Urinary Incontinence Naturopathic Treatment

Reclaim Bladder Control

Urinary Incontinence affects people world wide, and can cause people to avoid social contact and not want to deal with others. This ebook by Alice Benton gives you the best way to avoid the embarrassment and discomfort that is associated with urinary incontinence. Why would you want to deal with annoyance of being unable to control your own bladder when you could find a far better way to help heal yourself? This ebook gives you natural methods of taking back control of your bladder, without having to worry about the dangers associated with surgery or medications that can cause harm to your kidneys. You can learn the best natural way to heal yourself from urinary incontinence and give yourself the life that you deserve; start living the way that you deserve to live, without all of the problems that come with urinary incontinence. Take your life back now!

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Duloxetine and Propanamine Analogues

Duloxetine 11 (DLX), a dual SNRI, is approved for the treatment of depression 49 , pain associated with diabetic neuropathy 50 , fibromyalgia 51 and stress urinary incontinence 52 . Gallagher et al. at Eli Lilly have recently described the medicinal chemistry programme which led to the discovery of duloxetine 53 . Phenyl-naphthalene lead 58 showed encouraging levels of dual SNRI activity (Fig. 21, Table 8) however, substitution on the phenyl ring generally led to an erosion of NA reuptake activity. Bio-isosteric replacements of the phenyl group were then sought, and the 2-thienyl 59 was identified as a lead compound. The separate enantiomers 60 and 11 showed subtly different pharmacology, and (S) enantiomer 11 (duloxetine) was progressed on the basis of increased 5-HT reuptake potency. Rat microdialysis experiments were then carried out with 11 to determine the increase in synaptic concentrations of 5-HT and NA. Following po dosing at 10 mg kg, increases over basal levels of 5-HT and...

Diagnosis of Low Back Pain

It is often difficult to pinpoint a specific anatomical diagnosis for most patients with isolated low back pain. The majority of low back pain is benign in other words, the pain is musculoskeletal in origin. A careful history and physical examination (Tables 26.1, 26.2, and 26.3) can generally rule out serious causes of low back pain. A history of pain at night, fever, history of cancer and or unexplained weight loss, loss of bowel or bladder control, and progressive neurological deficits may be associated with serious causes of low back pain and should prompt urgent evaluation of the patient (Table 26.4). It should be noted that serious causes of low back pain are rare compared to mechanical low back pain or leg pain (Table 26.5).

Gastrointestinal and Lower Urinary Tract

Currently, muscarinic antagonists are considered front-line therapy for the treatment of detrusor instability or urge incontinence. Of these, oxybutynin and propantheline are recommended as front-and second-line therapy. Selective muscarinic receptor antagonists may offer therapeutic advantages over these agents in the treatment of urge incontinence. Darifenacin, for example, is a selective muscarinic M3 receptor antagonist in phase III clinical trial for urinary incontinence and irritable bowel syndrome (106,107). Vamicamide is also a novel compound under development for the treatment of this condition (105). It is selective toward muscarinic M1 and M3 receptors over M2 receptors in vitro. In vivo, vamicamide dose-dependently inhibits spontaneous bladder contractions caused by elevations in the intravesical volume. At 3-10-fold higher doses, no effect was seen on the contractions of stomach or colon, responses also mediated via activation of muscarinic M3 receptors (105). A feature...

Interstitial cystitis

Prevalence of IC is estimated to be 2 in 10,000.60 It has a female to male ratio of 10 1 although some are proposing that in males it may have a higher prevalence but is given the diagnosis of prostatitis. Patients with IC are 10-12 times more likely to report childhood bladder problems than the general population. Although a history of urinary tract infection is twice as common in IC patients than non-IC patients, most report infrequent urinary tract infections ( 1 year) prior to the onset of their IC symptoms. Urgency, frequency, nocturia, and associated pain are the primary symptoms of IC.61 Pain may be localized to the lower abdomen, pelvis, groin, and or perineum. The onset of the disease is normally abrupt with rapid progression of symptomatology, often following an event such as a prolonged episode of severe urgency while searching for a lavatory. Anxiety and depression are frequent comorbidities. Suprapubic tenderness to palpation may accompany a diagnosis of IC. As a...

Table 383 Forms of lumbosacral plexopathyradiculopathy in cancer patients

Typically, the disorder starts insidiously with leg weakness, numbness and paresthesias several months to 31 years (median, 5 years) after the treat-ment,41 although rare cases with acute, painful and early onset have been described,42 especially with preoperative daily irradiation fractions of 5.0-5.1 Gy for rectal adenocarcinoma.9 Slow progression and, finally, stabilization with a variable degree of functional disability characterize the following course. Pain is uncommon at the initial presentation but may develop later. Examination reveals asymmetric or symmetric lower motor neuron deficit in the L2-S1 or L5-S1 distribution associated with sensory loss but sparing sphincteric functions. Instances of urinary incontinence may be related to radiation-induced proctitis or bladder fibrosis,41 and, on rare occasions, fecal incontinence has been ascribed to RLSP in patients with cervical cancer.43 In contrast to RLSP, early and prominent pain, unilateral neurologic deficit, sphincter...

Other Potential Untoward Effects

Loss of tissue lining the vagina or bladder in postmenopausal women leads to a variety of symptoms, including dryness and itching of the vagina, dyspareunia, swelling of tissues in the genital region, pain during urination, a need to urinate urgently or often, and sudden or unexpected urinary incontinence. When estrogens are being used solely for relief of vulvar and vaginal atrophy, local administration as a vaginal cream, ring device, or tablets may be considered.

Muscarinic M3 Receptors

Collectively, these data suggest that muscarinic M3 blockade alone is useful for treating urinary tract disorders (Andersson 1993, 2003 Abrams et al. 2006 Fowler et al. 2008). Treatment of gastrointestinal motility disorders may require concurrent blockade of muscarinic M2 and M3 receptors. Several muscarinic antagonists have, in fact, been developed as therapeutics for hyperactive smooth muscle disorders, including overactive bladder (OAB), irritable bowel syndrome, and chronic obstructive pulmonary disease (COPD) (Peretto et al. 2009). Of these, tolterodine (Detrol) is a potent muscarinic antagonist developed for the treatment of OAB that possesses equivalent muscarinic M2 and M3 receptor affinities but exhibits selective

O Parasympathetic Postganglionic Blocking Agents

These three general effects of parasympatholytics can be expected in some degree from any of the known drugs, although, occasionally, one must administer rather heroic doses to demonstrate the effect. The mydriatic and cyclo-plegic effects, when produced by topical application, are not subject to any greatly undesirable side effects because of limited systemic absorption. This is not true for the systemic antispasmodic effects obtained by oral or parenteral administration. Drugs with effective blocking action on the GI tract are seldom free of adverse effects on the other organs. The same is probably true of drugs used for their antisecretory effects. Perhaps the most common side effects experienced from the oral use of these drugs, under ordinary conditions, are dryness of the mouth, mydriasis, and urinary retention. The latter effects have been exploited in the development of agents used to manage overactive bladder with symptoms of the urge of urinary incontinence, urgency, and...

Painful bladder syndrome interstitial cystitis

Painful bladder syndrome (PBS alternatively known as bladder pain syndrome) is a descriptive diagnosis that has been recently advocated for use on an international level as descriptive of a complex of urologic complaints including pain 59 . Thought to be an early form of the disorder interstitial cystitis (IC), there is an expectation that a majority of patients with PBS might have a common etiology. Notably, IC has no agreed etiology, pathophysiology or treatment and nor does the less defined PBS. The prevalence of IC is estimated to be 2 in 10,000 with a female to male ratio of 10 1. Patients with IC are 10-12 times more likely to report childhood bladder problems than the general population 60 . IC is frequently associated with other chronic disorders such as inflammatory bowel disease, systemic lupus erythematosus, irritable bowel syndrome, sensitive skin, fibromyalgia and allergies 61 .

Indirect Sympathomimetics

The CNS stimulant properties of a-alkyl-p-phenethylamines just described can be considerably attenuated by the expedient of placing a polar group (usually an OH) on the J-carbon. This increased polarity, of course, lessens penetration onto the CNS. It does tend to increase p-adrenorecptor agonist activity, however. This explains both the antiasthmatic and decreased, but still viable, CNS stimulant properties of ephedrine. Since ephedrine has 2 chiral centers, the a and p carbon, there are really four ephedrines, one stereomeric pair is (-) and (+) ephedrine, the other is named pseudoephedrine (T) (Fig. 9-9). The pressor activity of the enantiomers extends over a 36 1 range (see Table 1-5). To a large degree the ephedrines have an indirect action. The isomer with the most direct sympathomimetic activity appears to be d(-) ephedrine, the major isomer found in the natural source (see later). It is not a coincidence that the configuration of the p-OH is the same as in (-) NE. The clinical...

Noradrenaline Reuptake Inhibitors

Selective inhibition of noradrenaline reuptake has been shown to be an attractive approach for the treatment of a number of diseases. For example, reboxetine 14 (Sect. 4.1.1) is used clinically for the treatment of depression and atomoxetine 13 (Sect. 4.2.1) is a new therapy for the treatment of ADHD (Fig. 30). Furthermore, NRIs are under investigation as potential therapies for chronic pain, urinary incontinence, fibromyalgia and a variety of other indications 64,65 . A number of reviews have been published that summarize discoveries of NRIs 66-69 .

Petasites frigidus L Frigs

Arctic butterbur, more commonly known as petasites or Western coltsfoot, is primarily used in Western herbal medicine for the treatment of migraine headaches, allergies, and urinary incontinence. Petasites contains potentially toxic pyrollizidine alkaloids (PAs). Plants that contain PAs are prohibited from internal use in the European Union. Petasites is being cultivated to be low in or free of PAs. Petasites may also be mistakenly traded as American coltsfoot (Tussilago farfara). For the differentiation of these two species, see entry for Tussilago.

Transporters as Targets for Drug Discovery

Whitlock et al. describe progress in the discovery of SSRIs, noradrenaline reuptake inhibitors (NRIs), and SNRIs from 2000 to the present day. Whilst Chen et al. focus on recent developments in the search for triple SERT, NET and DAT reuptake inhibitors. The interest in these areas stems not only from the potential for improved antidepressant efficacy and side effect profiles, as has been proposed for the triple reuptake inhibitors 38 , but the recognition that by tweaking the transporter profile potential therapies for other diseases associated with neurotransmitter imbalance can be developed. For example, although duloxetine 6 (Fig. 1), a dual SNRI, was initially launched in 2004 for the treatment of major depressive disorder (MDD) 39 , since 2004 additional approvals have been granted for pain associated with diabetic neuropathy 40 and fibromyalgia 41 , for stress urinary incontinence 42 and generalised anxiety disorder 43 . NRIs have been licensed for the treatment of attention...

Herniated Lumbar Disk

Urgent or emergent surgery is indicated in the presence of cauda equina syndrome (loss of bowel or bladder control) and or progressive neurologic deficits. Otherwise, patients should be treated conservatively in the initial month following the presentation of pain. Bed rest is not helpful and is generally discouraged. Epidural steroid injections may provide faster onset of pain relief, although relief may not be long lasting. Surgery to remove the disk may provide immediate relief, but long-term advantage of surgery over non-surgical management is not clear. Options to remove the disk range from standard laminectomy and discectomy to microdiscectomy, laser discectomy, and percutaneous discectomy.


Also, an important role of TRPV1 has been suggested in bladder diseases (Birder, 2005). In the urinary bladder, TRPV1 is expressed on sensory nerve terminals and in the epithelial cells (urothelium) lining the bladder lumen (Birder et al., 2001). Overactive bladder symptoms due to various etiologies have been successfully treated with capsaicin or resiniferatoxin (RTX) (Kim and Chancellor, 2000- Cannon and Chancellor, 2002). Mice lacking TRPV1 display a higher frequency of low-amplitude (spontaneous low-volume spotting) non-voiding bladder contractions in comparison to WT animals (Birder et al., 2002). This gain of function was accompanied by reduction in both spinal cord signaling and reflex voiding during bladder filling. TRPV1 might also be

Chapter Overview

This chapter describes the role that the autonomic nervous system plays in regulating the mammalian system. This chapter supports the fact that acetylcholine (ACh) plays a critical role in the mechanisms of regulation of human physiology. This, in turn, not only serves in the development of agents that mimic the effect of ACh, but also those that block its effects as therapeutic agents. Through these developments, scientists are gaining a better understanding of how to treat diseases such as Alzheimer disease, Parkinson disease, and, most recently, overactive bladder. For pharmacists to be good practitioners, it is necessary that they understand how the autonomic nervous system influences normal physiological function as well as to how they can be used in manipulating diseases.

Genitourinary Tract

Overactive urinary bladder disease can be successfully treated with muscarinic antagonists, primarily tolterodine and trospium chloride, which lower intravesicular pressure, increase capacity, and reduce the frequency of contractions by antagonizing parasympathetic control of the bladder. Oxybu-tynin is used as a transdermal system (oxytrol) that delivers 3.9 mg day and is associated with a lower incidence of side effects than the oral immediate- or extended-release formulations. Tolterodine is metabolized by CYP2D6 to a 5-hydroxymethyl metabolite since this metabolite possesses similar activity to the parent drug, variations in CYP2D6 levels do not affect the duration of drug action. Trospium is as effective as oxybutynin, with better tolerability. Solifenacin is newly approved for overactive bladder with a favorable efficacy side effect ratio. Stress urinary incontinence has been treated with some success with duloxetine (yentreve), which acts centrally to influence 5-HT and NE...