Category: Health

Frequent sudden urges to urinate that are difficult to control could be caused by Overactive Bladder Syndrome (OAB), a common condition that occurs increasingly as we age. OAB is not a disease – it’s the name used to refer to a group of non-infectious conditions with different causes that cause a sudden urge to urinate.

Another common bladder problem, called Stress Urinary Incontinence (SUI), involves leakage of urine when sneezing, laughing or doing physical activities. It is a different condition than OAB and is treated differently, but a person can have both stress incontinence and overactive bladder. I’ll discuss both of these conditions in this article… so scroll down if “laughing so hard you peed your pants” is your main complaint!

OVERACTIVE BLADDER SYNDROME (OAB)

OAB is not just a normal part of getting older, part of “being a woman” or, for men, just part of having a prostate problem. If you need to urinate urgently 8 or more times during the day, or 2 or more times during the night, talk to your doctor to determine what may be the cause. Be aware that urinary tract infections and bladder cancer can cause symptoms similar to OAB, and these should be treated as soon as possible. There are effective treatments for OAB, both medicines and non-medical treatments, that can improve your quality of life.

Symptoms of OAB can have several different causes:

• Excess caffeine or alcohol
• Incomplete bladder emptying, leaving less room for storage of new urine
• Nerve disorders, such as stroke or multiple sclerosis, that affect nerve signals to the bladder
• Diabetes, which also can cause damage to nerves
• Mobility disorders, that make it more difficult to get to the bathroom quickly enough
• Medications that cause a rapid increase in urine production or require high fluid intake
• Abnormalities in the bladder, such as tumors or bladder stones
• The specific cause may be unknown

Diagnosis:

• A bladder diary kept for a few days before your doctor’s appointment, with the number of times you need to urinate, any urine leakage, amount and timing of fluid intake and timing of any medications you take can be helpful
• A scan may be done or a small tube called a catheter may be inserted to determine if any residual urine remains in the bladder after urinating.
• A urine culture may be done to ensure your symptoms are not being caused by a treatable infection.
• A scope may be performed to eliminate other causes.

TREATMENTS

Lifestyle changes (Behaviour therapy):

• Limit intake of food and drinks that you find irritate the bladder
• E.g. coffee, tea, artificial sweeteners, caffeine, alcohol, carbonated drinks, citrus fruit, tomatoes, chocolate, spicy foods
• Keeping a bladder diary for a few days may help you determine contributing causes (foods, activities, etc)
• Double voiding
• After urinating, wait a few seconds, relax and try again. This may be helpful if you have trouble emptying your bladder completely.
• Delayed voiding
• This involves waiting a few minutes before urinating, and gradually increasing the time to train the bladder to delay emptying. Check with your healthcare provider before trying this strategy, as it may not be helpful with some types of OAB.
• Scheduled voiding
• This involves urinating on a schedule instead of waiting until you feel the urge.
• Exercises to relax your bladder muscle
• These are sometimes called “quick flicks” – quickly squeezing and releasing the pelvic floor muscles (the muscles you use to hold urine in) can send a message to your nervous system and back to your bladder to stop squeezing and relax. Keeping still, relaxing and concentrating on the “quick flicks” can help the relaxation of the bladder.
• If you have urine leakage, specialized absorbent products are available that also control odor, allowing you to participate in activities that could cause problems for you.
• If you are overweight, losing weight may reduce symptoms
• Excessive fluid restriction may cause urine to become concentrated and irritating to the lining of the bladder, increasing the urge to urinate.
• Strengthening the pelvic floor muscles by doing Kegel exercises may be helpful. Click here for a description of how to do this exercise.

Medical and surgical treatments:

There are several prescription drugs available to relax the bladder muscle, and prevent it from contracting when the bladder isn’t full. These may be considered when lifestyle changes do not control the problem adequately. Common side effects include dry mouth and eyes, constipation, drowsiness and blurred vision. They are available as tablets and capsules taken by mouth, or as a gel or patch to deliver medication through the skin.

If medications don’t help, injections to partially paralyze the bladder muscle or stimulation of the sacral nerve that controls the bladder may be tried. These treatments would be performed by a specialist.

STRESS URINARY INCONTINENCE (SUI)

Stress incontinence is loss of urine due to physical movement or activities – such as coughing, sneezing, running, or heavy lifting – that put pressure or stress on your bladder. It occurs when muscles and tissues that support the bladder and the muscles that regulate the release of urine (urinary sphincter) weaken.

Risk factors include:

• Childbirth in women, particularly forceps delivery, and hysterectomy
• Prostate surgery in men
• Age – muscles generally weaken as you age, but SUI is not considered a normal part of aging. It can occur at any age.
• Body weight – being significantly overweight can increase pressure on the abdominal organs, including the bladder
• Illness or smoking can increase coughing, worsening stress incontinence

Treatment strategies:

• Pelvic floor muscle (Kegel) exercises (click here for a description)
• Fluid consumption – adjusting the amount and timing of fluid intake may help, but avoid dehydration. Avoiding alcohol and caffeine is of questionable benefit.
• Healthy changes – quitting smoking, losing extra weight, or treating a chronic cough may improve symptoms
• Bladder training or scheduled urinating may be helpful, especially before activity.

Medications:

There are no approved medications specifically for stress incontinence, but estrogen replacement (often given as a vaginal cream, suppository or ring when being used for urinary or vaginal problems) can help some post-menopausal women by improving the health of these estrogen-responsive tissues. The medication, desmopressin, given as a nasal spray, blocks the production of urine and is sometimes used to reduce the need to urinate at night.

Surgical treatments:

• Sling procedure – a strip of tissue or tape is surgically placed under the urethra for support
• Bladder neck suspension – designed to lift the bladder and support it. Can be performed laparoscopically, with instruments inserted through small incisions in the abdomen.

You can read more about these medications and procedures here.

References:

• Mayo Clinic – OAB
• Urology health.org
• Canadian Continence

#Overactivebladder #Stressincontinence #Incontinence #Urineleak

Diabetes increases your risk of heart disease, stroke, and damage to blood vessels and nerves, but did you know that studies suggest it may also increase your risk of eventually developing Alzheimer’s disease and other forms of dementia?

And the damage to your brain may even start before you have diabetes…

Type 2 diabetes begins with spikes in levels of sugar in the blood, which trigger your body to produce higher amounts of insulin to process this sugar. At first the higher amounts of insulin can reduce blood sugar to normal (this stage is referred to as pre-diabetes) but eventually, as your body becomes increasingly resistant to the effect of insulin, blood sugar can no longer be controlled at normal levels, and you are diagnosed with diabetes.

Research is suggesting that these increased levels of insulin begin the process of damaging the inside of blood vessels and, in the brain, also stimulate formation of toxic proteins that damage brain cells. Researchers have discovered that the same protein that is formed in Alzheimer’s patients’ brains, is found in the brains of people with type 2 diabetes (T2D). T2D patients often experience a sharp decline in cognitive function and almost 70% of them eventually develop signs of Alzheimer’s or another dementia, according to http://www.alzheimers.net.

Melissa Schilling, professor at NYU, suggests that all patients with dementia or who are at risk of developing dementia should be tested for hyperinsulinemia (high insulin in the blood). She suggests that high insulin could be responsible for almost half of all cases of dementia. However, she recommends that further research needs to be done to verify her arguments and implications for treating Alzheimer’s. Her article: Unraveling Alzheimer’s: Making Sense of the Relationship between Diabetes and Alzheimer’s Disease was published in the Journal of Alzheimer’s disease in Jan 2016. Click here for the full text.

Research points to the protein, amylin, that is co-secreted with insulin and, along with the beta-amyloid protein, it is thought to be important in the formation of amyloid plaques found in the brains of Alzheimer’s patients.

Another possibly important factor, may be levels of insulin-degrading enzyme (IDE), the enzyme that breaks down insulin, reducing levels once it’s finished its job. The presence of insulin stimulates increased activity of IDE, the enzyme that breaks down insulin. Lower insulin leads to less activity of this enzyme. IDE also breaks down amyloid proteins, but it favours breakdown of insulin.

It may be an imbalance between IDE, insulin and amyloid-beta production that ultimately is shown to be a major cause of dementia. Here are 4 suggested scenarios:

• Severe lack of insulin (as in type 1, insulin dependant diabetes), could lead to less IDE activity, and subsequent decrease in breakdown of amyloid proteins that create plaques in the brains of dementia patients.
• Lack of production of IDE itself would lead to increased levels of both insulin and beta-amyloid
• Excessively high levels of insulin (and amylin, secreted along with it) in early stages of type 2 diabetes could lead to competition for insulin-degrading enzyme between insulin and amyloid. Since the enzyme favours insulin, this would result in less breakdown of amyloid and increased amounts available for formation of plaque in the brain
• An individual could produce higher than normal amounts of amyloid proteins that outpace the ability of IDE to break it down.

You can see how both a lack of insulin and too much insulin could be a cause of dementias. Too little insulin-degrading enzyme or increased production of amyloid proteins could cause problems in people with normal production of insulin. These confusing scenarios could explain why researchers have not yet determined the causal relationship between diabetes and Alzheimer’s, despite reporting on the connection as far back as 2003!

This type of research is especially important, as the drugs currently available to treat Alzheimer’s offer only small improvements in symptoms and do not stop the progression of the disease, in spite of their high cost.

So, ask your doctor to screen for early signs of diabetes and aggressively treat it when discovered to keep your insulin levels in the normal range. Eat a healthy diet and exercise regularly, as these are also known to lower the risk of developing diabetes. It seems likely that these strategies will lower your chances of developing dementia years down the road.

References: MayoClinic.org; Alzheimers.net

#Alzheimers #Diabetes