FEMALE HEALTH
- particularly in the second and third trimesters - is a normal side effect of pregnancy due simply to the baby pressing on the bladder. There are some cases, however, when frequent urination may signal an underlying problem. If, for example, the frequent urge to urinate is accompanied by burning pain on urinating, the woman may have a urinary tract infection (UTI). Equally, if she frequently needs to urinate, but isn’t able to pass more than a small amount of fluid, a UTI may also be responsible.
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UTIs are a common cause of frequent urination even in women who are not pregnant. They’re usually caused by bacteria entering the bladder through the urethra and are actually so common that it’s estimated that between 50-60 per cent of women will experience at least one UTI during their lifetime, with one third of women experiencing one before the age of 24 that’s severe enough to require treatment with antibiotics!
TREATMENT
Treatment for stress incontinence varies according to the underlying cause of the patient’s problem. A GP will normally carry out tests to determine the cause of a patient’s incontinence and will then help the patient to manage her condition through a combination of medical treatment and possible lifestyle changes.
MEDICATION
The most commonly prescribed medicines for OAB or incontinence include:
Duloxetine: a medication that can increase the muscle tone of the urethra, which can help keep it closed; Antimuscarinics: such as oxybutynin tablets, which affect the detrusor muscles in the wall of the bladder; Mirabegron, which causes the bladder muscle to relax, helping the bladder fill up with and store urine, and Desmopressin, which reduces the amount of urine produced.
There are, however, various other forms of non-medication treatment which can be recommended by a GP.
Lifestyle changes: Known as behavioural therapy, a GP may suggest lifestyle changes, such as stopping smoking, since nicotine can actually irritate the bladder and may contribute to the problem. Caffeine and alcohol should also be avoided,
38 - SCOTTISH PHARMACIST
since these beverages act as bladder irritants. Weight loss may also be advised.
Pelvic muscle training: Particularly popular in pregnant women, pelvic floor muscle exercises can help treat stress incontinence, as these exercises, which are known as Kegel exercises, help to make the sphincter and pelvic muscles stronger.
SURGERY
In severe cases of stress incontinence, a GP may recommend surgery. Several types of procedures are available, such as vaginal repairs and other procedures which are designed to lift the bladder and urethra.
ACUPUNCTURE
Acupuncture is an ancient Chinese form of healing that has been used to treat illness for centuries. One recent study reported that manipulating specific acupuncture points could potentially ease urinary incontinence and frequent urination. •
SELF HELP
FOR PATIENTS As the pharmacist, you should advise a female patient to:
* Avoid food and beverages that could be bladder irritants, including coffee, caffeinated beverages, citrus fruits and juices, tomatoes, spicy food, carbonated drinks (including those that are sugar free) and alcohol in all forms.
* Try consuming most of her fluids during the day to reduce the number of trips she has to make to the bathroom in the middle of the night.
* Try, where possible, to not let her bladder get over full! If she has to go, she should go! At the same time, she shouldn't restrict her fluid intake as this may have detrimental effect in other ways.
* Take steps to avoid constipation as impacted stool can also put pressure on the bladder. straining hard during bowel movements can also weaken pelvic floor muscles.
* Keep a 'bladder diary', which is basically a detailed symptom record. This will enable the GP to determine the causes of bladder control problems more effectively.
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