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Home > 2023 > March

Month: March 2023
March 3, 2023

Cervical Spondylosis

The neck is part of a long flexible column, known as the spinal column or backbone, which extends through most of the body. The cervical spine (neck region) consists of seven bones (C1-C7 vertebrae), which are separated from one another by intervertebral discs. These discs allow the spine to move freely and act as shock absorbers during activity. ​(1)​ 

What does the cervical spine do?

Your cervical spine has several functions, including: (2)

  • Protecting your spinal cord. The nerves of your spinal cord pass through a large hole (called the vertebral foramen) that passes through the center of all of your vertebrae — from the base of your skull through the cervical vertebrae, the thoracic (middle back) vertebrae and ending between the first and second lumbar (lower back) vertebrae. Taken together, all the stacked vertebrae of your spine form a protective central canal that protects your spinal cord.
  • Supporting your head and allowing movement. Your cervical spine supports the weight of your head (average weight of 10 to 13 pounds). It also allows your head and neck to tilt forward (flexion), backward (extension), turn from side to side (rotation), or bend to one side (ear-to-shoulder; lateral flexion).
  • Providing a safe passageway for vertebral arteries. Small holes in cervical spine vertebrae C1 to C6 provide a protective pathway for vertebral arteries to carry blood to your brain. This is the only section of vertebrae in the entire spine that contains holes in the bone to allow arteries to pass through.

Cervical spondylosis

Cervical spondylosis (Arthritis of the Neck) is a general term for age-related wear and tear affecting the spinal disks in your neck. As the disks dehydrate and shrink, signs of osteoarthritis develop, including bony projections along the edges of bones (bone spurs). (3)

Cervical spondylosis is very common and worsens with age. More than 85% of people older than age 60 are affected by cervical spondylosis.

Symptoms

Most people experience no symptoms. When symptoms do occur, they typically include pain and stiffness in the neck.

Sometimes, cervical spondylosis results in a narrowing of the spinal canal within the bones of the spine (the vertebrae). The spinal canal is the space inside the vertebrae that the spinal cord and the nerve roots pass through to reach the rest of the body. If the spinal cord or nerve roots become pinched, you might experience: :​(3)​ 

  • Pain in the neck that may travel to your arms or shoulders
  • Headaches
  • A grinding feeling when you move your neck
  • Weakness in your arms and legs
  • Numbness in your shoulders, arms, or hands
  • Stiff neck
  • Trouble keeping your balance, especially when walking
  • Trouble controlling your bladder or bowels

Causes of cervical spondylosis

As you get older, your spine changes due to decades of normal wear and tear. Starting in middle age, the disks between your vertebrae start to change. These changes can include: (4)

  • Degeneration: The spinal disks in your neck may slowly wear down (degenerate). With time, the disks become thinner, and the soft tissue has less elasticity. If you or your parents measure in a little shorter in height than you did years ago, this is normal collapsing or settling of your disks.
  • Herniation: Normal aging can cause part of your spinal disk to tear or crack. This is called a herniated disk. The herniation can allow the disk to bulge out, pressing on nearby tissue or a spinal nerve. This pressure can cause pain, tingling, or numbness.
  • Osteoarthritis: Osteoarthritis is a progressive (ongoing) condition that causes the cartilage in your joints to degenerate (wear down with time). With osteoarthritis, cartilage degenerates faster than normal aging.
  • Bone spurs: When cartilage in the joints of the vertebrae in your spine starts to degenerate and bone tissue rubs directly against other bone tissue, abnormal bone growths develop along the edges of vertebrae. These growths (called osteophytes or bone spurs) are common as you age. Often, they cause no symptoms.

Diagnosis

Your healthcare provider will likely start with a physical exam that includes:(5)​​ ​(6)​ 

  • Checking the range of motion in your neck
  • Testing your reflexes and muscle strength to find out if there's pressure on your spinal nerves or spinal cord
  • Watching you walk to see if spinal compression is affecting your gait

Imaging tests

Imaging tests can provide detailed information to guide diagnosis and treatment. Examples include:

  • Neck X-ray. An X-ray can show changes in the spine, such as bone spurs, that indicate cervical spondylosis. Neck X-rays can also rule out rare and more serious causes of neck pain and stiffness, such as tumors, cancer, infections, or fractures.
  • MRI. Using radio waves and a strong magnetic field, MRI can produce detailed images that can help pinpoint areas where nerves might be pinched.
  • CT myelography. In this type of CT scan, a dye is injected into the spinal canal to provide more-detailed imaging. This test makes it easier to see the details of the spinal cord, spinal canal, and nerve roots.

Nerve function tests

You may need tests to determine if nerve signals are traveling properly to your muscles. Nerve function tests include:

  • Electromyography. This test measures the electrical activity in your nerves as they transmit messages to your muscles when the muscles are contracting and at rest.
  • Nerve conduction study. Electrodes are attached to the skin above the nerve to be studied. A small shock is passed through the nerve to measure the strength and speed of nerve signals

Treating cervical spondylosis

Treatments for cervical spondylosis focus on providing pain relief, lowering the risk of permanent damage, and helping you lead a normal life.

Nonsurgical methods are usually very effective.

Physical therapy

Your doctor might send you to a physical therapist for treatment. Physical therapy helps you stretch your neck and shoulder muscles. This makes them stronger and ultimately helps to relieve pain. (7)

You might also have neck traction. This involves using weights to increase the space between the cervical joints and relieve the pressure on the cervical discs and nerve roots.

Medications

Your doctor might prescribe certain medications if over-the-counter (OTC) drugs don’t work. These include: (7)​ 

Surgery

If your condition is severe and doesn’t respond to other forms of treatment, you might need surgery. This can involve removing bone spurs, parts of your neck bones or herniated discs to give your spinal cord and nerves more room.

Surgery is rarely necessary for cervical spondylosis. However, a doctor may recommend it if the pain is severe and it’s affecting your ability to move your arms.

Home treatment options

If your condition is mild, you can try a few things at home to treat it: (7)

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5 easy-to-follow at-home exercises to reduce cervical spondylosis pain: (8)​ 

Push forward

This exercise is very easy to follow and also helps better flexibility in the neck. Here's how to perform the neck push-forward exercise:

  • Stand straight
  • Try to push your neck forward as far as possible
  • At this point, your neck would be protruding forward ahead of the rest of your body
  • Hold this stretch for a few snoods and release
  • Repeat it a few times daily

Neck tilts

Neck tilts as the name suggests helps in stretching the neck in different directions and help relieve pain and stiffness. Here is how you can practice neck tilts.

  • Try to place your head on your right shoulder
  • At this point, your right ear should be touching your right shoulder
  • Hold this position for a few seconds
  • Now witch, with your head resting on your left shoulder
  • Repeat this at least 4-5 times, a few times a week, or whenever you feel discomfort

Neck bowing

Similar to the pushing the neck forward exercise, neck bowing focuses on stretching the neck out as far as possible. A combination of these two regularly can ensure better flexibility and a reduction in pain in the neck. Here's how you perform the neck-bowing exercise:

  • Try to rest your neck on your chest
  • In this position, your chin should be touching your chest
  • Hold this position for a few seconds and release
  • Repeat this along with push forward exercise, alternatively
  • Repeat at least 3-4 times

Look behind

As the name suggests, the looking behind neck exercise focuses on stretching the neck behind. For this exercise, the motive is to turn your neck around in an attempt to see behind you. Here's how to practice the look behind the exercise:

  • Stand straight and turn your neck to the left as far behind as you comfortably can
  • Hold for a few seconds
  • Repeat on the other side
  • Repeat this set 4-5 times or more, however comfortable
  • Please note that your body must stay in the same position and angle throughout

Raised shoulders

This is another easy-to-follow exercise for cervical spondylosis. It also helps release tension from the neck and promotes a calming feeling. This is how to practice raised shoulders:

  • As the name suggests, try to raise your shoulders as you normally would
  • At this point, your shoulders might be touching your ears
  • Hold this position for a few songs and release
  • You can practice this position 10-15 times daily to reduce pain and stiffness

References:  

​​1. Cervical Spine – Anatomy, Diseases, and Treatments [Internet]. [cited 2023 Feb 21]. Available from: https://www.aans.org/en/Patients/Neurosurgical-Conditions-and-Treatments/Cervical-Spine 

​2. Cervical Spine (Neck): What It Is, Anatomy & Disorders [Internet]. [cited 2023 Feb 21]. Available from: https://my.clevelandclinic.org/health/articles/22278-cervical-spine 

​3. Cervical spondylosis - Symptoms and causes - Mayo Clinic [Internet]. [cited 2023 Feb 21]. Available from: https://www.mayoclinic.org/diseases-conditions/cervical-spondylosis/symptoms-causes/syc-20370787 

​4. Cervical Spondylosis: Symptoms, Causes, Treatments [Internet]. [cited 2023 Feb 21]. Available from: https://my.clevelandclinic.org/health/diseases/17685-cervical-spondylosis 

​5. Theodore N. Degenerative Cervical Spondylosis. New England Journal of Medicine. 2020 Jul 9;383(2):159–68.  

​6. Cervical spondylosis - Diagnosis and treatment - Mayo Clinic [Internet]. [cited 2023 Feb 21]. Available from: https://www.mayoclinic.org/diseases-conditions/cervical-spondylosis/diagnosis-treatment/drc-20370792 

​7. Cervical Spondylosis: Causes, Symptoms, Home Treatments, and More [Internet]. [cited 2023 Feb 21]. Available from: https://www.healthline.com/health/cervical-spondylosis#treatment 

​8. Cervical Spondylosis: 5 Exercises To Reduce Neck Pain [Internet]. [cited 2023 Feb 21]. Available from: https://www.ndtv.com/health/cervical-spondylosis-5-exercises-to-reduce-neck-pain-2988112 

March 3, 2023

Thyroid

The thyroid gland is a small organ that’s located in the front of the neck, wrapped around the windpipe (trachea). It’s shaped like a butterfly, smaller in the middle with two wide wings that extend around the side of your throat. The thyroid is a gland. You have glands throughout your body, where they create and release substances that help your body do a specific thing. Your thyroid makes hormones that help control many vital functions of your body. (1)

What does the thyroid do?

Your thyroid has an important job to do within your body — releasing and controlling thyroid hormones that control metabolism. Metabolism is a process where the food you take into your body is transformed into energy. This energy is used throughout your entire body to keep many of your body’s systems working correctly. Think of your metabolism as a generator. It takes in raw energy and uses it to power something bigger. (1)

The thyroid controls your metabolism with a few specific hormones — T4 (thyroxine, which contains four iodine atoms) and T3 (triiodothyronine, which contains three iodide atoms). These two hormones are created by the thyroid and they tell the body’s cells how much energy to use. When your thyroid works properly, it will maintain the right amount of hormones to keep your metabolism working at the right rate. As the hormones are used, the thyroid creates replacements. (1)

This is all supervised by something called the pituitary gland. Located in the center of the skull, below your brain, the pituitary gland monitors and controls the amount of thyroid hormones in your bloodstream. When the pituitary gland senses a lack of thyroid hormones or a high level of hormones in your body, it will adjust the amounts with its hormone. This hormone is called thyroid-stimulating hormone (TSH). The TSH will be sent to the thyroid and it will tell the thyroid what needs to be done to get the body back to normal.

Thyroid disease is a general term for a medical condition that keeps your thyroid from making the right amount of hormones. Your thyroid typically makes hormones that keep your body functioning normally. When the thyroid makes too much thyroid hormone, your body uses energy too quickly. This is called hyperthyroidism. Using energy too quickly will do more than make you tired — it can make your heart beat faster, cause you to lose weight without trying, and even make you feel nervous. On the flip side of this, your thyroid can make too little thyroid hormone. This is called hypothyroidism. When you have too little thyroid hormone in your body, it can make you feel tired, you might gain weight and you may even be unable to tolerate cold temperatures.

Hyperthyroidism (overactive thyroid)

Symptoms

Hyperthyroidism sometimes looks like other health problems. That can make it hard to diagnose. It can cause many symptoms, including:(2,3)

  • Losing weight without trying.
  • Fast heartbeat, a condition called tachycardia.
  • Irregular heartbeat, also called arrhythmia.
  • Pounding of the heart, sometimes called heart palpitations.
  • Increased hunger.
  • Nervousness, anxiety, and irritability.
  • Tremor, usually a small trembling in the hands and fingers.
  • Sweating.
  • Changes in menstrual cycles.
  • Increased sensitivity to heat.
  • Changes in bowel patterns, especially more-frequent bowel movements.
  • Enlarged thyroid gland, sometimes called a goiter, which may appear as a swelling at the base of the neck.
  • Tiredness.
  • Muscle weakness.
  • Sleep problems.
  • Warm, moist skin.
  • Thinning skin.
  • Fine, brittle hair.

Causes

Many diseases and conditions can cause hyperthyroidism, including:(4)

  • Graves’ disease (the most common cause of hyperthyroidism)
  • Inflammation (thyroiditis) of the thyroid due to viral infections, some medicines, or after pregnancy (common)
  • Taking too much thyroid hormone (common)
  • Noncancerous growths of the thyroid gland or pituitary gland (rare)
  • Some tumors of the testes or ovaries (rare)
  • Getting medical imaging tests with contrast dye that has iodine (rare, and only if there is a problem with the thyroid)
  • Eating too many foods that contain iodine (very rare, and only if there is a problem with the thyroid)

Exams and Tests

The healthcare provider will do a physical exam. The exam may find the following:(5)

  • High systolic blood pressure (the first number in a blood pressure reading)
  • Increased heart rate
  • Enlarged thyroid gland
  • Shaking of the hands
  • Swelling or inflammation around the eyes
  • Very strong reflexes
  • Skin, hair, and nail changes

Blood tests are also ordered to measure your thyroid hormones TSH, T3, and T4.

You may also have blood tests to check:

  • Cholesterol levels
  • Glucose
  • Specialized thyroid tests like Thyroid receptor antibody (TRAb) or Thyroid Stimulating Immunoglobulin (TSI)

Imaging tests of the thyroid may also be needed, including:

  • Radioactive iodine uptake and scan
  • Thyroid ultrasound (rarely)

Risk factors

The main risk factors for hyperthyroidism are:(6)

  • Sex. Females are much more likely to have hyperthyroidism than males. Experts believe this may have to do with hormones.
  • Pregnancy. Pregnancy can stimulate hyperthyroidism in some people, which can cause complications for both the parent and fetus.
  • Age. You’re considered at higher risk for hyperthyroidism as an older adult, especially after age 60.
  • Genetics. A family history of hyperthyroidism usually indicates an increased likelihood of developing the condition.
  • Iodine exposure. You may get too much iodine from certain medications or foods.
  • Having another health condition. People with type 1 diabetes, primary adrenal insufficiency, or pernicious anemia are considered more at risk.

Lifestyle is an important part of lowering your risk factors for hyperthyroidism. This includes eating a balanced diet, taking nutritional supplements if necessary, and getting adequate physical activity during the week. Work with your doctor to create a plan with individualized goals.

How to treat hyperthyroidism

Medication(6,7)

Anti-thyroid medications prevent the thyroid from making hormones. The most common anti-thyroid medications are a class called thionamides, which includes the drugs methimazole (MMI) and propylthiouracil (PTU).

Thionamides have been used to treat hyperthyroidism for decades, and are considered safe for both children and adults, including pregnant people. Anti-thyroid medications can have uncomfortable side effects such as joint pain, hair loss, and rash. In rare cases, they can cause liver damage.

Make sure to tell your doctor if you’re pregnant or plan on becoming so and if you take other medications. Always take medication as directed by your doctor.

Radioactive iodine

Radioactive iodine (RAI), also just called radioiodine, effectively destroys the cells that produce thyroid hormones without damaging other bodily tissues. It is usually taken as an oral tablet or liquid.

Most people who receive radioiodine treatment for hyperthyroidism develop the opposite condition, hypothyroidism. However, this is easier to treat, and you’ll take a daily thyroid hormone supplement. RAI is also used in higher doses to treat thyroid cancer.

In rare cases, at sustained higher doses, RAI is associated with an increased risk of certain cancers. This is not true in lower doses used to treat hyperthyroidism.

Side effects can occur with RAI treatment, especially at higher doses. These include neck pain, nausea, and dry mouth. RAI treatment at high doses can also impact fertility.

Surgery

During a thyroidectomy, all or part of your thyroid gland is removed. This surgery may be recommended for certain people with hyperthyroidism, but it’s evaluated on an individual basis. Surgery may be used for patients that don’t respond to other treatment options or can’t partake in them.

Thyroid gland removal is also used to treat types of thyroiditis, thyrotoxicosis, and thyroid cancer.

If your thyroid gland is fully removed, you will need to take thyroid hormone supplements for the rest of your life. The drug levothyroxine is a synthetic version of the thyroid’s T4 hormone and is usually prescribed in pill form. Taking this drug prevents hypothyroidism, an under-active thyroid that secretes too little hormone.

As with all surgeries, thyroid removal comes with risks and complications. The surgery is usually done by an endocrine surgeon, otolaryngologist, or general surgeon.

Hyperthyroidism diet 

Foods to eat if you have hyperthyroidism(8)

  • Low-iodine foodsThe mineral iodine plays a key role in making thyroid hormones. A low-iodine diet helps to reduce thyroid hormones. Add these foods to your daily diet:(8)
    • non-iodized salt
    • coffee or tea (without milk or dairy- or soy-based creamers)
    • egg whites
    • fresh or canned fruit
    • unsalted nuts and nut butter
    • homemade bread or bread made without salt, dairy, and eggs
    • popcorn with non-iodized salt
    • oats
    • potatoes
    • honey
    • maple syrup

    Cruciferous vegetables

    Cruciferous vegetables and other types may stop your thyroid from using iodine properly. They may be beneficial for hyperthyroidism:(8)

    • bamboo shoots
    • bok choy
    • broccoli
    • Brussels sprouts
    • cassava
    • cauliflower
    • collard greens
    • kale
    • mustard
    • rutabaga

    Vitamins and minerals

    Several nutrients are essential for thyroid health and to balance thyroid hormone production.

    Iron

    Iron is important for many vital bodily functions, including thyroid health. This mineral is needed for blood cells to carry oxygen to every cell in your body. (9)

    Low levels of iron are linked to hyperthyroidism. Get plenty of iron in your diet with foods such as:

    • dried beans
    • green leafy vegetables
    • lentils
    • nuts
    • poultry, such as chicken and turkey
    • red meat
    • seeds
    • whole grains

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Selenium

Selenium-rich foods may help to balance thyroid hormone levels and protect your thyroid from disease. Selenium helps to prevent cell damage and keep your thyroid and other tissues healthy. (8)

Good food sources of selenium include:
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Zinc

Zinc helps you use food for energy. This mineral also helps keep your immune system and thyroid health. Food sources of zinc include:(8)

Makkah Pharmacy recommends: 

Treatment(10)

Your doctor determines your breast cancer treatment options based on your type of breast cancer, its stage and grade, size, and whether the cancer cells are sensitive to hormones. Your doctor also considers your overall health and your own preferences.

Breast cancer surgery

  • Removing the breast cancer (lumpectomy). During a lumpectomy, which may be referred to as breast-conserving surgery or wide local excision, the surgeon removes the tumor and a small margin of surrounding healthy tissue.

A lumpectomy may be recommended for removing smaller tumors. Some people with larger tumors may undergo chemotherapy before surgery to shrink a tumor and make it possible to remove it completely with a lumpectomy procedure.

  • Removing the entire breast (mastectomy). A mastectomy is an operation to remove all of your breast tissue. Most mastectomy procedures remove all of the breast tissue — the lobules, ducts, fatty tissue, and some skin, including the nipple and areola (total or simple mastectomy).

Newer surgical techniques may be an option in selected cases to improve the appearance of the breast. Skin-sparing mastectomy and nipple-sparing mastectomy are increasingly common operations for breast cancer.

  • Removing a limited number of lymph nodes (sentinel node biopsy). To determine whether cancer has spread to your lymph nodes, your surgeon will discuss with you the role of removing the lymph nodes that are the first to receive the lymph drainage from your tumor.

If no cancer is found in those lymph nodes, the chance of finding cancer in any of the remaining lymph nodes is small and no other nodes need to be removed.

    • Removing several lymph nodes (axillary lymph node dissection). If cancer is found in the sentinel lymph nodes, your surgeon will discuss with you the role of removing additional lymph nodes in your armpit.
    • Removing both breasts. Some women with cancer in one breast may choose to have their other (healthy) breast removed (contralateral prophylactic mastectomy) if they have a very increased risk of cancer in the other breast because of a genetic predisposition or strong family history.
  • Radiation therapy
  • Chemotherapy
  • Hormone therapy
  • Immunotherapy

Most women with breast cancer in one breast will never develop cancer in the other breast. Discuss your breast cancer risk with your doctor, along with the benefits and risks of this procedure.

References 

  1. Thyroid Disease: Causes, Symptoms, Risk Factors, Testing & Treatment [Internet]. [cited 2023 Jan 21]. Available from: https://my.clevelandclinic.org/health/diseases/8541-thyroid-disease
  2. Davies TF, Schwartz AE. Hyperthyroidism. Endocrine Surgery [Internet]. 2003 Jan 1 [cited 2023 Jan 21];101–14. Available from: https://www.mayoclinic.org/diseases-conditions/hyperthyroidism/symptoms-causes/syc-20373659
  3. Hyperthyroidism - Symptoms and causes - Mayo Clinic [Internet]. [cited 2023 Jan 21]. Available from: https://www.mayoclinic.org/diseases-conditions/hyperthyroidism/symptoms-causes/syc-20373659
  4. Ross DS, Burch HB, Cooper DS, Greenlee MC, Laurberg P, Maia AL, et al. 2016 American Thyroid Association Guidelines for Diagnosis and Management of Hyperthyroidism and Other Causes of Thyrotoxicosis. Thyroid. 2016 Oct 1;26(10):1343–421. 
  5. Hyperthyroidism (Overactive Thyroid) - Symptoms and Causes [Internet]. [cited 2023 Jan 21]. Available from: https://www.pennmedicine.org/for-patients-and-visitors/patient-information/conditions-treated-a-to-z/hyperthyroidism-overactive-thyroid
  6. Hyperthyroidism: Causes, Symptoms, Treatment, Diagnosis & More [Internet]. [cited 2023 Jan 21]. Available from: https://www.healthline.com/health/hyperthyroidism#risk-factors
  7. Overactive thyroid (hyperthyroidism) - Treatment - NHS [Internet]. [cited 2023 Jan 21]. Available from: https://www.nhs.uk/conditions/overactive-thyroid-hyperthyroidism/treatment/
  8. Hyperthyroidism Diet Plan: Foods to Eat and Foods to Avoid [Internet]. [cited 2023 Jan 21]. Available from: https://www.healthline.com/health/hyperthyroidism-diet#foods-to-eat
  9. Wang YP, Lin HP, Chen HM, Kuo YS, Lang MJ, Sun A. Hemoglobin, iron, and vitamin B12 deficiencies and high blood homocysteine levels in patients with anti-thyroid autoantibodies. Journal of the Formosan Medical Association. 2014;113(3):155–60. 
  10. Hypothyroidism (underactive thyroid) - Symptoms and causes - Mayo Clinic [Internet]. [cited 2023 Jan 21]. Available from: https://www.mayoclinic.org/diseases-conditions/hypothyroidism/symptoms-causes/syc-20350284
  11. Hypothyroidism (Underactive Thyroid): Symptoms, Causes, Tests, Treatments [Internet]. [cited 2023 Jan 21]. Available from: https://www.webmd.com/women/hypothyroidism-underactive-thyroid-symptoms-causes-treatments
  12. Underactive thyroid (hypothyroidism) - Diagnosis - NHS [Internet]. [cited 2023 Jan 21]. Available from: https://www.nhs.uk/conditions/underactive-thyroid-hypothyroidism/diagnosis/
  13. Hypothyroidism: Causes and Risk Factors [Internet]. [cited 2023 Jan 21]. Available from: https://www.verywellhealth.com/hypothyroidism-causes-risk-factors-3231721
  14. Hypothyroidism (Underactive Thyroid): Symptoms, Causes, Treatment [Internet]. [cited 2023 Jan 21]. Available from: https://www.healthline.com/health/hypothyroidism/symptoms-treatments-more#medication
March 3, 2023

Urinary Incontinence

When you're on your way to a shopping mall, do you think about the exact location of each toilet before you get there? And when you are out and laughing with your friends, do you hold back your laughter for fear of getting your clothes wet (with urine)? And when you put the key in the lock of the door of your house or apartment, do you feel confused by the uncontrollable urge to urinate? Does urine leak when you cough or sneeze?

If you answered yes to any of these questions, you may have urinary incontinence.

Urinary incontinence is the leaking of urine that you can't control. Many people suffer from urinary incontinence. We don't know for sure exactly how many. That's because many people do not tell anyone about their symptoms. They may be embarrassed, or they may think nothing can be done. So they suffer in silence.​(1)​ 

Urinary incontinence is not just a medical problem. It can affect emotional, psychological, and social life. Many people who have urinary incontinence are afraid to do normal daily activities. They don't want to be too far from a toilet. Urinary incontinence can keep people from enjoying life.

Many people think urinary incontinence is just part of getting older. But it's not. And it can be managed or treated.

Types of urinary incontinence include:​(2)​​

  • Stress incontinence: Urine leaks when you exert pressure on your bladder by coughing, sneezing, laughing, exercising, or lifting something heavy.
  • Urge incontinence: You have a sudden, intense urge to urinate followed by an involuntary loss of urine. You may need to urinate often, including throughout the night. Urge incontinence may be caused by a minor condition, such as infection, or a more severe condition such as a neurological disorder or diabetes.
  • Overflow incontinence: You experience frequent or constant dribbling of urine due to a bladder that doesn't empty.
  • Functional incontinence: A physical or mental impairment keeps you from making it to the toilet in time. For example, if you have severe arthritis, you may not be able to unbutton your pants quickly enough.
  • Mixed incontinence: You experience more than one type of urinary incontinence — most often this refers to a combination of stress incontinence and urges incontinence. 

You may feel uncomfortable discussing incontinence with your doctor. But if incontinence is frequent or is affecting your quality of life, it's important to seek medical advice because urinary incontinence may:​(2)​ 

  • Cause you to restrict your activities and limit your social interactions 
  • Negatively impact your quality of life 
  • Increase the risk of falls in older adults as they rush to the toilet 
  • Indicate a more serious underlying condition

Causes of urinary incontinence 

Chronic or long-term causes of incontinence can include:​(3)​ 

  • Pelvic floor disorders: When you have an issue with your pelvic floor muscles, it can impact the way your organs function, including your bladder.
  • Stroke: A stroke can cause you to experience issues with muscle control. This can include the muscles that regulate your urinary system.
  • Diabetes: When you have diabetes, your body produces more urine. This increase in the amount of urine can cause leakage issues. In addition, peripheral neuropathy can affect the bladder’s function.
  • Menopause: Menopause is another time of change in a woman’s body when hormone levels change rapidly and pelvic floor muscles can also become weaker — something that also can happen as you get older.
  • Multiple sclerosis (MS): If you have MS, you may experience a loss of control of your bladder, leading to leakage issues.
  • Enlarged prostate: When the prostate is larger than normal, it can cause several bladder control issues. You might also hear this condition called benign prostatic hyperplasia, or BPH.
  • After prostate cancer surgery: During prostate cancer surgery the sphincter muscle can sometimes be damaged leading to stress incontinence.

Why does pregnancy cause incontinence?​(3)​ 

During pregnancy, your body goes through a lot of physical changes. As your uterus stretches to hold the growing baby, a few things happen. Your bladder can be squished by the expanding baby, making your bladder hold less than before. You might experience an increased urgency to pee during pregnancy because your bladder cannot hold as much as before. This might become even more challenging towards the end of pregnancy when the baby is at its largest. 

Another reason for incontinence during pregnancy is the weakening of your pelvic floor muscles. These muscles are the support structures for all of the organs in your pelvis. During pregnancy, they can be stretched and weakened as your uterus expands. 

Signs and Symptoms of Urinary Incontinence​(4)​ 

  • Leaking urine during normal activities like lifting, bending, coughing, or exercising​(5)​ 
  • Sudden, strong urges to urinate, or feeling like you might not make it to the toilet in time 
  • Leaking urine without feeling any warning signs or urge 
  • Bed-wetting 

Treatment

Treatment will depend on several factors, such as the type of incontinence, the patient’s age, general health, and mental state. 

Stress incontinence 

Pelvic floor exercises, also known as Kegel exercises, help strengthen the urinary sphincter and pelvic floor muscles – the muscles that help control urination.​(5)​ 

Bladder training​(5)​ 

  • Delaying the event: The aim is to control the urge. The patient learns how to delay urination whenever there is an urge to do so. 
  • Double voiding: This involves urinating, then waiting for a couple of minutes, then urinating again. 
  • Toilet timetable: The person schedules the bathroom at set times during the day, for example, every 2 hours. 

Bladder training helps the patient gradually regain control over their bladder. 

Medications for urinary incontinence 

If medications are used, this is usually in combination with other techniques or exercises. 

The following medications are prescribed to treat urinary incontinence:​(5)​ 

  • Anticholinergics calm overactive bladders and may help patients with urge incontinence. 
  • Topical estrogen may reinforce tissue in the urethra and vaginal areas and lessen some of the symptoms. 

Imipramine (Tofranil) is a tricyclic antidepressant. 

Medical devices 

The following medical devices are designed for females.​(5)​ 

  • Urethral inserts: A woman inserts the device before activity and takes it out when she wants to urinate. 
  • Pessary: A rigid ring inserted into the vagina and worn all day. It helps hold the bladder up and prevent leakage. 
  • Radiofrequency therapy: Tissue in the lower urinary tract is heated. When it heals, it is usually firmer, often resulting in better urinary control. 
  • Botox (botulinum toxin type A): Injected into the bladder muscle, this can help those with an overactive bladder. 
  • Bulking agents: Injected into the tissue around the urethra, these help keep the urethra closed. 
  • Sacral nerve stimulator: This is implanted under the skin of the buttock. A wire connects it to a nerve that runs from the spinal cord to the bladder. The wire emits an electrical pulse that stimulates the nerve, helping bladder control. 

 

Surgery​(5)​ 

Surgery is an option if other therapies do not work. Women who plan to have children should discuss surgical options with a doctor before making the decision. 

  • Sling procedures: A mesh is inserted under the neck of the bladder to help support the urethra and stop urine from leaking out. 
  • Colpo suspension: Lifting the bladder neck can help relieve stress incontinence. 
  • Artificial sphincter: An artificial sphincter, or valve, may be inserted to control the flow of urine from the bladder into the urethra. 

Supplements for Incontinence 

Magnesium

 Magnesium helps your body with a host of functions, including lowering high blood pressure, regulating mood, and helping to guard against Type 2 diabetes. It also ensures our muscles and nerves function properly, and some experts believe that it may help improve incontinence symptoms by reducing bladder muscle spasms, and allowing the bladder to empty.​(6)​ 

   sources of magnesium: bananas, avocados, black beans, cooked quinoa, certain fish, dark leafy greens, nuts, and seeds. 

 

Using Supplements for Diabetes Treatment 

According to the American Diabetes Association, diabetics are more likely to use supplements than those without the disease.​(9)​ 

Supplements should not be used to replace standard diabetes treatment. Doing so can put your health at risk. 

It is important to talk to your doctor before using any supplements. Some of these products can interfere with other treatments and medications. Just because a product is natural does not mean it is safe to use.

Cinnamon

A study has shown that cinnamon, in whole form or extract, helps lower fasting blood glucose levels​(9)

Chromium

Chromium is an essential trace element. It is used in the metabolism of carbohydrates. However, research on the use of chromium for diabetes treatment is mixed. Low doses are safe for most people, but there is a risk that chromium could make blood sugar go too low. High doses also have the potential to cause kidney damage.​(9)

Green Tea

Green tea contains polyphenols, which are antioxidants. 

The main antioxidant in green tea is known as epigallocatechin gallate (EGCG). Laboratory studies have suggested that EGCG may have numerous health benefits including:​(9)​ 

  • lower cardiovascular disease risk 
  • prevention of type 2 diabetes 
  • improved glucose control 
  • better insulin activity 

Magnesium 

Magnesium is an essential nutrient. It helps regulate blood pressure. It also regulates insulin sensitivity. Supplemental magnesium may improve insulin sensitivity in diabetics. 

A high magnesium diet may also reduce the risk of diabetes. Researchers have found a link between higher magnesium intake, lower rates of insulin resistance, and diabetes.​(9)

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Vitamin D

 Vitamin D is known to help with bone health, as well as the immune system, heart health, blood sugar levels, and mood regulation. Studies have also found that vitamin D deficiency is associated with a higher risk of pelvic floor disorders. And, in one study of older women, the risk of developing urinary incontinence was 45% lower among those with normal vitamin D levels. ​(6)​ 

  

The best way to get most of the vitamin D you need is from sun exposure, but it’s also found in many dairy products, such as milk, yogurt, eggs, fish, and supplements. 
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Vitamin C  

Good sources of Vitamin C can be found in citrus fruits, green and red peppers, broccoli, Brussels sprouts, cauliflower, leafy greens, sweet and white potatoes, and tomatoes (including tomato juice!).​(7)​ 

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References

​​1. Incontinence: Symptoms & Treatment - Urology Care Foundation [Internet]. [cited 2022 Dec 30]. Available from: https://www.urologyhealth.org/urology-a-z/u/urinary-incontinence 

​2. Urinary incontinence - Symptoms and causes - Mayo Clinic [Internet]. [cited 2022 Dec 30]. Available from: https://www.mayoclinic.org/diseases-conditions/urinary-incontinence/symptoms-causes/syc-20352808 

​3. Incontinence: Leakage, Causes, Diagnosis, Treatment & Prevention [Internet]. [cited 2022 Dec 30]. Available from: https://my.clevelandclinic.org/health/diseases/17596-urinary-incontinence#symptoms-and-causes 

​4. What Is Urinary Incontinence? Symptoms, Causes, Diagnosis, Treatment, and Prevention | Everyday Health [Internet]. [cited 2022 Dec 30]. Available from: https://www.everydayhealth.com/urinary-incontinence/guide/ 

​5. Urinary incontinence: Treatment, causes, types, and symptoms [Internet]. [cited 2022 Dec 30]. Available from: https://www.medicalnewstoday.com/articles/165408#treatment 

​6. Supplements for Incontinence | Incontinence Institute [Internet]. [cited 2022 Dec 30]. Available from: https://myconfidentlife.com/blog/supplements-for-incontinence 

​7. 3 Vitamins That May Help With Bladder Control - National Association For Continence [Internet]. [cited 2022 Dec 30]. Available from: https://nafc.org/bhealth-blog/3-vitamins-that-may-help-with-bladder-control/ 

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