For those accustomed to modern medicine, it is difficult to put alternative medicine and urology in the same sentence. However, there has been a growing interest in the use of alternative and complementary medicine in treating several diseases, and the trend is witnessed even in Western nations. For instance, more than 30 percent of patients in the U.S use complementary and alternative medicine (CAM), and they spend over $50 billion per year. The most common providers of alternative treatments include chiropractors, acupuncturists, and herbalists.
Patients Who Use CAM
A survey done in the U.S found that CAM was popular among younger patients with higher income levels and education compared to uneducated people with lower income. In the UK, organizations that educate medical practitioners and the public on CAM have been established. In addition, the UK parliament in 2002 published a comprehensive report on the use of CAM, areas of future research, and the training of healthcare professionals on the regulations and guidelines to be followed.
In the U.S, the NCCAM (National Center for Complementary and Alternative Medicine) has categorized CAM into five key domains. The domains include:
1. Mind-body treatments; these include mental healing, prayer and meditation;
2. Alternative medical approaches, such as Ayurveda, traditional Chinese medicine, and homeopathy;
3. Biological therapies, for example, the use of special diets and herbs, amino acids, minerals, and vitamins;
4. Body manipulation methods, such as massage and chiropractic therapy; and
5. Energy-based therapies, such as therapeutic touch and Reiki, Qui gong, and bio-field therapies.
Biological therapies are the most relevant to urology because they provide provisions and products that are increasingly being used to treat simple urological conditions.
CAM Treatments for Prostate Disorders
CAM treatment for prostate cancer entails the use of diet, fruits, vegetables and observing general nutritional guidelines. Several studies have shown that adopting a diet with low calories, low amounts of saturated fat, but contains lots of phytoestrogen, high amounts of isoflavones (found in green tea and soy products), and fruit and vegetables reduces the chances of developing prostate disorders. Moreover, the diet improves the prognosis of prostate disorders and prostate cancer in patients suffering from the conditions.
Researchers have noted that the type of diet and lifestyle habits in Western and Asian countries might explain the low prevalence of prostate cancer in these populations. Approximately 30 to 75 percent of patients suffering from cancer globally use CAM therapies that include biological, herbal, and dietary based approaches. About 60 percent of people with prostate cancer also utilize the aforementioned CAM treatments in treating their condition.
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The use of CAM in Treating Erectile Dysfunction
The use of CAM in treating ED has not shown higher success rates compared to clinical trials that have used placebos and chemical drugs. Some of the CAM products used to treat ED include zinc supplements, acupuncture, gingko extracts, red ginseng products, and yohimbine among others. However, the use of these herbal products has not proven to be superior over placebos.
The Use of CAM Therapy in Treating Urinary Tract Infections
In alternative medicine and urology, cranberry juice is the most commonly used in treating urinary tract infections because the juice can prevent bacteria from adhering to thin inner walls of the bladder. Clinical trials at nccih.nih.gov have demonstrated that cranberry juice is effective in treating urinary tract infections in women compared to placebos. Furthermore, cranberry reduces the risk of developing urinary tract infection symptoms in women who have been sexually active in the last six months. However, studies have shown that the use of cranberry juice can lower the absorption rate of antibiotics used to treat urinary tract infections. Moreover, excessive consumption of cranberry juice can lead to gastrointestinal problems and diarrhea.
Red Wine and the Risk of Prostate Cancer
Earlier studies have shown that a strong relationship between intake of alcohol and certain cancers such as prostate, lung and rectal cancer exists. However, red wine prostate cancer study done recently have shown that consuming red wine may lower the risk of developing prostate cancer. One study compared the history of alcohol intake of 753 men between the ages of 40 and 64 years with prostate cancer, and a similar number of men without the disease. The findings indicated that the risk of developing prostate cancer in the group that consumed red wine dropped by 24 percent. Another earlier study done in Australia indicated that women who consumed one or several glasses of wine on a daily basis reduced their chances of developing ovarian cancer by 40 percent.
The use of CAM in treating different medical conditions is becoming popular across the globe, especially in Western nations. Complementary and alternative medicines include a variety of therapies. Some of the therapies under the approach are complete treatments on their own, while others are used to enhance modern medicine. Nevertheless, more studies are needed to establish the efficacy of CAM in treating urological conditions and other diseases.
Classical View of Women’s Bladder Problems
Urinary incontinence or bladder leaking happens when the when the bladder storage system fails. When it fails you lose urine in small amounts at the wrong time. All women with incontinence can be helped – some women will be cured and others will at least have their quality of life improved.
Facts About Urinary Incontinence
- One third of women over 30 years of age suffer from urinary incontinence.
- It is not a disease but is a symptom indicating that the bladder is not working properly.
- It is not caused by being female.
- It is not caused by aging (but changes with age may add to the problem).
Urinary incontinence has a significant negative effect on women’s quality of life. Many women forgo social and/or physical activities because of their urine leakage. This site will explain why leakage happens and outline factors in your life which you can modify to help your problem. As well, we will describe various treatments for your urine leakage and give you strategies to cope with your incontinence.
Risk Factors of Urinary Incontinence
- certain medications (e.g. diuretics)
- constipation/fecal impaction
- physical conditions affecting mobility and dexterity (e.g., MS, arthritis)
- caffeine and fluid intakes
- high impact physical activities
- occupations which involve heavy lifting and straining
- certain medical conditions (e.g., diabetes, stroke)
Urinary Tract Components
- The kidneys which produce the urine by removing water from the blood
- The ureters which are tubes connecting the kidneys to the bladder
- The bladder which stores the urine in the body
- The urethra, the tube which carries the urine out of the bladder.
- The bladder is a hollow balloon-shaped organ. Its walls are made of muscle. The walls of the urethra are surrounded by muscles which squeeze to keep the urethra closed and hold the urine in.
Types of Incontinence
Women who are having leaking from the bladder usually have one of the following problems:
Urgency Incontinence – Failure of the storage system
- A loss of urine that is associated with a strong desire to urinate and an inability to delay long enough to get to a toilet.
- It usually involves a large amount of urine loss at one time (soaked clothing, running down legs).
- It may include urine loss on the way to the bathroom or the “key in the lock” / “hand on the doorknob” syndrome (no urge to urinate until the key is in the door lock or the hand is on the knob and then it is impossible to wait).
- A condition called “an unstable bladder” often causes urge incontinence. It may be caused by a urinary tract infection or abnormalities in the nerve control of the bladder. However, in 85% of cases no abnormality is found. More commonly, unstable bladder is caused by bladder irritation resulting from consumption of too much caffeine.
- The bladder storage system fails and you cannot hold your urine.
Stress Incontinence – Failure of the urethra or the “valve” which closes the bladder
- The involuntary loss of small amounts of urine in response to increased pressure on the bladder (for example, when a person coughs, sneezes, laughs, or lifts heavy objects urine leaks out).
- Stress Incontinence results from weakened pelvic support of the urethra and/or weakness of the sphincter muscle of the urethra.
It may be due to the effects of childbirth or menopause on the pelvic structures.
- The weakened urethra fails to act as a valve to keep the urine in the bladder.
Mixed Incontinence – Both stress and urge incontinence at the same time
- Women with mixed incontinence will leak urine with coughing and lifting but they will also have an urgent need to pee and will have trouble holding their urine until they can get to the bathroom.
- There is a problem with both the urethral valve and the bladder storage system. In this case treatments for both problems may be necessary.
- A continuous leaking of urine from the bladder. You have no control over your bladder.
- This condition is very uncommon. It can be caused by severe prolapse of your bladder ( the bladder is coming out of the vagina). It can also be caused by damage to the nerves which control bladder emptying.
Tests to Check Incontinence
There are several routine tests which are usually performed to try to find out what is causing bladder leaking. There are some supplementary tests which may be done to provide your healthcare professional with more information about your particular bladder problem. There are other specialized tests which are only necessary when it is difficult to find a cause for the leaking.
- Urine test for infection
- Medical history (including any medications you may be on)
- Physical exam of your pelvis – uterus, ovaries, tubes, and bladder
- Bladder diary
- Test of the support of the urethra (tube leading from bladder to outside your body)
- Cough stress test
- Post-Void Residual Volume
- Pad Test -determines how much urine leaks from the bladder with physical activity.
- Record of Dietary Intake and Bowel Evacuation
- Cystoscopy – looking inside the bladder with a scope
- Urodynamics – measuring pressures in the bladder and urethra
- Other imaging tests (e.g. bladder ultrasound)
You can help your bladder by:
- avoiding fluids which irritate the bladder (e.g., caffeinated beverages)
- keeping your bowels regular
- losing weight
- keeping yourself fit and mobile
- avoiding repeated exposure to high impact physical activities
- stopping smoking
- asking your doctor whether any of your medications have a negative affect
- on the bladder – tell her/him about your urine leakage
1. How successful is surgery for urinary incontinence?
The success of surgery for urinary incontinence depends to a large extent upon the type of surgery performed and to a lesser extent on the type of incontinence experienced by a woman. The best surgical procedures cure about 85% of women who undergo surgery. Examples of the best surgeries include the Burch procedure and most sling type procedures. These surgeries are designed to cure stress incontinence.
2. How do I find a health care provider in my area experienced in treating incontinence?
The Canadian Continence Foundation maintains a list of specialists across Canada. For information about treatment in your area, or for more information about incontinence, see their web address under ‘websites’.
3. How long will it take for the medication for urinary incontinence to work? Is it something I must take lifelong?
The most commonly used medications for the bladder work by keeping the bladder muscle relaxed to control frequent voiding and urgency incontinence. They begin to work immediately and should produce results within a couple of days of use. These medications are used to control your symptoms, not to cure the problem. You will have to take the medication as long as you have these symptoms.
4. Can you have intercourse with a pessary?
It is possible to have intercourse with some models of pessaries in place in the vagina. This is not possible for all women, but is most likely to be possible for women using incontinence ring pessaries or ring pessaries for prolapse. However, it is recommended that pessaries be removed before intercourse.
5. Does catheterization or urodynamics cause bladder infections?
Catheterization performed carefully and in a clean fashion should not cause bladder infection. Short-term catheterization, as is the case for urodynamics, is much less likely to cause infection than is a catheter left in to drain the bladder for several days.
6. If my mother had bladder surgery, does that mean that I will have to have surgery?
Bladder surgery is used to cure stress incontinence by restoring support to the urethra. Damage to the support of the urethra can be caused by childbirth but also by constant strain on pelvic supports caused by heavy lifting or chronic straining or coughing. Your mother needed surgery because she had damaged support for her urethra and was not able to correct the problem with conservative treatments. You will only require surgery if you experience the same problem and conservative methods of management don’t work for you (e.g., kegel’s exercises, pessaries).
7. What is interstitial cystitis?
Interstitial cystitis is a condition in which the bladder lining becomes inflammed. This causes pain and frequent voiding. It is diagnosed by looking into the bladder (cystoscopy). There are a variety of treatments for interstitial cystitis which include dietary changes and medications.
8. What should I do if I see blood in my urine?
Blood in the urine (hematuria) means that there is a problem somewhere in the urinary tract. Common causes of hematuria include bladder infection or a kidney stone. Another more rare cause may be a tumor somewhere in the urinary tract. However, the incidence of bladder cancer in women is very low. (The rate of bladder cancer in women in Nova Scotia is approximately 1 in 10,000 women). You should tell your doctor immediately if you see blood in your urine. He or she will arrange the appropriate investigations and treatments.