Urinary Incontinence Naturopathic Treatment

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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Avoidance of Permanent Sexual and Urinary Disturbances

Good surgical technique is necessary to avoid nerve damage leading to sexual dysfunction or urinary incontinence problems. The critical steps are at the pelvic rim, where the dissection is between the hypogastric nerves to the lateral and mesorectum and by dissection far down in the pelvis. When identifying the Denonvilliers' fascia, the surgeon must be aware that just lateral of it near the back side of prostate, the nerve bundles responsible for adequate bladder and sexual function may easily be injured. In rectal carcinomas, which are situated very deep and on the anterior wall, damage to this nerve structure can rarely be avoided. Routine use of the nerve stimulator Cavermap as a guidance tool has been recently proposed 26 . Extended lymphadenectomy as described by Koyama et al. in 1984 leads to a better survival rate (18 overall, 36 in Dukes C), with the price of urinary dysfunction in 39 vs. 9 and impo-tency 76 vs. 28 27 . Therefore, today we cannot recommend this approach.

Shortterm complications

One advantage of the laparoscopic radical prostatectomy is the magnified view of the operative field with improved visualization of the vesicourethral anastomosis. Nadu et al. reported on their laparoscopic technique, in which a running suture is used for the anastomosis, theoretically improving the watertight closure and allowing earlier catheter removal. Cystograms were performed on postoperative days 2-4 and no leak was seen in 85 of patients. One potential pitfall of this approach is that 10 of the patients in this series experienced urinary retention shortly after catheter removal, presumably due to edema at the anastomosis or postoperative pain. In all of these patients a catheter was replaced manually at the bedside without difficulty. The rates of urinary incontinence and bladder neck contracture were no different in this study.35

Longterm complications

Urinary incontinence is one of the dreaded and most feared complications of RRP, and one that causes significant bother to patients.43 The rate of urinary incontinence varies widely in published series. As shown in Table 24.2, the published rates vary depending on how incontinence is measured, either from the surgeon's interview with the patient, a written survey from the institution or a population-based survey. Thus, obtaining an accurate measure of postoperative urinary incontinence remains difficult. Eastham et al. looked at risk factors for urinary incontinence after RRP.44 This study examined the Baylor database from 1983 to 1994, overlapping a procedural change in RRP in 1990 in which meticulous care was taken to avoid traction on the urethra with minimal suture bites taken through the urethral stump, and to stomatize the bladder neck hiatus completely prior to performing the vesicourethral anastomosis. In a multivariate analysis, where incontinence is defined as leakage with...

Risk Factors And Prevention

Of urinary incontinence in those undergoing RP following TURP.30-32 It is possible that these series included patients with significant pre-existing detrusor dysfunction (see discussion earlier). Other historical series do not report this relationship.26'33 More recent series do not support an increased risk of PPI in patients who have had prior TURP.29'34

Genitourinary Function After Sphincter Sparing Surgery for Rectal Cancer

Injury to the pelvic nerves usually results in mixed sympathetic, parasympathetic and pudendal nerve impairment. The most common manifestation of this disorder is a failure to void following removal of the urethral catheter and the development of painless urinary retention. The condition is often misdiag-nosed as prostatic obstruction in men or psychogenic retention in women caution should be used before resorting to transurethral surgery in either of these circumstances. Further outflow resistance may not only fail to produce normal voiding, which is the result of the damage to the parasympa-thetic innervation of the detrusor rather than outflow obstruction, but also may further damage an already neuropathic distal sphincter and precipitate urinary incontinence.

Urinary complications

Up to one-half of patients experience some degree of urinary frequency, dysuria and urgency during EBRT. These acute symptoms typically resolve within 3 weeks after the completion of radiation. Late side effects are uncommon in modern series one multi-institutional review reported a urinary incontinence rate of 0.3 after EBRT. 48

Results of salvage cryosurgery

In our experience in a series of 43 patients, we found urinary incontinence to be present in only 7.9 of the patients (Table 49.2). This reduction in incontinence rates over previously published reports is likely to be due to our ability to monitor the temperature within the external sphincter. When the temperature readings within the sphincter reach values below 0 C, the iceball can be thawed, thus preventing damage to the area and allowing the patient to remain continent. Moreover in our series, we did not experience any rectal fistula.

Pre Operative Radiochemotherapy

Improved in Group A (6 of recurrence), as compared with Group B (13 ). In Group A there were fewer acute 3 or 4 grade (especially diarrhoea, haematologic effects, dermatologic effects) and long-term toxic effects (strictures of the anastomoses, bladder problems, chronic diarrhoea, SBO) respectively 27 and 14 , as compared with Group B (40 and 24 ). Post-operative complication rates were similar in both arms, with about 11 of anastomotic leakage of any grade in the pre-operative group as compared with 12 in the post-operative group. The rates of ileus, post-operative bleeding and delayed sacral wound healing were similar also.

Who best determines quality of life

Nearly universally available, and any reported series of radical prostatectomy or radiation therapy will include an estimate of urinary incontinence, erectile dysfunction, bowel toxicity, etc. However, as the science of survey research began to be applied to cancer patients, it became clear that physician estimates and patient estimates of QOL often disagree.38 Litwin etal.39 utilized the CAPSURE database to assess differences in physician and prostate cancer patients' estimates of QOL using the SF-36 and UCLA PCI. Substantial differences were seen in assessment of physical, urinary, bowel, sexual function, fatigue and pain, with urologists generally underestimating quality of life. This trend has been noted by other studies,40-42 and explains why most modern QOL studies distribute questionnaires with return envelopes addressed to research coordinators, so as to remove the physician from the process as much as possible.

Radical prostatectomy

Radical prostatectomy is historically associated with significant urinary incontinence and impotence. Recent improvements in the anatomic approach to the procedure and nerve preservation have improved but not eliminated these side effects. During the first year after surgery, continence and potency (with nerve sparing) improves, but the degree of improvement and final outcome varies widely in the literature. Talcott etal.49 reported a prospective cohort study and found that, at

Artificial urinary sphincter

Revision Urinary Sphincter

Films during a cystogram in evaluation recurrent incontinence following AMS 800 implantation. No extravasation of contrast is seen to suggest urethral erosion. In the upper image, in the activated state, the column of contrast in the urethra stops at the level of the urethral cuff (black arrow). There appears to be contrast distal to the cuff, which represents the filling catheter. In the lower image, when the device is deactivated, contrast is seen to flow through the cuff (white arrow). Urodynamic evaluation revealed an overactive bladder as the cause of the recurrent incontinence. Fig. 34.5. Films during a cystogram in evaluation recurrent incontinence following AMS 800 implantation. No extravasation of contrast is seen to suggest urethral erosion. In the upper image, in the activated state, the column of contrast in the urethra stops at the level of the urethral cuff (black arrow). There appears to be contrast distal to the cuff, which represents the filling catheter....

Indications And Contraindications

Suggested an increased incidence of urinary incontinence in men with a prior history of a TURP, recent reports do not substantiate. Different rates of toxicity between investigators are likely secondary to different degrees of a TURP defect in reported patients. The authors of this chapter judge each patient's case separately, avoiding PB in men with very large TURP defects.

Comparative studies for localized disease

Since validating the EPIC survey, the Michigan group66 has published their comprehensive cross-sectional analysis of brachytherapy, XRT and RP compared to age-matched controls. They included the SF-36, FACT-G and P, AUASI, and EPIC, and achieved a 72-79 response rate - a remarkable achievement for such a large set of questions. As with the previously cited studies, no significant differences were seen in the general health measures. However, with the EPIC survey's additional urinary obstruction irritation, and hormonal domain, brachytherapy appeared just as morbid as RP and XRT. As with other studies, RP was associated with worse urinary incontinence and sexual function, and XRT with worse bowel and sexual function. By contrast, brachytherapy was associated with urinary irritation and obstruction, worse bowel function, and worse sexual function compared to controls. In the bother domains, brachytherapy reported significant bother for urinary, sexual and bowel XRT reported significant...

RRP after radiotherapy

One of the major concerns with salvage surgery has been the high reported rate of complications, including the risk of rectal injury and incontinence, as well as high rates of positive surgical margins.94 In the Mayo Clinic series mentioned above, the rates of rectal injury, bladder neck contracture and urinary incontinence were 6 , 21 and 50 , respectively.93 In fact, some have advocated radical cystoprostatectomy in this setting because of these concerns.95 In a more recent review from MSKCC, rectal injury is now uncommon, but incontinence remains problematic.96 One potential advance is that of preoperative endorectal MRI evaluation urethral length measured on coronal MRI sections has been correlated with postoperative continence (unpublished). Patient selection for salvage RRP remains paramount despite the reduction in morbidity and complications, the incidence of advanced disease on final pathologic examination of the prostate and pelvic lymph nodes remains high.94 Patients must...

Neurodegenerative Disorders

Multi Infarct Dementia

Infarctions, confluent white matter and irregular periventricular hyperintensities. Quantitative analysis has previously demonstrated an increased volume of WMH in patients with vascular dementia compared with normal subjects, but no correlation between volume of lesions and global cognitive decline (Giubilei et al., 1997). Alzheimer's disease is characterized by severe temporal atrophy, WMH involving the hippocampal or insular cortex, and gyral hypointense bands. Regions of extratemporal white matter signal change in Alzheimer's disease have also been assessed quantitatively on T2-weighted images using ROI and automatic thresholding and voxel counting methods (Hirono et al., 2000 Parsey and Krishnan, 1998). Hirono etal. (2000) reported that the volume of irregular periven-tricular and deep confluent hyperintensities did not correlate with dementia severity, consistent with previous qualitative and semiquantitative studies (Leys etal., 1990 Erkinjuntti etal., 1994 Smith etal., 2000)....

Behavioral modification and pelvic floor exercise

Pelvic floor exercise is an integral component of a behavioral modification program (see Table 34.2) and is often utilized to treat PPI in the immediate postoperative period. This program consists of (1) patient education regarding the function of the lower urinary tract (2) fluid and dietary management (3) timed voiding, and bladder training (4) pelvic floor exercises and (5) a voiding log or diary. For the patient with PPI, the aim of behavioral therapy is to help regain bladder control by increasing the effective capacity of the bladder and improving outlet resistance, thereby reducing the symptoms of UI. This type of program can be used for both sphincteric and bladder-related causes of PPI. Keeping a record in the form of a frequency volume chart or voiding log plays a central role. Dietary items, such as coffee, tea and alcohol, may precipitate symptoms, and this will become obvious upon review of the voiding log, if this information has been included. The initiation of pelvic...

Alternatives To Allogeneic Transfusion

Blood can be collected even postoperatively. Significant bleeding postoperatively is rare, especially bleeding requiring transfusion. A small hematoma can be treated expectantly. A larger one could cause some anatomic deformity in the anastomotic area between bladder and urethra, and should be explored as in any other surgery. Hedican and Walsh reported on seven patients with delayed postoperative bleeding in their series of 1350 patients.61 Four were treated surgically and did well. The remaining three were treated conservatively by draining their pelvic hematoma through urethral anastomosis all three developed bladder neck contracture and urinary incontinence persisted in two patients.


May appear as a consequence of the major symptoms, such as difficulties with speech, bowel and bladder problems, and a vacant, masklike facial expression. There are striking variations among patients in the number and severity of the symptoms and the timing of the progression.

Early complications

Men with very large prostate glands or a prior transurethral resection are at a higher risk for side effects after interstitial therapy. Prostatic inflammation and swelling can occur acutely in these men, and urinary retention can be severe enough to require catheterization. The risk of urinary retention in large prostates after HDR therapy is not such a problem. Transur-ethral resection to improve flow after brachytherapy is a relative risk for urinary incontinence, as smaller TURP defects are less problematic than larger ones.

Patient evaluation

Currently, there are no defined guidelines for urologists to follow that would enable them to select patients properly for salvage cryoablation. The optimal candidates for the procedure would be those patients that are candidates for localized therapy. For patients with a locally recurrent cancer following radiation, cryosurgery should be considered when there is absence of clinical evidence of metastatic deposits. Salvage cryosurgery can be performed under spinal anesthesia or general anesthesia. Patients with a prior history of transurethral resection of the prostate (TURP) should be exluded from cryosurgery, especially if there is a large TUR defect present, as these patients are at increased risk for sloughing and urinary incontinence.

Clinical Data

Clinical trial in 1992 and reported in 1999 on 50 patients with localized prostate cancer unsuitable for radical prostatectomy who underwent a total of 113 HIFU treatment sessions.7 Median follow-up was 24 months (range 3-46 months). Negative post-HIFU biopsies and a prostate specific antigen (PSA) nadir of less than 4.0 ng ml were seen in 28 patients (56 ), 6 had negative biopsies but a serum PSA exceeding 4.0 ng ml, yet 38 had residual cancer on the follow-up biopsies.7 The complication rate was as high as 50 with the first prototype this number declined to 17 (urinary retention, urinary tract infection, bladder neck sclerosis, urinary incontinence) in those treated with a modified HIFU system.

Available Doses

With declining estrogen levels, vaginal pH rises from acidic to basic levels, resulting in the decline of the previously predominant lactobacilli and a newly hospitable environment to previously atypical bacteria colonizing the vagina, most significantly enterobacteria. This is thought to result in an increased risk of urinary tract infections. There are also marked atrophic changes of the urethra, resulting in dysuria and frequency. Atrophy of the vulva and vagina can also be seen in the menopause. Genital symptoms include decreased lubrication, burning, itching, discharge, dyspareunia, and sexual dysfunction. Urinary symptoms include frequency, dysuria, hematuria, and incontinence. Numerous studies have demonstrated the effectiveness of local, oral, or transdermal estrogen for treating symptoms of vulvar and vaginal atrophy. A review of the literature shows conflicting results regarding the role of estrogen therapy in treating urinary incontinence, including a meta-analysis that...