Health Watch

Urinary incontinence in women:

Is there a way out?

Dr. K Sivanesan

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I just cannot wait to go to the loo... A helpful advice regarding overactive bladder

What is overactive bladder?

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If you have the sudden rush to go to the loo, it is called urgency and if you leak urine associated with this, it is called urge incontinence of urine. This condition is also called unstable bladder or overactive bladder. Your bladder tries to squeeze urine out even though it is not full.

This could be associated with the need to go to pass urine many times a day (called frequency) and you might be passing very little amount of urine on these occasions. In some patients, it could be associated with the need to get up in the night more than two occasions (nocturia).

This condition can occur at any age. Women most often are embarrassed to discuss this with their doctor and might go on for many years without reporting to anyone about this. One in five women in the UK have this problem and I do not know the true prevalence of this condition in Sri Lanka. But this condition can be controlled with simple measures and medications in most patients.

Your bladder has a smooth muscle called detrusor muscle. During the filling of urine which is produced by kidneys, bladder fills without much pressure due to stretching of the bladder muscle and is able to have 400-500 mls of urine without much urge. When the time is ready, the bladder muscle contracts and the bladder empties. Usually people go to the loo between four - eight times a day.

What causes this condition?

It is often very difficult to say as to why this condition occurs. In most instances, we cannot find a cause for these symptoms. This could be due to simple bladder infection which has not been treated. Drinks containing caffeine and alcohol can irritate the bladder.

Some people do not drink enough water and this can irritate the bladder too. In some patients, it could be due to bladder stone or tumour. Alzheimer’s disease, stroke and multiple sclerosis also can cause these symptoms. Uncontrolled diabetes too can lead to these symptoms including bothersome nocturia.

What should you do if you think you are having overactive bladder?

It is important that you discuss this with your doctor (family doctor or your gynaecologist). They will explore your symptoms and be able to advice and treat you depending on your symptoms and causes.

What are the investigations your doctor might carry out?

Urine dipstick and urine culture - this is to rule out any ongoing infection in your bladder as well as to rule out any presence of blood in the urine.

Residual urine in the bladder - this could be done with a simple scan of your bladder after you emptied it or by passing a catheter into your bladder.

Bladder diary - this involves filling a chart where you record the amount, time and type of fluid/drink intake for at least three days during day and night. You also need to record the time and amount of urine passed as well as be able to record when the urine leaks occurred.

Internal examination - this is to check your pelvic muscle strength as well as to rule out any presence of prolapse of pelvic organs.

Cystometry - this is not required in all the patients and usually reserved for patients where initial treatment is not working. This can be a very uncomfortable investigation.

Cystoscopy - this is required if your urine has blood or if the initial medications and lifestyle changes haven’t made any significant impact on your symptoms.

What are the treatments available to treat this condition?

There are many simple measures which can help to control the symptoms. First of all drinking adequate amount of fluids every day. We recommend at least 1500 - 2000 mls of fluids every day.

If you drink less, then you should consider increasing the amount little by little. Cutting down the number of cups of tea or coffee you drink every day can help.

You may want to try decaffeinated tea instead. Cutting down fizzy drinks such as cola is a good idea. Good control of diabetes is advised.

If you have to get up in the night many times, reducing the amount of fluids in the evenings would help.

Bladder retraining

This is a simple method but needs a lot of determination and effort. If you go to the bathroom every hour, you may want to wait for another 30 mins and you can increase this time interval gradually.

Also try to think or do something else when you get the urge to pass urine. This helps your bladder to retrain itself. It will get used to hold more urine for longer period and symptoms of urgency will gradually improve.

Pelvic floor exercises

Your physiotherapist might be able to show how to squeeze your pelvic muscles and be able to make sure that you are doing them correctly. Pelvic muscle squeeze can help you to overcome urgency.

Medications

There are many different medications which help the bladder muscle to relax. They may be expensive in Sri Lankan setting. They have side effects such as dry mouth and nausea. They can reduce the times you need to go to the bathroom, reduce the sense of rush/urgency as well as number of episodes you leak.

Tablets take few weeks to make any change in your symptoms and your doctor might try few medications to find the one that suits you! These tablets are not suitable if you are suffering from glaucoma.

If the tablets do not work, your doctor may want to perform Cystoscopy (passing a camera to look inside your bladder).

Other treatments

Injections of botox into the bladder muscle, sacral nerve modulation, percutaneous tibial nerve stimulation, clam ileocystoplasty or urinary diversion are the other forms of treatment options available to treat this condition.

For queries contact: [email protected].

BAHA surgery a success

Edward Arambewala

Sri Lanka has successfully completed the first-ever local BAHA (Bone Anchored Hearing Aid) surgery. This high-tech surgery will help those suffering from hearing impairments due to their middle ear being blocked or damaged or for those with only one ear functional.

Being able to complete such surgery locally is a new step to providing cost-effective hope to those lacking the gift of hearing.

WISH President Mihira Wickramarachchi – Wickramarachchi Institute of Speech and Hearing initiated this program in partnership with private and Government hospitals. These implants are done when neither the use of hearing aids nor Cochlear implants are effective. This is the final step of hearing solutions and it has not been implemented in Sri Lanka previously.

Now we have implemented all sophisticated palpable hearing solutions in Sri Lanka creating a landmark in ENT surgical practice. WISH has served by providing hearing solutions to more than 1 million Sri Lankans over the last thirty years, and through its aural therapy arm, WISH has already completed more than 100 Cochlear Implant Surgeries in Sri Lanka. About 5 percent of the Sri Lankan population suffers from hearing impairments and President fund has helped this program to reduce their surgery cost.

Wickramarachchi says that Sri Lanka has every hearing assessment and all surgical techniques used are the same as in any developed country and WISH, together with Apollo Hospital, Durdans Hospital, Lady Ridgeway Hospital and the National Hospital are implementing these surgical procedures.

There are many surgeons in Sri Lanka who are now capable of performing these surgeries upto international standards. The institute also implements auditory verbal therapy and has trained many speech therapists in the health, education and social service sectors free and donated more than 3000 hearing aids to schoolchildren.

Talk on rebirth

Edward Arambewala

Health Watch is making arrangements for Sri Lanka’s leading Clinical Hypnotist and Family Physician in Kandy Dr H B Jayasinghe (MBBS, MCGP, MDCH (Lon) MBS CH (UK) CH (USA) to give an interesting talk on (Rebirth is there acceptable proof?) at the SLMA Auditorium, Wijerama Mawatha in June, when he returns from UK.

Dr Jayasinghe who has earlier also given a talk at the SLMA arranged by the Health Watch has accepted to give this talk on the new area of proof and research done so far. Health Watch invites readers, to send their questions and views on this and it will be responded by Dr Jayasinghe at the talk.

Send your questions and views addressed to Health Watch Talk on Rebirth, c/o Features Editor, Daily News, ANCL Lake House, D R Wijewardena Mawatha Colombo 10.

EA

Arthritis impacts physical, mental health

Amanda Gardner

Arthritis can limit mobility and make everyday tasks painful, and it can also take a toll on your mental health and overall quality of life, a new study suggests.

Researchers analyzed data from several national health surveys conducted by the Centers for Disease Control and Prevention (CDC) and found that people with arthritis—which includes those with aging-related osteoarthritis and similar conditions such as rheumatoid arthritis and gout—tend to rate lower than their peers on measures of overall health.

Twenty-seven percent of the survey respondents with some form of arthritis described their health as “fair” or “poor,” versus just 12 percent of those without arthritis Those with arthritis also reported having more than twice as many “physically unhealthy days” in the previous month.

The surveys showed a similar pattern for mental health. People with arthritis experienced an average of five “mentally unhealthy days” per month, compared to three per month among those who were arthritis free, according to the study, which appears in Arthritis Care & Research.

“People who have arthritis, particularly rheumatoid arthritis, have significant rates of depression,” Mayo Clinic, in Rochester, Minnessota rheumatology chair Eric L. Matteson, MD, who was not involved with the study. “And there’s no question that when you feel depressed, it influences your general sense of well-being and how arthritis affects you.”

Moreover, when arthritis is acting up, metabolic and other changes in the body can increase levels of inflammation, which can worsen depression, Dr. Matteson says. “That highlights the importance of not only controlling the disease or managing the disease but also getting depression under control, too.”

More than one-fifth of the US population has some form of arthritis, according to the CDC.

The rate has been rising, partly because of the aging of the baby-boom generation.

But the obesity epidemic is also partly to blame, since excess weight can strain inflamed joints.

Physical activity was linked to a higher quality of life, the researchers found.

People who managed to exercise in spite of their arthritis were 53 percent less likely to be in fair or poor health than were inactive arthritis patients, says the lead author of the study, Sylvia Furner, PhD, an epidemiologist at the University of Illinois at Chicago.

“Physical activity does a lot to strengthen and support the joints, and there’s a lot of pain relief that comes along with exercise,” says rheumatologist Allyson McDonough, MD, assistant professor of internal medicine at the Texas A&M Health Science Center College of Medicine, in Temple.

Low-impact exercise - such as walking, swimming, yoga, or tai chi - is “extremely important to improve quality of life,” she says.

“There’s a significant perception that there’s nothing that can be done about arthritis,” says Dr. McDonough, who was not involved in the research.

“That’s inaccurate. Seeking care and looking for avenues of self-help will help improve quality of life.”

Health.com

Questionnaire may help predict autism at one year

A quick and simple questionnaire given to parents during a regular checkup in a pediatrician’s office may help detect autism in children as young as 1 year old, a new study suggests.

The 24-item questionnaire, which assesses a child’s ability to communicate with eye contact, sounds, and gestures, may steer infants who show early signs of autism spectrum disorders (ASDs) into appropriate treatment at earlier ages, the researchers say.

Identifying language and developmental delays in babies may also help scientists uncover the underlying neurological processes of autism, paving the way for more effective treatments, says Karen Pierce, Ph.D., the lead author of the study.

“Most of the studies on autism are on adolescents and adults,” says Pierce, an assistant professor of neuroscience at the University of California San Diego (UCSD), in La Jolla. “Some (are) on children, but very few people have the ability to study autism in babies, because we can’t diagnose it until 3 or 4 years.

How in the world are we going to discover the causes if we’re studying brains that have had a lifetime of living with autism, and (have) a host of compensatory mechanisms?”

The average age of ASD diagnosis is around 5 years old, though most of those children show signs of developmental problems before age 3, according to the Centers for Disease Control and Prevention.

There are no biomarkers to indicate that a child has autism, so clinicians have to rely on behavioral clues, making diagnosis tricky. And even when a child is accurately diagnosed early, he or she often doesn’t start treatment until some time after the diagnosis.

The questionnaire used in the study is a simple checklist that asks parents to say whether their baby displays certain types of communication “often,” “sometimes,” or “not yet.” It takes just five minutes to fill out and can be scored on the spot.

The checklist does not zero in specifically on autism but “will tell you something is wrong,” Pierce says. That could be the early signs of autism or another type of language or developmental delay.

In the study, which appears in the Journal of Pediatrics, 137 pediatricians in the San Diego area screened more than 10,000 children who were undergoing their one-year checkup.

Of those, 184 were determined to be below the appropriate levels of development for their age, and were referred to UCSD’s Autism Center of Excellence for further evaluation.

Doctors examined them every six months until they were 3 years old.

So far, 32 children have been definitely or provisionally diagnosed with an autism spectrum disorder, 56 with a learning disorder, and nine with another disorder.

Based on these findings, the researchers estimate that 20 percent of children flagged by the checklist at 12 months will go on to develop autism and 55 percent will develop a learning or developmental disorder.

Twenty-five percent will get a false-positive result, they say, giving the questionnaire a high accuracy rate of 75 percent.

Five children in this study sample who were initially diagnosed with ASD were later determined not to have an autism disorder. And, as hoped, the children who were assigned a diagnosis of autism or a learning or developmental delay started treatment at an average age of 19 months.

In theory, earlier treatment might influence how connections between neurons are being made in the brain, greatly influencing a child’s emotional and social development, Pierce says.

But that remains an open question, says Keith A. Young, PhD, vice chairman for research in the department of psychiatry and behavioral science at the Texas A&M Health Science Center College of Medicine, in Temple.

“At this point in time, there are no validated treatments at that young of an age,” Young says. “There are various treatments that have been tested in older kids, but do they work in younger kids? How do we need to adapt them? All of that stuff needs to be done before we go out and say, ‘OK, there needs to be screening.’”

Health.com

Medical Crossword Draw No 46 in Galle

Medical Crossword Draw No 46 will be held in Galle on May 15 at 10am at J M Wickremarachchi Opticians No 17, Wakwella Road, Galle.

A talk on how glare affects the eye, is being arranged by the Crossword Sponsors wish Institute.

We wish to thank retired Director of Meteorology Dr Ian D T de Mel for writing to us, offering his help in an advisory capacity to Dr Kelum Pelpola in compiling the Crossword.

EA