Urinary Incontinence Naturopathic Treatment
With regard to CN XI or XII, bihemispherical lesions may result in significant weakness of the SCM, trapezeii, or extrinsic tongue muscles. Other features that confirm the presence of bihemispherical lesions are urinary incontinence, gait apraxia, pseudobulbar palsy (i.e., dysarthria, dysphagia, and emotional incontinence), cognitive deficits, and alterations in personality.
Leads to large changes in the atrial dimensions as their transmural pressure alters. The repetitive stretching of the atria leads to increased secretion of atrial natri-uretic peptide (ANP) which increases renal sodium and water loss resulting in nocturia and occasionally urinary incontinence.
Multiple system atrophy (MSA, Shy-Drager syndrome) is a degenerative disorder of the CNS that affects the extrapyramidal, cerebellar, and autonomic neurons (see Chaptei.34,). Autonomic dysfunction in patients with MSA is due to the loss of preganglionic neurons in the brain stem and spinal cord. Patients with MSA typically present with diffuse autonomic failure and parkinsonian, cerebellar, or pyramidal deficits in different combinations. y Autonomic features include orthostatic intolerance, erectile dysfunction in males, bowel hypomotility, urinary incontinence due to denervation of the external urinary sphincter, and respiratory disturbances (sleep apnea and laryngeal stridor). There is usually a poor response to levodopa. Pathologically, cell loss and gliosis in striatonigral, olivopontocerebellar, and autonomic neurons are evident, and intracytoplasmic oligodendroglial and neuronal inclusions are frequently present.
The structure and function of the GU tract can be assessed by a variety of techniques. Simple screening methodologies include the history, with particular attention to urinary incontinence, urine volumes and urine character (bloody or foamy), as well as, the urinalysis. Creatinine clearance is a simple, cost-effective screen of kidney function. Structural abnormalities can be investigated by several tests, including ultrasound, IVP, CT scan and MRI. Retrograde studies may be useful for structural and functional evaluation of the bladder and ureters. Cystoscopy may be necessary to evaluate hematuria in the long-term survivor. In patients with late-onset hemorrhagic cystitis, cystoscopy may be useful to assess the degree of mucosal damage and to evaluate the etiology of the hematuria. Patients with late-onset hemor-
Growing up with a chronic illness such as CF has both a physical and emotional toll on young people's psycho-social development. The growth and pubertal delay common in CF has been shown to have a negative effect on young people's self-esteem and body image and other people's perception of their age and development (Sawyer etal. 1995). This is further complicated by the other obvious physical markers of CF, such as surgical scars, the visibility of permanent intravenous access ports and body habitus such as a barrel-shaped chest. These can all interfere with young people's development of peer and romantic relationships, and perception of physical attractiveness and self-worth (Sawyer 2000 Sawyer etal. 1995). The urinary incontinence experienced by many women with CF has also been shown to affect young women's social life and intimate relationships negatively (Nixon et al. 2003). Emotionally, growing up with a life-limiting condition has been shown to influence some young people into...
The development of clinical guidelines would assist CF teams to better address aspects of sexual and reproductive health in young people with CF. For young men, initial discussions should include discussion of pubertal development and the basics of male fertility, highlighting the distinction between infertility and impotence and the importance of preventing sexually transmitted infections. Discussions with older adolescents should include the offer of semen analysis and provide more information on assisted reproductive options - discussions that need to be repeated with young adults. For young women with CF, initial discussions about sexual and reproductive health should include pubertal development, urinary incontinence and recurrent vaginal yeast infections, normal fertility and the need to prevent unplanned pregnancy and sexually transmitted infections. Over time, pregnancy risks need to be reviewed, reinforcing the importance of pregnancy planning.
Clinical Findings and Associated Disorders. The triad of progressive dementia, gait disturbance, and urinary incontinence was originally described by Adams and colleagues. In most instances, gait disturbance is the first sign, followed by dementia, and, later, urinary dysfunction. The gait is slow, unsteady, and wide based. Steps are usually short, and patients have difficulty picking their feet off the ground to ambulate (so-called magnetic gait). Turning is difficult and takes several steps. On examination, there is bradykinesia, and the legs may be spastic with increased reflexes. Patients may have difficulty in handwriting and dressing, and may appear to be mildly parkinsonian, but their tremor, if present, is usually postural, not resting. One particular feature is the discrepancy between leg function during walking and simulated walking when sitting. Patients can usually move their legs well and imitate walking while in a chair, but they become awkward and severely impaired as...
Removal of a paired structure, such as a kidney, is not usually associated with subsequent functional impairment, unless the remaining organ has been damaged from either therapy or the tumor. (In fact, the remaining kidney may undergo compensatory hypertrophy 1 ). Conversely, the removal of a non-paired structure such as the bladder, prostate or uterus can produce severe and life-long impairment, such as urinary incontinence or infertility. Urinary diversion after total cystectomy for bladder sarcoma in childhood can be associated with infection and eventual renal impairment from pyelonephritis, ureteral or stomal obstruction or both 2,3 . In addition, ureterocolic diversion and bladder augmentation have occasionally been associated with early development of colon cancer 4 (This is reported in the urology literature. It is also seen with reconstruction of the neurogenic bladder. The hypothesis is that the
Young people with CF face the same array of sexual and reproductive health issues as otherwise healthy young people, but face additional sexual and reproductive health issues that are specific to CF. The focus here has been on fertility and the management of reproduction, but could equally have focused on other sexual and reproductive health complications of CF, such as vaginal yeast infections and urinary incontinence.