Tag Archives: Urinary incontinence

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.

 YOU MAY CLICK TO SEE

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.


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

Frequent urination

Alternastive Name:Urgency (the need to pass water); Urinary frequency or urgency

Definition:
Frequent urination means needing to urinate more often than usual. Urgent urination is a sudden, compelling urge to urinate, along with discomfort in your bladder.This  is  due to bladder spasms or contractions.

A frequent need to urinate at night is called nocturia. Most people can sleep for 6 to 8 hours without having to urinate. Middle aged and older men often wake to urinate once in the early morning hours.

Symptoms:
•Frequent urination, in the daytime and at night
•Involuntary loss of urine
•Sudden and urgent need to urinate (urinary urgency)

Causes:
A person’s ability to hold urine depends on normal function of the lower urinary tract, kidneys, and nervous system. The person must also have the physical and mental ability to recognize and respond to the urge to urinate.

click & see
The bladder’s ability to fill and store urine requires a working sphincter muscle (which controls the flow of urine out of the body) and a stable bladder wall muscle (detrusor).

The process of urination involves two phases:

•Filling and storage
•Emptying
During the filling and storage phase, the bladder stretches so it can hold the increasing amount of urine. The bladder of an average person can hold 350 ml to 550 ml of urine. Generally, a person feels like they need to urinate when there is approximately 200 ml of urine in the bladder.

The nervous system tells you that you need to urinate. It also allows the bladder to continue to fill.

The emptying phase requires the detrusor muscle to contract, forcing urine out of the bladder. The sphincter muscle must relax at the same time, so that urine can flow out of the body.

You may clicl & Watch this video about: Bladder function – neurological control :

The bladder of an infant automatically contracts when a certain volume of urine is collected in the bladder. As the child grows older and learns to control urination, part of the brain (cerebral cortex) helps prevent bladder muscle contraction. This allows urination to be delayed until the person is ready to use the bathroom.

Undesired bladder muscle contractions may occur from nervous system (neurological) problems and bladder irritation.

URGE INCONTINENCE

Urge incontinence is leakage of urine due to bladder muscles that contract inappropriately. Often these contractions occur regardless of the amount of urine that is in the bladder.

Together, frequent and urgent urination are classic signs of a urinary tract infection.

Diabetes, pregnancy, and prostate problems are other common causes of these symptoms.

Other causes include:

•Anxiety
•Enlarged prostate
•Interstitial cystitis
•Medicines such as diuretics
•Overactive bladder syndrome
•Prostatitis (infection of the prostate gland)
•Stroke and other brain or nervous system diseases
•Tumor or mass in the pelvis
•Urinary incontinence
•Vaginitis
•Infection
•Neurological diseases (such as multiple sclerosis)
•Neurological injuries (such as spinal cord injury or stroke)

Less common causes:
•Bladder cancer
•Bladder dysfunction
•Radiation therapy to the pelvis, used to treat certain cancers

Drinking too much before bedtime, especially caffeine or alcohol, can cause frequent urination at nighttime. Frequent urination may also simply just be a habit.
Risk Factors:
You should also think about being tested for diabetes, particularly if you’re feeling very thirsty, tired or have diabetes in the family.

Complications:
Physical complications are rare. However, psychological and social problems may arise, particularly if you are unable to get to the bathroom when you feel the urge.
Diagnosis:
Your health care provider will take a medical history and perform a physical examination. Medical history questions may include:

•When did the increased urinary frequency start?
•How many times each day are you urinating?
•Is there more frequent urination during the day or at night?
•Do you have an increased amount of urine?
•Has there been a change in the color of your urine? Does it appear lighter, darker, or more cloudy than usual? Have you noticed any blood?
•Do you have pain when urinating, or a burning sensation?
•Do you have other symptoms? Increased thirst? Pain in your abdomen? Pain in your back? Fever?
•Do you have difficulty starting the flow of urine?
•Are you drinking more fluids than usual?
•Have you had a recent bladder infection?
•Are you pregnant?
•What medications are you taking?
•Have you had any previous urinary problems?
•Have you recently changed your diet?
•Do you drink beverages containing alcohol or caffeine?

.
Tests that may be done include:

•Urinalysis
•Urine culture and sensitivity tests
•Cystometry (a measurement of the pressure within the bladder)
•Cystoscopy
•Neurological tests (for some urgency problems)
•Ultrasonography (such as an abdominal ultrasound or a pelvic ultrasound)
Treatment is determined by the cause of the urgency and frequency. Antibiotics and medicine may be prescribed to lessen the discomfort, if needed.

Treatment:
The choice of treatment will depend on how severe the symptoms are, and how much they interfere with your lifestyle. There are three main treatment approaches for urge incontinence: medication, retraining, and surgery.

MEDICATION

If evidence of infection is found in a urine culture, your doctor will prescribe antibiotics.

Medications used to treat urge incontinence relax the involuntary bladder contractions and help improve bladder function. There are several types of medications that may be used alone or in combination:

•Anticholinergic medicines help relax the muscles of the bladder. They include oxybutynin (Oxytrol, Ditropan), tolterodine (Detrol), darifenacin (Enablex), trospium (Sanctura), solifenacin (Vesicare)
•These are the most commonly used medications for urge incontinence and are available in a once-a-day formula that makes dosing easy and effective.
•The most common side effects of these medicines are dry mouth and constipation. The medications cannot be used by patients with narrow angle glaucoma.
Flavoxate (Urispas) is an antispasmodic drug. However, studies have shown that it is not always effective at controlling symptoms of urge incontinence.

Tricyclic antidepressants (imipramine, doxepin) have also been used to treat urge incontinence because of their ability to “paralyze” the bladder smooth muscle. Possible side effects include:

•Blurred vision
•Dizziness
•Dry mouth
•Fatigue
•Insomnia
•Nausea
DIET

Drink plenty of water:

•Drinking enough water will help keep odors away.
•Drinking more water may even help reduce leakage.
Some experts recommend controlling fluid intake in addition to other therapies for managing urge incontinence. The goal of this program is to distribute fluids throughout the course of the day, so the bladder does not need to handle a large volume of urine at one time.

Do not drink large quantities of fluids with meals. Limit your intake to less than 8 ounces at one time. Sip small amounts of fluids between meals. Stop drinking fluids approximately 2 hours before bedtime.

It also may be helpful to eliminate foods that may irritate the bladder, such as:

•Caffeine
•Carbonated drinks
•Highly acidic foods such as citrus fruits and juices
•Spicy foods

.
BLADDER RETRAINING

Managing urge incontinence usually begins with a program of bladder retraining. Occasionally, electrical stimulation and biofeedback therapy may be used with bladder retraining.

A program of bladder retraining involves becoming aware of patterns of incontinence episodes. Then you relearn skills necessary for bladder storage and proper emptying.

Bladder retraining consists of developing a schedule of times when you should try to urinate. You try to consciously delay urination between these times.

One method is to force yourself to wait 1 to 1 1/2 hours between trips to the bathroom, despite any leakage or urge to urinate in between these times. As you become skilled at waiting, gradually increase the time intervals by 1/2 hour until you are urinating every 3 – 4 hours.

KEGEL EXERCISES……..click & see

Pelvic muscle training exercises called Kegel exercises are primarily used to treat people with stress incontinence. However, these exercises may also be beneficial in relieving the symptoms of urge incontinence.

The principle behind Kegel exercises is to strengthen the muscles of the pelvic floor to improve the function of the urethral sphincter. The success of Kegel exercises depends on proper technique and sticking to a regular exercise program.

Another approach is to use vaginal cones to strengthen the muscles of the pelvic floor. A vaginal cone is a weighted device that is inserted into the vagina. The woman contracts the pelvic floor muscles in an effort to hold the device the place. The contraction should be held for up to 15 minutes and should be performed twice daily. Within 4 – 6 weeks, about 70% of women trying this method had some improvement in symptoms.
You may click to see :1.Kegel Exercises For Men.….2.Kegel Exercises For Women

BIOFEEDBACK AND ELECTRICAL STIMULATION

Biofeedback and electrical stimulation can help identify the correct muscle group to work, to make sure you are performing Kegel exercises correctly.

Some therapists place a sensor in the vagina (for women) or the anus (for men) to assess contraction of the pelvic floor muscles. A monitor will display a graph showing which muscles are contracting and which are at rest. The therapist can help you identify the correct muscles for performing Kegel exercises.

Electrical stimulation involves using low-voltage electric current to stimulate the correct group of muscles. The current may be delivered using an anal or vaginal probe. The electrical stimulation therapy may be performed in the clinic or at home. Treatment sessions usually last 20 minutes and may be performed every 1 – 4 days.

SURGERY

Surgery can increase the storage ability of the bladder and decrease the pressure within the bladder. It is reserved for patients who are severely affected by their incontinence and have an unstable bladder (severe inappropriate contraction) and a poor ability to store urine.

Augmentation cystoplasty is the most often performed surgical procedure for severe urge incontinence. In this surgery, a segment of the bowel is added to the bladder to increase bladder size and allow the bladder to store more urine.

Possible complications are those of any major abdominal surgery, including:

•Blood clots
•Bowel obstruction
•Infection
•Pneumonia
There is a risk of developing abnormal tubelike passages (urinary fistulae) that result in abnormal urine drainage, urinary tract infection, and difficulty urinating. Augmentation cystoplasty is also linked to a slightly increased risk of developing tumors.

Sacral nerve stimulation is a newer surgical option that consists of an implanted unit that sends small electrical pulses to the sacral nerve. The electrical pulses can be adjusted to each patient’s symptoms.

ACTIVITY

People with urge incontinence may find it helpful to avoid activities that irritate the urethra and bladder, such as taking bubble baths or using harsh soaps in the genital area.

MONITORING

Urinary incontinence is a long-term (chronic) problem. Although you may be considered cured by treatment, you should continue to see your health care provider to evaluate the progress of your symptoms and monitor for possible treatment complications.
Home Care:
Follow the therapy recommended by your doctor to treat the underlying cause of your urinary frequency or urgency. It may help to keep a diary of times and amounts of urine voided to bring with you to the doctor.

In some cases, you may experience some urinary incontinence for a period of time. You may need to take steps to protect your clothing and bedding.

Prevention:
For nighttime urination, avoid excessive fluid before going to bed, particularly coffee, other caffeinated beverages, and alcohol.

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.nlm.nih.gov/medlineplus/ency/article/001270.htm
http://www.nlm.nih.gov/medlineplus/ency/article/003140.htm
http://hubpages.com/hub/Benefits-of-Kegal-Exercises
http://www.urogynics.org/pages/pops/seif/uui.html
http://www.healthcentral.com/incontinence/treatment-000050_12-145.html

Enhanced by Zemanta

Hydrocephalus

Definition:
Hydrocephalus (pronounced hi-dro-SEF-a-lus) is a potentially harmful build up of cerebrospinal fluid (CSF) in parts of the brain.
CLICK & SEE THE PICTURES…………

Images from a patient with normal pressure hyd...

Images from a patient with normal pressure hydrocephalus (NPH) showing pulsations of CSF with heartbeat. (Photo credit: Wikipedia)

Cerebrospinal fluid (CSF)A clear fluid produced in the brain’s ventricular system – the four cavities in the brain. It travels throughout the brain and in the area outside the brain and spinal cord. It bathes and protects or cushions the brain and spinal cord.

Hydrocephalus literally means water (hydro) in the head (cephalus). It is sometimes called water on the brain. The “water” is actually cerebrospinal fluid. Cerebrospinal fluid is normally present in areas both inside and outside the brain.

Children with hydrocephalus have too much cerebrospinal fluid in the areas of the brain called ventricles.

Ventricles are four small cavities in the brain that produce cerebrospinal fluid (CSF). This fluid flows through the ventricles to the area around the brain and spinal cord.
.

The ventricles store and circulate cerebrospinal fluid. Children with hydrocephalus may also have extra fluid in spaces between the brain and the skull called the  subarachnoid spaces

Subarachnoid spaces  are the spaces lie between the three membranes protecting the brain. Cerebrospinal fluid moves through these spaces. Delicate connective tissue extends across them.

When a child’s cerebrospinal fluid cannot flow or be reabsorbed properly, it builds up. This makes the ventricles bigger and puts pressure on the tissues of the brain

Hydrocephalus is sometimes present at birth, although it may develop later. About 1 out of 500 children is born with the disorder. The outlook if  some one has hydrocephalus depends on how quickly the condition is diagnosed and whether any underlying disorders are present.

Symptoms:
The signs and symptoms of hydrocephalus vary by age group and disease progression.

In infants, common signs and symptoms of hydrocephalus include:

*An unusually large head
*A rapid increase in the size of the head
*A bulging “soft spot” on the top of the head
*Vomiting
*Sleepiness
*Irritability
*Seizures
*Eyes fixed downward (sunsetting of the eyes)
*Developmental delay

In older children and adults, common signs and symptoms of hydrocephalus include:

*Headache followed by vomiting
*Nausea
*Blurred or double vision
*Eyes fixed downward (sunsetting of the eyes)
*Problems with balance, coordination or gait
*Sluggishness or lack of energy
*Slowing or regression of development
*Memory loss
*Confusion
*Urinary incontinence
*Irritability
*Changes in personality
*Impaired performance in school or work

Hydrocephalus produces different combinations of these signs and symptoms, depending on its cause, which also varies by age. For example, a condition known as normal pressure hydrocephalus, which mainly affects older people, typically starts with difficulty walking. Urinary incontinence often develops, along with a type of dementia marked by slowness of thinking and information processing.
Causes:
The cause of hydrocephalus is excess fluid buildup in the brain.

Our brain is the consistency of gelatin, and it floats in a bath of cerebrospinal fluid. This fluid also fills large open structures, called ventricles, which lie deep inside the brain. The fluid-filled ventricles help keep the brain buoyant and cushioned.

Cerebrospinal fluid flows through the ventricles by way of interconnecting channels. The fluid eventually flows into spaces around the brain, where it’s absorbed into your bloodstream.

Keeping the production, flow and absorption of cerebrospinal fluid in balance is important to maintaining normal pressure inside your skull. Hydrocephalus results when the flow of cerebrospinal fluid is disrupted — for example, when a channel between ventricles becomes narrowed — or when your body doesn’t properly absorb this fluid.

Defective absorption of cerebrospinal fluid causes normal pressure hydrocephalus, seen most often in older people. In normal pressure hydrocephalus, excess fluid enlarges the ventricles but does not increase pressure on the brain. Normal pressure hydrocephalus may be the result of injury or illness, but in many cases the cause is unknown.

Risk Factors:
Premature infants have an increased risk of severe bleeding within the ventricles of the brain (intraventricular hemorrhage), which can lead to hydrocephalus.

Certain problems during pregnancy may increase an infant’s risk of developing hydrocephalus, including:

*An infection within the uterus
*Problems in fetal development, such as incomplete closure of the spinal column

Congenital or developmental defects not apparent at birth also can increase older children’s risk of hydrocephalus.

Other factors that increase your risk of hydrocephalus include:

*Lesions or tumors of the brain or spinal cord
*Central nervous system infections
*Bleeding in the brain
*Severe head injury

Complications:
The severity of hydrocephalus depends on the age at which the condition develops and the course it follows. If the condition is well advanced at birth, major brain damage and physical disabilities are likely. In less severe cases, with proper treatment, it’s possible to have a nearly normal life span and intelligence

Diagnosis:
Doctors will examine the child, looking for signs of hydrocephalus. They may also use techniques to monitor pressure inside your baby’s head. Doctors also use imaging tests to see signs of hydrocephalus. These tests include:

*CT scan (computerized tomography) of the head
*MRI (magnetic resonance imaging)

If the child has hydrocephalus, doctors may use ultrasound images of the brain to monitor the condition.
Treatment:
To treat hydrocephalus, doctors try to improve the flow of cerebrospinal fluid. Most often, they use surgery to do this.
Surgery:
Neurosurgeons most often perform three types of operations for hydrocephalus.

1.Shunts
The most common surgery for hydrocephalus is putting in a shunt.

A shunt is a small tube (catheter) that drains extra cerebrospinal fluid from a ventricle in your child’s brain to another area in the body. There, the fluid is either reabsorbed by your child’s body or passed out through the kidneys.

Neurosurgeons place one end of the small tube in the ventricle where extra fluid is causing problems. A valve in the tube controls the amount of fluid that runs through it. This controls the pressure in your child’s head. It also makes sure that the fluid flows in only one direction, away from the brain.
CLICK & SEE

The three areas a VP shunt can be placed in the head
The tube is placed under the skin and drains the fluid to another area of the body. The end of the tube most often is placed in the belly (abdomen). This is called a ventricular to peritoneal shunt. If the abdomen is not suitable for the tube, it may be placed in the heart (ventricular to atrial shunt), chest, or other areas. No matter where the tube ends, the fluid from the brain is reabsorbed by the body.

Placement of a VP shunt from the head to the belly.
Our neurosurgeons choose from many different types of shunts and valves, depending on your child’s needs. In some cases, they use a valve that can be adjusted from the outside by a small magnet. If your child has an MRI, these types of valves must always be reset immediately by one of our neurosurgery nurse practitioners.

2.Endoscopy:
An endoscope is a thin, flexible tube that carries a light and a camera. Surgeons can use it to see inside the body and perform some operations. Endoscopy requires smaller cuts (incisions) than other types of surgery (open surgery). It is a minimally invasive technique. Neurosurgeons use it to treat some types of hydrocephalus.

The approach made by an endoscope to make a hole in the ventricle so that the patient can avoid needing a shunt.
Some children have a complex type of the condition called multiloculated hydrocephalus. This happens when bleeding or infection causes scars within the ventricles of the brain. The scaring causes many small compartments of spinal fluid that do not connect with each other to develop.

In the past, doctors treated this condition by placing a separate shunt in each area with fluid and draining it. But by using an endoscope, they can make small holes in each of the areas. This connects them so they need only one shunt to drain the entire system.

3.Endoscopic third ventriculostomy (ETV)
Depending on your child’s brain structures and age, the neurosurgeon may talk with you about using an ETV instead of putting in a shunt.

During an ETV, the neurosurgeon makes a small hole in your child’s skull. Then the neurosurgeon uses an endoscope to reach the third ventricle in brain. Using the endoscope, the neurosurgeon makes a hole in the ventricle. This lets the extra fluid drain out and be reabsorbed.

An ETV lets neurosurgeons avoid putting in any permanent hardware, such as a shunt. Such a treatment may avoid the complications of using shunt hardware. But the treatment may fail and a shunt may be needed.

This video, developed by Anthony M. Avellino, MD, shows an example of an endoscopic third ventriculostomy procedure for treatment of obstructed hydrocephalus.

Prevention:

To reduce the risk of hydrocephalus:

*If you’re pregnant, get regular prenatal care. Following your doctor’s recommended schedule for checkups during pregnancy can reduce your risk of premature labor, which places your baby at risk of hydrocephalus and other complications.

*Protect against infectious illness. Follow the recommended vaccination and screening schedules for your age and sex. Preventing and promptly treating the infections and other illnesses associated with hydrocephalus may reduce your risk.

To prevent head injury:

*Use appropriate safety equipment. For babies and children, use a properly installed, age- and size-appropriate child safety seat on all car trips. Make sure all your baby equipment — crib, stroller, swing, highchair — meets all safety standards and is properly adjusted for your baby’s size and development. Older children and adults should wear a helmet while riding a bicycle, skateboard, motorcycle, snowmobile or all-terrain vehicle.

*Always wear a seat belt in a motor vehicle. Small children should be secured in child safety seats or booster seats. Depending on their size, older children may be adequately restrained with seat belts.

Should you be vaccinated against meningitis?

Ask your doctor if you or your child should receive a vaccine against meningitis, once a common cause of hydrocephalus. A meningitis vaccine is now recommended for people ages 2 and older who are at increased risk of this disease due to:

*Traveling to countries where meningitis is common

*Having an immune system disorder called terminal complement deficiency

*Having a damaged spleen or having had your spleen removed

*Living in a dormitory as a college freshman

*Joining the military

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://sbhi.ie/images/What-is-ETV.pdf
http://en.wikipedia.org/wiki/Hydrocephalus
http://trialx.com/curebyte/2011/06/01/hydrocephalus-photos/
http://www.mayoclinic.com/health/hydrocephalus/DS00393

Urinary incontinence

Definition:
Urinary incontinence is the loss of bladder control. This means that you can’t always control when you urinate. Urinary incontinence can range from leaking a small amount of urine (such as when coughing or laughing) to having very strong urges to urinate that are difficult to control.
CLICK & SEE THE PICTURES
It is a common and distressing problem, which may have a profound impact on quality of life. Urinary incontinence almost always results from an underlying treatable medical condition but is under-reported to medical practitioners. There is also a related condition for defecation known as fecal incontinence.

Incontinence affects up to 20 per cent of the older female population. One factor is declining oestrogen levels after the menopause.

Urinary incontinence is less common in men but still occurs, especially if the man has any sort of prostate disease or is frail and weak.

It’s more frequent in people with reduced mobility and other medical problems, as they’re less able to get to the toilet when necessary.

It’s a common problem among people living in residential or nursing homes.

If you leak a small amount of urine when you cough, laugh or move (or without any obvious trigger), it’s worth talking to your doctor. Incontinence isn’t an inevitable part of growing older and you don’t have to accept it.

Faecal incontinence is even more abnormal and usually requires investigation.

Physiology of continence:
Continence and micturition involve a balance between urethral closure and detrusor muscle activity. Urethral pressure normally exceeds bladder pressure, resulting in urine remaining in the bladder. The proximal urethra and bladder are both within the pelvis. Intraabdominal pressure increases (from coughing and sneezing) are transmitted to both urethra and bladder equally, leaving the pressure differential unchanged, resulting in continence. Normal voiding is the result of changes in both of these pressure factors: urethral pressure falls and bladder pressure rises.

Causes:
*Polyuria (excessive urine production) of which, in turn, the most frequent causes are: uncontrolled diabetes mellitus, primary polydipsia (excessive fluid drinking), central diabetes insipidus and nephrogenic diabetes insipidus.  Polyuria generally causes urinary urgency and frequency, but doesn’t necessarily lead to incontinence.

*Caffeine or cola beverages also stimulate the bladder.

*Enlarged prostate is the most common cause of incontinence in men after the age of 40; sometimes prostate cancer may also be associated with urinary incontinence. Moreover drugs or radiation used to treat prostate cancer can also cause incontinence.

*Brain disorders like multiple sclerosis, Parkinson’s disease, strokes and spinal cord injury can all interfere with nerve function of the bladder.

Types:
*TypesStress incontinence, also known as effort incontinence, is due essentially to insufficient strength of the pelvic floor muscles.

*Urge incontinence is involuntary loss of urine occurring for no apparent reason while suddenly feeling the need or urge to urinate.

*Overflow incontinence: Sometimes people find that they cannot stop their bladders from constantly dribbling, or continuing to dribble for some time after they have passed urine. It is as if their bladders were like a constantly overflowing pan, hence the general name overflow incontinence.

*Mixed incontinence is not uncommon in the elderly female population and can sometimes be complicated by urinary retention, which makes it a treatment challenge requiring staged multimodal treatment.

*Structural incontinence: Rarely, structural problems can cause incontinence, usually diagnosed in childhood, for example an ectopic ureter. Fistulas caused by obstetric and gynecologic trauma or injury can also lead to incontinence. These types of vaginal fistulas include most commonly, vesicovaginal fistula, but more rarely ureterovaginal fistula. These may be difficult to diagnose. The use of standard techniques along with a vaginogram or radiologically viewing the vaginal vault with instillation of contrast media.

*Functional incontinence occurs when a person recognizes the need to urinate, but cannot physically make it to the bathroom in time due to limited mobility. The urine loss may be large. Causes of functional incontinence include confusion, dementia, poor eyesight, poor mobility, poor dexterity, unwillingness to toilet because of depression, anxiety or anger, drunkenness, or being in a situation in which it is impossible to reach a toilet.  People with functional incontinence may have problems thinking, moving, or communicating that prevent them from reaching a toilet. A person with Alzheimer’s Disease, for example, may not think well enough to plan a timely trip to a restroom. A person in a wheelchair may be blocked from getting to a toilet in time. Conditions such as these are often associated with age and account for some of the incontinence of elderly women and men in nursing homes.  Disease or biology is not necessarily the cause of functional incontinence. For example, someone on a road trip may be between rest stops and on the highway; also, there may be problems with the restrooms in the vicinity of a person.

*Bedwetting is episodic UI while asleep. It is normal in young children.
Transient incontinence is a temporary version of incontinence. It can be triggered by medications, adrenal insufficiency, mental impairment, restricted mobility, and stool impaction (severe constipation), which can push against the urinary tract and obstruct outflow.

*Giggle incontinence is an involuntary response to laughter. It usually affects children.

Diagnosis:
Patients with incontinence should be referred to a medical practitioner specializing in this field. Urologists specialize in the urinary tract, and some urologists further specialize in the female urinary tract. A urogynecologist is a gynecologist who has special training in urological problems in women. Gynecologists and obstetricians specialize in the female reproductive tract and childbirth and some also treat urinary incontinence in women. Family practitioners and internists see patients for all kinds of complaints and can refer patients on to the relevant specialists.

A careful history taking is essential especially in the pattern of voiding and urine leakage as it suggests the type of incontinence faced. Other important points include straining and discomfort, use of drugs, recent surgery, and illness.

The physical examination will focus on looking for signs of medical conditions causing incontinence, such as tumors that block the urinary tract, stool impaction, and poor reflexes or sensations, which may be evidence of a nerve-related cause.

A test often performed is the measurement of bladder capacity and residual urine for evidence of poorly functioning bladder muscles.

Other tests include:
*Stress test – the patient relaxes, then coughs vigorously as the doctor watches for loss of urine.

*Urinalysis – urine is tested for evidence of infection, urinary stones, or other contributing causes.

*Blood tests – blood is taken, sent to a laboratory, and examined for substances related to causes of incontinence.

*Ultrasound – sound waves are used to visualize the kidneys, ureters, bladder, and urethra.

*Cystoscopy – a thin tube with a tiny camera is inserted in the urethra and used to see the inside of the urethra and bladder.

*Urodynamics – various techniques measure pressure in the bladder and the flow of urine.

Patients are often asked to keep a diary for a day or more, up to a week, to record the pattern of voiding, noting times and the amounts of urine produced

Treatment:
The treatment options range from conservative treatment, behavior management, medications and surgery. In all cases, the least invasive treatment is started first. The success of treatment depends on the correct diagnoses in the first place.

Most treatment options are most appropriate for a specific underlying cause of the incontinence (though these can overlap if there is a mixed component to the incontinence.) However, some approaches (such as use of absorbent products) address the problem symptomatically, and can be applicable to more than one type. It is also sometimes possible to use a treatment for the pathophysiology of one type of incontinence to provide relief for an unrelated type of incontinence.

The Doctor may also suggest self-help techniques you can try before resorting to medication.

For example :-
Kegel exercises:
•To locate the right muscles, try stopping or slowing your urine flow without using your stomach, leg or buttock muscles. When you’re able to slow or stop the stream of urine, you’ve located the right muscles.
•Squeeze your muscles. Hold for a count of 10. Relax for a count of 10.
•Repeat this 10 to 20 times, 3 times a day.
•You may need to start slower, perhaps squeezing and relaxing your muscles for 4 seconds each and doing this 10 times, 2 times a day. Work your way up from there.

….

Bladder training:...CLICK & SEE
Some people who have urge incontinence can learn to lengthen the time between urges to go to the bathroom. You start by urinating at set intervals, such as every 30 minutes to 2 hours (whether you feel the need to go or not). Then gradually lengthen the time between when you urinate (for example, by 30 minutes) until you’re urinating every 3 to 4 hours.

You can practice relaxation techniques when you feel the urge to urinate before it is time to go to the bathroom. Breathe slowly and deeply. Think about your breathing until the urge goes away. You can also do Kegel exercises if they help control your urge.

After the urge passes, wait 5 minutes and then go to the bathroom even if you don’t feel you need to go. If you don’t go, you might not be able to control your next urge. When it’s easy to wait 5 minutes after an urge, begin waiting 10 minutes. Bladder training may take 3 to 12 weeks.

•Retraining the bladder with regular trips to the toilet can help, especially when the bladder has been overstretched by ‘holding on’ or failing to empty it completely.

•Bowel retraining can help some forms of faecal incontinence. It’s also important to make motions as formed and regular as possible, using dietary changes and medication as necessary.

•Exercises can help women to strengthen pelvic floor muscles that have been damaged or stretched during childbirth.

•Some women find it hard to become aware of, and so exercise, their pelvic floor muscles. There are a number of devices that doctors, incontinence nurses or physiotherapists can recommend which 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.

•It can be helpful to treat any problems that increase pressure on the bladder, such as constipation and fibroids. Losing excess weight may also help.

•Drugs are available to treat urinary incontinence, depending on the cause. Most improve the muscle tone of the bladder. These may have to be taken for at least several months.

Urinary incontinence isn’t a serious disease or life-threatening, but it can seriously disrupt quality of life. With the appropriate treatment it may be cured or improved dramatically. There’s no need for anyone to suffer in silence.

Faecal incontinence may require surgery.

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.bbc.co.uk/health/physical_health/conditions/incontinence.shtml
http://familydoctor.org/online/famdocen/home/women/gen-health/189.html
http://en.wikipedia.org/wiki/Urinary_incontinence
http://www.lifespan.org/adam/indepthreports/10/000050.html

http://www.doh.state.fl.us/Family/wh/lifespan/Middleage/urinary.html

Enhanced by Zemanta

Epispadias

Definition:
An epispadias is a rare type of malformation of the penis in which the urethra ends in an opening on the upper aspect (the dorsum) of the penis. It can also develop in females when the urethra develops too far anteriorly. It occurs in around 1 in 120,000 male and 1 in 500,000 female births.

An epispadia occurs when the urethra opening is abnormally placed. In a male infant with epispadias, the urethra will be generally open on the top or side of the penis.

Click to see the picture…>…...(01).…..(2).…..(1)

Boys will suffer from a short, wide penis and widened pubic bone. In a female infant with epispadias, the urethra will generally be located between the clitoris and the labia or in the abdominal area. Girls will suffer from a widened pubic bone and an abnormal clitoris and labia. In both males and females, urine will flow into the kidney and urinary tract infections are common. It is also common for the child to have urinary incontinence, kidney damage and often infertility issues as an adult.

A doctor will perform a series of tests to diagnose epispadias, which may include blood tests, x-rays and ultrasounds. Treatment involves surgery to help with urine control and appearance.

It is also called bladder exstrophy

Symptoms:

In males:
*Abnormal opening from the joint between the pubic bones to the area above the tip of the penis
*Backward flow of urine into the kidney (reflux nephropathy)
*Short, widened penis with an abnormal curvature
*Urinary tract infections
*Widened pubic bone

In females:……..Picture
*Abnormal clitoris and labia
*Abnormal opening where the from the bladder neck to the area above the normal urethral opening
*Backward flow of urine into the kidney (reflux nephropathy)
*Widened pubic bone
*Urinary incontinence
*Urinary tract infections

Causes:
The causes of epispadias are unknown at this time. It may be related to improper development of the pubic bone.

In boys with epispadias, the urethra generally opens on the top or side of the penis rather than the tip. However, it is possible for the urethra to be open along the entire length of the penis.

In girls, the opening is usually between the clitoris and the labia, but may be in the belly area.

Epispadias can be associated with bladder exstrophy, an uncommon birth defect in which the bladder is inside out, and sticks through the abdominal wall. However, epispadias can also occur with other defects.

Epispadias is an uncommon and partial form of a spectrum of failures of abdominal and pelvic fusion in the first months of embryogenesis known as the exstrophy – epispadias complex. While epispadias is inherent in all cases of exstrophy it can also, much less frequently, appear in isolation as the least severe form of the complex spectrum. It occurs as a result of defective migration of the genital tubercle primordii to the cloacal membrane, and so malformation of the genital tubercle, at about the 5th week of gestation.

Presentation:
Most cases involve a small and bifid penis, which requires surgical closure soon after birth, often including a reconstruction of the urethra. Where it is part of a larger Exstrophy, not only the urethra but also the bladder (bladder exstrophy) or the entire perineum (cloacal exstrophy) are open and exposed on birth, requiring closure.

Relationship to other conditions:
Despite the similarity of name, an epispadias is not a type of hypospadias, and involves a problem with a different set of embryologic processes.

In women:
Women can also have this type of congenital malformation. Epispadias of the female may occur when the urethra develops too far anteriorly, exiting in the clitoris or even more forward. For females, this may not cause difficulty in urination but may cause problems with sexual satisfaction. Frequently, the clitoris is bifurcated at the site of urethral exit, and therefore clitoral sensation is less intense during sexual intercourse due to frequent stimulation during urination. However, with proper stimulation, using either manual or positional techniques, clitoral orgasm is definitely possible

Diagnosis:
•Blood test to check electrolyte levels
•Intravenous pyelogram (IVP), a special x-ray of the kidneys, bladder, and ureters
•MRI and CT scans, depending on the condition
•Pelvic x-ray
•Ultrasound of the urogenital system

Treatment:
The main treatment for isolated epispadias is a comprehensive surgical repair of the genito-urinary area usually during the first 7 years of life, including reconstruction of the urethra, closure of the penile shaft and mobilisation of the corpora. The most popular and successful technique is known as the modified Cantwell-Ransley approach. In recent decades however increasing success has been achieved with the complete penile disassembly technique despite its association with greater and more serious risk of damage

Prognosis:
Even with successful surgery, patients may have long-term problems with:
*incontinence, where serious usually treated with some form of continent urinary diversion such as the Mitrofanoff
*depression and psycho-social complications
*sexual dysfunction

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.nlm.nih.gov/medlineplus/ency/article/001285.htm
http://en.wikipedia.org/wiki/Epispadias
http://health.stateuniversity.com/pages/794/Hypospadias-Epispadias.html
http://www.wikidoc.org/index.php/Epispadias
http://www.eclips.consult.com/eclips/article/Pediatrics/S0084-3954(07)70134-3

Enhanced by Zemanta