What is the treatment of Cystitis?
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Analgesic or antispasmodic medicine

Antibiotics for infections especially after urine bacterial culture

Lots of fluids

What is the prognosis of Cystitis?
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Prognosis is usually good with medication.

Recurrence is quite common.

cystitis,frequency,painful,nocturia,sexual activity,antibiotics,analgesic, cystoscopy, urine test, bacteria culture,prostate

A Simple Guide to Prostate Cancer

A Simple Guide to Prostate Cancer

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What is prostate cancer?

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Cancer of the prostate occurs when the cells of the prostate gland mutates and turn cancerous.

Prostate cancer is a group of abnormal cells in the prostate which is a gland about the size of a walnut found in men between the bladder and rectum.

It produces and secretes prostatic fluid, one of the main components of semen.

How does prostate cancer occur?

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Prostate cancer occurs when a malignant (harmful) tumour develops inside the gland. This could be caused by the male hormone testosterone.

However, the exact cause of prostate cancer is not known.

What are the types of Prostate Cancer?

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Prostate cancer can be

1.aggressive, which means it grows quickly and spreads to other parts of the body, such as the bone.

2.slow-growing, where the cancer patient can expect to live as long as men who do not have cancer. Most patients with slow-growing cancer will never have symptoms.

Three out of four cases of prostate cancer are of the slow-growing type that is relatively harmless.

What are the symptoms of prostate cancer?

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Those with prostate cancer may experience similar symptoms to those with enlarged prostate gland and prostatitis (infection of the prostate gland), such as:
1.Difficulty starting to urinate

2.Having an interrupted or weak flow of urine

3.Dribbling after you finish urinating

4.Urinating too frequently, especially at night

5.Blood or pus in the urine

6.Pain or burning feeling while urinating

Other symptoms include:

1.Being unable to have an erection

2.Having blood in the semen

3.Constant pain in the hips, upper thighs or lower back area

Who is affected by prostate cancer?

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Prostate cancer usually develop slowly, and is seldom the sole or final cause of death.

Men over 65 years of age are more likely to be diagnosed with prostate cancer.

However, men aged 50 and above with a close relative who has had prostate cancer before 60 years of age, have a higher risk and should go for screening.

How can prostate cancer be detected?

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Your doctor may examine your prostate by putting a gloved, lubricated finger a few inches into your rectum to feel your prostate gland. A normal prostate feels firm. If there are hard spots on the prostate, your doctor may suspect cancer.It is difficult to detect prostate cancer accurately.

The current approach is to measure the amount of prostate-specific antigen (PSA) present in the blood. PSA is a protein produced by the prostate. However, this test is not always reliable. This is because infections or an enlarged prostate can also increase PSA levels and affect the test results.

Thus, a biopsy is normally used to confirm the diagnosis.

How is prostate cancer treated?

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Surgery, radiation and drugs are the main treatment options.

They can cure prostate cancer if it's caught early.

However, these treatments can cause serious problems, such as impotence and incontinence.

Surgery or radiation may help treat the more aggressive cancers that are most often found in middle-aged men.

In serious cases, the tumour in the prostate gland can be removed with surgery.

After surgery, it is important that the patient has a healthy diet to build up strength and resistance. The patient must also be monitored closely, as in some cases the cancer could recur.

In rare cases,chemotherapy may be necessary for cancer which has spread to outside of the prostate.

Some mild cases may not require surgery, but require regular monitoring by doctors.

The treatment decision will depend on a combination of clinical and psychological factors.

Men diagnosed with localised prostate cancer today will likely live for many years.

Careful consideration of the different options is an important first step in deciding on the best treatment course.
Consultation with all three types of prostate cancer specialists—a urologist, a radiation oncologist and a medical oncologist—will offer the most comprehensive assessment of the available treatments and expected outcomes.