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Incontinence

 

Bladder complaint - typically female?


Vesical illnesses are often looked as "gynaecological disorders".


Since anatomical, hormonal and psychosomatic causes are responsible for the fact that urinary tract infections, stimulus bladder, vesical ptosis and micturition incontinence (incapacity to hold back micturition) appear as much more frequent than with men with women.


While acute infections of the urinary tract ordinarily heal quickly and without a hitch, the micturition incontinence often shows a many years' ailment way for the affected persons to itself. Today with the new cures can be helped in most cases also to these patients.


While to men generally only at the advanced old person suffer from Zystitidien (micturition pale inflammation) and incontinence discomforts as a result of Prostataerkrankungen, women are confronted from the youth with different vesical discomforts.


Thus every second woman falls ill at least once in your life with a cystitis; ever fifth even several times yearly. The information for the prevalence of the micturition incontinence (30 %-60 %) which is by no means only one illness postmenopausalen (the time after non-appearance of the monthly period) woman is similarly high. According to a multinational study two of five women suffer at the old person between 35 and 54 years from a stress incontinence. These are almost just many like in the age group more than 55 years.


Acute cystitis (inflammation the micturition-pale) - mobile bacteria are off sick


The acute cystitis is almost always the result of a bacterial infection. The fact that she appears as so frequent just with women, lies from the female anatomy.


Women have a substantially shorter urethra than men who is in narrow neighborhood to the anal area and genital area. Therefore, embryos from the fecal flora or vaginal flora can easily immigrate and climb up in the bladder.


The bringing on embryo is actual in the majority of the cases (80 %-90 %) Escherichia coli; also frequent cystitis causes are Proteus, Entero-and Staphylokoken as well as Chlamydien which lead with young women increasingly to infections.


Normally the flowing through urine provides for the fact that, perhaps, climbing up bacteria ausgeschwemmt will remain and the urinary tract aseptic. If the urine amount decreases on the basis of low drinking amounts, or drain obstacles (e.g., kidney stones) cause a micturition traffic jam, this can favour an infection.


The risk of an urinary tract infection in the gestation is especially big, because the flow speed of the urine decreases during the last gestation months considerably. Also the advice of our mothers not to sit on cold calculi, to keep in the kidneys and to avoid cold feet is not so silly at all. Since undercooling is also valid as a potent pioneer of a cystitis. In this case one speaks of a "cold foot cystitis".


With some women always appear against urinary tract infections after the sexual intercourse. This so-called "Honeymoon cystitis" can have many causes. Psychosomatic reasons, like a subliminal partnership conflict or emotional stress, are as discussed as infection by "foreign" bacteria of the partner or disorders of the natural defences by contraceptive.


Basically every foreign body, above all the vesical catheter, the normal bacterial flora of the urinary tract can interfere so strongly that immigrating embryos have a light play.


Genetic causes are also recently discussed with piled up appearing urinary tract infections: So that the penetrated bacteria are not washed away by the micturition, they need special custody mechanisms, so-called Fimbrien with which they can hold on in the mucosa of the micturition tract. Some people own in her urinary tract epithelium Glykolipid receptors which particularly make easy it for the Fimbrien of the E. coli bacteria to stick.


Diagnosis and treatment of the cystitis


A constant urge to pass water, burning with the Wasserlassen and spasmodic pains in the lower abdomen are the typical symptoms of an acute cystitis.


The urine is murky, in 30% of the cases also bloody. He has a typical "rotten" odour. Large amounts are found with the lab examination of the medium ray urine in leucocytes and bacteria, moreover, mucus, dead cell leftovers and erythrocytes. It concerns an acute bacterial inflammation if more than 100,000 bacteria per milliliter of urine exist. To the regulation of the cause type a culture is necessary. It can be tied together with a resistance regulation.


As a danger signal the occurrence must be evaluated by fever, shake and strong back pains which emit in the groin area. In this case the infection has spread out to other organs, like kidneys or prostate gland. It has come to a pyelitis or Prostatitis (inflammation of the prostate gland). With these patients antibiotics must be used anyway to the therapy.


For the treatment of the uncomplicated cystitis are available a row of naturheilkundlicher therapy measures. They are aimed above all at an intensive Durchspülung of the micturition tract and a disinfection of the urine.
To reach a good lavage, the everyday drinking amount should amount to from two to three litres. Particularly there are suited tea mixtures which contain birch pox, golden rod herb, because these stimulate the micturition education. Bear's grape pox is since time immemorial as a micturition antiseptic (antiseptic medicine) famously.

Therefore, they are also called micturition herb or vesical herb. Their main agent, the Arbutin, disinfects the urinary tract and prevents sticking the bacteria. Because the high tannic acid salary of the bear's grape pox essence to irritations can lead that of the stomach mucosa, dragée will better stand generally than Teezuberreitungen.


To the treatment of rezidivierender (returning) Zystitidien the drinking from Cranberry-or Preiselbeersaft has proved itself. The Tannine contained in the juice also prevent the adhesion of the bacteria in the urinary tract epithelium. The Rezidivrate could be lowered under this treatment upon less than 30%.


If with this medicine no sufficient therapy success is achievable, an antibiotic dose is unavoidable. Indeed, today three days of durable treatment are looked as enough; partly disposable doses, so-called "single shot", are also prescribed. To the "classical" antibiotics with urinary tract infections belong beside Nitrofurantoin above all the combination Trimerhoprim/Sulfamethoxazol (=Cotrimoxazol) and broadband antibiotics like the Gyrase inhibitors (e.g., Ciprofloxacin). The latter are used above all with resistant causes.


Piled up cystitises can also be signs of a general resistance infirmity. In these cases it is advisable to strengthen the endogenic resistance by drugs and to accelerate with it the healing and to bend forward other infections. Also the dose of ascorbic acid has turned out with rezidivierenden Zystitiden successful.


The most frequent cause of the cystitis


Bacteria immigrate to the bladder:


- by wrong anal hygiene
- with colpitis or excretion
- after the sexual intercourse


The factors which favour an infection:


- Undercooling, above all of the feet
- Micturition traffic jam, e.g., with kidney stones, prostate gland hypertrophy (enlargement of the prostate), gestation
- weak resistance position


Micturition incontinence (incapacity to hold back micturition)


Although more than four million people predominantly women are concerned in Germany by a micturition incontinence, she still belongs to the serious ailments.


Sense of shame and the faith, it would give no effective treatment possibilities, the patients often hesitate let for years, before they search help to her doctor. Wrongfully, because there are more and more modern treatment procedures with which the affected persons can regain the controls about her bladder.


Causes


On account of the different causes five forms of the micturition incontinence are distinguished in the international nomenclature.
Division of the micturition incontinence
Terminology of the Internationally Incontinence Society
- Compulsion incontinence
- Stress incontinence
- Reflex incontinence
- Überlaufinkontinenz
- Extraurethrale incontinence (beyond the urethra)


Both most frequent and most important forms are the compulsion and stress incontinence. Ordinarily they can be diagnosed with the help of her leading symptoms and the anamnestischen information of the patient easily. More difficultly it becomes if hybrid forms appear; with about 30% of the incontinence patients causes and symptoms of both forms can exist.


Causes of the micturition incontinence


The cause of the compulsion incontinence is a morbid Übereregbarkeit of the vesical muscle. This means which reacts the bladder already with minimum micturition amount with the signal of the urge to pass water.
Ordinarily there appears the compulsion to have to let water, only with possibly half-filled bladder.

 The patients feel many times on the day a suddenly appearing, very strong urge to pass water with which also involuntarily urine can go off. The cause of the Überregbarkeit are varied: Beside morbid changes in the area of the bladder or urethra chronic urinary tract infections, estrogen deficiency or neuro-logical vesical illnesses can be the trigger.


With women between the 30th and 50th year are often Dysfunktionen of the vesical musculature which are still strengthened by stress, nervous restlessness or expectation fear, for the vesical infirmity responsibly. Then one speaks of a stimulus bladder.


A failure of the vesical sphincter forms the basis of the stress or strain incontinence. It is caused by a pelvic ground infirmity as a result by childbirths, surgical interventions or hormone deficiency and is to be found predominantly with women. The leading symptom is an involuntary urine departure, as soon as it comes by physical activities like lifting, carrying, cough or sternutation for a pressure projection in the abdominal cavity.


With men an incomplete vesical evacuation can lead as a result of a prostate gland hypertrophy to constant urge to pass water and in the extreme case to a Überlaufinkontinenz.
The people with whom an interruption of the nerve tracts, has led, e.g., by a paraplegia, to a disorder of the vesical function suffer from a Refelxinkontinenz.


Therapeutic possibilities with micturition incontinence


For the treatment of the micturition incontinence are would pass away questions indispensably:
1-drinking habits
2-Miktionsverhalten
3-frequencies of the presentation change
4-micturition losses with physical strain
5-preceding operations
6-numbers of the births
7-neuro-logical illnesses (M. Parkinson, multiple sclerosis)
8-drug anamneses


The different forms of the incontinence must be treated to her causes and according to symptoms differently.
With the stress incontinence the pelvic ground training shows to itself the most important conservative therapeutic measure. If on time is begun with it, from 50 to 70% of healing or improvement of the complaints can be reached.


The exercises are learnt under ill-gymnastic instructions and are carried out later several times daily at home. The order of homoeopathic drugs can support the training success. Many homoeopathic preparations Have proved themselves with illnesses of the female genitals (sepia, Lilium tigrinum, Aletris) as well as of the supporting tissue and connective tissue (silicon, calcium fluoratum).


With the patients who can tighten your pelvic ground not arbitrarily an electric stimulation treatment should be added, so that the contractility can be improved and the musculature be strengthened. In certain situations, e.g., with the sport, the aid, as for example an Urethrapresser or an incontinence pack which stabilise the vesical neck can complement intravaginale (in the vagina) the treatment. Nevertheless, for longer time this aid may not be applied because of danger by infections or ulcers.


Only if all conservative therapy strategies have remained fruitless, surgical procedures should be used to the therapy of the stress incontinence. Besides, the introduction of Pole's cord loops has outstripped/TVT procedure) during the last years all former operation methods. With this minimum invasive (in an organ crucial) operation a plastic cord is placed freely of tone behind the Urethra (urethra).

 It establishes itself without cicatrix into the surrounding tissue and supports in this manner vesical neck and urethra.
The treatment of the compulsion incontinence is still a domain of the medicinal therapy. In the school medicine are prescribed predominantly Anticholinerghika which suppress the involuntary contractions of the vesical musculature and which should increase vesical capacity.


Nevertheless, this medicine has on account of her disagreeable side effects (fatigue, oral dryness, Akkomodationsstörungen (reaction of the pupils)) above all with older patients a bad Compliance. Therefore, big hopes are put on a new preparation which is still in the test: Selective Serotonin-Noradrenalin-Wiederaufnahmehemmer Duloxin the vesical evacuation should normalise about an inhibition of the parasympathischen nervous system.


As a quite new therapy principle is valid the injection of the Botulinum A poison which should cause a sedation of the vesical muscle. Indeed, it can thereby come to vorrübergehenden Akontraktibilität (no moving together), so that the patient must empty the bladder with the help of a catheter.
If complaints are due the incontinence to a hormone deficiency in the postal menopause, they respond especially well to local estrogen applications or the dose of natural medicine to the regulation of the hormone household.


The vesical evacuation disorders whose cause chronic urinary tract infections are must be treated anyway antibacterial. On account of his diuretic (increased Wasserlassen) and antiseptic effect a kidney bladder tea is suited moreover especially well.

 

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