Why we need to talk about light bladder leakage

HERE’S A QUICK health survey: Do you ever suffer from heartburn? Dandruff? How about light bladder leakage? Chances are that most people wouldn’t want to answer that last question. Yet light bladder leakage is a lot more common than people think—or would care to admit.

An estimated 3.3 million Canadians live with incontinence, and the majority of cases occur in women. Some 30 per cent of women over age 30 suffer from urinary incontinence. However, figures vary due to under-reporting, so they’re probably much higher.

Simply, it’s too embarrassing, and since no one talks about it, consequently no one knows how widespread the problem is, and they end up feeling alone. This is the message we are trying to promote: You are not alone. Millions suffer this in silence.

People are also reluctant to tell their doctor. Online survey data indicates that people wait approximately two years before telling their general practitioner.

So let’s start talking about it now. Urinary incontinence is any kind of unwanted leakage, and there are two forms: stress incontinence and urge incontinence (also called overactive bladder). This aggravating condition is treatable.

Two types, many factors

Stress incontinence results from a weakening of the sphincter, the master control of bladder response. It controls the opening of
the urethra, which allows urine to pass through. The main causes of weakness are vaginal childbirth, uterine prolapse and aging, which includes menopause.

A number of factors can trigger leakage, including anything that increases pressure in the abdomen, such as walking, sneezing, laughing or jumping. Another growing cause is obesity, since it increases abdominal pressure.

The Canadian Urological Society describes urge incontinence as a “failure of the storage system.” It has nothing to do with muscles or weakness but the contraction of the involuntary muscle of the bladder, which contracts prematurely or at an inappropriate time.

The exact cause of urge incontinence is unknown, but common risk factors include aging, urinary tract infections and nervous system diseases (such as diabetes, Parkinson’s, stroke and multiple sclerosis). All of these affect the physiological control of bladder function.

Men suffer, too

About 5 to 10 per cent of Canadian men suffer from incontinence, and it’s typically urge incontinence. Aging and an enlarged prostate (which obstructs and places undue pressure on the urethra) are to blame. As for stress incontinence, it rarely exists in men, except for those who have had surgery to remove their prostate—surgery can damage the sphincter. As women age, they often experience both types of incontinence, which is known as mixed incontinence.

Those who suffer with the problem are reluctant to talk about it, and many people just put up with it. Any amount of leakage is abnormal, even one drop.

Treatment methods are available

So what can you do about bladder leakage? Lots, apparently.

The important message is that lifestyle changes, such as avoiding alcohol and caffeine, losing weight and stopping smoking, can significantly improve incontinence—both kinds. For women, expert recommends doing Kegels (pelvic floor exercises) after childbirth to strengthen the pelvic floor. Research shows men might benefit from Kegels after prostate surgery.

Surgery is also an option to treat stress incontinence if other measures don’t work well enough. As for urge incontinence, it can be treated first through lifestyle changes and/or drugs that stop the bladder muscle from contracting too soon.

The message that needs to get out is that incontinence is treatable and often curable. People need to speak out to each other and their [general practitioners], thus breaking the taboo and learning that they’re not alone.

Source: CostcoConnection

Low Vitamin D: A Global Concern

Recent studies suggest that vitamin D is much more important in fighting off disease than previously thought. Being deficient in this vitamin puts one at risk of diseases such as cancer, osteoporosis, and multiple sclerosis. Chances are that if you live in a northerly geographic region you do not get enough vitamin D. Persons who live a rather sedentary lifestyle and do not get outside for at least a 15-minute daily walk in the sun are in the same position. Latinos, African-Americans and others with dark skin tend to have much lower levels of vitamin D, as do people who are overweight or obese. All around the world millions of persons suffer from vitamin D deficiency. This phenomenon is so common that it affects persons on every continent, of all ethnic groups, and across all ages. Some surveys suggest that perhaps half of the world’s population has inadequate blood levels of vitamin D. Sadly, physicians, even in industrialized countries, are seeing the resurgence of rickets, the bone-weakening disease that had been largely eradicated through vitamin D fortification.

As with most research findings, there is plenty of debate. Indeed, as opposed to what many people think, there are few certainties in science; its nature is to be open to criticism, discussion, and revision. The Institute of Medicine (IOM) released a report in November 2010 which recommends a daily vitamin D intake of 600 IU per day, for people ages 1 to 70, and 800 IU, for people over age 70—the report referred to persons living in the U.S. and Canada. The report also recognized the safety of vitamin D by increasing the upper limit from 2,000 to 4,000 IU per day, and acknowledged that even at 4,000 IU per day, there was no good evidence of harm.

Some in the scientific community believe the new guidelines are too conservative about the intake, and that they do not give due consideration to the latest findings about vitamin D and health. They contend that the new guidelines are not enough to prevent chronic disease, and they are not sufficient to help those who have problems with their bones. This is an important debate, and in order to understand it better it is necessary to know the origins of vitamin D and how it functions in the human body.

Vitamin D Sources and Function

Our body makes vitamin D and it is also a nutrient we eat. The body produces vitamin D from cholesterol, which itself is triggered by sun lighting on the skin. Yet many persons do not make enough vitamin D from the sun, persons with darker skin, those who are overweight, and persons who use products that block sunlight being among them. Correctly applied sunscreen reduces our ability to absorb vitamin D by more than 90 percent.

To be sure, not all sunlight is of the same quality and intensity: The sun’s ultraviolet B (UVB) rays—the so-called “tanning” rays, and the rays that trigger the skin to produce vitamin D—are stronger near the equator and weaker at higher latitudes. Indeed, persons who live in places prone to considerable cloudiness and rain can suffer from vitamin D deficiency. The other way we get vitamin D is to eat food that contains a lot of it. However, few foods are naturally rich in vitamin D, so the biggest dietary sources of vitamin D are fortified foods and vitamins supplements.

Vitamin D helps the body absorb and retains calcium and phosphorus, which are critical elements for building bone. Laboratory studies show that vitamin D can reduce cancer cell growth, can increase muscle strength, and can help control infections. There may yet be other functions for vitamin D, and scientists continue to explore the many other uses for this important substance.

New Vitamin D Research: Beyond Building Bones

Vitamin D research has proved to be of considerable fecundity. Although there have been many reports issued over the years, there are only a few that offer enough evidence to constitute a clear medical breakthrough. Here we provide the more promising areas of vitamin D research, highlighting the complex role of vitamin D in disease prevention—and the many unanswered questions that remain.

Vitamin D and Bone and Muscle Strength

A number of random trials have shown that high doses of vitamin D supplements help reduce bone fractures. A summary of the evidence comes from a combined analysis of 12 fracture prevention trials that included more than 40,000 elderly people, most of them women. Researchers found that high intakes of vitamin D supplements—of about 800 IU per day—reduced hip and non-spine fractures by over 20 percent, while lower intakes (400 IU or less) failed to offer any fracture prevention benefit.

It has been shown that vitamin D may also help increase muscle strength, which can help prevent elderly persons from falling, a common problem that leads to increased rates of disability and death among them. A combined meta-analysis found that taking 700 to 1,000 IU of vitamin D per day lowered the risk of falls by 19 percent; the combined studies also show that taking 200 to 600 IU per day offered no such protection. Based on this data, the International Osteoporosis Foundation recommends that adults over age 60 maintain vitamin D blood levels of 30ng/ml. This means that most people will need vitamin D supplements of at least 800 to 1,000 IU per day, and possibly higher, to reach these levels.

Vitamin D and Heart Disease

The heart, as a skeletal muscle, is a receptor of vitamin D. A number of studies have found that lack of vitamin D is linked to heart disease. The Health Professional Follow-Up Study observed the vitamin D blood levels in nearly 50,000 men who were healthy. They followed the same group for 10 years and found that men who were low in vitamin D were twice as likely to have a heart attack as men who had adequate levels of vitamin D. Other studies have linked low vitamin D levels to an increased of heart failure, sudden cardiac death, stroke, overall cardiovascular disease, and cardiovascular death. There is some evidence that vitamin D plays a vital role in controlling blood pressure and preventing artery damage. This goes some ways in explaining the findings above. However, more research is needed before a sounder conclusion can be made.

Vitamin D and Cancer

Nearly 30 years ago, researchers discovered an interesting correlation between colon cancer deaths and geographic location. They found that people who lived at higher latitudes, such as in the northern U.S. or Canada, had higher rates of death from colon cancer than people who lived closer to the equator. The sun’s UVB rays are weaker at higher latitudes, and in turn, people’s vitamin D levels in these high latitude locales tend to be lower. Researchers formed the hypothesis that vitamin D deficiency can lead to an increased risk for getting colon cancer

Some time has passed, but dozens of studies suggest a relationship does exist between low vitamin D levels and increased risks of colon and other cancers. The evidence is strongest for colorectal cancer, with observational studies have found that persons with lower vitamin D levels are at higher risk of getting such diseases. Vitamin D levels may also predict cancer survival, but there is as yet little evidence to support this. However, it is not yet certain that taking vitamin D supplements necessarily lowers the risk of contracting cancer. This latter idea will be tested in the VITAL trial. The VITAL trial will look specifically at whether vitamin D supplements lower cancer risk. However, it is likely to be years before the trial produces any results. Additionally, the VITAL trial could fail to detect a real benefit of vitamin D. There are several reasons for this. First, if people in the placebo group decide to take their own vitamin D supplements, the differences between the placebo group and the supplement group could be minimized. Second, the study may not follow participants for a long enough time to show a cancer prevention benefit; or study participants may be starting supplements too late in life to lower their cancer risk.

In any case, given the evidence now on hand, 16 scientists have circulated a “call for action” on vitamin D and cancer prevention. Given the high rates of vitamin D inadequacy in North America, the strong evidence for reduction of osteoporosis and fractures, the potential cancer-fighting benefits of vitamin D, and the low risk of vitamin D supplementation, these scientists recommend vitamin D supplementation of 2,000 IU per day. The Canadian Cancer Society has also recommended that Canadian adults consider taking vitamin D supplements of 1,000 IU per day during the fall and winter. They also recommend that people who are at high risk of having low vitamin D levels because of old age, dark skin, or geographic location take vitamin D supplements year round.

Coping With Incontinence

While pregnant women and those who’ve had children are most susceptible to bladder control problems, men can suffer from embarrassing incontinence after prostate surgery or as a sign of prostate issues. Symptoms range from occasional leakage to bedwetting, and also can be a result of benign causes like certain foods or medications.

But frequent incontinence can signal a more serious condition — such as bladder cancer, kidney stones, enlarged prostate, and even neurological diseases (Parkinson’s, multiple sclerosis, brain tumors). While you should visit your doctor if you experience urine loss regularly, your complications worsen, or blood appears, some behavioral and physical tips can tame milder symptoms.

  • Strengthen your pelvic floor (also called Kegels) by contracting and releasing the urinary sphincter muscle that controls urine flow. One study found that specialized instruction from a physiotherapist can dramatically improve the success rate of these exercises.
  • Schedule visits to the bathroom to anticipate overflow. You can also control bouts through bladder training, which includes learning to relax, count, and breathe when the urge strikes, or releasing your stream once, then stopping again after a brief pause.
  • Drink water throughout the day. Dehydration can cause your urine to concentrate and aggravate the bladder. Taking in fluid regularly helps maintain a constant flow of liquid through your system. Sodas and sugary or acidic drinks can irritate the bladder and further dehydrate, so stick with water.

Multiple Sclerosis Pump

An estimated 40 thousand Americans suffer severe spasticity due to diseases such as multiple sclerosis and spinal cord injuries. The problem causes muscles to contract involuntarily or tighten up. There’s a new way to deliver relief.

These days, playing cards with her husband is a real treat for Brenda. She has multiple sclerosis. Three months ago, she couldn’t play cards, or even sit for long periods of time. And she was in excruciating pain.

“It got to a point that it was so bad, I would straighten out like a board and almost come right out of the chair.”

For Brenda, this silver disc holds the key to relief. It’s actually a medicine pump that surgeons implanted into her abdomen. A small tube delivers a continuous flow of baclofen — a drug that controls spastic muscles — right into her spinal cord area.

The baclofen when it’s in the spinal fluid just soaks in the spinal cord area by diffusion. And that’s the area that’s creating the spasticity and spasms.

Taking medicine by mouth lets it travel to the brain and other parts of the body causing confusion and other problems. Getting the drug right in the spinal area means fewer side effects. One hitch — the pump has to be refilled every one to three months. For Brenda, that’s better than four pills, four times a day.

“It means more life to me.”

The pump comes with a portable computer and magnetic wand.

Clinical tests show the baclofen pump reduced spasticity in 97 percent of patients. The same delivery system has also been used to administer chemotherapy drugs or morphine to cancer patients and for treatment of other types of chronic pain.

DHEA for Lupus

Lupus, it’s called an autoimmune disorder. It causes inflammation of various parts of the body including skin, joints, blood and major organs. Doctors say more people have lupus than AIDS, cerebral palsy, cystic fibrosis, multiple sclerosis and sickle-cell anemia combined. A new study of a natural drug may bring patients relief from their pain.

It was right before college graduation and a year before meeting her husband that Darnell wasn’t feeling well. “I was running a fever, had joint pain, felt like I had the flu constantly,” says Darnell.

She was diagnosed with lupus. Her immune cells turned on her own body.

Rheumatologist, Darnell’s doctor. “A number of decades ago the mortality rate from lupus was considered to be fifty percent.”

With the use of anti-inflammatories and steroids like prednisone, the mortality rate has dropped to five percent. Yet the side effects of the drugs are often intolerable. “I was having a hard time sleeping, felt jittery. You did not feel like a normal person while you’re taking that,” says Darnell.

So Darnell joined a study of an experimental drug called GL-701. It is a purified form of the natural hormone DHEA. In a study of 381 patients, 66 percent of patients responded to GL-701. Flare-ups were more than 24 percent lower in patients taking GL-701 compared to those on the placebo.

“Their arthritis improved. Second, fatigue improved, and patients were able to decrease prednisone when they were on prednisone,” says Dr.

Darnell says getting off prednisone completely was great for her. “Things seem to be on an even keel,” she says. Now even simple tasks like typing are no longer painful.

Patients say the side effects of GL-701 were minimal and included acne and excess hair growth. While you can purchase DHEA supplements in health food stores, there’s not a guarantee of what’s actually in the product.

Combo May Help Multiple Sclerosis Patients

A new study shows adding a new medication to the standard treatment of Multiple Sclerosis (MS) may help better control the disease. Doctors at the University of Baltimore and Brown University in Rhode Island say adding an immunosuppressive drug to the routine treatment of MS is well tolerated by patients.

Within the last decade, there have been three major medications available to MS patients: Betaseron, Avonex and Copaxone. Doctors say all three effectively treat the disease, but many patients still need more. In this study of 16 people, doctors treated patients with the drug methotrexate and Avonex. Previous studies show methotrexate is safe and effective in patients with psoriasis, rheumatoid arthritis and inflammatory bowel disease.

None of the 16 patients reported any serious side effects. The most common effect was nausea, which lasted for 24 hours after the drug was given. The doctors say, not only is the drug well tolerated, but it also appears to reduce the number of lesions visible on an MRI by 44 percent.

No one is sure what causes MS but it occurs when the body’s immune system mistakenly attacks the protective myelin sheath surrounding nerve fibers in the brain and spine. Symptoms of MS include muscle weakness and stiffness, balance and coordination problems, numbness and vision disturbances.

Doctors hope this small study will open the door for further research into combining medications to help patients with their disease.