DIABETES AND ITS EFFECT ON THE BLADDER AND URINARY SYSTEM

Diabetes has quite an adverse effect on your bladder. You might have seen that a diabetic person drinks too much water or juice or other fluids etc., and also he goes to the toilet to pass urine every now and then. That is due to the reason that in the case of diabetes, our kidneys experience difficulty to filter or separate glucose from the blood and since they are working most of the time in this filtering process therefore the urine remains most of the time in the kidneys, ureters and the bladder and this results into the condition of osmotic dieresis. Osmotic dieresis is the increased urination due to the presence of certain substances in the urine that came out from the kidneys. The process of osmosis created by these substances causes the additional water to increase the volume of urine. 

At the initial stage of this condition, the patient with diabetes repeatedly passes water at short intervals. His bladder wall muscles also change due to which certain side effects can develop that make the bladder hyperactive due to detrusor overactivity. In this situation, a diabetic person goes to the bathroom very frequently and often wakes up in the middle of his sleep at night to pass water which is contrary to his habitual routines in the past but now it has changed. That is because of various reasons for example diabetes also affects a patient’s nervous system. That is why you might have noticed that some individuals suffering from diabetes complain that they are feeling insensitivity or have a tingling sensation in the sole of their feet and fingers. Anyhow this condition can lead to diabetic cystopathy in the long run which is its bad effect on the bladder. Diabetic cystopathy is a chronic complication of diabetes with symptoms like decreased bladder sensation, increased bladder capacity, and impaired detrusor contractility.

It means that the bladder of a diabetic patient remains no more hyperactive. However, it becomes now troublesome for him to void his bladder. He starts urinating after some more time of stressing and straining and his urine stream is not continuous but stops in the middle and starts again repeatedly. After some time it will become quite difficult for him to fully empty his bladder. However, if he can control his blood sugar to a good level it may prove to be quite helpful to overcome this condition. If it becomes very difficult for you to void the bladder despite all frightfully troubling symptoms, you can likewise get an intermittent infection of the bladder or urinary tract. The reason this happens is that perhaps your diabetes is very much above normal; the urine in your bladder has abnormally high sugar which becomes nourishment for microorganisms or bacteria and it gives them a more ideal environment to remain there; you cannot void your bladder completely; your bladder has shortened in the inside and your bladder muscles have been damaged because of neuropathy encountered by your bladder. (@ chhanno blogspot com 13112021)

The bottom line here is that you must manage the level of sugar in your blood since ensuring a controlled sugar in your blood can assist to keep a healthy bladder. Anyway, in case your bladder is hyperactive and in case you're experiencing difficulty in fully voiding the bladder kindly consult a specialist doctor since he can help you a lot through various ways and treatment strategies for the improvement of your healthy living.

 

 As a marginal comment for male patients of diabetes please note that it can be a reason for bad erectile functions. Men at a very young age can have erection problems due to prolonged or chronic diabetes. Although erection problems have many remedies available yet it’s a big issue in the level of comfort living for some men with diabetes mellitus. It is one more indication for you to ensure assume responsibility to manage a good level of your blood sugar. Also please go consult a specialist doctor preferably a urologist in case it’s a matter of great distress for you as he can help you quite very well. 

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(Updated on 07-12-2022)

WHAT IS THE ULTIMATE TREATMENT FOR OVERACTIVE BLADDER | PACEMAKER FOR OVERACTIVE BLADDER:

 

Overactive bladder means frequent urination or passing urine more than eight times a day, waking up at night to pass urine more than twice, and cannot reach the washroom in time occasionally and having a mishap. If you have an overactive bladder and you have tried your best to overcome this situation, you have consulted your specialist doctor, you have restricted all bladder irritant foods and drinks, you have dealt with your irregular bowels and taken all possible medicines but nothing proved successful. Now, is there any other remedy for this situation? In this article, we shall discuss bladder pacemaker implants which could assist patients with such symptoms. We shall discuss the real course of action, how it is done and the side effects that you may come across after the implant is done. 

A bladder pacemaker also called sacral neuromodulation is a treatment used to help many patients with bladder control problems and who do not respond to behavioral and pharmacological therapy. It is a safe, efficacious and minimally invasive advanced therapy indicated to treat urinary incontinence, urinary retention, urgency, frequency, and fecal incontinence. There are sacral nerves that control the muscles in the pelvic floor, the bladder, and the muscles needed for urinary control. A bladder pacemaker balances the performance of the bladder by triggering the sacral nerve root going down the bladder.  

In this case, clinical success is defined if the symptoms of overactive bladder achieve progress by fifty percent. Overactive bladder is defined by the following four indications. One is the urinary frequency which means frequently going to the toilet to pass urine; urinary urgency means immediate and urgent need of going to the toilet to pass urine and it’s quite hard to stop or linger on; nocturia means to get up to pass urine in the middle of your night sleep while urinary incontinence means unintentional discharge of urine before reaching the toilet on feeling the sensation of passing urine. If we consider statistics concerning the successful implant of bladder pacemakers we come to know that clinical success has been achieved by eighty-three percent of patients within one year, seventy-six percent of patients within three years, and sixty-seven percent were successful on completion of five years of the implant. The statistics given here may not presumably contain the real figures and may be on the lower side because the individuals who left the survey were categorized as unsuccessful whether they did not come back for a re-examination of their implant or they shifted elsewhere and couldn't go on in the survey.  (@ chhanno blogspot com 01112021). 

Let’s discuss the working of a bladder pacemaker. Its implant is initially done for a trial for one or two weeks which is quite good due to the implant of a provisional wire or lead for one or two weeks in your back, very close to the nerve root. Your spine is kept away or at a small distance from this wire or implant and has no contact with this gadget. It simply goes very close to the nerve root. This is quite a thin wire and it’s the only wire that is implanted as a final one. That lead excites the nerve through its single contact point. One end of that lead is inserted inside of the body while its other end is connected to an outside battery. You have to wear that battery to remain there, out of your body. During the trial period, you have to wear the battery for seven to about fourteen days keeping in view the place from where your initial phase of surgery was performed. This initial phase of surgery may be done in some medical centers wherein local anesthesia is used meaning the area under surgery is numbed using a medicine locally. If you like this procedure can also be done in some OT. The anesthesia used in the OT is not so strong and does not make you completely snooze however you take a few more medicines to be somewhat more at ease during the surgery. At the same time, the wire is inserted through your back for a trial period which extends from seven to fourteen days as stated earlier. Following seven days or fourteen days you have the option to choose whether the condition of your overactive bladder has improved or otherwise and depending upon that assessment in case your condition has improved you may choose to go for the second procedure for the implant of second and last lead. 

There are four contact points in the second and final lead and it is accompanied by a programmable remote control through which each point can be stimulated separately or in the desired combination. With the help of this remote control, the best and desired stimulation can be detected easily. The pacemaker gets power from a battery which is available in two types that can be chosen as per your choice. One type of it cannot be recharged and is being used for a long time, most often for cardio pacemakers and others. Its efficient life span extends around 3 years to 5 years. The second type of battery is a rechargeable one and its size is nearly one-fourth of the first battery. The good thing is that it keeps working for as long as fifteen years after every seven days or so of regular recharging. A Velcro belt that contains a battery charger is required for you to wear. Whenever needed, you just have to push on a button on it and sit for around twenty minutes to fully charge it. Very simple and easy, and it also allows you to schedule how often you need to recharge it. 

 

Indeed, you will have some pain during and after the surgery. Although the feeling of pain depends on person to person basis however most of the patients consider it not a severe one. However, to add strength to the patients some light or sometimes a stronger painkiller may be helpful. Ordinarily, such medicines are sufficient for you since you have only minor cuts or incisions during this procedure. You have only one small cut for the lead position and another comparatively large cut sufficient to insert the battery beneath the skin. Batteries are manufactured mainly for implanting them beneath the skin. Therefore, the cut or procedure is exceptionally not much excruciating. 

Like all surgeries, there may also be some minor hazards in the procedure of pacemaker implant. For instance, the patient may catch some exceptionally rare infection, especially in a typical sterilized environment where this is done. In case some discharge oozes out from the cut and some inflammation or rosy tint is encircling the cut or such things it indicates an infection and if it happens you have to get the pacemaker device taken out which is again an incredibly rare case. Nearly twenty percent of the patients report uneasiness due to stimulation by the pacemaker which is quite a common response. This is so because its stimulation creates a humming or quivering feeling down there or in the bladder region. In case the stimulation is once in a while turned excessively high it tends to be painful or uneasy. Sometimes people also report uneasy feelings when the program of the device is modified. Such humming feelings are most commonly felt at the beginning when the program of the pacemaker is started but when you are accustomed to it you take it as something quite ordinary and do not feel it at all any longer. In nearly fifteen percent of the cases, people complain of some annoying pain in the implant site or the area where the battery is inserted. While this is truly irritating, however, physicians have certain methods and ways of assessing the pain and choosing if it is because of device stimulation or any other thing that is causing it. Your physician then coordinates with you to ensure find a solution for you to recover from pain.  (@ chhanno blogspot com 01112021). 

Finally, if we look at the statistics about the clinical effectiveness of this device and the patients who are not satisfied with it and complain that the bladder pacemaker is not giving the desired results anymore it has been found that such cases are nearly thirteen percent. Now, this is also a risk factor because although the device worked quite alright earlier it may quit working for you eventually. It happens because there are so many distinct reasons that can cause overactive bladder symptoms. 

 

This device has an additional feature that is quite fascinating. It can also be utilized for the treatment of non-obstructive urinary retention or experiencing it hard to pass urine despite there being no obstacle. Suppose you cannot pass urine easily and prostate enlargement is not the reason in male patients or a shorter sling narrowing urethra in ladies, this device can be helpful in such cases. Similarly, it is useful for fecal incontinence as well. Generally speaking, this is a magnificent device. Patients who have used this device are excited about their satisfaction. To succeed in your effort to control your urinary incontinence, please also go see a nearby urologist and ask about the use of this medical procedure and implant. In case you do not like to undergo surgery you may try more choices still there as well. For example, you have bladder Botox or posterior tibial nerve stimulation that resembles acupuncture therapy for bladder incontinence. 

OK, thank you so much. Take care everywhere and always.  

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 (Updated on 25-01-2023)

WHAT ARE THE BEST AND SAFE MEDICINES FOR OVERACTIVE BLADDER?

What is overactive bladder, what medicines or remedies are available for its treatment, are these medicines safe for all people and how much are these medicines effective? Let’s find out what urologists say all about it. Maybe we have answers to all of these questions that can satisfy you. 

 

The term overactive bladder portrays a group of various indications comprising urinary urgency, urinal frequency, urinary incontinence, and nocturia. Urinary urgency is a condition wherein people have to hurry to reach the toilet to pass water since it’s difficult for them to wait any longer. When you frequently go to the toilets to pass water that exceeds 8 times daily which is above normal you have an indication called urinary frequency. Some patients suddenly feel an urgent need to pass water that is so immediate and forceful that they cannot reach the toilets and have to face leakage of urine every now and then. It is called urinary incontinence. Then there is Nocturia which means waking up to urinate in the middle of your sleep at night. 

There are medicines for the treatment of any of the above-mentioned indications and anyone who comes across them should, first of all, try medicines. Overactive bladder medicines are normally categorized into two groups. One group is called anticholinergics which include Trospium, Oxybutynin, Solifenacin, Tolterodine, and several other types of medicines. According to a most recent study, anticholinergic medicines are associated with dementia and that will be discussed at the end of this article. The other group is called Beta-3 agonists and the only medicine of this group available in the stores for urinary incontinence is called Mirabegron. 

Due to anticholinergic medicines there is no contraction or shrinking of the bladder or the bladder has quite a powerless contraction. When there are fewer contractions of the bladder you feel the urinary urgency will also decrease as a consequence and you will not feel so strong an urge to go to the washroom. Moreover, you will have a longer period to reach the toilet and thus have fewer mishaps. Your bladder will build in size and the gap between the two voidings will also increase. Your frequent daytime toilet visits will get reduced considerably due to such medicines.  (@ chhanno blogspot com 24102021) 

In various studies, it has been observed that people got relief from incontinence, urinary urgency, and frequent urination significantly by taking anticholinergic medicines. The volume of their urine passed each time also increased significantly. That is a sort of alternate method to know the real size of your bladder and the real volume of your urine that you can hold in the bladder. So such medicines are effective but patients with bladder incontinence often don’t take them constantly. The reason is that these medicines have a few critical adverse reactions like dry mouth, dry eyes, blurry eyesight, constipation, etc. The patients also experience a few mental changes which involve impairments of thinking, reasoning, and remembering however every patient does not experience such changes but a few of them surely can experience them. Individuals who have a history of these adverse effects are not advised to take these medicines. These medicines are also not given to patients who have any kind of urinary retention. Further, in case of having narrow-angle glaucoma, (perhaps an ophthalmologist can better explain it) you would be prohibited to take them even if these are required by you. This medicine is also not given to patients who have Gastroparesis which means slow movement of food from your stomach to your small intestine. 

 

The statistics on anticholinergic medicines reveal that nearly 60% of overactive bladder patients quit these medicines within a half year and they do it due to so many reasons. Perhaps they quit these medicines for being ineffective or having unpleasant adverse effects or they think they can happily survive not using them or they think they should not always take these medicines or they have no information about alternate options, therefore, they simply discontinued taking it and didn't request any other thing. Thus, whenever patients of urinary incontinence are advised to take anticholinergic medicines they should continue taking them and in case of any side effect or adverse effect follow the advice of their physician since many alternative remedies are available which may strengthen conditions of a weak bladder without medicines. 

 

Beta-3 Agonist is another type of medicine and only one medicine with the name Mirabegron is available in the market. It portrays a normal thing that sticks to the bladder receptors which makes the bladder loosen up and not contract. It functions by decreasing the feeling that you need to go to the washroom. It also expands the size of the bladder to retain more urine and does not have too many side effects. However, one of its side effects is that patients’ BP slightly increases by nearly 10 mm Hg and that’s why they remain under observation after seven days of starting the medicine to ensure that their blood pressure remains within limits instead of getting excessively elevated. There is also some nasal congestion and headaches but these are not too severe. If you're already on some other medicine you should regulate it while using this medicine by consulting your physician. The beta blockers called Toprol or Metoprolol are the most well-known medicine the dosage of which needs to be adjusted. Usually, this medicine is very well tolerated and many patients respond to it well enough. However, medicines with trademarks at times cost too much. Thus, although it is somewhat well-tolerated people occasionally can't bear its cost and look for alternative medicines. 

 

On the subject of an association between anticholinergic medicines and dementia, the two latest studies were released comparatively not long ago. It was released in the British Medical Journal, and by analyzing a very large research database already available, they discovered in that database nearly 40 thousand individuals more than 65 years of age have dementia. These individuals were placed in one group. Individuals of the same age and other significant medical conditions but without dementia were also traced from the same large database and placed in the second group. People in the group having dementia were coupled with people having similar ages and medical conditions in the other group not having dementia and the two groups were then compared. The main focus of this study was explicitly on medicines these people were taking from four to twenty years earlier than their dementia was identified. The confounding factors were also tried to be controlled. Confounding factors means the things which may be interconnected with dementia and may likewise be seen ordinarily in individuals using anticholinergic medicines. The age of the people, their smoking habits, their medicines being used, and different factors which may be causing dementia were also considered. It was found that the danger to get dementia was explicitly connected with the medicines for bladder incontinence in case these medicines were taken four to twenty years earlier than their dementia was identified. This study faced much criticism. The main criticism was that they are retrospectively analyzing a past database, and secondly, we couldn’t say whether the confounding factors could be managed since we have no idea about the basic reason for dementia. Further, we cannot regulate if the prescribed medicine were used or anticholinergics that were accessible without a prescription were used. May be that certain individuals were attributed to the “dementia-free” category but they could be taking these medicines. 

The criticism of the above-mentioned database resulted in one more hypothesis namely “a few things, say urinary incontinence might be almost the same amongst the people who had been taking anticholinergic medicine and those who had dementia in both groups separately which implies that the basic reason, for instance, urinary incontinence, maybe going before their dementia.” This is so because urinary incontinence in a few cases like multiple sclerosis is the first-ever indication of neurological issues. Thus there is a possibility of its being the initial sign of dementia. In case you see some urinary incontinence this may be the first indication that you will be seeing however nothing can be said with certainty. It’s difficult to assess which one of the two symptoms is responsible to cause the other however what we can say with surety is that an association between the two is there. Does it mean to stop taking medicines for overactive bladder that are helpful to further elevate your level of well-being? Well, the decision in this respect is yours however in case your level of well-being is unsatisfactory these medicines may be quite helpful. (@ chhanno blogspot com 24102021). 

Quite like the above study another study was released by American Medical Association. In this study, the data of sixty-thousand individuals having dementia were analyzed. The quantity of standard dose of anticholinergic medicine that is required per day was taken into account in this analysis to establish an association between the medicine and dementia. Now we can’t say with surety whether it’s the basis of dementia however what we can say with surety is that an association between the two is there. Anyhow, it was observed that taking a standard dose of this medicine per day continuously for 3 years or proportionate thereof is closely linked to dementia. Only the individuals above the age of 65 were taken in this study and the data of a maximum of the past eleven years till their dementia was identified during which they had been taking anticholinergic medicines was analyzed. 

Although these are perfect and all-around good studies however in the end we have no idea about the actual reason for dementia so far. It’s difficult to decide whether in the two groups anticholinergic medicines explicitly or a collective confounding component is responsible for dementia. The net result is that please use it carefully as an association between the two is there. For instance suppose a change in mental attitudes like carelessness or poor memory is noticed by you whether in yourself or a close relative on anticholinergic medicine then you must influence to stop that medicine forthwith, of course in consultation with your physician. Whenever you visit the physician you should talk to him about the effectiveness of your medicines since some medicines including anticholinergics which were prescribed for urinary incontinence yet you no longer remember their actual reason as well as these may not be so beneficial for you if continued. Therefore, you have to reassess your medicines each time you see your physician. Finally, you must be informed about the fact that more options are available for the treatment of bladder incontinence for example Botox injections, bladder pacemakers, or acupuncture. All these are nontraditional remedies and may function to improve overactive bladder. 

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(Updated on 08-01-2023)

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