Urinary Incontinence Naturopathic Treatment
The first animal studies to demonstrate the usefulness of hylan B gel in viscoaugmentation as a tissue bulking agent for urinary sphincter muscle were completed in 1993 (Biomatrix, Inc., Ridgefield, NJ). Later clinical trials demonstrated the beneficial effect of this viscoelastic gel slurry injected intramuscularly to augment the connective tissue between the sphincter muscles of the urethra in patients with certain types of urinary incontinence. Hyaluronan was also used in pilot clinical studies combined with dextran particles for endoscopic treatment of vesicoureteral reflux in children (77) and in women with a history of stress incontinence (78). In this case the dextran particles were suspended in 1 elastoviscous hyaluronan solution to decrease the foreign body reaction caused by the dextran.
Tissue engineering with viscoelastic hyaluronan focused first on its use as a tissue filler or tissue augmentator (viscoaugmentation). Unlike collagen and non-biological tissue fillers, hyaluronan is an extremely elastic molecule and as such provides elasticity to the intercellular spaces into which it is injected. Hylan B gel was first used for viscoaugmentation of the vitreus after retinal detachment surgery, and later for correcting facial wrinkles and depressed scars for vocal cord augmentation in glottal insufficiency and augmentation of the connective tissue in sphincter muscles to treat urinary incontinence.
Because meningiomas grow slowly and may become large before raising the ICP, partial or generalized seizures are often the presenting or only clinical manifestations for months or years. Focal neurologic symptoms and signs develop later and indicate the anatomic site. Bilateral parasagittal and falx meningiomas, by pressing on the leg area of the motor cortex, present with spastic paraparesis and urinary incontinence, mimicking a spinal cord lesion. On CT scan and MRI, meningiomas appear as extra-axial mass lesions compressing the brain substance. The surrounding edema and mass effect usually are not marked. CT scan readily identifies a calcified meningioma. On nonenhanced CT scan, a meningioma is iso- or hyperdense it densely enhances with contrast media. It shows a dense homogenous enhancement on T1-weighted MR images, and is iso- or hyperintense on T2-weighted images.
There is some consensus that the basic clinical features of the frailty syndrome should include the following domains a) mobility, such as lower extremity performance and gait abnormalities b) muscle weakness c) poor exercise tolerance d) unstable balance e) factors related to body composition, such as malnutrition, and sarcopenia (loss of lean body mass), and weight loss. Validity of these factors as critical elements of the frailty syndrome is provided by studies showing that in older, non-disabled persons, individual components are associated with the classical geriatric syndromes (e.g. falls, symptomatic depression, urinary incontinence and functional impairment) and are strong and independent risk factors of disability and death.
Genuine stress incontinence Following trauma and or other causes of weakness of the pelvic diaphragm (such as childbearing), the proximal urethra may fall below the pelvic diaphragm. When the patient coughs, intra-abdominal pressure is exerted to the bladder but not to the proximal urethra. When the bladder pressure equals or exceeds the maximal urethral pressure, then urinary flow occurs. Because this is a mechanical problem, the patient feels no urge to void, and the loss of urine occurs simultaneously with coughing. There is no delay from cough to incontinence. Urethropexy replaces the proximal urethra back to its intra-abdominal position (Figure 1-1). More recently, narrow strips of polypropylene mesh have been used to suspend the midurethra because of the theory that urinary incontinence occurs due to pubourethral ligament insufficiency. These include various tension-free vaginal tape procedures, but long-term outcomes are not yet available. nence, and after urethropexy....
Chronic cough represents a common complaint and a large portion of health care dollars. Ironically, the complications from the cough, including subjective perceptions of exhaustion and self-consciousness, along with symptoms of hoarseness, musculoskeletal pain, sweating, and urinary incontinence, usually drive the patient to the doctor's office. Physiologically, the cough serves two main functions (a) to protect the lungs against aspiration and (b) to clear secretions or other material into more proximal airways to be expectorated from the tracheobronchial tree. Patients with hemoptysis, immunocompromised stales, comorbidities such as COPD or cystic fibrosis, current or previous infections such as tuberculosis or HIV. and significant symptoms such as weight loss, night sweats, and chills are beyond the scope of this discussion.
Cancer is low, ranging from 20 to 68 . In addition, because the DRE has a high rate of false positives, further testing by transrectal ultrasound or even biopsy is common. Many professional societies recommend annual DRE between the ages of 40 or 50 and 70. In contrast, the U.S. Preventive Health Services Task Force currently recommends against routine screening by DRE until there is more definitive evidence of increased survival from early detection and of decreased adverse effects from testing and even surgery (prostatectomy carries up to a 20 risk of impotence and a 5 risk of urinary incontinence). Instead, the Task Force advises clinicians to counsel all men requesting screening about the utility of testing and the benefits and harms of early detection and treatment.
American College of Obstetricians and Gynecologists. Urinary incontinence in women. ACOG Practice Bulletin 63. Washington. DC American College of Obstetricians and Gynecologists, 2005. Bhatia NN. Genitourinary dysfunction pelvic organ prolapse, urinary incontinence, and infections. In Hacker NF. Moore JG. Gambone JC. eds. Essentials of obstetrics and gynecology, 4th ed. Philadelphia Saunders, 2004 309-324.
Sexual function is impaired also in women. The female analogue to erectile dysfunction, that is, loss of lubrication, needs treatment. Fertility is unaffected, but the autonomic disturbances make the woman with spinal cord injury at increased risk of urinary incontinence, urinary tract infection and pressure sores during child bearing. They are also at risk of developing severe autonomic dysreflexia during labor.
When a tumor spreads to the vertebrae, the spinal cord can be compressed and can cause some patients to lose mobility or bladder control. Researchers wondered whether surgery to remove the tumor in addition to radiation would benefit cancer patients by alleviating the pressure and stabilizing the spine. Spinal cord compression occurs in 10 to 20 percent of all cancer patients, especially lung, prostate, and breast cancer patients.
The term bioelectrode is broadly used to denote a class of devices which transmit information into or out of the body as an electrical signal. Those that transmit information out of the body generally comprise a category of electrodes called biosensors. Examples of these are sensors for oxygen, glucose, and urea. Chapter 7.12 provides a discussion of these devices. Bioelectrodes that transmit information into the body are found in electrical stimulation devices. Examples of these are the cardiac pacemaker, transcutaneous electronic nerve stimulators ( TENS devices) for pain suppression, and neural prostheses such as auditory stimulation systems for the deaf, and phrenic nerve stimulators for artificial respiratory control. More complex experimental or possible future neural control devices include neuromuscular stimulation prostheses for restoration of hand, arm, or leg function in paralyzed individuals, visual prostheses for the blind, spinal cord stimulators for artificial bladder...
Up to 30 of older patients are concerned about urinary incontinence, an involuntary loss of urine that may become socially embarrassing or cause problems with hygiene. If the patient reports incontinence, ask when it happens and how often. Find out if the patient has leaking of small amounts of urine with increased intra-abdominal pressure from coughing, sneezing, laughing, or lifting. Or is it difficult for the patient to hold the urine once there is an urge to void, and loss of large amounts of urine Is there a sensation of bladder fullness, frequent leakage or voiding of small amounts but difficulty emptying the bladder As described earlier, bladder control involves complex neuroregulatory and motor mechanisms (see p. 319). A number of central or peripheral nerve lesions may affect normal voiding. Can the patient sense when the bladder is full And when voiding occurs Although there are four broad categories of incontinence, a patient may have a combination of causes. See Table 9-7,...
NPH occurs in individuals 60 to 70 years of age or older. The clinical criteria include the triad of progressive gait disorder, often the presenting symptom dementia and urinary incontinence. The gait disorder manifests with short shuffling steps and postural instability (frontal gait apraxia). The dementia has components of frontal lobe dysfunction psychomotor slowing, loss of initiative, and apathy. Spasticity in the legs and the
Cerebral cysticercosis, granular ependymitis, and acute obstructive hydrocephalus. A 44-year-old woman experienced episodic fever and two episodes of lymphocytic meningitis within 1 year prior to her death. Six days before she died, she developed acutely severe headache, confusion, constantly falling backwards, and urinary incontinence due to an acute hydrocephalus from occlusion of the third ventricle. A. A collapsed, dead cystocercous cyst in the dorsomedial aspect of the thalamus displays a structureless wavy collagenous wall (van Gieson). B. Wall of the third ventricle shows perivascular lymphocytic cuffing (HE). C. Granulation tissue infiltrates the floor of the third ventricle (von Gieson). Cerebral cysticercosis, granular ependymitis, and acute obstructive hydrocephalus. A 44-year-old woman experienced episodic fever and two episodes of lymphocytic meningitis within 1 year prior to her death. Six days before she died, she developed acutely severe headache, confusion, constantly...