Tag: Pelvic floor

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Pelvic pain

Definition:
Pelvic pain is pain in the lowest part of your abdomen and pelvis. In women, pelvic pain may refer to symptoms arising from the reproductive or urinary systems or from musculoskeletal sources. Pelvic pain can occur suddenly, sharply and briefly (acute) or over the long term (chronic). Chronic pelvic pain refers to any constant or intermittent pelvic pain that has been present for more than a few months. It can affect both women and men.

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Depending on its source, pelvic pain may be dull or sharp; it may be constant or off and on (intermittent); and it may be mild, moderate or severe. Pelvic pain can sometimes radiate to one’s lower back, buttocks or thighs.

Common causes in include: endometriosis in women, bowel adhesions, irritable bowel syndrome, and interstitial cystitis. The cause may also be a number of poorly understood conditions that may represent abnormal psychoneuromuscular function.

Most women, at some time in their lives, experience pelvic pain. As girls enter puberty, pelvic or abdominal pain becomes a frequent complaint.
Sometimes, it is noticed that pelvic pains only at certain times, such as when  urinating  or during sexual activity.

According to the CDC, Chronic pelvic pain (CPP) accounted for approximately 9% of all visits to gynecologists in 2007. In addition, CPP is the reason for 20—30% of all laparoscopies in adults.

Causes:
Several types of diseases and conditions may cause pelvic pain. Often chronic pelvic pain results from more than one condition.

Pelvic pain may arise from one’s digestive, reproductive or urinary system. Recently, doctors have recognized that some pelvic pain, particularly chronic pelvic pain, may also arise from muscles and connective tissue (ligaments) in the structures of the pelvic floor. Occasionally, pelvic pain may be caused by irritation of nerves in the pelvis.

The different conditions that may cause pelvic pain includs:

*exaggerated bladder, bowel, or uterine pain sensitivity (also known as visceral pain)
pelvic girdle pain (SPD or DSP)

Gynecologic:

*Dysmenorrhea—pain during the menstrual period

*Endometriosis—pain caused by uterine tissue that is outside the uterus. Endometriosis can be visually confirmed by laparoscopy in approximately 75% of adolescent girls with chronic pelvic pain that is resistant to treatment, and in approximately 50% of adolescent in girls with chronic pelvic pain that is not necessarily resistant to treatment.

*Müllerian abnormalities

*Pelvic inflammatory disease—pain caused by damage from infections

*Ovarian cysts—the ovary produces a large, painful cyst, which may rupture

*Ovarian torsion—the ovary is twisted in a way that interferes with its blood supply

*Ectopic pregnancy—a pregnancy implanted outside the uterus

Abdominal:

*Loin pain hematuria syndrome

*Proctitis—infection or inflammation of the anus or rectum

*Colitis—infection or inflammation of the colon

*Appendicitis—infection or inflammation of the bowel

Internal hernias are difficult to identify in women, and misdiagnosis with endometriosis or idiopathic chronic pelvic pain is very common. One cause of misdiagnosis that when the woman lies down flat on an examination table, all of the medical signs of the hernia disappear. The hernia can typically only be detected when symptoms are present, so diagnosis requires positioning the woman’s body in a way that provokes symptoms.

Female reproductive system:
Pelvic pain arising from the female reproductive system may be caused by conditions such as:

*Adenomyosis
*Endometriosis
*Menstrual cramps (dysmenorrhea)
*Ectopic pregnancy (or other pregnancy-related conditions)
*Miscarriage (before the 20th week) or intrauterine fetal death
*Mittelschmerz (ovulation pain)
*Ovarian cancer
*Ovarian cysts
*Pelvic inflammatory disease (PID)
*Uterine fibroids
*Vulvodynia

Other causes in women or men:
Examples of other possible causes of pelvic pain — in women or men — include:

*Colon cancer
*Chronic constipation
*Crohn’s disease
*Diverticulitis
*Fibromyalgia
*Interstitial cystitis (also called painful bladder syndrome)
*Intestinal obstruction
*Irritable bowel syndrome
*Kidney stones
*Past physical or sexual abuse
*Pelvic floor muscle spasms
*Prostatitis
*Ulcerative colitis
*Urinary tract infection (UTI)

Diagnosis:
The diagnostic workup begins with a careful history and examination, followed by a pregnancy test. Some women may also need bloodwork or additional imaging studies, and a handful may also benefit from having surgical evaluation.

The absence of visible pathology in chronic pain syndromes should not form the basis for either seeking psychological explanations or questioning the reality of the patient’s pain. Instead it is essential to approach the complexity of chronic pain from a psychophysiological perspective which recognises the importance of the mind-body interaction. Some of the mechanisms by which the limbic system impacts on pain, and in particular myofascial pain, have been clarified by research findings in neurology and psychophysiology.

Differential diagnosis:
In men, chronic pelvic pain (category IIIB) is often misdiagnosed as chronic bacterial prostatitis and needlessly treated with antibiotics exposing the patient to inappropriate antibiotic use and unnecessarily to adverse effects with little if any benefit in most cases. Within a Bulgarian study, where by definition all patients had negative microbiological results, a 65% adverse drug reaction rate was found for patients treated with ciprofloxacin in comparison to a 9% rate for the placebo patients. This was combined with a higher cure rate (69% v 53%) found within the placebo group.

Treatment:
Many women will benefit from a consultation with a physical therapist, a trial of anti-inflammatory medications, hormonal therapy, or even neurological agents.

A hysterectomy is sometimes performed.

Spinal cord stimulation has been explored as a potential treatment option for some time, however there remains to be consensus on where the optimal location of the spinal cord this treatment should be aimed. As the innervation of the pelvic region is from the sacral nerve roots, previous treatments have been aimed at this region; results have been mixed. Spinal cord stimulation aimed at the mid- to high-thoracic region of the spinal cord have produced some positive results.

The sensation of pain travels through nerves up the spinal cord to the brain. Mild antidepressants like amitriptyline and gabapentin can block these transmissions and relieve the pain. They are especially effective if combined with anti-inflammatory medications like ibuprofen.

IBS and food allergies should also be tackled. Sometimes avoiding milk or wheat or both, and tackling abnormal gut motility works.

Physical activity reduces pain to an extent. Walking, jogging or running for 40 minutes a day is important. This should be combined with stretching and pelvic exercises. And if there is stress, cut it down with yoga and meditation.

Kegel exercise  or pelvic floor exercise   is most effective for Pelvic pain

CLICK TO SEE :Ultra-thin hot water bottle could help ease menstrual pain

Click to see :.—>..Homeopathic Treatment for Pelvic Pain

 Ayurvedic Treatment.….(1) .…..(2)

The treatment of pelvic pain with acupuncture

Pelvic Pain Recovery: Getting Your Life Back with Yoga  :

Disclaimer: This information is not meant to be a substitute for professional medical advise or help. It is always best to consult with a Physician about serious health concerns. This information is in no way intended to diagnose or prescribe remedies.This is purely for educational purpose.

Resources:
http://en.wikipedia.org/wiki/Pelvic_pain
http://www.mayoclinic.org/symptoms/pelvic-pain/basics/definition/sym-20050898
http://www.telegraphindia.com/1141103/jsp/knowhow/story_18992189.jsp#.VFmWH2d2E1I

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Pelvic prolapse

Definition:
Prolapse literally means “to fall out of place”, from the Latin prolabi meaning “to fall out”. In medicine, prolapse is a condition where organs, such as the uterus, fall down or slip out of place.

As the muscles, ligaments and supporting tissues in the pelvis become weaker, they are less able to hold in the organs of the pelvis such as the womb (uterus) or bladder.

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Gravity pulls these organs down and, in the more severe cases, may appear through the entrance to the vagina.

A variety of problems can occur, depending on where the weakness lies and which organs are able to descend, but in every case there is some degree of prolapse of the vaginal wall, which begins to invert (rather like a sock turning inside out).

•Prolapse of the womb or uterus is the most common prolapse, affecting as many as one in eight older women to some degree
•Prolapse of the bladder, known as a cystocele, is less common.
•Prolapse of the urethra (the tube that carries urine out of the bladder) is known as a urethrocele.
•Prolapse of the intestines is quite rare, and known as an enterocele or rectocele.

Some experts say up to 50 per cent of women who have had more than one child will eventually develop a prolapse .

Symptoms:
Symptoms depend on which tissues descend, and how severe the prolapse is.

They may include:
•A sense of heaviness or pressure in the pelvis.
•The appearance of a bulge of tissue in the genital area, which can be quite alarming, and is often red and sore.
•Urinary problems, such as having to urinate more frequently, feeling the need urgently, being incontinent (losing control of the bladder) or, conversely, being unable to pass urine when you need to.
•Pain in the pelvis or lower back.
•Sexual problems, including pain and decreased libido.
•Constipation.
•Vaginal discharge or bleeding.

Causes:

Several factors make a prolapse more likely. They include:

•Age: prolapse is rare in young women. As a woman passes the menopause and levels of the female hormone oestrogen decline, the supporting tissues of the pelvis can lose their elasticity and strength very quickly.

•Pregnancy and childbirth: this is one of the most important risk factors for prolapse. Pregnancy stretches and strains the tissues of the abdomen and pelvis. Then during labour and delivery of the baby, the pelvic floor is stretched as the baby passes through. Trauma, tears or lacerations during delivery compound the problem.

•Genetics: research has shown that younger women who develop a prolapse have up to 30 per cent lower levels of collagen (the fibres that form the internal scaffolding of the tissues). This suggests there may be a genetic predisposition, and it certainly seems to run in some families. It is also more common in certain inherited conditions such as Marfan’s syndrome and Ehlers-Danlos syndrome, where there’s abnormal collagen production.

•Muscular defects: uterine prolapse can occur very occasionally in tiny babies who have a weakness of the pelvic muscles or problems with the nerve supply to the area.

•Wide pelvic inlet: this is the round gap in the base of the pelvic bones, through which the baby passes during birth and women with this are more at risk because the tissues bridging the gap have to work even harder to hold the organs above in.

•Chronically increased pressure inside the abdomen: due to obesity or lung disease, for example, helps push the organs down and out.

Risk Factors:
Some of the risk factors for pelvic prolapse include, multiple vaginal births, especially large babies, prolonged labor, chronic conditions such as diabetes, COPD (chronic obstructive pulmonary disease), obesity, and finally genetic factors.

Treatment:
Pelvic prolapse in women is a very common condition that is sometimes avoided by patients and their caretakers. This is a general terms that describes the weakening of the tissues, and ligaments that give support to the uterus, vagina, bladder, and rectum.

Treatment will depend on the type of pelvic organ prolapse you have. Your doctor may recommend first treating some types without surgery. However, in most people, surgery is eventually necessary.

*Medications. Menopause results in lower estrogen levels, which weakens the muscles of the vagina. Estrogen replacement therapy (ERT) may strengthen these muscles. However, some people shouldn’t use ERT. If you develop symptoms of one type of prolapse, you’re more likely to develop other types.

*Physical therapy. Physical therapy can include electrical stimulation and biofeedback.

*Electrical stimulation. During electrical stimulation, the doctor applies small electrical currents to certain muscles in your vagina or pelvic floor. The current causes your muscles to contract, which strengthens them.

*Biofeedback. As you perform pelvic floor exercises, a sensor monitors muscular contractions to determine if the exercises affect certain muscles.

*Surgery.  Doctors may use robot-assisted surgery to treat some types of pelvic organ prolapse. Robotic surgery allows your surgeon to make smaller incisions and can shorten your hospital stay. There are different strategies for various types of prolapse.

*Rectal prolapse (rectocele). Your surgeon will secure the tissue between your vagina and rectum to keep the organ in its proper position. Your surgeon also removes excess tissue.

*Bladder prolapse (cystocele). Your surgeon will push your bladder up and secure the connective tissue between your bladder and vagina to keep the organ in its proper position and remove excess tissue. If you have urinary incontinence, your doctor will use a bladder neck suspension or sling to support your urethra.

*Uterine prolapse. If you’re postmenopausal or don’t want more children, your surgeon may perform a hysterectomy to correct uterine prolapse.

*Vaginal vault prolapse and herniated small bowel (enterocele). These often occur high in the vagina, so your surgeon may perform the surgery through the vagina or abdomen (for severe vaginal vault prolapse). Your surgeon will attach the vagina to the tailbone at the base of the spine (vaginal vault suspension).

Kegel exercise or pelvic floor exercise:-   This exercise consists of repeatedly contracting and relaxing the muscles that form part of the pelvic floor, now sometimes colloquially referred to as the “Kegel muscles”. The exercise needs to be performed multiple times each day, for several minutes at a time, for one to three months, to begin to have an effect.

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Non-surgical pelvic prolapse treatment can be 60 to 70% successful if the prolapse is identified early. These non-invasive pelvic prolapse repair modalities include Kegel exercises, biofeedback, and the use of pessaries.
Prevention:
Women need to be aware of the risks of prolapse and the steps they can take to avoid it, including maintaining a healthy weight, eating plenty of fruit and vegetables to avoid constipation, and learning correct lifting techniques.

There are also specific exercises to keep the pelvic floor muscles strong, sometimes known as Kegel exercises. For example:

•Empty your bladder fully and then, while still sitting on the toilet, practice squeezing your pelvic muscles as if you were trying to stop the flow of urine (don’t do this while actually urinating as it can cause a potentially harmful backflow within the urinary system).

•Practise holding specially designed weighted cones within the vagina.

•Once you have some awareness of the ‘feel’ of the pelvic floor muscles, repeatedly contract them (but not the gluteal or buttock muscles) 50 to 200 times a day for a few seconds at a time.

•Some women find it hard to become aware of, and so exercise, their pelvic floor muscles. There are a number of devices that can help. These are put in the vagina where they either mechanically or electrically trigger the muscles to contract automatically. They are fairly simple to use, very discreet and have been shown to improve continence.

You can get expert advice on pelvic floor exercises from a physiotherapist, who’ll be able to teach you the techniques involved. Your GP may be able to refer you to one, or to a local incontinence clinic where the nurses are also trained on this issue.

It’s also important to aim to minimise trauma to the pelvic tissues during childbirth. Some physiotherapists and also some midwives specialise in teaching women how to strengthen their pelvic floor muscles before giving birth, and retrain them after the stretching of the tissues that occurs during delivery of the baby.

Disclaimer: This information is not meant to be a substitute for professional medical advise or help. It is always best to consult with a Physician about serious health concerns. This information is in no way intended to diagnose or prescribe remedies.This is purely for educational purpose

Resources:

http://www.mayoclinic.org/pelvic-organ-prolapse/treatment.html

http://my.clevelandclinic.org/ob_gyn/womens_health/urogynecology_pelvic_floor_disorders/pelvic_organ_prolapse.aspx

http://www.bbc.co.uk/health/physical_health/conditions/pelvic_prolapse.shtml

http://en.wikipedia.org/wiki/Prolapse

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New mom? Eat right and exercise

 

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The thought, preparation and expense that go into “the great Indian wedding” are unbelievable. Yet barely have the stars faded from the new bride’s eyes than subtle pressure from parents, in-laws, spouse and well-wishers sets in. Everyone wants to hear the “good news” —a baby on the way. People don’t stop to think if the bride is ready for motherhood. And once the mother-to-be has been coddled through the pregnancy and everyone has oohed and aahed over the little bundle of joy, the excitement and interest fades. The new mother finds that she is totally unprepared for the drastic changes in her life after the birth of a baby. No one told her that she might have a baby that refuses to sleep at night or that she would feel and look like an elephant after childbirth.

A weight gain of between 12 to 14kg during pregnancy is normal and healthy. Many women expect all the extra kilos to disappear immediately after delivery. Actually, around 5kg (the weight of the baby and the placenta) will disappear immediately. The rest should disappear gradually within nine months.

Kegel exercise  is very much useful so that the pelvic floor muscles to remain shape & size.

 

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It is very easy to start overeating after childbirth. Visitors arrive laden with delicious tidbits and vociferously advise rest and a high calorie diet to ensure adequate breast milk. In truth, breast-feeding requires only around 750 extra calories. Since brand new moms tend to be sedentary, their caloric intake should be limited to approximately 2,500 calories. Even though many women complain that they continue to “feel like a bloated elephant” after delivery, this is not the correct time to go on a drastic diet. Healthy eating and judicious exercise will ensure a gradual and safe return to pre-pregnancy weight.

Light aerobic exercise or walking can be started around two weeks after delivery, even by a person who did not exercise at all during pregnancy. But it is important not to do too much too soon. A hormone called relaxin, responsible for making the joints loose during pregnancy so that delivery is easy, persists in the body for about six months after delivery. So vigorous exercise should be started only after six months to avoid damaging joints. Walking 15 minutes a day is a good start. Increase the time by 15 minutes every week until you reach an hour. Endorphins released during walking will help to elevate the mood and combat any post partum depression. It will also help to tone the muscles. Exercise does not reduce breast milk production.

Pain in the genital and the caesarian site often comes as a shock. It makes going to the bathroom or even sitting an ordeal. Many are afraid to take medication (with reason) for fear that it might cross over in the breast milk to the newborn baby. Heat or cold applied locally to the area will relieve the pain. You can use an infra red lamp, a hot water bottle, or apply ice. The ice needs to be in a plastic bag or bottle. To prevent infection, always wash the area with water after going to the bathroom.

The skin over the abdomen may show white lines called stretch marks. These may itch. Applying coconut oil for half an hour before a bath helps.

These usually fade over time. If there is a scar (caesarian or episiotomy), it should be left alone until it has healed completely.

The hormones responsible for maintaining the pregnancy drop suddenly after childbirth. This abrupt change can lead to depression, bouts of crying and feelings of inadequacy. These usually last for around two weeks and then subside by themselves. If they last for a month or longer, then postnatal depression may have developed and a physician should be consulted.

The abdominal wall becomes lax during pregnancy. The abdomen itself may appear pendulous. Sits ups with the knees bend and oblique abdominal exercises will help with this. Start with 10 sets twice a day. Aim to reach 50 repetitions morning and evening within four months. You need to continue doing this exercise at least thrice a week.

A few drops of urine may leak out while coughing, sneezing or laughing. It may be difficult to hold the urine for even a limited time if the bladder is full. This is because the pelvic floor muscles become weakened during childbirth, making the sphincters, which control urination, lax. This can occur even if the delivery was by caesarian section.

These humiliating accidents can be tackled by doing “Keegles’s exercises”. Sit on the floor in the namaz position or in the yoga “child’s pose”. Touch the nose to the ground, concentrate on the pelvic muscles and consciously tighten them. Also, try to “stop and start” consciously while passing urine.

New mothers have lost a great deal of blood. The baby needs to be fed frequently so that sleep patterns are disturbed and often inadequate. Tiredness and fatigue are common and normal after childbirth. Try to sleep whenever the baby sleeps. And those colourful iron and calcium supplements need to be continued as long as you are feeding the baby.

Source: The Telegraph ( Kolkata, India)

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Ailmemts & Remedies

Managing Symptoms of Menopause

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The following tips may be beneficial for these common symptoms of menopause:

Hot Flashes:
1.Wear fabrics that breathe, such as cotton. Do not wear silk, polyester and other synthetics that tend to trap body heat.

2.If you feel a hot flash coming on, drink a glass of cold water.

3.If troubled by night sweats, keep a cold facecloth or ice pack by your bed.

4.Instead of pantyhose, wear cotton pants or thigh high stockings.

5.Decrease your intake of caffeine and alcohol.

6.Avoid spicy foods and hot drinks.

7.Avoid tobacco.

8.Try eating and drinking more soy products.

9.Some women claim that taking vitamin E daily helps.
Vaginal Dryness/Urinary Problems
(urinary tract infections, incontinence)

10. Use a vaginal cream or lubricant (avoid petroleum jelly) to help reduce pain from dryness during sexual intercourse.

11.Urinate before and after sexual intercourse to help prevent bladder infections.

12.Drink plenty of fluids and empty your bladder frequently.

13. Try Kegel exercises (tighten and relax the muscles you use to stop urination) daily. They strengthen the vaginal muscles, enhance orgasm, and help prevent incontinence.

Psychological Problems
(anxiety, irritability, depression)

1.Communicate openly with your partner about your symptoms and ask for support.

2.Join or even start a support group specific to menopause or other life changes you are experiencing.

3.Find and share support with colleagues at work who are going through the same thing.
Seek counseling.

4.Medication such as tranquilizers and antidepressants may help.

5.Identify which sources of stress you can eliminate from your life.

Forgetfulness
1.Write things down.

2.Use appointment books, calendars, post-it notes, alarm clocks and timers.

3.Ask other people for reminders.

Weight Gain:
1.Engage in an aerobic or Yoga exercise at least three times per week for at least 30 minutes per session.

2.Find ways to incorporate more exercise into your daily routine, such as taking the stairs instead of the elevator.

3.Decrease your intake of fat and calories.

Native Remedies has put together a trio of effective, natural remedies proven Menopause and PMS. Each, on its own, has been shown to be highly effective.

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Disclaimer: This information is not meant to be a substitute for professional medical advise or help. It is always best to consult with a Physician about serious health concerns. This information is in no way intended to diagnose or prescribe remedies.

 

Source:www.beliefnet.com

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You can exert control your bladder

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Incontinence should not be summarily dismissed as an inevitable consequence of ageing. Basic tests should be done to rule out any correctable cause Dr Gita Mathai

The urge to urinate is under voluntary control and can be suppressed until a suitable opportunity appears…...click & see
Coughing, sneezing and laughing are normal, unavoidable day-to-day activities which cause a transient increase in intra abdominal pressure. Young people are unaffected, but in 25 per cent of women and 15 per cent of men above 65 years of age, the actions involuntarily produce embarrassing dribbling of urine or stress incontinence.

The bladder can normally accommodate 500 ml of urine. The urge to void appears when it contains 200 ml. If there is an obstruction to free voiding due to an enlarged prostate, an uterine or ovarian tumour, or even constipation, the bladder becomes overfilled. The urine can then leak from the full bladder in small quantities leading to overflow incontinence.

The urge to urinate is under voluntary control; it can be suppressed until a suitable opportunity appears. Hyperactivity of the muscles in the bladder can allow urine to escape even if the bladder is not overfilled, as soon as the urge is felt, before reaching the toilet. This can occur with increasing age especially if the person also has diabetes, stroke, dementia or Parkinson’s disease. It may be secondary to stones in the bladder or an urinary tract infection.

Incontinence is commoner in women. Statistics show that 50 per cent of women have occasional urinary incontinence and 10 per cent have frequent incontinence. The incidence increases until 20 per cent of women over the age of 75 years experience daily urinary incontinence.

This is because anatomically, women have a shorter urethra and weaker pelvic muscles. Damage can also occur as a result of childbirth. The onset of menopause decreases the levels of the female hormones, causing atrophy of the vaginal mucosa and loss of pelvic muscle tone. This causes the bladder to protrude into the vaginal space increasing incontinence.

Incontinence should not be summarily dismissed as an inevitable consequence of ageing. Basic tests should be done to rule out any correctable cause .

A physical pelvic examination to rule out abnormalities of the pelvic organs.

Blood tests to rule out diabetes.

Urinalysis and culture if infection is suspected.

A few simple lifestyle interventions can help to reduce stress incontinence .

Reduction in weight, such that the BMI (body mass index) is around 25.

Control over volume of fluids drunk and reduction in the quantity if it is more than two-three litres per day.

Prevention of constipation as hard faecal matter acts as an obstruction that aggravates stress incontinence.

Regular voiding, so that the bladder is never too full.

Women can increase the strength and tone of the pelvic muscles and re-train their pelvic musculature with Keegle’s exercises.

To perform these exercises correctly, the right muscles first need to be located. To do this, stop and start urination without using the stomach, leg or buttock muscles.

Squeeze these muscles. Hold for a count of 10. Relax for a count of 10. Do this 20 times, three-four times a day.

Alternatively, each time you go to the toilet to pass urine, stop and restart the process voluntarily several times, so that you exert control over the action.

The bladder can also be re-trained by consciously increasing the time between voiding.

Within four weeks, 70 per cent of women markedly improve and 15 per cent are permanently cured. The benefit disappears within a few days if the exercises are not consciously continued.

Medications can be used as an adjuvant to exercises. Tricyclic antidepressants and other groups of medications can be used to treat stress incontinence in patients with mild-to-moderate symptoms. Fifty per cent of the people respond favourably.

Oestrogen replacement, either taken orally as part of HRT (hormone replacement therapy) or applied locally in the vagina as a cream, improves urinary frequency, urgency, stress incontinence and burning in postmenopausal women.

Surgical treatment can be considered after a thorough evaluation, examination and investigation to determine the exact cause of the urinary incontinence. Surgery can help by correcting the anatomical abnormalities, supporting the bladder and urethra in the proper position, and tightening the urethral sphincter. This helps to achieve voluntary control. Surgery has a 75-95 per cent cure rate if the patients are carefully selected. The procedure involves anaesthesia and hospital stay and is not totally risk free. The eventual outcome is unsatisfactory in people .

With prior surgical failures

If there are other genital or urinary problems

In case of other complicating diseases that may prevent adequate healing or make the technical aspects of the surgery more difficult.

As age advances, the bladder capacity reduces; the urinary stream becomes weaker, and visits to the toilet more frequent. This does not, however, mean that urinary frequency, urgency and stress incontinence have to be accepted as an inevitable part of ageing.

Most incontinence problems, provided they do not require corrective surgery, can be cured by motivation, weight loss, dedicated re-training of the bladder and pelvic exercises.

Source:The Telegraph (Kolkata,India)

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