Almost everyone will experience back pain at some point in their
lives. Back pain varies from one person to the next. It can range from
mild to severe, and can be short-lived or long-lasting.
Preventing all back pain may not be possible. We cannot avoid the
normal wear and tear on our spines that goes along with aging. But there
are things we can do to lessen the impact of low back problems.
Guidelines for Protecting Your Back
Having a healthy lifestyle is a good start to preventing back pain.
Exercise
Combine exercise, like
walking or swimming, with specific exercises to keep the muscles in your
back and abdomen strong and flexible.
Weight Loss
Maintain a healthy weight. Being overweight puts added pressure on your spine and lower back.
Avoid Smoking
Both the smoke and the nicotine cause your spine to age faster than normal.
Proper Posture
Good posture is important to
avoiding low back problems. How you stand, sit, and lift things has an
increasing effect on your spine health.
proper sitting;
proper standing;
proper walking;
proper running;
proper sleeping;
Back safety[proper lifting technics]
Guidelines for Proper Lifting
Plan ahead what you want to do and do not be in a hurry.
Position yourself close to the object you want to lift.
Separate your feet shoulder-width apart to give yourself a solid
base of support.
Bend at the knees.
Tighten your stomach muscles.
Lift with your leg muscles as you stand up.
If an object is too heavy or is an awkward shape, do not try to lift it by yourself. Get help.
Picking Up a Light Object
To lift a very light object from the floor, such as a piece
of paper, lean over the object, slightly bend one knee and extend the
other leg behind you. Hold on to a nearby chair or table for support
as you reach down to the object.
Picking Up a Heavy Object
Whether you are lifting a heavy laundry basket or a heavy
box in your garage, remember to get close to the object, bend at the
knees, and lift with your leg muscles. Do not bend at your waist.
When lifting luggage, stand alongside of the luggage, bend
at your knees, grasp the handle and straighten up.
Holding An Object
While you are holding the object, keep your knees slightly
bent to maintain your balance. If you have to move the object to one
side, avoid twisting your body. Point your toes in the direction you
want to move and pivot in that direction. Keep the object close to
you when moving.
Placing an Object on a Shelf
If you must place an object on a shelf, move as close as
possible to the shelf. Spread your feet in a wide stance, positioning
one foot in front of the other to give you a solid base of support. Do not lean forward and do not fully extend your arms while holding
the object in your hands.
If the shelf is chest high, move close to the shelf and place
your feet apart and one foot forward. Lift the object chest high, keep
your elbows at your side and position your hands so you can push the
object up and on to the shelf. Remember to tighten your stomach muscles
before lifting.
Supporting Your Back While Sitting
When sitting, keep your back in a normal, slightly arched
position. Make sure your chair supports your lower back. Keep your
head and shoulders erect. Make sure your working surface is at the
proper height so you don't have to lean forward. Once an hour, if possible,
stand, and stretch. Place your hands on your lower back and gently
arch backward.
Snoring is the hoarse or harsh sound that occurs when your breathing
is partially obstructed in some way while you're sleeping. Sometimes
snoring may indicate a serious health condition.
As many as half of adults snore sometimes. Snoring occurs when air
flows past relaxed tissues in your throat, causing the tissues to
vibrate as you breathe, which creates those irritating sounds.
Lifestyle changes, such as losing weight, avoiding alcohol close to bedtime or sleeping on your side, can help stop snoring.
In addition, medical devices and surgery are available that may
reduce disruptive snoring. However, these aren't suitable or necessary
for everyone who snores.
Symptoms:
Depending on the cause of your snoring, your symptoms may include:
Noise during sleep
Excessive daytime sleepiness
Difficulty concentrating
Sore throat
Restless sleep
Gasping or choking at night
High blood pressure
Chest pain at night
Causes;
Many factors, such as the anatomy of your mouth and sinuses, alcohol
consumption, allergies, a cold, and your weight, can lead to snoring.
When you doze off and progress from a light sleep to a deep sleep,
the muscles in the roof of your mouth (soft palate), tongue and throat
relax. The tissues in your throat can relax enough that they partially
block your airway and vibrate. And, the more narrowed your airway, the
more forceful the airflow becomes. This causes tissue vibration to
increase, which causes your snoring to grow louder.
The following conditions can affect the airway and cause snoring:
Your mouth anatomy.
Having a low, thick soft
palate can narrow your airway. People who are overweight may have extra
tissues in the back of their throat that may narrow their airways.
Likewise, if the triangular piece of tissue hanging from the soft palate
(uvula) is elongated, airflow can be obstructed and vibration
increased.
Alcohol consumption.
Snoring also can be
brought on by consuming too much alcohol before bedtime. Alcohol relaxes
throat muscles and decreases your natural defenses against airway
obstruction.
Nasal problems.
Chronic nasal congestion or a crooked partition between your nostrils (deviated nasal septum) may contribute to your snoring.
Sleep apnea.
Snoring also may be associated
with obstructive sleep apnea. In this serious condition, your throat
tissues partially or completely block your airway, preventing you from
breathing.
Sleep apnea often is characterized by loud snoring followed by
periods of silence when breathing stops or nearly stops. Eventually,
this reduction or pause in breathing may signal you to wake up, and you
may awaken with a loud snort or gasping sound. You may sleep lightly due
to disrupted sleep. This pattern of breathing pauses may be repeated
many times during the night.
People with sleep apnea usually experience periods when breathing
slows or stops at least five times during every hour of sleep.
Risk factors;
Risk factors that may contribute to snoring include:
Being a man. Men are more likely to snore or have sleep apnea than are women.
Being overweight. People who are overweight or obese are more likely to snore or have obstructive sleep apnea.
Having a narrow airway. Some people may have a long soft palate, or large tonsils or adenoids, which can narrow the airway and cause snoring.
Drinking alcohol. Alcohol relaxes your throat muscles, increasing the risk of snoring.
Having nasal problems. If you have a structural
defect in your airway, such as a deviated septum, or your nose is
chronically congested, your risk of snoring is greater.
Having a family history of snoring or obstructive sleep apnea.
Complications;
Habitual snoring may be more than just a nuisance. Depending on the cause of your snoring, it may result in:
Daytime sleepiness
Frequent frustration or anger
Difficulty concentrating
A greater risk of high blood pressure, heart conditions and stroke
An increased risk of behavior problems, such as aggression or learning problems, in children with obstructive sleep apnea
An increased risk of motor vehicle accidents due to lack of sleep
To diagnose your condition,
your doctor will review your signs and
symptoms, and your medical history. Your doctor will also perform a
physical examination.
Your doctor may ask your partner some questions about when and how
you snore to help assess the severity of the problem. If your child
snores, you'll be asked about the severity of your child's snoring.
Imaging
Your doctor may request an imaging test, such as an X-ray, a
computerized tomography scan or magnetic resonance imaging, to check the
structure of your airway for problems, such as a deviated septum.
Sleep study
Depending on the severity of your snoring and other symptoms, your
doctor may want to conduct a sleep study. Often, sleep studies may be
done at home. However, depending upon your other medical problems and
other sleep symptoms, you may need to stay overnight at a sleep center
to undergo an in-depth analysis of your sleep habits by a team of
specialists during a sleep study, called polysomnography.
In polysomnography, you're connected to many devices and observed
overnight. During the sleep study, your brain waves, blood oxygen level,
heart rate and breathing rate, sleep stages, and eye and leg movements
will be recorded during your sleep.
When a home sleep study doesn't provide the needed information, polysomnography may be needed.
Lifestyle and home remedies
To prevent or quiet snoring, try these tips:
If you're overweight, lose weight. People who
are overweight may have extra tissues in the throat that contribute to
snoring. Losing weight can help reduce snoring.
Sleep on your side. Lying on your back allows
your tongue to fall backward into your throat, narrowing your airway and
partially obstructing airflow. Try sleeping on your side.
Raise the head of your bed. Raising the head of your bed by about four inches may help.
Nasal strips. Adhesive strips applied to your
nose help many people increase the area of their nasal passage,
enhancing their breathing. These strips aren't effective for people with
sleep apnea, however.
Treat nasal congestion or obstruction. Having
allergies or a deviated septum can limit airflow through your nose. This
forces you to breathe through your mouth, increasing the likelihood of
snoring.Don't use an oral or spray decongestant for more than three days
in a row for acute congestion unless directed to do so by your doctor. Long-term use of these medications can have a rebound effect and make
your congestion worse. Ask your doctor about a prescription steroid
spray if you have chronic congestion.
To correct a structural defect in your airway, such as a deviated septum, you may need surgery.
Limit or avoid alcohol and sedatives. Avoid
drinking alcoholic beverages at least two hours before bedtime, and let
your doctor know about your snoring before taking sedatives. Sedatives and alcohol depress your central nervous system,
causing excessive relaxation of muscles, including the tissues in your
throat
Treatments and drugs;
To treat your condition, your doctor likely will first recommend
lifestyle changes, such as losing weight, avoiding alcohol close to
bedtime and changing sleeping positions.
If lifestyle changes don't
eliminate snoring, your doctor may suggest:
Oral appliances.
Oral appliances are
form-fitting dental mouthpieces that help advance the position of your
tongue and soft palate to keep your air passage open.
Continuous positive airway pressure (CPAP).
This
approach involves wearing a pressurized mask over your nose while you
sleep. The mask is attached to a small pump that forces air through your
airway, which keeps it open. CPAP (SEE-pap) eliminates snoring and
treats sleep apnea.
Although CPAP is the most reliable method of treating obstructive
sleep apnea, and it's effective, some people find it uncomfortable or
have trouble adjusting to the noise or feel of the machine. Your doctor
may be able to make adjustments to the device if you're having trouble
adjusting to the machine, such as adding a heated humidifier or nasal
pillows, that might help make you more comfortable.
Palatal implants;In this procedure, known as
the pillar procedure, doctors inject braided strands of polyester
filament into your soft palate, which stiffens it and reduces snoring.
Palatal implants don't have any known serious side effects; however, the
benefits and safety of the procedure are still being studied.
Traditional surgery. In a procedure called
uvulopalatopharyngoplasty (UPPP), you're given general anesthetics and
your surgeon tightens and trims excess tissues from your throat — a type
of face-lift for your throat. The risks of this procedure include
bleeding, infection, pain and nasal congestion.
Laser surgery. In laser-assisted
uvulopalatopharyngoplasty (LAUPPP), an outpatient surgery for snoring,
your doctor uses a small hand-held laser beam to shorten the soft palate
and remove your uvula. Removing excess tissue enlarges your airway and
reduces vibration. You may need more than one session to get your
snoring under control.
Laser surgery and palatal implants aren't generally recommended
as treatment for sleep apnea, because they haven't been proved effective
for sleep apnea. Possible risks from these procedures include pain,
infection, bleeding and nasal congestion.
Radiofrequency tissue ablation (somnoplasty).
In this outpatient procedure, you'll be given local anesthetic. Doctors
use a low-intensity radiofrequency signal to shrink tissue in the soft
palate to help reduce snoring. The effectiveness of this newer procedure
needs further study. Generally, this procedure is less painful than
other types of snoring surgery.
You can prevent heart disease by following a heart-healthy lifestyle. Here are strategies to help you protect your heart......
Heart disease may be a leading cause of death, but that doesn't mean
you have to accept it as your fate. Although you lack the power to
change some risk factors — such as family history, sex or age — there
are some key heart disease prevention steps you can take.
You can avoid heart problems in the future by adopting a healthy
lifestyle today. Here are six heart disease prevention tips to get you
started.
1. Don't smoke or use tobacco
Smoking or using tobacco of any kind is one of the most significant
risk factors for developing heart disease. Chemicals in tobacco can
damage your heart and blood vessels, leading to narrowing of the
arteries (atherosclerosis). Atherosclerosis can ultimately lead to a
heart attack.
Carbon monoxide in cigarette smoke replaces some of the oxygen in
your blood. This increases your blood pressure and heart rate by forcing
your heart to work harder to supply enough oxygen. Women who smoke and
take birth control pills are at greater risk of having a heart attack or
stroke than are those who don't do either because both smoking and
taking birth control pills increase the risk of blood clots.
When it comes to heart disease prevention, no amount of smoking is
safe. But, the more you smoke, the greater your risk. Smokeless tobacco
and low-tar and low-nicotine cigarettes also are risky, as is exposure
to secondhand smoke. Even so-called "social smoking" — smoking only
while at a bar or restaurant with friends — is dangerous and increases
the risk of heart disease.
The good news, though, is that when you quit smoking, your risk of
heart disease drops almost to that of a nonsmoker in about five years.
And no matter how long or how much you smoked, you'll start reaping
rewards as soon as you quit.
2. Exercise for 30 minutes on most days of the week
Getting some regular, daily exercise can reduce your risk of fatal
heart disease. And when you combine physical activity with other
lifestyle measures, such as maintaining a healthy weight, the payoff is
even greater.
Physical activity helps you control your weight and can reduce your
chances of developing other conditions that may put a strain on your
heart, such as high blood pressure, high cholesterol and diabetes.
Try getting at least 30 to 60 minutes of moderately intense physical
activity most days of the week. However, even shorter amounts of
exercise offer heart benefits, so if you can't meet those guidelines,
don't give up. You can even get the same health benefits if you break up
your workout time into three 10-minute sessions most days of the week.
And remember that activities, such as gardening, housekeeping, taking
the stairs and walking the dog all count toward your total. You don't
have to exercise strenuously to achieve benefits, but you can see bigger
benefits by increasing the intensity, duration and frequency of your
workouts.
3. Eat a heart-healthy diet
Eating a healthy diet can reduce your risk of heart disease. Two
examples of heart-healthy food plans include the Dietary Approaches to
Stop Hypertension (DASH) eating plan and the Mediterranean diet.
A diet rich in fruits, vegetables and whole grains can help protect
your heart. Beans, other low-fat sources of protein and certain types of
fish also can reduce your risk of heart disease.
Limiting certain fats you eat also is important. Of the types of fat —
saturated, polyunsaturated, monounsaturated and trans fat — saturated
fat and trans fat are the ones to try to limit or avoid. Try to keep
saturated fat to no more than 10 percent of your daily calories. And,
try to keep trans fat out of your diet altogether.
Major sources of saturated fat include:
Red meat
Dairy products
Coconut and palm oils
Sources of trans fat include:
Deep-fried fast foods
Bakery products
Packaged snack foods
Margarines
Crackers
If the nutrition label has the term "partially hydrogenated," it means that product contains trans fat.
Heart-healthy eating isn't all about cutting back, though. Healthy
fats from plant-based sources, such as avocado, nuts, olives and olive
oil, help your heart by lowering the bad type of cholesterol.
Most people need to add more fruits and vegetables to their diet —
with a goal of five to 10 servings a day. Eating that many fruits and
vegetables can not only help prevent heart disease but also may help
prevent cancer and improve diabetes.
Eating several servings a week of certain fish, such as salmon and mackerel, may decrease your risk of heart attack.
Following a heart-healthy diet also means keeping an eye on how much
alcohol you drink. If you choose to drink alcohol, it's better for your
heart to do so in moderation. For healthy adults, that means up to one
drink a day for women of all ages and men older than age 65, and up to
two drinks a day for men age 65 and younger. At that moderate level,
alcohol can have a protective effect on your heart. More than that
becomes a health hazard.
4. Maintain a healthy weight
Being overweight, especially if you carry excess weight around your
middle, ups your risk of heart disease. Excess weight can lead to
conditions that increase your chances of heart disease — high blood
pressure, high cholesterol and diabetes.
One way to see if your weight is healthy is to calculate your body
mass index (BMI), which considers your height and weight in determining
whether you have a healthy or unhealthy percentage of body fat. BMI
numbers 25 and higher are associated with higher blood fats, higher
blood pressure, and an increased risk of heart disease and stroke.
The BMI is a good, but imperfect guide. Muscle weighs more than fat,
for instance, and women and men who are very muscular and physically fit
can have high BMIs without added health risks. Because of that, waist
circumference also is a useful tool to measure how much abdominal fat
you have:
Men are considered overweight if their waist measurement is greater than 40 inches (101.6 centimeters, or cm).
Women are overweight if their waist measurement is greater than 35 inches (88.9 cm).
Even a small weight loss can be beneficial. Reducing your weight by
just 5 to 10 percent can help decrease your blood pressure, lower your
blood cholesterol level and reduce your risk of diabetes.
5. Get enough quality sleep
Sleep deprivation can do more than leave you yawning throughout the
day; it can harm your health. People who don't get enough sleep have a
higher risk of obesity, high blood pressure, heart attack, diabetes and
depression.
Most adults need seven to nine hours of sleep each night. If you wake
up without your alarm clock and you feel refreshed, you're getting
enough sleep. But, if you're constantly reaching for the snooze button
and it's a struggle to get out of bed, you need more sleep each night.
Make sleep a priority in your life. Set a sleep schedule and stick to
it by going to bed and waking up at the same times each day. Keep your
bedroom dark and quiet, so it's easier to sleep.
If you feel like you've been getting enough sleep, but you're still
tired throughout the day, ask your doctor if you need to be evaluated
for sleep apnea. Obstructive sleep apnea blocks the airflow through your
windpipe and causes you to stop breathing temporarily. Signs and
symptoms of sleep apnea include snoring loudly; gasping for air during
sleep; waking up several times during the night; waking up with a
headache, sore throat or dry mouth; and memory or learning problems.
Treatments for obstructive sleep apnea include losing weight or using
a continuous positive airway pressure (CPAP) device that keeps your
airway open while you sleep. CPAP treatment appears to lower the risk of
heart disease from sleep apnea.
6. Get regular health screenings
High blood pressure and high cholesterol can damage your heart and
blood vessels. But without testing for them, you probably won't know
whether you have these conditions. Regular screening can tell you what
your numbers are and whether you need to take action.
Blood pressure;
Regular blood pressure
screenings usually start in childhood. Adults should have their blood
pressure checked at least every two years. You may need more-frequent
checks if your numbers aren't ideal or if you have other risk factors
for heart disease.
Optimal blood pressure is less than 120/80
millimeters of mercury.
Cholesterol levels;
Adults should have their
cholesterol measured at least once every five years starting at age 20
if they have risk factors for heart disease, such as obesity or high
blood pressure.
If you're healthy, you can start having your cholesterol
screened at age 35 for men and 45 for women. Some children may need
their blood cholesterol tested if they have a strong family history of
heart disease.
Diabetes screening;
Since diabetes is a risk
factor for developing heart disease, you may want to consider being
screened for diabetes. Talk to your doctor about when you should have a
fasting blood sugar test to check for diabetes.
Depending on your risk
factors, such as being overweight or having a family history of
diabetes, your doctor may recommend early screening for diabetes. If
your weight is normal and you don't have other risk factors for type 2
diabetes, the American Diabetes Association recommends starting
screening at age 45, and then retesting every three years.
Acidity and heartburn are due
to presence of too much acid in the stomach that causes exasperation of the gastrointestinal casing. This causes a blazing pain. When this excessive acid
leaks back into the throat this inflames and the reaction of heartburn is
produced.
Causes of Acidity and Heartburn
The following circumstances can create excessive acid in stomach causing
acidity and heartburn.
Consumption of rich and spicy foods
Eating speedily, very fast devoid of proper chewing
Eating hurriedly while beneath stress
Inappropriate sleep
Alcohol utilization
Pregnant women may undergo because when the baby grows, the uterus exerts
force on the digestive area
Overweight people may bear because of unnecessary pressure on their digestive
tract.
Stomach ailments like peptic ulcers, gastro-esophageal reflux disease, stomach tumors, etc.
Medications like non-steroidal anti-inflammatory drugs
Symptoms
Acidity can be extremely unpleasant and be accompanied with the following symptoms.
Burning in the stomach
Burning in the throat
Restlessness
Belching
Nausea
Sour taste
Indigestion
Constipation
Treatment
Usually, acidity is treated with the help of antacids whichcontain
either magnesium or calcium or aluminium containing compounds. These
antacids neutralise the excess acid in the stomach thus providing relief
from the symptoms.
Sometimes, Histamine blocking
agents (H2 receptor blockers) such as cimetidine, ranitidine,
famotidine or nizatidine or proton pump inhibitors such as omeprazole
and lansoprazole can also be prescribed by your physician. In rare
cases, surgery (vagotomy) is performed to reduce the acid sensation.
Before you decide to pop that antacid, try using natural remedies.......
Natural treatment of Acidity & Heartburn
Bananas have defensive action against the acidity and heart burn. Eating a
banana every day will stop such conditions
Obtain a mixture of 2 tsp of normal apple cider vinegar and 2 tsp raw honey
in a glass of water earlier than meals. One of the well liked home remedy for
acidity.
Stay away from fried foods, pickles, hot spicy foods, vinegar, and chocolate
Stay away from raw salad of vegetables like onion, cabbage, radish, and peppers
Keep away from unripe high pectin fruits, such as unripe apple. But ripe
apple such as delicious apple or fuji apple may help out
Grind up the food properly. Do not consume in hurry
Do not bounce meals. Do not keep great gap between meals. This produces gas /
current of air.
Drink lots of water, at least 8 glasses each day
Do not eat just previous to going to bed
End smoking and cut down on alcohol
Home Remedy for Acidity
A good Home Remedy for Acidity is to chew few basil (tulsi) leaves to obtain
relief from blazing, nausea and gas
Stay a small part of jaggery (gur) in your jaws and slowly suck it. Repeat it
each hour till acidity subsides.
Some of the best home remedies for acidity are
Eat watermelon, banana or cucumber each hour.
Eat a few almonds when your experience heartburn symptoms. This is good Home
Remedy for Acidity
Gulp coconut water 4-5 periods a day
Drink a glass of cold milk for quick relief of heartburn and acidity
Drink fresh mint juice gradually after meals. This remedy is best Home
Remedies for Acidity
Common tests and processes for urinary incontinence
include:
Bladder diary:
Your doctor may ask you to keep a bladder diary for several days. You record
how much you drink, when you urinate, the amount of urine you produce, whether
you had an urge to urinate and the number of incontinence episodes.
Urinalysis:
A sample of your urine is sent to a laboratory, where it's checked for signs of
infection, traces of blood or other abnormalities.
Blood test:
Your doctor may have a sample of your blood drawn and sent to a laboratory for
analysis. Your blood is checked for various chemicals and substances related to
causes of incontinence.
Specialized testing:
If further information is needed, you may undergo
additional testing, including:
Postvoid residual (PVR) measurement:
For this procedure, you're asked to urinate (void) into a container that
measures urine output. Then your doctor checks the amount of leftover
(residual) urine in your bladder using a catheter or ultrasound test. A large amount of leftover urine in your bladder may mean that
you have an obstruction in your urinary tract or a problem with your bladder
nerves or muscles.
Pelvic ultrasound:Ultrasound also may be used to view other parts of your urinary tract or
genitals to check for abnormalities.
Stress test:
For this test, you're asked to cough vigorously or bear down as your doctor
examines you and watches for loss of urine.
Urodynamic testing:
These tests measure pressure in your bladder when it's at rest and when it's
filling and it's an important tool for
distinguishing the type of incontinence you have.
Cystogram:
These images help reveal problems with your urinary tract.
Cystoscopy.
A thin tube with a tiny lens (cystoscope) is inserted into your urethra. During
cystoscopy, your doctor can check for — and potentially remove — abnormalities
in your urinary tract.
Treatments and drugs:
Treatment for urinary incontinence depends on the
type of incontinence, the severity of your problem and the underlying cause.
Your doctor will recommend the approaches best suited to your condition. A
combination of treatments may be needed.
In most cases, your doctor will suggest the least
invasive treatments first, so you'll try behavioral techniques and physical
therapy first and move on to other options only if these techniques fail.
Behavioral techniques;
Behavioral techniques and lifestyle changes work
well for certain types of urinary incontinence. They may be the only treatment
you need.
Bladder training:
Your doctor may recommend bladder training — alone or in combination with other
therapies — to control urge and other types of incontinence. Bladder training
involves learning to delay urination after you get the urge to go. You may
start by trying to hold off for 10 minutes every time you feel an urge to
urinate.
The goal is to lengthen the time between trips to the toilet until
you're urinating every two to four hours.
Bladder training may also involve double voiding —
urinating, then waiting a few minutes and trying again. This exercise can help
you learn to empty your bladder more completely to avoid overflow incontinence.
In addition, bladder training may involve learning to control urges to urinate.
When you feel the urge to urinate, you're instructed to relax — breathe slowly
and deeply — or to distract yourself with an activity.
Scheduled toilet trips:
This means timed urination — going to the toilet according to the clock rather
than waiting for the need to go. Following this technique, you go to the toilet
on a routine, planned basis — usually every two to four hours.
Fluid and diet management.
In some cases, you can simply modify your daily habits to regain control of
your bladder. You may need to cut back on or avoid alcohol, caffeine or acidic
foods. Reducing liquid consumption, losing weight or increasing physical
activity are other lifestyle changes that can eliminate the problem.
Physical therapy:
Urinary Incontinence Treatment with Exercise:
Anti-incontinence exercises{kegel exercises} are designed to strengthen the pelvic floor
muscles (the muscles that hold the bladder in place). These muscles are also called
the levator ani muscles. They are named levator muscles because they hold
(elevate) the pelvic organs in their proper place. When the levator muscles
weaken, the pelvic organs move out of their normal place (prolapse), and stress
incontinence results.
Physical therapy is usually the first step to treat
stress incontinence caused by weakened pelvic muscles. If aggressive physical
therapy does not work, surgery may be necessary.
There are special exercises to strengthen the pelvic muscles. Exercises can
be done alone or with vaginal cones, biofeedback therapy, or electrical
stimulation. In general, exercise
is a safe and effective treatment that should be used first to treat urge and
mixed incontinence.
It is important that you exercise the correct muscles. Your doctor may refer
you to a continence advisor or physiotherapist for advice on the exercises. The
sort of exercises are as follows:
Learning to exercise the right muscles:
Sit in a
chair with your knees slightly apart. Imagine you are trying to stop wind
escaping from your anus (back passage). You will have to squeeze the
muscle just above the entrance to the anus. You should feel some movement in
the muscle. Don't move your buttocks or legs.
Now
imagine you are passing urine and are trying to stop the stream. You will
find yourself using slightly different parts of the pelvic floor muscles
to the first exercise (ones nearer the front). These are the ones to
strengthen.
Doing the exercises:
You need
to do the exercises every day.
Sit, stand
or lie with your knees slightly apart. Slowly tighten your pelvic floor
muscles under the bladder as hard as you can. Hold to the count of five,
then relax. Repeat at least five times. These are called slow pull-ups.
Then do
the same exercise quickly for a second or two. Repeat at least five times.
These are called fast pull-ups.
Keep
repeating the five slow pull-ups and the five fast pull-ups for five
minutes.
Aim to do
the above exercises for about five minutes at least three times a day, and
preferably 6-10 times a day.
Ideally,
do each five-minute bout of exercise in different positions. That is,
sometimes when sitting, sometimes when standing, and sometimes when lying
down.
As the
muscles become stronger, increase the length of time you hold each slow
pull-up. You are doing well if you can hold each slow pull-up for a count
of 10 (about 10 seconds).
Do not
squeeze other muscles at the same time as you squeeze your pelvic floor
muscles. For example, do not use any muscles in your back, thighs, or buttocks.
In
addition to the times you set aside to do the exercises, try to get into
the habit of doing exercises whilst going about everyday life. For
example, when answering the phone, when washing up, etc.
After
several weeks the muscles will start to feel stronger. You may find you
can squeeze the pelvic floor muscles for much longer without the muscles
feeling tired.
It takes time, effort and practice to become good at these exercises. It is
advised that you do these exercises for at least three months to start with.
You should start to see benefits after a few weeks. However, it often takes
8-20 weeks for most improvement to occur. After this time you may be cured from
stress incontinence. If you are not sure that you are doing the correct
exercises, ask a doctor, physiotherapist or continence advisor for advice.
If possible, continue exercising as a part of everyday life for the rest of
your life to stop the problem recurring. Once incontinence has gone, you may
only need to do 1-2 five-minute bouts of exercise each day to keep the pelvic
floor muscles strong and toned up, and incontinence away.
Other ways of exercising pelvic floor muscles
Sometimes a continence advisor or physiotherapist will advise extra methods
if you are having problems or need some extra help performing the pelvic floor
exercises. These are in addition to the above exercises. For example:
Electrical stimulation.
Sometimes a special electrical device is used to stimulate the pelvic
floor muscles with the aim of making them contract and become stronger.
Biofeedback. This is a
technique to help you make sure that you exercise the correct muscles. For
this, a physiotherapist or continence advisor inserts a small device into
your vagina when you are doing the exercises. When you squeeze the right
muscles, the device makes a noise (or some other signal such as a display
on a computer screen) to let you know that you are squeezing the correct
muscles
Vaginal cones. These are
small plastic cones that you put inside your vagina for about 15 minutes,
twice a day. The cones come in a set of different weights. At first, the
lightest cone is used. You need to use your pelvic floor muscles to hold
the cone in place. So, it helps you to exercise your pelvic floor muscles.
Once you can hold on to the lightest one comfortably, you move up to the
next weight, and so on.
Other devices. There are
various other devices that are sold to help with pelvic floor exercises.
Basically, they all rely on placing the device inside the vagina with the
aim of helping the pelvic muscles to exercise and squeeze. There is little
research evidence to show how well these devices work. It is best to get
the advice from a continence advisor or physiotherapist before using any.
One general point is that if you use one, it should be in addition to, not
instead of, the standard pelvic floor exercises described above.
Pelvic floor exercises if you do not have incontinence:
The type of exercises are exactly the same as above. If you are not used to
pelvic floor exercises then perhaps do the exercises as often as described
above for the first three months or so. This will strengthen up the pelvic
floor muscles. Thereafter, a five-minute spell of exercises once or twice a day
should keep the muscles strong and toned up which may help to prevent
incontinence from developing in later life.
For urge
incontinence, pelvic floor muscle exercises are used to retrain the
bladder. When one contracts the urethral sphincter, the bladder
automatically relaxes, so the urge to urinate eventually goes away. Strong
contractions of the pelvic floor muscles suppress bladder contractions.
Whenever an individual feels urinary urgency, they can try to stop the
feeling by strongly contracting the pelvic floor muscles. These steps may
give the person more time to walk slowly to the bathroom with urinary
control.
This
technique may be used for stress and urge symptoms (mixed incontinence).
Medications
Often, medications are used in conjunction with
behavioral techniques. Drugs commonly used to treat incontinence include:
Anticholinergics.
These prescription medications calm an overactive bladder, so they may be
helpful for urge incontinence. Several drugs fall under this category,
including oxybutynin (Ditropan), tolterodine (Detrol), darifenacin (Enablex),
fesoterodine (Toviaz), solifenacin (Vesicare) and trospium (Sanctura). Possible
side effects of these medications include dry mouth, constipation, blurred
vision and flushing.
Topical estrogen.
Applying low-dose, topical estrogen in the form of a vaginal cream, ring or
patch may help tone and rejuvenate tissues in the urethra and vaginal areas.
This may reduce some of the symptoms of incontinence.
Imipramine.
Imipramine (Tofranil) is a tricyclic antidepressant that may be used to treat
mixed — urge and stress — incontinence.
Duloxetine.
The antidepressant medication duloxetine (Cymbalta) is sometimes used to treat
stress incontinence.
Medical devices
Several medical devices are available to help treat
incontinence. They're designed specifically for women and include:
Urethral insert.
This small tampon-like disposable device inserted into the urethra acts as a
plug to prevent leakage. It's usually used to prevent incontinence during a
specific activity, but it may be worn throughout the day. Urethral inserts
aren't meant to be worn 24 hours a day. They are available by prescription and
may work best for women who have predictable incontinence during certain
activities, such as playing tennis. The device is inserted before the activity
and removed before urination.
Pessary (PES-uh-re).
Your doctor may prescribe a pessary — a stiff ring that you insert into your
vagina and wear all day. The device helps hold up your bladder, which lies near
the vagina, to prevent urine leakage. You may benefit from a pessary if you have incontinence due to a
dropped (prolapsed) bladder or uterus.
Interventional therapies
Bulking material injections.
Bulking agents are materials, such as carbon-coated zirconium beads
(Durasphere), calcium hydroxylapatite (Coaptite) or polydimethylsiloxane
(Macroplastique), that are injected into tissue surrounding the urethra. This
helps keep the urethra closed and reduce urine leakage. The procedure — usually
done in a doctor's office — requires minimal anesthesia and takes about five
minutes. The downside is that repeat injections are usually needed.
Botulinum toxin type A.
Injections of onabotulinumtoxinA (Botox) into the bladder muscle may benefit
people who have an overactive bladder. Researchers have found this to be a promising
therapy, but the Food and Drug Administration (FDA) has not yet approved this
drug for incontinence.
Nerve stimulators.
Sacral nerve stimulators can help control your bladder function. The
device,which resembles a pacemaker, is implanted under the skin in your
buttock. A wire from the device is connected to a sacral nerve — an important nerve
in bladder control that runs from your lower spinal cord to your bladder.
Through the wire, the device emits painless electrical pulses that stimulate
the nerve and help control the bladder.
Another device, the tibial nerve
stimulator, is approved for treating overactive bladder symptoms. Instead of
directly stimulating the sacral nerve, this device uses an electrode placed
underneath the skin to deliver electrical pulses to the tibial nerve in the
ankle. These pulses then travel along the tibial nerve to the sacral nerve,
where they help control overactive bladder symptoms.
Surgery:
If other treatments aren't working, several
surgical procedures have been developed to fix problems that cause urinary
incontinence.
Some of the commonly used procedures include:
Sling procedures.
A sling procedure uses strips of your body's tissue, synthetic material or mesh
to create a pelvic sling or hammock around your bladder neck and urethra. The
sling helps keep the urethra closed, especially when you cough or sneeze. There
are many types of slings, including tension-free, adjustable and conventional.
Bladder neck suspension.
This procedure is designed to provide support to your urethra and bladder neck
— an area of thickened muscle where the bladder connects to the urethra. It
involves an abdominal incision, so it's done using general or spinal
anesthesia.
Artificial urinary sphincter.
This small device is particularly helpful for men who have weakened urinary
sphincters from treatment of prostate cancer or an enlarged prostate gland.
Shaped like a doughnut, the device is implanted around the neck of your
bladder. The fluid-filled ring keeps your urinary sphincter shut tight until
you're ready to urinate. To urinate, you press a valve implanted under your
skin that causes the ring to deflate and allows urine from your bladder to
flow.
Absorbent pads and catheters
If medical treatments can't completely eliminate
your incontinence — or you need help until a treatment starts to take effect —
you can try products that help ease the discomfort and inconvenience of leaking
urine.
Pads and protective garments:Various absorbent pads are available to help you manage urine loss.
Catheter:
If you're incontinent because your bladder doesn't empty properly, your doctor
may recommend that you learn to insert a soft tube (catheter) into your urethra
several times a day to drain your bladder (self-intermittent catheterization).
This should give you more control of your leakage, especially if you have
overflow incontinence. You'll be instructed on how to clean these catheters for
safe reuse.
Lifestyle and home remedies
Protecting your skin
Problems with urine leakage may require you to take
extra care to prevent skin irritation. Some things you can do to protect your
skin include:
Use a washcloth to clean yourself.
Allow your skin to air dry.
Avoid frequent washing and douching because these
can overwhelm your body's natural defenses against bladder infections.
Consider using a barrier cream, such as petroleum
jelly or cocoa butter, to protect your skin from urine.
Making the toilet more convenient
If you have urge incontinence or nighttime
incontinence:
Move any rugs or furniture you might trip over or
collide with on the way to the toilet.
Use a night light to illuminate your path and
reduce your risk of falling.
If you have functional incontinence, possible
changes may include:
Keeping a bedpan in your bedroom
Installing an elevated toilet seat
Adding a bathroom in a more convenient location
Widening an existing bathroom doorway
Coping and support
If you're embarrassed about having a
bladder control problem, you may try to cope on your own — wearing absorbent
pads, carrying extra clothes, avoiding going out. You may even cut back on
drinking liquids — and risk dehydration — to avoid wetting episodes.
But there are better ways to manage
urinary incontinence, and effective treatments are available. That's why it's
important to see your doctor and ask about treatment. You'll be on your way to
regaining an active and confident life — and control of your bladder.
Prevention
Urinary incontinence is not always
preventable. However, you may be able to decrease your risk of incontinence
with these steps:
Maintain a healthy weight.
If you're overweight, reaching a healthy weight may help.
Don't smoke.
Get help with quitting if you do smoke.
Practice Kegel exercises.
Doctors often advise pregnant women to do Kegel exercises during pregnancy as a
preventive measure.
Avoid bladder irritants.
Avoiding or limiting certain foods and drinks may help prevent or limit urinary
incontinence. For example, if you know that drinking more than two cups of
coffee makes you have to urinate uncontrollably, cutting back to one cup of
coffee or forgoing caffeine-containing drinks may be all that you need to do.
Eat more fiber.
Including more fiber in your diet or taking fiber supplements can help prevent
constipation, a risk factor for urinary incontinence.
Exercise.
Physical activity reduces your risk of developing incontinence.
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