Botox Injections In The Bladder
An option for women who have failed all other medications. Onabotulinum toxin A is injected into the bladder muscle and causes partial paralysis of the detrusor muscle. Each course last approximately 6-12 months and patients typically will require multiple top-ups for the botox to be effective . This is performed under sedation in hospital as a day case and the botox takes approximately 7-10 days before working.
The botox is injected into the bladder wall as shown in the image, thru a small cystoscope that is introduced via the urethra. Approximately 5% of women will have trouble emptying there bladder following botox and use of a temporary catheter would then be required. The botox is now funded on the PBS in Australia when administered by a Urogynaecologist.
Living With Bph: A Toolbox For Managing Urinary Symptoms
BPH progresses slowly, so most men can decide for themselves if and when they would like to consider medication or surgery. Men with mild to moderate symptoms often find that the changes in fluid intake, medication use, and bladder habits listed below can noticeably relieve BPHs bothersome effects.
MEDICATION USE: Alter use of medications that could worsen urinary symptoms.
- Talk to your doctor or pharmacist about prescription or over-the-counter medications that may be contributing to your BPH symptoms. Antihistamines and decongestants can cause problems for some.
- If you use medications that could make you urinate more, dont take them right before driving, traveling, attending an event, or going to bed.
- Dont rely on ineffective dietary supplements. Saw palmetto and other herbal supplements have failed rigorous scientific testing so far.
FLUID RESTRICTION: Change how much fluid you drink and when to prevent bothersome bathroom visits.
- Dont drink liquids before driving, traveling, or attending events where finding a bathroom quickly could be difficult.
- Avoid drinking caffeinated or alcoholic beverages after dinner or within two hours of your bedtime.
Why Uti Pain Happens At Night
According to Eilber, UTI pain and other symptoms arent worse at night. They are just more bothersome because people arent as distracted by their daily activities and the symptoms of frequency and urgency are forcing you to get out of bed.
UTI discomfort may also seem worse because youre not emptying your bladder as much as you would during the day. The pressure from collecting urine then creates discomfort against the inflamed walls of your infected bladder.
To reduce your risk of getting a UTI, there are specific lifestyle steps you can take, including:
- Drink plenty of fluids, especially water.
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Why Does Urinary Incontinence Happen
There are two main types of urinary incontinence:
- Stress incontinence
- Urge incontinence
“Stress incontinence occurs when your pelvic floor muscles the muscles that support your bladder and urethra weaken, either due to childbirth or over time,” says Dr. Lindo.
If you’re experiencing stress incontinence, you might find yourself leaking urine when you cough, sneeze, laugh, exercise or lift something heavy.
“Urge incontinence, on the other hand, occurs when the bladder muscle squeezes to empty out urine when it is not supposed to. It may be due to the amount or type of fluids you drink, resulting in spasms,” explains Dr. Lindo. “Additionally, urgency incontinence can sometimes be a sign of a larger health complication, such as a bladder infection.”
With urge incontinence, you likely experience an overwhelming, sudden need to urinate and leak urine before you can make it to the bathroom.
“For many women the exact cause of their urge urinary incontinence is unknown,” adds Dr. Lindo. “However, there are many treatments that can help you manage symptoms.”
Treatment For Frequent Urination
Treatment for frequent urination will address the underlying problem that is causing it. For example, if diabetes is the cause, treatment will involve keeping blood sugar levels under control.
The treatment for overactive bladder should begin with behavioral therapies, such as:
- Bladder retraining. This involves increasing the intervals between using the bathroom over the course of about 12 weeks. This helps retrain your bladder to hold urine longer and to urinate less frequently.
- Diet modification. You should avoid any food that appears to irritate your bladder or acts as a diuretic. These may include caffeine, alcohol, carbonated drinks, tomato-based products, chocolate, artificial sweeteners, and spicy foods. Itâs also important to eat high-fiber foods, because constipation may worsen the symptoms of overactive bladder syndrome.
- Monitoring fluid food intake. You should drink enough to prevent constipation and over-concentration of urine. Avoid drinking just before bedtime, which can lead to nighttime urination.
- Kegel exercises. These exercises help strengthen the muscles around the bladder and urethra to improve bladder control and reduce urinary urgency and frequency. Exercising pelvic muscles for five minutes three times a day can make a difference in bladder control.
- Biofeedback. This technique can help you learn how your pelvic muscles work to help you better control them.
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From Leaking Urine To Sudden Urges To Go: An Ob
You dont have to suffer in silence there are many treatment options available.
Whether its a few drops of leaking urine or a complete emptying of the bladder, incontinence is a bladder control issue that women are twice as likely to have as men. And by the time a womanhas made an appointment to talk about what shes dealing with, she has had enough.
Incontinence can be embarrassing, super annoying, and costly. But you dont have to suffer in silence there are many treatment options available.
What Is Urinary Incontinence
Urinary incontinence is the accidental loss of urine. According to the National Association for Continence, over 25 million adult Americans experience temporary or chronic urinary incontinence. UI can occur at any age, but it is more common among women over 50. Urinary incontinence may be a temporary condition that results from an underlying medical condition. It can range from the discomfort of slight losses of urine to severe, frequent wetting.
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Other Bladder Control Medications
If symptoms of urinary incontinence are thought to be caused by an enlarged prostate, different medications can be offered to reduce these symptoms. The prostate gland wraps around the urethra , and if it is enlarged, it could squeeze the urinary passage tight, making the emptying of bladder more difficult and incomplete.
In brief, the following categories are available for the treatment of urinary symptoms caused by an enlarged prostate :
- Alpha-blockers, terazosin , doxyzosin , alfuzosin , silodosin , and tamsulosin , work by relaxing the muscles around the urethra and prostate, thus, making urination more comfortable and complete. These medications start to relieve symptoms within a few weeks, but they do not affect the prostate size.
- 5-alpha reductase inhibitors, finasteride and dutasteride , work by reducing the size of the prostate gland. They may take several months to become effective.
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Effective Ways To Reduce Urinary Urgency
Lets look at each of the tips listed to help reduce urinary urgency. If you have any questions, feel free to reach out. Maybe well make a video or article to answer your specific question.
1. Sip fluids throughout the day vs. all at once
I typically recommend drinking ~½ your body weight in oz. of fluid per day to stay properly hydrated. If you are very active, this should increase to ensure you are staying hydrated. If you sip throughout the day vs drink a lot at once, this can help to decrease a sudden urge to void.
2. Diaphragmatic Breathing
Deep diaphragmatic breathing can be performed anywhere and it is a very effective way to reduce urgency. During inhalation, the diaphragm dips down into the abdominal cavity and the pelvic floor can more readily relax. During exhalation, the diaphragm raises which is ideal for pelvic floor contraction. This allows the pelvic floor muscles to go through a full range of motion rather than being too tense or too relaxed and causing increased urgency or incontinence.
3. Quick contractions of pelvic floor
As with diaphragmatic breathing, quick contractions of the pelvic floor can help with urgency in the same way. This allows the pelvic floor muscles to move through an optimal range of motion vs. being too relaxed or too overactive which can worsen symptoms.
4. Reduce bladder irritants in your diet
5. Distract your brain
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What Position Should I Sleep In With A Uti
Try sleeping in a position that helps to relax the pelvic muscles. Lying on your side and pulling your legs up into a fetal position, or spreading your legs apart if you sleep on your back, should be more comfortable. Put a hot water bottle on your abdomen or between your legs for 30 minutes before bed.
Drink Unsweetened Cranberry Juice
One of the most well-known UTI treatments is cranberry juice. Polyphenols are a type of antioxidant found in cranberry juice. They contain antibacterial and anti-inflammatory properties, which can help treat and prevent infections.
Studies show that cranberry juice can help relieve UTI symptoms, as well as reduce how often you get them.
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Kegel Exercises And Muscle Training
You can also do special pelvic floor exercises, or Kegel exercises, in addition to regular exercise. Kegel exercises strengthen the muscles to minimize involuntary contractions and improve posture. Its also one of the safest behavioral therapies without side effects and complications.
To do Kegel exercises:
You can also talk to a physical therapist to see if youre squeezing the right muscles.
Reducing Urinary Incontinence: Drink Water Wisely
Controlling your intake of liquids can be tricky. You might think that cutting back on liquids across the board would reduce OAB. In fact, it can make urine more concentrated, which can irritate the bladder. On the other hand, it’s a good idea not to pressure the bladder by drinking too much liquid at once. Try these strategies:
- Drink plain water when youâre thirsty, from four to eight 8-ounce glasses a day. Youâll know youâre drinking enough if your urine is light yellow or almost colorless.
- Sip water throughout the day, instead of gulping down a lot at one time.
- Unless youâre exercising, donât carry a large water bottle. It may tempt you to drink too much at once.
- If youâre waking up to urinate more than twice a night, drink most of your liquids during the waking hours. Limit how much you drink two to three hours before bedtime.
- If you take a diuretic, try taking it in the morning. That way, you should be able to empty your bladder by bedtime.
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If You Have Had Little Luck With Other Incontinence Interventions You May Need To Consider These Interventional Therapies:
- BotoxInjections of Botox into the bladder muscle may benefit you if you have an overactive bladder. Botox generally is prescribed only if medications or conservative treatments haven’t been successful.
- InterStim therapy With this therapy, a small device the size of a pacemaker is placed under the skin in your hip area. A lead wire is connected to the device and sends electrical impulses to the sacral nerves, which control bladder contraction and function.
- Percutaneous tibial nerve stimulation This therapy is designed to stimulate the nerves responsible for bladder control using the tibial nerve in your lower leg. During the procedure, a small, slim needle electrode is inserted near your tibial nerve and connected to a battery-powered stimulator. The impulses travel to the tibial nerve and then to the sacral nerve, which controls bladder control and function.
Watch this video to learn more about urinary incontinence treatments including sacral neuromodulation therapy:
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How Is Urinary Urgency And Frequency Treated
Treatment will depend on the type and cause of your urination problems. You may need any of the following:
- Medicines may be given to relax your bladder and decrease urination. You may also need antibiotics if your symptoms are caused by a bacterial infection.
- Sacral nerve stimulation sends electrical signals to your sacral nerve through a small device implanted under your skin. Your sacral nerve controls your bladder, sphincter, and pelvic floor muscles.
- Botox injections into your bladder may help relax your bladder muscle to decrease urgency and frequency.
- Surgery may be done if all other treatments cannot help you control your bladder.
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Disturbance Of Sphincter Function
Offperiod urinary urgency is a common problem . Urodynamic studies in the on and offstate have shown that apomorphine will improve voiding by decreasing bladder outflow resistance , whereas levodopa gives inconsistent results . Another sphincter problem occurring predominantly in the offperiod is constipation , rarely to the extent of anismus. Apomorphine has been demonstrated to relieve paradoxical striated muscle contraction during defecation . Some patients report fluctuating abdominal discomfort and bloating due to suppression of peristalsis that occurs during offperiods .
Lisa Klingelhoefer, … Roongroj Bhidayasiri, in, 2017
How Is Incontinence Treated
There are many different factors that your healthcare provider will consider when creating a treatment plan for your incontinence. The type of incontinence and the ways it affects your life are both big considerations. Your provider will also talk to you about the type of treatment you are most comfortable with. There are three main types of treatment you can explore for incontinence medications, lifestyle changes and surgery. Each option has pros and cons that your provider will discuss with you.
Medications to treat incontinence
There are quite a few medications that can reduce leakage. Some of these drugs stabilize the muscle contractions that cause problems with an overactive bladder. Other medications actually do the opposite thing relaxing muscles to allow your bladder to empty completely. Hormone replacement therapies can often involving replacing estrogen thats decreased during menopause may also help restore normal bladder function.
In many cases, medications can work very well to return normal function to the bladder. Your provider will carefully select a medication that matches your specific needs. Often, your provider will start you on a low dose of the medication and then increase it slowly. This is done to try and reduce your risks of side effects and to keep track of how well the medication is working to treat your incontinence.
Common medications that can be used to treat incontinence include:
Lifestyle changes to manage incontinence
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Treatment Of Urgency Urinary Incontinence
Initial conservative treatment of UUI includes behavioral modifications and lifestyle changes, such as reducing fluid input by 25% as long as the patient is drinking more than 1L/day , stopping smoking, reducing weight, and avoiding caffeinated and fizzy drinks that may irritate the bladder .The patient is also taught bladder training and pelvic floor muscle training to supplement the fluid manipulation. These treatments must be attempted for at least 6 weeks to obtain benefit, and they should ideally be tried for 3 months.
If patients are unable to tolerate antimuscarinics or the antimuscarinics have failed to control symptoms, then patients can be prescribedmirabegron, which is a 3-agonist lipophilic medication that is metabolized in liver, and more than 50% is excreted in the urine. It has been licensed for the treatment of OAB in several countries, including the United States, the United Kingdom and other European countries, and Japan. Mirabegron showed proven efficacy and superiority to tolterodine in terms of urinary incontinence episodes and frequency .
Sarah K. Hwang, … Jaclyn Bonder, in, 2021
Can Nerve Stimulation Help Overactive Bladder
Yes, nerve stimulation can help improve OAB. Your nerves help tell your brain that your bladder is full. By treating your nerves, you can improve your bladder control.
Nerve stimulation is a reversible treatment. Healthcare providers only recommend it if other treatments dont work.
There are several types of nerve stimulation treatments. These include:
Sacral nerve stimulation
Sacral nerve stimulation is a therapy that electrically stimulates the nerves that control your bladder.
A healthcare provider will implant a small device called a neurotransmitter under the skin near your upper buttock area. The neurotransmitter sends mild electrical impulses through a wire near your sacral nerve. Your sacral nerve is a nerve in your lower back. The impulses help you control your bladder.
Sacral nerve stimulation can reduce the number of times you have to use the bathroom or the number of times you accidentally leak pee. Its overall very effective. Its also an outpatient procedure, so you can go home afterward.
Percutaneous tibial nerve stimulation
Percutaneous tibial stimulation sends small nerve impulses to a nerve branch near your ankle. It helps stimulate bladder control.
Percutaneous tibial nerve stimulation is an outpatient procedure. Many people need 12 weekly sessions and then monthly maintenance sessions afterward.
Botulinum toxin injections
Botox® is the most well-known botulinum toxin brand. A healthcare provider injects Botox into your bladder wall using a cystoscope.
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