An Overactive Bladder Old And New Treatment Options

When you live with an overactive bladder (OAB), your overwhelming worry becomes, “Where is the nearest bathroom?” You never know when you’ll feel the sudden urge to urinate — the hallmark of ‘urge’ incontinence. And every time you cough, sneeze, laugh, or lift your groceries, there’s a good chance you’ll leak urine if you have stress incontinence. The two often co-exist in women.
One challenge in treating OAB has been to relieve both types of incontinence  stress and urge. “The problem is, we don’t have a single treatment that takes care of both,” says Linda Brubaker, MD. “We could give you medications that help with urge incontinence, but you might still be bothered by stress.” Or even more frustrating, you might have had surgical and non-surgical treatments to combat stress incontinence, only to find that you still urgently need to run to the bathroom three or four times a night  and not always make it.
OAB Treatment Options
There are a number of treatments for OAB, and researchers are studying more in clinical trials. If you have symptoms of more than one type of incontinence, it’s likely that you’ll need more than one treatment, Brubaker says. “And incontinence is also a chronic condition that tends to get worse as people age. This means we need a lot of options.”
You may have already tried many of the most common urinary incontinence treatments — medications, Kegel exercises, and bladder retraining. If you’re still frustrated by an overactive bladder or other continence problems that won’t let up or go away, you might want to learn more about other OAB treatment options.
Medications for OAB
Several different medications have been approved to relieve the symptoms of urinary frequency and urgency. They include oxybutynin, tolterodine, solifenacin, fesoterodine fumarate, trospium, and darifenacin. These drugs help prevent the uncontrollable muscle contractions that can lead to overactive bladder and leaking. However, they can cause side effects, including dry mouth, blurred vision, constipation, and urinary retention. Extended-release versions of these drugs may help reduce side effects.
Percutaneous Tibial Nerve Stimulation
If your overactive bladder hasn’t improved with bladder retraining and medicines and you don’t want to have surgery, percutaneous tibial nerve stimulation (PTNS) is an option. During this technique, the doctor inserts a fine-needle electrode into the nerve just above your ankle. A mild electrical impulse is passed along the needle to nerves of the spine that control bladder function.
“It’s a fairly simple procedure, done in the office,” says Ross Rames, MD, associate professor of urology at theMedical University of South Carolina. “Often, we’ll see improvement within the first couple of weeks after the patient starts PTNS treatments.” With PTNS, you’ll need a series of 12 treatments, scheduled about a week apart. You may need more than one treatment to keep seeing results.
Sacral Nerve Stimulation Therapy
Sacral nerve stimulation is a treatment in which mild electrical impulses are sent to the sacral nerves near the lower back. A device — implanted in the upper buttocks under the skin — is used to provide electrical pulses that influence bladder function. The procedure to implant the device does involve surgery, but it is minimally invasive, and reversible.
Botulinum Toxin Injections for OAB
Botulinum toxin injections are approved to treat urinary incontinence in people with spinal cord injuries and other nervous system problems, but they may also provide some relief for people with overactive bladder. You might be wondering, “Botox? Like movie stars use on their forehead?” Yes, the same substance that dermatologists use to smooth out wrinkles can also be used to relax an overactive bladder.
To treat incontinence, doctors inject botulinum toxin into the bladder muscle. This is done with a needle that is inserted via a long tube called a cystoscope that goes up into the bladder. “The goal is to reduce the over-activity of the bladder muscle so that the patient has better control, but still allow enough muscle contraction to empty the bladder,” Rames says. The effects generally last for about 9 months. So far there don’t seem to be any major side effects from botulinum toxin, although more research is still needed to determine the benefits and risks of this technique for treating OAB.n
(Reviewed By Brunilda Nazario, MD )


Kidneys : Sophisticated Processing Machines

  •  Your body has 2 kidneys. Each kidney is about 5 inches long (13 centimeters) and weighs approximately 4 to 6 ounces (120-140 grams).
  •  Our kidneys have a higher blood flow than our brain, liver or heart.
  •  The kidneys absorb and distribute 99.9 per cent of the blood volume. Only 0.1 per cent of the blood filtered turns into urine.
  •  The kidneys filter almost 200 quarts of blood every day.
  •  Risk factors for Chronic Kidney Disease CKD include: diabetes, hypertension, high cholesterol, obesity, advanced age, family history of CKD, and tobacco use.
  •  Each kidney has about a million tiny nephrons. A nephron is the basic functional unit of the kidney. It has a group of tiny blood vessels called a glomerulus, the small structure responsible for filtering and cleaning blood as it flows through the kidney. Most kidney diseases attack the nephrons, causing them to lose filtering capacity. Interestingly, kidney diseases destroy the nephrons slowly and silently. The damage will become apparent only years or even decades later.
  •  The most frequent causes of kidney disease are Diabetes and High blood pressure. Other causesinclude, Glomerulonephritis (inflammation of the glomerulus) and Polycystic Kidney Disease (an inherited disease, causing large cysts to form in the kidney). What most people don’t realise is that taking over-the-counter pain-relieving medicines can also result in kidney disorder. Please keep in mind that these medicines can be toxic to your kidneys and may even provoke some serious damage.
  •  Heart disease is very common among people with Chronic Kidney Disease. CKD patients are more likely than the general population to develop heart condition. I cannot stress enough the importance of salmon, albacore tuna, sardines, walnuts or flaxseed oil in your diet.
  •  Patients with kidney dysfunction commonly develop anemia as a result of decreased hormone production in kidneys.
  •  Kidney failure is not always permanent, which is great news for many people.
  •  Dialysis (there are two types) is the most common therapy for people suffering from end stage kidney failure.
  •  Dialysis and Kidney Transplantation can extend the lives of people with kidney failure. Fortunately, there are ways to prevent kidney disease.
  •  Only one donated kidney is needed to replace two failed kidneys.
  •  Although most back pain has nothing to do with the kidneys, some kidney-related conditions could lead to back ache. The most common root of kidney-related back pain is a kidney stone.

                                                                (Dr. Simon Prince)


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