URINARY SYMPTOMS
URINARY SYMPTOMS AND INCONTINENCE IN WOMEN: RELATIONSHIPS
BETWEEN OCCURRENCE, AGE AND PERCEIVED IMPACT
There is an acknowledged discrepancy between the number
of women who admit to incontinence and the number who seek
treatment. Therefore, a study was carried out to determine
the prevalence of urinary symptoms and their perceived impact
in a community population of women. The study group consisted
of 2,075 women who responded to a postal survey incorporating
a validated self-completed questionnaire. The number of
women who reported some degree of incontinence in the previous
month was 1,414 (69%), although only 578 (30%) indicated
that it had social or hygienic impact. Other urinary tract
symptoms reported included nocturia (19%), poor stream (19%),
urgency (61%), and dysuria (23%). The most troublesome symptoms
were incontinence for no obvious reason (73%), nocturnal
incontinence (69%), and nocturia (63%). Thus, incontinence
and other urinary symptoms are more common than previously
thought. In particular, nocturia in women is commoner than
might have been supposed and is extremely troublesome to
sufferers.
Swithinbank, L.V. et al
BR. J. GEN. PRACT. 1999, 49 (448) 897-900
VACCINIUM MACROCARPON – CRANBERRY
Kerry Bone provides a profile of American cranberry, Vaccinium
macrocarpon, a urinary tract antiseptic.
Indications:
- Prevention and treatment of urinary tract infections.
- Improvement in urinary odour, urinary tract mucous
production and peristomal skin condition in patients who
have undergone urinary tract surgery or in those who are
immobilised or catheterised.
- Prevention of struvite and calcium carbonate kidney
stones, which are linked to an alkaline urine.
Cranberry combines well with other herbs such as Arctostaphylos
uva ursi, Barosma and Crataeva nurvala an Ayurvedic herb.
Adverse reactions
In one study cranberry increased the renal excretion of
hippuric acid and increased acid secretory activity in the
nephron, which indicates that it is inadvisable in patients
with renal insufficiency or those with a tendency to develop
uric acid or calcium oxalate stones due to the high oxalate
content.
MEDIHERB PROFESSIONAL REVIEW No. 72, November 1999.
EXERCISE FOR STRESS INCONTINENCE
A six month comparison of the three most commonly recommended
conservative treatments for stress incontinence in women
- pelvic floor exercises, electrical stimulation, and vaginal
cones - found that pelvic floor exercises were superior
to the other methods in increasing strength of the pelvic
floor muscles and reducing leakage.
BMJ no.7182 (20th Feb '99) pp487-493
COMPARATIVE EFFICACY OF BEHAVIOURAL INTERVENTIONS IN THE
MANAGEMENT OF FEMALE URINARY INCONTINENCE
Behavioural interventions, bladder training, and pelvic
muscle exercises are recommended as a first line of treatment
in the management of stress and urge incontinence. A study
was therefore carried out to compare the efficacy of bladder
training, pelvic muscle exercise with biofeedback assisted
instruction, and combination therapy, on urinary incontinence
in women. The test group was 204 women diagnosed with genuine
stress incontinence and/or detrusor instability who received
a 12-week intervention program with immediate and 3-month
follow-up.
It was found that the combination group had significantly
fewer incontinent episodes, better quality of life, and
greater treatment satisfaction immediately after treatment.
However, no differences among groups were observed 3 months
later. Women with genuine stress incontinence had greater
improvement in life impact, and those with detrusor instability
had less symptom distress at immediate follow-up. Thus,
combination therapy had the greatest immediate efficacy
in the management of female urinary incontinence regardless
of urodynamic diagnosis. However, the results also suggest
that the specific treatment may not be as important as having
a structured intervention program with education, counselling,
and frequent patient contact.
Wyman, J.F. et al
AM. J. OBST. GYN. 1998, 179 (4) 999-1007
NANOBACTERIA MAY LIE AT THE HEART OF KIDNEY STONES
Finnish researchers have proposed that very small bacteria
- nanobacteria - may act as crystalline centres for the
initiation of kidney stones and other pathological calcifications.
Nanobacteria have a cell diameter of 0.2-0.5um and are the
smallest known cell-walled bacteria. The researchers found
that nanobacteria produce carbonate apatite on their cell
envelope during growth. Also, mineral aggregates closely
resembling those found in tissue calcification and kidney
stones form around nanobacteria in serum-free medium. The
researchers also found that 30 human kidney stones all stained
positively with nanobacteria-specific monoclonal antibodies.
They suggest that apatite produced by nanobacteria may play
a key role in the formation of all kidney stones by making
a central calcium phosphate deposit around which other crystalline
components can collect. It is suggested that nanobacteria
may also play a role in a variety of pathological calcification
conditions such as atherosclerotic plaques.
Bradbury, J.
LANCET 1998, 352 (9122) 121
IS THERE AN IRRITABLE BLADDER IN THE IRRITABLE BOWEL SYNDROME?
A group of 16 premenopausal women with irritable bowel
syndrome and 16 controls answered a standardised bowel and
urinary symptom questionnaire and underwent twin channel
subtracted cystometry. The irritable bowel patients also
underwent oesophageal balloon distension studies for perception
and pain. Urinary frequency and urgency and the urodynamic
finding of detrusor instability were significantly more
common in women with irritable bowel syndrome. There was
no relationship between first sensation of bladder fullness
and oesophageal perception or between maximum bladder capacity
and oesophageal pain thresholds. These findings suggest
that there is an irritable bladder in the irritable bowel
syndrome and support the concept that irritable bowel syndrome
is part of a generalised disorder of smooth muscle.
Monga, A.K. et al.
BRIT. J. OBSTET. GYNAECOL. 1997, 104 (12) 1409-12
