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Urinary Incontinence, Nocturia and Overactive Bladder

Urinary Incontinence, Nocturia and  Overactive Bladder
Lata (name changed for privacy) was a 46-year-old manager working in a high-powered job. She came to see me with complaints of fatigue, low energy, and irritability. She was unhappy with the quality of her life and was aware that this problem was affecting her work and relations with her colleagues. When I checked her blood pressure, it was high. I questioned her about the quality of her sleep, to which she responded that she had to wake up 4-5 times every night to pass urine. I asked her if she had the same problem during the day. She said yes and that she was forced to plan her meetings so that she could use the toilet every 25-30 minutes. If the meeting didn’t finish on time, she was uncomfortable and unable to think and respond. She found her frequent urge to urinate caused her stress, affected her performance at her job, and affected her state of mind and her ability to meet her clients. She was always afraid that she would wet her clothes if she could not get to the toilet quickly. She started wearing adult diapers on client visits and on her way home. Going to the market to buy her daily needs had become a nightmare. I told her that the lack of good quality sleep and the constant anxiety over the need to use the toilet was raising her blood pressure, as well as making her tired and irritable. I examined her and discovered she had a cystocele (sagging of the bladder into the vagina) and many spasms in the para-vaginal muscles and ligaments, which were causing a twisting of the uterus and pulling on the urethral sphincter. I corrected this, and she reported after 2-3 days that she was now able to hold her urine for up to an hour at a time. Encouraged by this, she returned for more treatment, which included further correction of the abnormalities followed by acupuncture. She reported further improvement over the next ten days, waking up only twice most nights to pass urine. She could now manage without using the toilet for almost 2 hours daily. With further treatment using correction of the problem, pelvic exercises, Yoga, acupuncture and PEMF treatment, she was within 5-6 months easily able to control her urge to urinate for 3-4 hours at a time. With this change, her work improved, her energy levels rose, her blood pressure returned to normal, and she received her long overdue promotion. Her libido returned, and she started to enjoy her sex life again, with improvement in her relationship with her husband. Her life had changed for the better! Over my 41 years of practising medicine, I have worked with hundreds of women with urinary incontinence. This is an embarrassing problem that millions of women worldwide cope with daily. The symptoms include sudden strong urges to urinate, difficulty in delaying the urge to urinate, frequent trips to the bathroom, and, in many cases, involuntary loss of urine when urgency strikes. They may wear pads or adult diapers for accidents, plan for access to bathrooms, and modify their social and work lives to accommodate their symptoms. Some ladies are very distressed by the mild or severe symptoms, while others find mechanisms to adapt to the problem by reducing their water intake. Some women have little trouble with the symptoms, which do not significantly interfere with their everyday lives. Other women complain that their symptoms negatively influence their quality of life causing loss of self-esteem, attractiveness, and sexual function. Many women believe that some amount of urinary incontinence is inevitable with increasing age. Most of the time, these were women who had delivered babies. Women with these symptoms tend not to talk with their doctors concerning their bladder dysfunction, and doctors usually do not routinely inquire about the bladder. As a result, only a tiny minority receive treatment. Between 10% and 40% of women have some degree of urinary incontinence and the percentage increases with age. Significant incontinence is present in about 15% of women over the age of 55 and in 25% over the age of 70. Incontinence also affects men as they age and is very common in older men, especially when they have prostate enlargement. In younger men, it may originate from Prostatitis, which is an infection in the prostate that causes enlargement of the prostate. Nocturia. Many people wake up 2-6 times a night to pass urine. This disturbs Sleep and can cause many problems like irritability, loss of memory, poor concentration, high blood pressure and stress. This may be due to fluid accumulation in the legs during the day in older adults. If there is swelling in the legs, it confirms the cause. This problem often accompanies problems in the liver, heart, and kidneys and with hormonal issues like hypothyroidism and menopausal problems. Elevating the legs for 2 hours before sleeping allows this fluid to drain back into the circulation and allows the kidney to eliminate this excess fluid as urine before you sleep. Ultrasound treatment of the kidneys can help circulation and allow better elimination of excess liquid. This allows more hours of uninterrupted sleep. Stress incontinence is the loss of small amounts of urine associated with coughing, laughing, sneezing, exercising, passing gas, or any movement that increases intra-abdominal pressure and, thus, pressure on the bladder. Urge incontinence is a sudden and intense need to urinate. Overflow incontinence is frequent or constant dribbling of urine due to a bladder that doesn't empty. Functional incontinence. A physical or mental impairment prevents you from reaching the toilet in time. For example, if you have severe arthritis, you may not be able to get to the bathroom and unbutton your pants quickly enough. Incontinence may also arise from damage to the nerves due to childbirth, surgery or injury, as well as from injuries to the spine or brain, including strokes. The commonly used term today for different types of Incontinence is overactive bladder [OAB]. Overactive bladder syndrome (OAB) is defined as “urgency, with or without urge incontinence, usually with frequency and nocturia (excessive urine at night)”. Urinary infections often cause frequent urine, which should always be checked and treated appropriately. Other causes of urinary incontinence are menopause; hysterectomy, which affects the structure of the pelvis, obesity which increases the pressure on the bladder; Bloating of the abdomen due to gas, functional or cognitive impairment; family history, genetics, and a host of other factors, including diabetes, use of diuretics, cigarette smoking, and dementia. Constipation may also cause incontinence. The rectum is located near the bladder and shares many of the same nerves. Hard, compacted stool in your rectum causes these nerves to be overactive and increases urinary frequency. I have found that many ladies with incontinence had spasms in the ligaments and muscles surrounding the vagina. On questioning, they often complained of pain during sexual intercourse (dyspareunia). This was often accompanied by displacement of the uterus either backward or to one side. Other patients had a Prolapse of the bladder wall into the vagina along with low muscle tone in the vaginal muscles and urethral sphincter. Correction of these abnormalities, if present, usually leads to an immediate improvement in urine control. Patients were also advised to do Yoga and pelvic exercises to strengthen the muscles of the pelvis and bladder [Kegel exercises] to reduce the symptoms of stress incontinence. Tighten (contract) the muscles you would use to stop urinating, hold for five seconds, and then relax for five seconds. (If this is too difficult, start by holding for two seconds and relaxing for three seconds.) Work up to having the contractions for 10 seconds at a time. Aim for at least three sets of 10 repetitions each day. Combining this with electro-acupuncture to stimulate the bladder and sphincter muscles in 2-3 sets of 10 treatments each usually led to further improvement in incontinence. Some ladies required follow-up acupuncture treatments at 6-12 monthly intervals to maintain the improvement. Combining this with high-intensity PEMF treatment can often get dramatic results quickly. Pulsed electromagnetic frequency (PEMF) treatment strengthens the nerves and muscles of the bladder, sphincter, and pelvis and helps restore normal muscle tone and function. Some patients may require long-term, low-intensity PEMF treatment at home to sustain improvement. We can offer significant relief to millions of women suffering from overactive bladder and urinary incontinence. Males also have improvement of their urinary incontinence by treatment with Acupuncture, Biofeedback & PEMF treatment. Conventional treatment for this problem with varying rates of success is medications or patches, surgeries, sacral neuromodulation, botulinum injections, reflexology and behavioural interventions such as bladder training.
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