URINARY INCONTINENCE, NOCTURIA AND OVERACTIVE BLADDER
Lata (name changed for privacy) was a 46 year old lady 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, affected her state of mind and her ability to go meet her clients. She was always afraid that if she could not get to the toilet in time she would wet her clothes. On visits to clients and on her way to and from work she started wearing adult diapers. Going to the market to buy her daily needs had become a nightmare for her.
I examined her, discovered she had a cystocoele, many spasms in the para-vaginal muscles and ligaments, which were causing a twisting of the uterus and pulling on the urethral sphincter. 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 corrected this and she reported after 2-3 days that she was now able to hold her urine for upto an hour at a time. Encouraged by this, she came back for more treatment which included further correction of the abnormalities followed by acupuncture. Over the next 10 days she reported further improvement waking up only twice on most nights to pass urine. She was now able to manage without using the toilet for almost 2 hours during the day. 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 levels, 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 37 years of practicing medicine, I have worked with hundreds of people with urinary incontinence. This is an embarrassing problem, which millions of women worldwide, cope with on a daily basis. The symptoms that 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 ahead for access to bathrooms, and modify their social and work lives to accommodate their symptoms.
Some ladies are very distressed by the symptoms, whether mild or severe, 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 normal lives. Other women complain that their symptoms affect 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. These were women who had delivered babies. Women with these symptoms usually do not talk with their doctors concerning their bladder dysfunction, and doctors usually do not routinely inquire about the bladder. As a result, only a small minority receive treatment.
10-40% 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 years.
Incontinence also affects men as they age and is very common in elderly men especially when they have prostrate enlargement. In younger men it may originate from Prostatitis which is an infection in the prostrate which causes enlargement of the prostate.
Nocturia. Many people wake up 2-6 times a night to pass urine. This disturbs the Sleep and can many problems like irritability, loss of memory, poor concentration, high blood pressure and stress. In elderly people this may be due to accumulation of fluid in the legs during the day. If there is swelling in the legs it confirms the cause. This problem often accompanies problems in the liver, heart, kidneys and with hormonal problems like hypothyroidism, and menopausal problems. Elevating the legs for 2 hours before sleeping allows this fluid to drain back to the circulation and allows the kidney to eliminate this excess fluid as urine before you go to sleep. Ultrasound treatment of the kidneys can help circulation and allow better elimination of the excess fluid. 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 which increases intra-abdominal pressure and thus increases pressure on the bladder.
Urge incontinence is a sudden and strong need to urinate.
Overflow incontinence is frequent or constant dribbling of urine due to a bladder that doesn't empty completely.
Functional incontinence. A physical or mental impairment does not let you reach the toilet in time. For example, if you have severe arthritis, you may not be able to get to the toilet and unbutton your pants quickly enough.
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 can also cause frequency of urine and this should always be checked and treated appropriately. Other causes of urinary incontinence are damage to the sphincter during pregnancy and childbirth, menopause, hysterectomy which affects the structure of the pelvis, obesity which increases the pressure on the bladder, 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 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 led to an immediate improvement in the control of urine.
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 and 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 holding 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 the 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 in a short time. Pulsed electromagnetic Frequency (PEMF) treatment strengthens the nerves and muscles of the bladder, sphincter and pelvis and help to restore normal muscle tone and function. Some patients may require long term low intensity PEMF treatment at home to sustain the improvement.
We can offer significant relief to millions of women suffering from overactive bladder and urinary incontinence
Males often had similar results to females in the improvement of their OAB and urinary incontinence with Acupuncture, Biofeedback & PEMF treatment.
Conventional treatment for this problem, with varying rates of success are medications or patches, surgeries, sacral neuro-modulation, botulinum injections, reflexology and behavioural interventions such as bladder training.
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, affected her state of mind and her ability to go meet her clients. She was always afraid that if she could not get to the toilet in time she would wet her clothes. On visits to clients and on her way to and from work she started wearing adult diapers. Going to the market to buy her daily needs had become a nightmare for her.
I examined her, discovered she had a cystocoele, many spasms in the para-vaginal muscles and ligaments, which were causing a twisting of the uterus and pulling on the urethral sphincter. 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 corrected this and she reported after 2-3 days that she was now able to hold her urine for upto an hour at a time. Encouraged by this, she came back for more treatment which included further correction of the abnormalities followed by acupuncture. Over the next 10 days she reported further improvement waking up only twice on most nights to pass urine. She was now able to manage without using the toilet for almost 2 hours during the day. 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 levels, 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 37 years of practicing medicine, I have worked with hundreds of people with urinary incontinence. This is an embarrassing problem, which millions of women worldwide, cope with on a daily basis. The symptoms that 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 ahead for access to bathrooms, and modify their social and work lives to accommodate their symptoms.
Some ladies are very distressed by the symptoms, whether mild or severe, 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 normal lives. Other women complain that their symptoms affect 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. These were women who had delivered babies. Women with these symptoms usually do not talk with their doctors concerning their bladder dysfunction, and doctors usually do not routinely inquire about the bladder. As a result, only a small minority receive treatment.
10-40% 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 years.
Incontinence also affects men as they age and is very common in elderly men especially when they have prostrate enlargement. In younger men it may originate from Prostatitis which is an infection in the prostrate which causes enlargement of the prostate.
Nocturia. Many people wake up 2-6 times a night to pass urine. This disturbs the Sleep and can many problems like irritability, loss of memory, poor concentration, high blood pressure and stress. In elderly people this may be due to accumulation of fluid in the legs during the day. If there is swelling in the legs it confirms the cause. This problem often accompanies problems in the liver, heart, kidneys and with hormonal problems like hypothyroidism, and menopausal problems. Elevating the legs for 2 hours before sleeping allows this fluid to drain back to the circulation and allows the kidney to eliminate this excess fluid as urine before you go to sleep. Ultrasound treatment of the kidneys can help circulation and allow better elimination of the excess fluid. 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 which increases intra-abdominal pressure and thus increases pressure on the bladder.
Urge incontinence is a sudden and strong need to urinate.
Overflow incontinence is frequent or constant dribbling of urine due to a bladder that doesn't empty completely.
Functional incontinence. A physical or mental impairment does not let you reach the toilet in time. For example, if you have severe arthritis, you may not be able to get to the toilet and unbutton your pants quickly enough.
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 can also cause frequency of urine and this should always be checked and treated appropriately. Other causes of urinary incontinence are damage to the sphincter during pregnancy and childbirth, menopause, hysterectomy which affects the structure of the pelvis, obesity which increases the pressure on the bladder, 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 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 led to an immediate improvement in the control of urine.
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 and 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 holding 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 the 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 in a short time. Pulsed electromagnetic Frequency (PEMF) treatment strengthens the nerves and muscles of the bladder, sphincter and pelvis and help to restore normal muscle tone and function. Some patients may require long term low intensity PEMF treatment at home to sustain the improvement.
We can offer significant relief to millions of women suffering from overactive bladder and urinary incontinence
Males often had similar results to females in the improvement of their OAB and urinary incontinence with Acupuncture, Biofeedback & PEMF treatment.
Conventional treatment for this problem, with varying rates of success are medications or patches, surgeries, sacral neuro-modulation, botulinum injections, reflexology and behavioural interventions such as bladder training.