Physiotherapy for incontinence in women

by R.T.K. Rajapaksha

Incontinence is the involuntary leakage of urine. When intra abdominal pressure rises in a woman whenever she laughs, sneezes, coughs, exercises or lifts heavy weights.

It is a silent epidemic that is bothersome and debilitating, preventing women from enjoying many activities and daily work. It makes them feel embarrassed and causing emotional stress. The World Health Organisation (WHO) has estimated that about 10 p.c. of all women suffer from the socially crippling condition.

The figure may be higher, as women do not tend to report the condition because they are too embarrassed to talk about it. Most of them think nothing can be done about it.

Incontinence happens due to the hyper-mobility of the bladder, neck and proximal urethra resulting in the failure of transmission of inter abdominal pressure caused by laughing, coughing and sneezing.

Pregnancy

During the pregnancy period the pelvis floor muscles are overloaded with increased weight of the baby, uterus, amniotic sac and the amniotic fluid causing weakness of the muscles.

Stretching, stress and tension of the pelvis floor muscles after pushing the baby out makes them weak, slack and a tonic.

If the pudendal nerve is injured during long labour or with forcep delivery, stress incontinence tends to occur later in life.

When the uretus along with surrounding muscles are removed in hysterectomy, the bladder loses its support. Thus, even a slight pressure can cause urine leakage. Hormonal changes in oestrogen withdrawal agents render the muscles weak and decreases the muscle tone. A high percentage of women suffer from stress incontinence.

Over-weight in the abdominal area adds pressure to the bladder and cause urine leakages. Losing weight can decrease the severity of incontinence. Women suffering from chronic constipation run the risk of continence due to the severe stress on their pelvis floor muscles when straining for bowel movement.

Many women do not know that help is available and they suffer in silence thinking that incontinence is a sign of ageing. In this context, physiotherapy is the 1st line of treatment for stress incontinence. For a long time stress incontinence was treated surgically without going through physiotherapy. However, the outcome of surgery has not always been positive.

Therefore, it is advisable to go for physiotherapy as it has no side effects. It is also an easy method of treatment. The aim of physiotherapy treatment is to strengthen the pelvis floor muscles.

Physiotherapy treatment consists of electrotherapy.

This is done by electrical stimulation of the pelvis floor muscles using therapeutic current. Such stimulation can help strengthen the muscles.

The pelvis floor is exercised. This is known as Kegel's exercises. They are very important and should be done by all incontinence patients.

The most important point about the exercises is that they can be done anytime and anywhere.

Methods

Imagine that you are outdoors and you need to go to the washroom urgently. But there is no washroom nearby. So, what will you do? You will try to hold or tighten your urinary passage preventing leakage. As soon as you find a washroom, you relax or release your urinary passage muscles.In this exercise you have to contract and release your pelvis floor muscles about 200 times a day.

However, be sure to contract the right muscle.Tighten your pelvis floor muscles to stop passing wind or motion. Stop yourself from urinating and stop passing urine mid stream.

Then pass urine. Imagine that the pelvis floor is a lift moving upwards. Make your pelvic muscles also to go up.

Then slowly bring them down. In bladder training exercise urinate every two hours whether you feel to do so or not. The pelvis floor muscle training can also be done with perineometer exercises, cones and weight.

Advantages

The exercise help you strengthen and tone your pelvis floor muscles. You can do the exercises on your own once you have mastered the technique. The childbirth becomes easier, prevents uterine prolapse in the future. Social life becomes more enjoyable.

You can laugh and cough without worrying.To lead an incontinence free life and to make your life easier and happier, you should practise the pelvis floor exercises.

The writer is a physiotherapist / counsellor at the Salvation Army Hope House .

Homoeopathy, a cure for dengue

by Fahima FARISZ

Homoeopathic medicine has been around for about 200 years. It is based on the principle 'like cures like'. The medicines used in the therapy stimulate the body's defence mechanism to correct illnesses naturally.

Now with allopathic medicine having side effects Homoeopathy is being sought by quite a number of patients.

It is a slow healing process but there are no side effects, said Homoeopathic Medical Practitioner, Dr. (Mrs). Yasmin Latif Fazli.

"We treat the person and not the disease to bring about a permanent cure." Homoeopathy has also a cure for dengue, according to Dr..Fazli.

Homoeopathy has a cure and Dengue, can be arrested with Homoeopathic medicine.

Fever

"The patient is treated straight-away for fever and headache and then dengue can be arrested.

In the case of allopathic medicine dengue is detected only after a blood test and the disease surfaces after a while; by then sometimes the damage might be done, but if the patient is treated with homoeopathy potions as soon as there is a fever then dengue can be arrested", she said.

Dr. Yasmin said homoeopathy aims to treat the patient according to the totality of symptoms.

Degrees,

If about four or five members of the same family are afflicted with flu, in varying degrees, the medicine dose would also vary in composition based on the patient's medical history and the symptoms.

It is quite different from allopathic treatment where the same medicine or antibiotics would be prescribed for every person who suffers with similar symptoms, she said.

Clinical trials show the effectiveness of homoeopathic remedies to treat a wide variety of illnesses: infectious diseases such as flu and colds and chronic conditions such as allergies, asthma, migraines and pre-menstrual symptoms.

They have shown positive effects on treatment of dermatological complaints, female disorders and mental and emotional disorders. The period of treatment varies from patient to patient - normally three days or longer, depending on their immunity.

"The effects are gradual with small improvements seen every day," she says adding that the medicine acts fast on children and pregnant women.

Dr. Fazli is in favour of alternative medicine because of its efficacy and low risk status. She is of the view that conventional medicine is tested on animals, while homoeopathy that is natural and non-addictive is tried on healthy human beings who are able to talk and express symptoms.

Tongue

Further in homoeopathic treatment the tablets are placed on the tongue to treat nerves, thereby enhancing the body's ability to fight infection and cure itself.

The form and taste makes the medicine potions easy to consume. However, one must keep in mind to take the medicine half an hour before food and refrain from coffee, mint, bitter gourd, kola-kenda and of course fizzy drinks as Dr. Fazli stressed the homoeopathic potions are to work on the nerves.

Various kinds of balms should not be applied as this would reduce the efficacy of the homoeopathic medicines.

Talking of the medical course she said that it was just the same as the MBBS course but the subject of Pharmacology varied.

New genetic cause identified for chronic kidney disease

A new single-gene cause of chronic kidney disease has been discovered that implicates a disease mechanism not previously believed to be related to the disease, according to new research.

"In developed countries, the frequency of chronic kidney disease is continually increasing for unknown reasons.

The disease is a major health burden," said Friedhelm Hildebrandt, M.D., the paper's senior author and professor of pediatrics.

Using whole exome sequencing, Hildebrandt and his colleagues studied a model disorder for renal fibrosis, nephronophthisis, and detected a new single-gene cause of CKD that implicates a disease mechanism formerly not related to CKD - DNA damage response signalling (DDR).

"Since DNA damage is caused by a whole variety of chemical compounds it may now be important to see whether certain 'genotoxins' may play a role in the increase of CKD," says Hildebrandt who is also an investigator for the Howard Hughes Medical Institute.The researchers identified mutations of Fanconi anemia-associated nuclease 1 (FAN1) as causing karyomegalic interstitial nephritis (KIN) in patients with CKD. Depletion of fan1 in a zebrafish model of disease revealed increased DDR, apoptosis, and kidney cysts akin to nephronophthisis.

"Our findings implicate susceptibility to environmental genotoxins and inadequate DNA repair as novel mechanisms of renal fibrosis and CKD," Hildebrandt said.

- NYT

HIV drugs also reduce risk of infection

People at high risk of HIV infection can reduce their risk of acquiring the disease by taking antiretroviral drugs, according to Cochrane researchers. In an update of a systematic review first published in 2009, the researchers found that uninfected people in relationships with HIV-infected partners, men who have sex with men and those in other high risk groups are at a lower risk of becoming infected with the virus if they regularly take drugs that are normally prescribed to treat people with HIV.

Antiretroviral therapy (ART) is the standard drug treatment for HIV in patients whose disease has progressed to a certain level. Antiretroviral drugs are also beginning to be used as prophylactics in people at high risk of acquiring the disease from sexual partners.

The use of antiretroviral drugs in preventing as opposed to treating HIV infection is referred to as pre-exposure prophylaxis (PrEP). PrEP is often considered controversial, not only because uninfected people may develop resistance to the drugs and experience serious side effects such as kidney toxicity and bone density loss, but also because the idea that PrEP offers protection may encourage people to indulge in riskier sexual behaviour, thereby increasing their overall risk of HIV infection. It is therefore important to establish whether PrEP really works and what level of protection it affords.

The researchers analysed data from six trials that tested the protective effect of daily doses of the oral antiretroviral drug tenofovir disoproxil fumarate (TDF) with or without emtricitabine (FTC), compared to a placebo or intermittent use.

In total, the trials involved 9,849 people, including men who have sex with men, partners of HIV-infected people, sex workers and people who have multiple sexual partners.

Data from four of the trials and a total of 8,813 people showed that giving TDF plus FTC reduces the risk of HIV infection by around half, from 37 in 1,000 to 19 in 1,000.

Data from two trials and a total of 4,027 people showed that TDF alone reduces the risk of HIV infection by nearly two thirds, from 26 in 1,000 to 10 in 1,000.

Those taking antiretroviral drugs did not suffer more adverse effects in the trials, and sexual risk behaviour was similar in both the intervention and control groups.

- MNT

Stress reduction therapy prevents brain lesions

A weekly stress management program for patients with multiple sclerosis (M.S.) prevented the development of new brain lesions, a marker of the disease's activity in the brain, according to new Northwestern Medicine research.

Brain lesions in M.S. often precede flare-ups of symptoms such as loss of vision or use of limbs or pain.

"This is the first time counselling or psychotherapy has been shown to affect the development of new brain lesions," said David Mohr, principal investigator of the study and professor of preventive medicine at Northwestern University Feinberg School of Medicine. "In M.S., the prevention of new brain lesions is an important marker used to judge how effective medications are."

"The new finding is an important step and the strongest evidence we have to date that stress is involved in M.S.," Mohr added.

The results indicate that stress management therapy may be a useful adjunct treatment with drug therapy for M.S., but a larger clinical trial is needed to confirm this, Mohr said.

The study is published in Neurology, the medical journal of the American Academy of Neurology.

Mohr's previous research showed a connection between psychological distress and the development of new brain lesions. Stress is one of many factors, he said, that influence whether the underlying M.S. disease processes escalate to the point of a new lesion or a relapse. Mohr has spent more than a decade studying the link between emotional distress, including a study on depression , and M.S. For an event to be stressful, a person has to feel it is a threat to something important, and that he or she doesn't have any control over it.

"We taught patients strategies to evaluate how much of a threat something truly is," Mohr said. "When people overestimate the threat of an event or underestimate their ability to manage it, we teach them how to evaluate their own thinking about the stress and how to challenge and change that thinking to a more realistic and helpful appraisal of the actual threat. That often leads to improved ability to manage stressful events."

In the national clinical trial, 121 patients were randomised to receive stress management therapy for M.S. or be in a control group. Those in the therapy group received 16 sessions over a 24-week period during which they were taught coping skills to enhance their ability to prevent stressful events from occurring and to improve their capacity to manage their responses to stressful events that did arise. They also received a 24-week post-treatment follow-up. The first type, gadolinium-enhancing brain lesions, indicates a breakdown of the blood-brain barrier, allowing the immune system access to attack and damage brain cells. Gadolinium is injected into an M.S. patient during the MRI and can be observed passing through the blood-brain barrier, if these types of lesions are present. These lesions may disappear over time or may leave more permanent damage in the brain.

The second type, a T2 brain lesion, is a more global marker of the effect of M.S. on the brain and is a more permanent lesion. These markers are commonly used in evaluating M.S. medications in Phase II trials. If the lesions are decreased, the implication is the drug is working.

Among patients who received stress management therapy, 55 percent had a new gadolinium-enhancing brain lesion during the treatment period, compared to 77 percent of those in the control group. Similarly, 43 percent receiving

stress management therapy had a new T2 brain lesion during the treatment period, compared to 70 percent in the control group. The stress reduction prevented new lesions whether or not the patients were taking M.S. disease-modifying medications (e.g., beta-interferons or glatiramer acetate).

But the improvement in brain lesions didn't last after the stress management program ended.

- MNT