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Uterine fibroids

Uterine fibroids (also called leiomyomas or myomas) are benign growths of the muscle inside the uterus. They are not cancerous, nor are they related to cancer. Fibroids can cause a wide variety of symptoms, including heavy menstrual bleeding and pressure on the pelvis.

Description

Uterine fibroids are extremely common. About 25% of women in their reproductive years have noticeable fibroids. There are probably many more women who have tiny fibroids that are undetected.

Fibroids develop in women between the ages of 30–50. They are never seen in women younger than 20 years old. After menopause, if a woman does not take estrogen, fibroids shrink. It appears that African American women are much more likely to develop uterine fibroids.


Fibroids are divided into different types, depending on the location. Submucous fibroids are found in the uterine cavity; intramural fibroids grow on the wall of the uterus; and subserous fibroids are located on the outside of the uterus. Many fibroids are so large that they fit into more than one category. The symptoms caused by fibroids are often related to their location.

Causes and symptoms

No one knows exactly what causes fibroids. The growth of fibroids, however, appears to depend on the hormone estrogen. Fibroids often grow larger when estrogen levels are high, as in pregnancy. Medications that lower the estrogen level can cause the fibroids to shrink.

The signs and symptoms of fibroids include:

• Heavy uterine bleeding. This is the most common symptom, occurring in 30% of women who have fibroids. The excess bleeding usually happens during the menstrual period. Flow may be heavier, and periods may last longer. Women who have submucous or intramural fibroids are most likely to have heavy uterine bleeding.
• Pelvic pressure and pain. Large fibroids that press on nearby structures such as the bladder and bowel can cause pressure and pain. Larger fibroids tend to cause more severe symptoms.
• Infertility. This is a rare symptom of fibroids. It probably accounts for less than 3% of infertility cases. Fibroids can cause infertility by compressing the uterine cavity. Submucous fibroids can fill the uterine cavity and interfere with implantation of the fertilized egg.
• Miscarriage. This is also an unusual symptom of fibroids, probably accounting for only a tiny fraction of the miscarriages that occur.
• Pregnancy complications. Fibroids can greatly increase in size during pregnancy, because of increased levels of estrogen. They can cause pain, and even lead to premature labor.

Diagnosis

A healthcare provider can usually feel fibroids during a routine pelvic examination. Ultrasound can be used to confirm the diagnosis, but this is not generally necessary.

Treatment

There are several natural treatments that help lower estrogen levels and slow the growth of the benign tumors. One study of alternative and complementary treatments for uterine fibroids found, however, that the cost of the alternative remedies was significantly higher than the cost of conventional treatments.

Nutritional therapy

There are several things women can do nutritional-wise to avoid having fibroids or prevent them from getting bigger:

• Eat more fruits, green or sea vegetables, whole grains, nuts, and seeds.
• Eat more soy foods such as tofu, tempeh, miso, or soy burger. Soy products contain isoflavones, which help reduce high levels of estrogens in the body.
• Avoid foods with high fat or sugar content, caffeine,or alcohol.
• Avoid eating produce sprayed with insecticides.

Nutritional supplements

The following supplements may be helpful in lowering estrogen levels and controlling fibroids:

• Bromelain: reduces inflammation.
• Choline: may improve liver function.
• Flaxseed: helps reduce excessive production of estrogens and other hormones.
• Vitamin E and evening primrose oil: help to regulate hormone production and may even shrink the fibroids.
• Vitamin C and bioflavonoids: have antiinflammatory and antioxidant effects.

Herbal treatment

Kuei-chih-fu-ling-wan (Keishi-bukuryo-gan; KBG) is a traditional Chinese herbal preparation that can effectively shrink fibroid tumors in 60% of patients, according to one study conducted by Japanese scientists. KBG is a mixture of the following herbs: cassia bark (Keihi), herbaceous peony roots (Shakuyaku), peach kernels (Tounin), herbaceous fungus (Bukuryo), and root bark of peony (Botanpi).

In addition to reducing fibroid size, KBG also successfully alleviated fibroid symptoms such as severe menstrual bleedings or menstrual pain in 90% of the women in the study. These researchers suggest that KBG may work by inhibiting the production of sex hormones including estrogen.

Unlike many other presently available herbal preparations that may be effective but lack scientific evidence to support their uses, KBG is proven safe as well as having few side effects. Women with fibroids, therefore, have one more alternative treatment to hysterectomy.

There are many herbal formulas that can be used depending on specific symptoms and body types. Another herbal treatment that may also be effective is wild yam progesterone cream. However, these are potent drugs and patients should consult their doctors before trying any of these treatments.

Homeopathy

A homeopathic physician may prescribe patient-specific homeopathic remedies to control fibroid symptoms.

Allopathic treatment

Not all fibroids cause symptoms. Even fibroids that do cause symptoms may not require treatment. In the majority of cases, the symptoms are inconvenient and unpleasant, but do not result in health problems.

Occasionally, fibroids lead to such heavy menstrual bleeding that the woman becomes severely anemic. In these cases, treatment of the fibroids may be necessary. Very large fibroids are much harder to treat. Therefore, many doctors recommend treatment for moderatelysized fibroids, in order to prevent them from growing into large fibroids that cause worse symptoms.

The following are possible treatment plans:

• Observation (watchful waiting). Most women already have symptoms at the time their fibroids are discovered, but feel that they can tolerate their symptoms. Therefore, no active treatment is given, but the woman and her physician stay alert for signs that the condition might be getting worse.
• Hysterectomy. This procedure involves surgical removal of the uterus, and it is the only definitive cure for fibroids. In fact, 25% of hysterectomies are performed because of symptomatic fibroids. A gynecologist can remove a fibroid uterus during either an abdominal or a vaginal hysterectomy. The choice depends on the size of the fibroids and other factors such as previous births and previous surgeries.
• Myomectomy. In this surgical procedure only the fibroids are removed; the uterus is repaired and left in place. This is the surgical procedure many women choose if they are not finished with childbearing. At first glance, it seems that this treatment is a middle ground between observation and hysterectomy. However, myomectomy is actually a difficult surgical procedure, more difficult than a hysterectomy. Myomectomy often causes significant blood loss, and blood transfusions may be required. In addition, some fibroids are so large, or buried so deeply within the wall of the uterus, that it is not possible to save the uterus, and a hysterectomy must be done, even though it was not planned.
• Lowering estrogen levels. Since fibroids are dependent on estrogen for their growth, medical treatments that lower estrogen levels can cause fibroids to shrink. A group of medications known as GnRH antagonists can dramatically lower estrogen levels. Women who take these medications for three to six months find that their fibroids shrink in size by 50% or more. They usually experience dramatic relief of their symptoms of heavy bleeding and pelvic pain.
• Uterine artery embolization (UAE). Embolization is a newer alternative to hysterectomy that shrinks fibroids by cutting off their blood supply. In UAE, the surgeon inserts a catheter into the uterine arteries. Small particles of polyvinyl foam or other inert substances are injected through the catheter into the arteries. The particles form an embolus, or clump, that blocks the blood supply to the fibroids and causes them to shrink. UAE is still controversial, however, because it has been associated with significant complications.

Unfortunately, GnRH antagonists cause unpleasant side effects in over 90% of women. The therapy is usually used for only three months, and should not be used for more than six months because the risk of developing brittle bones (osteoporosis) begins to rise.

Once the treatment is stopped, the fibroids begin to grow back to their original size. Within six months, most of the old symptoms return. Therefore, GnRH agonists cannot be used as long-term solution.

Uterine fibroids infographic

At the moment, treatment with GnRH antagonists is used mainly in preparation for surgery (myomectomy or hysterectomy). Shrinking the size of the fibroids makes surgery much easier, and reducing the heavy bleeding allows a woman to build up her blood count before surgery.

Fibroids can cause problems during pregnancy because they often grow in size. Large fibroids can cause pain and lead to premature labor.

Fibroids cannot be removed during pregnancy because of the risk of injury to the uterus and hemorrhage. GnRH antagonists cannot be used during pregnancy. Treatment is limited to pain medication and medication to prevent premature labor, if necessary.

Expected results

Many women who have fibroids have no symptoms or have only minor symptoms of heavy menstrual bleeding or pelvic pressure. However, fibroids tend to grow over time, and gradually cause more symptoms. Many women ultimately decide to have some form of treatment. Currently, hysterectomy is the most popular form of treatment.

Prevention

Eating a healthful diet, reducing stress, and exercising regularly is the preferred preventive treatment regimen of many diseases including fibroids.

Uterine cancer

Uterine cancer can be divided into two primary forms, cervical and endometrial. Cancer of the cervix most often affects the neck of the cervix or the opening or the opening into the uterus from the vagina. Endometrial cancer affects the inside lining of the uterus.

Cervical cancer is much more prevalent than cancer of the endometrium; some estimate the incidence ratio as 3:1. Statistics from the year 2000 indicated cervical cancer was the second leading cause of cancer deaths in women ages 20-39 years, and the fifth leading cause of cancer

death in women from 40-59 years old. Unlike many other cancers, early cancer of the cervix can be identified as much as 10 or more years before the cancer invades other tissues. These visible changes in the structure and activity of the cervical cells are seen under the microscope with Papanicolaou (Pap) tests and are referred to as mild dysplasia.


Over a time period of five to 10 years, these aneh cells may disappear without treatment, or may invade into deeper tissues and progress into a true cancer. The cancerous cells then may spread to endometrium, lymph glands, and nerves in the pelvic region.

As the population ages, cancer of the endometrium is becoming more common. Statistics indicate that approximately 50% of women with postmenopausal bleeding are diagnosed with endometrial cancer.

This early symptom of irregular vaginal bleeding often allows removal of the uterus to result in cure of the disease, as endometrial cancer progresses and spreads slowly.

While all women are at risk for developing uterine cancer, specific risk factors for cervical cancer include sexual activity at an early age, and sex with multiple partners.

Infertility, diabetes, obesity, and estrogen therapy place a woman at high risk for endometrial cancer. Other risk factors for uterine cancer include: endometrial hyperplasia, sexual inactivity, undergoing menopause after age 59 years, and never having had children.

Causes and symptoms

A completed cancer awareness ribbon for sarcoma use pink for breast cancer, or peach for uterine cancer.

An important factor linked to cervical cancer is infection with one of the most common sexually transmitted diseases—warts while others have no observable symptoms.

Individuals infected with the herpes simplex virus, human immunodeficiency virus (HIV) or acquired immune deficiency syndrome (AIDS) are at increased risk for developing cancer of the cervix; the associated suppression of the immune system allows the HPV to more easily invade. Other chronic infections and erosions of the cervix also may increase the risk of cervical cancer.

While some women who have precancerous cervical changes experience no symptoms, others notice heavier or longer menstrual periods or vaginal bleeding after douching, intercourse or between periods.

Symptoms of more advances stages of uterine cancer may include a foul-smelling vaginal discharge, rectal pressure or constipation, loss of appetite, fatigue, and back or leg pain.

Diagnosis

An annual Pap test and pelvic examination beginning as soon as young woman becomes sexually active, or between the age 17-20 years, are the most important diagnostic steps for early detection of uterine cancer.

The Pap smear can pick up cervical dyplasia and the conventional physican may then perform a colposcopy and biopsy of the cervix to give a better understanding of the abnormalities.

If only a small area of the cervix is affected, the recommendation may be made for more frequent Pap tests (about every three to six months) to monitor for changes in the cells of the cervix. Additional diagnostic tests for uterine cancer may include laparoscopy, laparotomy, or vaginosonography.

In 2002, a Food and Drug Administration (FDA) advisory panel suggested adding a screening test for HPV in addition to Pap smears since HPV is such a high risk factor for cervical cancer. The screening test could help separate women at high risk for more frequent screening than women not at high risk.

Treatment

pinky uterus

After cervical dysplasia has been found, several herbal remedies and supplements may be helpful. Practitioners of herbal medicine refer to this class of herbs as emmenagogues.

It includes supplements such as selenium, and vitamins B6 and C.

While these studies make no claim that taking a multivitamin or mineral supplement can reverse advanced cervical dysplasia, taking these supplements preventively may make sense.

The woman with uterine cancer will also benefit from nutritional supplements and a diet aimed at strengthening the immune system. Echinacea and garlic supplements may not only have positive effects on immunities, but also counteract the side effects of cancer treatment.

Many trace elements, flavonoids, and other phytochemicals are provided by eating a well balanced diet that may not be provided in a pill. Even with relatively low levels of dietary intake, shiitake mushrooms, lentinus edodes, laminaria sea vegetables, and kombu kelp are believed to have anticancer properties.

The use of any supplements or specific dietary modification should be discussed with the physician treating the cancer in order to avoid any undesirable drug interactions or side effects.

Research emphatically supports the mind-body connection when considering the health of the individual with cancer. Studies have also shown the positive effects of imagery on boosting immunities and natural killer cells.

Visualization of the dominant white blood cells successfully attacking weak cancer cells can not only have a positive effect on the mood and mental status, but may also shrink tumors and extend the life of a patient with cancer. Laughter has also been found to enhance immunities and stimulate the sympathetic nervous system, pituitary gland, and the hormones that reduce stress, inflammation, and pain.

In addition to the well known effects of massage for relaxation and stress reduction, there are other physiologic effects that may help the individual with cancer.

Massage may slow the body’s release of the stress hormone cortisol, decreasing anxiety and allowing for more effective periods of sleep and regeneration. Massage has also been found to increase the production of serotonin, which can improve overall mood and immune status.

Allopathic treatment

Early stages of cervical dysplasia may require only frequent reevaluation to monitor progression or regression of the aneh cells. Regression of aneh cells may occur due to the immune response or lifestyle changes, such as discontinuing smoking or oral contraceptive use. In more advanced cases, the cervical lining may be removed via cautery, freezing or laser procedures.

Age, overall health status, and the presence of other aneh findings will impact on the selection of most appropriate treatment plan for uterine cancer. Surgery may be presented as a treatment option for invasive cancer.

Extent of the surgical procedures will depend upon the stage of the cancer. A hysterectomy, lymphadenectomy, or total pelvic exenteration may be recommended. Radiation therapy may be offered instead of or in addition to surgical removal of the affected tissues.

Depending on the individual’s disease stage, and the response and tolerance to the radiation, treatment may be provided by external beams directed over the pelvis, or by the insertion of radium tubes into the uterus and/or vagina. Chemotherapy may also be recommended, involving the infusion of tumor-fighting drugs directly into the circulatory system.

Expected results

The outcomes for the individual with uterine cancer are significantly related to the stage of the disease when cancer is found and treatment initiated. Early interventions can result in nearly 100% cure rates, while those individuals whose cancer is not discovered until aneh tissue growth has invaded surrounding organs may have less positive outcomes. Those with advanced disease may experience pain, vaginal bleeding and/or foul smelling discharge, and intestinal obstruction.

Prevention

The best preventive measure against uterine cancer is an annual pelvic examination and Pap test. In fact, a 2002 report from the College of American Pathologists stated that 80 percent of the women who die from cervical cancer had not had a Pap test in the five years preceding their diagnosis.

Recognition of risk factors for uterine cancer, along with an awareness of the early signs and symptoms of cervical dysplasia, can promote the early detection of changes in the cervical cells.

Usnea

Usnea is a unique species of herb because it is created through a symbiotic relationship between lichens and algae. Symbiosis refers to the living together of two different organisms.

In the case of lichens, both the alga and the fungus benefit from the relationship. Other names for usnea include lichen moss and old man’s beard. Usnea can be found in forests in northern North America and are also found in Europe.

Some usnea are able to keep growing even after being broken off from the parent organism. Usnea are very sensitive to the air quality and may be killed by absorbing pollutants. In fact, usnea are used as indicators of regional pollution levels.


When a fungus and an alga combine, the resulting organism does not resemble either component. The fungal component has the main influence over the appearance and is the determinant for the species name of each lichen.

The local environment also influences the appearance of the lichen. In general, usnea appear as long, hairy or fuzzy strings that hang from trees, rocks, and decomposing wood.

The fibers (branches) of usnea are round and contain a slender white cord at the core. During wet conditions, the white cord has elastic properties. Lichens are usually gray or green in color that varies depending upon the algal component. For instance, green lichens have a green algal component.

Usnea are very sensitive to the air quality

The primary active ingredient in usnea is usnic acid. Usnic acid protects the lichen from overexposure to light and its bitter taste prevents invertebrates (creatures that lack a spinal cord) from eating it. Usnic acid has antibacterial and antitumor activities.

Against certain bacteria, usnic acid is stronger than the antibiotic penicillin. Usnic acid is effective against gram-positive bacteria including Streptococcus, Staphylococcus, and Pneumococcus but, unlike many antibiotics, does not harm the gram-negative bacteria that live in the gut and vagina.

It is also effective against the bacterium that causes tuberculosis and may be effective against certain fungi and protozoans (simple, single-celled organisms such as trichomonas). It is believed that usnic acid works by disrupting the metabolism (the chemical and physical processes of an organism) of bacteria while leaving human cells unharmed.

Usnea contains mucilage, which can help ease coughing. It also has expectorant (brings up lung mucous) activity. Mucilage is a thick slimy substance produced by plants that has a soothing effect on mucous membranes. Herbalists consider usnea a muscle relaxant and an immune system stimulant.

Other constituents of usnea species may include barbatolic, evernic, lobaric, tartaric, thamnolic, stictinic, and usnaric acids.

General use

Usnea was historically used to treat indigestion because of its bitter taste and activity as a digestive system stimulant. The peoples of ancient China, Egypt, and Greece used usnea to treat infections. In the fourteenth century, it was believed that usnea could strengthen hair because of its hair-like appearance.

Usnea is used to treat abscesses, colds, cough, cystitis, fungal infections (such as athletes foot or ringworm), gastrointestinal (stomach and intestine) irritations, influenza, sore throats (including strep throat), respiratory infections (sinusitis, bronchitis, pneumonia, etc.), skin ulcers, urinary tract infections, and vaginal infections.

Extracts of lichens have been used in deodorants and soaps. Usnea is also used to promote healthy teeth and gums and to treat oral infections. It is used by naturopathic physicians to treat mild cervical dysplasia (abnormal growth of cells on the cervix).

Harvested usnea

Usnea barbata is a homeopathic remedy for headaches and sunstroke. Usnea hirta is used as an antibiotic as is Usnea florida, which can also be an antituberculosis agent. Usnea longissima is used as an expectorant.

Because of the absorbent quality of usnea, it has been used in baby diapers, wound dressings, and feminine napkins (sanitary pads).

Preparations

Usnea is commercially available in bulk form or as a powder, capsule, or tincture.

The tincture should be diluted in water before ingesting or using externally. Usnea tincture may be taken every two hours to treat bacterial infections. Other sources recommend taking 3-4 ml of tincture three times daily.

A usnea tea can be prepared by steeping 2-3 tsp of dried lichen or 1-2 tsp of powdered lichen in 1 cup of boiling-hot water. The tea may be taken three times a day.

In the capsule form, the patient should take 100 mg of usnea three times a day.

Usnea is used externally to treat fungal infections and skin ulcers. It can also be used as a douche to treat cystitis, urinary tract infections, and vaginal infections.

Another kind of Usnea

Usnea is generally used as a vaginal suppository to treat mild cervical dysplasia. It is taken by mouth to treat colds, strep throat, influenza, sore throats, respiratory infections, and gastrointestinal disorders.

Precautions

Usnea should not be used for more than three weeks in a row. Pregnant women should not use usnea because it may promote uterine contractions.

Side effects

Usnea may cause gastrointestinal disorders in some persons.

Interactions

As of 2004, there are no reports of interactions between usnea and other drugs or herbal medicines.

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Urinary incontinence is unintentional loss of urine that is sufficient enough in frequency and amount to cause physical and/or emotional distress in the person experiencing it.

Approximately 13 million Americans suffer from urinary incontinence. Women are affected by the disorder more frequently than are men; one in 10 women under age 65 suffers from urinary incontinence.

A study published in late 2002 found that between 21% and 29% of adult women in the workforce reported at least one potongan of urinary incontinence each month. Older Americans, too, are more prone to the condition. Twenty percent of Americans over age 65 are incontinent. In general, the condition is underrecognized and undertreated.


There are five major categories of urinary incontinence: overflow, stress, urge, functional, and reflex:

• Overflow incontinence. Overflow incontinence is caused by bladder dysfunction. Individuals with this type of incontinence have an obstruction to the bladder or urethra, or a bladder that doesn’t contract properly. As a result, their bladders do not empty completely, and they have problems with frequent urine leakage.
• Stress incontinence. Stress incontinence occurs when an individual involuntarily loses urine after pressure is placed on the abdomen (i.e., during exercise, sexual activity, sneezing, coughing, laughing, or hugging).
• Urge incontinence. Urge incontinence occurs when a person feels a sudden need to urinate and cannot control the urge to do so. As a consequence, urine is involuntarily lost before the individual can get to the toilet.
• Functional incontinence. Individuals who have control over their own urination and have a fully functioning urinary tract, but cannot make it to the bathroom in time due to a physical or cognitive disability, are functionally incontinent. These individuals may suffer from arthritis, Parkinson’s disease, multiple sclerosis,or Alzheimer’s disease.
• Reflex incontinence. Individuals with reflex incontinence lose control of their bladder without warning. They typically suffer from neurological impairment.

In some cases, an individual may develop short-term or acute incontinence. Acute incontinence may occur as a symptom or byproduct of illness, as a side effect of medication, or as a result of dietary intake. The condition is typically easily resolved once the cause is determined and addressed.

Causes and symptoms

Urinary incontinence can be caused by a wide variety of physical conditions, including:

• Childbirth. Childbirth can stretch the pelvic muscles and cause the bladder to lose some support from surrounding muscles, resulting in stress incontinence.
• Dysfunction of the bladder and/or the urinary sphincter. In a continent individual, as the bladder contracts, the outlet that releases urine into the urethra (bladder sphincter) opens and urine exits the body. In individuals with overflow incontinence, bladder contractions and dilation of the sphincter do not occur at the same time.
• Enlarged prostate. In men, an enlarged prostate gland can obstruct the bladder, causing overflow incontinence.
• Hysterectomy or other gynecological surgery. Any surgery involving the urogenital tract runs the risk of damaging or weakening the pelvic muscles and causing incontinence.
• Menopause. The absence of estrogen in the postmenopausal woman can cause the bladder to drop, or prolapse.
• Neurological conditions. The nervous system sends signals to the bladder telling it when to start and stop emptying. When the nervous system is impaired, incontinence may result. Neurological conditions such as multiple sclerosis, stroke, spinal cord injuries, or a brain tumor may cause the bladder to contract involuntarily, expelling urine without warning, or to cease contractions completely, causing urinary retention.
• Obesity. Persons who are overweight have undue pressure placed on their bladder and surrounding muscles.
• Obstruction. A blockage at the bladder outlet may permit only small amounts of urine to pass, resulting in urine retention and subsequent overflow incontinence. Tumors, calculi, and scar tissue can all block the flow of urine. A urethral stricture, or narrow urethra caused by scarring or inflammation, may also result in urine retention.

Acute incontinence is a temporary condition caused by a number of factors, including:

• Bladder irritants. Substances in the urine that irritate the bladder may cause the bladder muscle to malfunction. The presence of a urinary tract infection and the ingestion of excess caffeine can act as irritants. Highly concentrated urine resulting from low fluid intake may also irritate the bladder.
• Constipation. Constipation can cause incontinence in some individuals. Stool that isn’t passed presses against the bladder and urethra, triggering urine leakage.
• Illness or disease. Diabetes can greatly increase urine volume, making some individuals prone to incontinence. Other illnesses may temporarily impair the ability to recognize and control the urge to urinate, or to reach the toilet in time to do so.
• Medications and alcohol. Medications that sedate, such as tranquilizers and sleeping pills, can interfere with the proper functioning of the urethral nerves and bladder. Both sedatives and alcohol can also impair an individual’s ability to recognize the need to urinate, and act on that need in a timely manner. Other medications such as diuretics, muscle relaxants, and blood pressure medication can also affect bladder function.
• Surgery. Men who undergo prostate surgery can suffer from temporary stress incontinence as a result of damage to the urethral outlet.

Diagnosis

Urinary incontinence may be diagnosed by a general practitioner, urologist, or gynecologist. If the patient is over age 65, a gerontologist may diagnose and treat the condition.

A thorough medical history and physical examination is typically performed, along with specific diagnostic testing to determine the cause of the incontinence. Diagnostic testing may include x rays, ultrasound, urine tests, and a physical examination of the pelvis.

It may also include a series of exams that measure bladder pressure and capacity and the urinary flow (urodynamic testing). The patient may also be asked to keep a diary to record urine output, frequency, and any episodes of incontinence over a period of several days or a week.

Treatment

Adjusting dietary habits and avoiding acidic and spicy foods, alcohol, caffeine, and other bladder irritants can help to prevent urinary leaking. The patient should eat recommended amounts of whole grains, fruits, and vegetables to avoid constipation.

Bladder training, used to treat urge incontinence, can also be a useful treatment tool. The technique involves placing a patient on a toileting schedule. The time interval between urination is then gradually increased until an acceptable time period between bathroom breaks is consistently achieved.

Therapies designed to strengthen the pelvic muscles are also recommended for the treatment of urinary incontinence. Pelvic toning exercises, known as Kegel or PC muscle exercises, can alleviate stress incontinence in both men and women. These exercises involve repeatedly tightening the muscles of the pelvic floor.

Biofeedback techniques can teach incontinent patients to control the urge to urinate. Biofeedback uses sensors to monitor temperature and muscle contractions in the vagina to help incontinent patients learn to increase their control over the pelvic muscles.

An infusion, or tea, of horsetail (Equisetum arvense), agrimony (Agrimonia eupatoria), and sweet sumac (Rhus aromatica) may be prescribed by an herbalist or naturopath to treat stress and urge incontinence. These herbs are natural astringents and encourage toning of the digestive and urinary tracts.

Other herbs, such as urtica or stinging nettle (Urtica urens), plantain (Plantago major), or maize (Zea mays) may be helpful. Homeopathic remedies may include pulsatilla and causticum. Chinese herbalists might recommend golden lock tea, a mixture of several herbs that helps the body retain fluids.

Urinary incontinence infographic

Allopathic treatment

There are numerous invasive and noninvasive treatment options for urinary incontinence:

• Behavior modification therapy. Behavior modification is a psychological approach to the treatment of urinary incontinence in which patients gradually increase the length of the time interval between voidings and “retrain” the bladder in other ways. It is reported to be highly effective in treating urge incontinence.
• Collagen injections. Collagen injected in the tissue surrounding the urethra can provide urethral support for women suffering from stress incontinence.
• External occlusive devices. A new single-use disposable urethral cap is available without a prescription as of late 2002 for women suffering from stress urinary incontinence. The cap is noninvasive and appears to be quite effective in managing incontinence.
• Inflatable urethral insert. Sold under the tradename Reliance, this disposable incontinence balloon for women is inserted into the urethra and inflated to prevent urine leakage.
• Intermittent urinary catheterization. This procedure involves the The periodic insertion of a catheter into a patient’s bladder to drain urine from the bladder into an attached bag or container.
• Medication. Estrogen hormone replacement therapy can help improve pelvic muscle tone in postmenopausal women. Other medications, including flurbiprofen, capsaicin and botulinum toxin, are sometimes prescribed to relax the bladder muscles or to tighten the urethral sphincter. As of late 2002, newer medications for the treatment of urinary incontinence are undergoing clinical trials. One of these drugs, duloxetine, differs from present medications in targeting the central nervous system’s control of the urge to urinate rather than the smooth muscle of the bladder itself.
• Perineal stimulation. Perineal stimulation is used to treat stress incontinence. The treatment uses a probe to deliver a painless electrical current to the perineal area muscles. The current tones the muscle by contracting it.
• Permanent catheterization. A permanent, or indwelling, catheter may be prescribed for chronic incontinence that doesn’t respond to other treatments.
• Sacral nerve stimulation (SNS). Also known as sacral neuromodulation, SNS is a procedure in which a surgeon implants a device that sends continuous stimulation to the sacral nerves that control the urinary sphincter. The FDA approved sacral nerve stimulation for the treatment of urinary urge incontinence in 1997 and for urinary frequency in 1999.
• Surgery. Bladder neck suspension surgery is used to correct female urinary stress incontinence. Bladder enlargement surgery may be recommended to treat incontinent men and women with unusually small bladders.
• Urinary sphincter implant. An artificial urinary sphincter may be used to treat incontinence in men and women with urinary sphincter impairment.
• Vaginal inserts. Devices constructed of silicone or other pliable materials can be inserted into a woman’s vagina to support the urethra.

Expected results

Left untreated, incontinence can cause physical and emotional upheaval. Individuals with long-term incontinence suffer from urinary tract infections, and skin rashes and sores. Incontinence can also affect their self-esteem and cause depression and social withdrawal.

They frequently stop participating in physical activities they once enjoyed because of the risk of embarrassing “accidents.” However, with the wide variety of treatment options for incontinence available today, the prognosis for incontinent patients is promising. If incontinence cannot be stopped, it can be improved in the majority of cases.

Prevention

Women who are pregnant or who have gone through childbirth can reduce their risk for stress incontinence by strengthening their perineal area muscles with Kegel exercises. Men who have undergone prostate surgery may also benefit from pelvic muscle exercises. Men and women should consult with their doctor before initiating any type of exercise program.

Unani-tibbi

Unani-tibbi denotes Arabic or Islamic medicine, also known as prophetic medicine. It traditionally makes use of a variety of techniques including diet, herbal treatments, manipulative therapies, and surgery. Unani-tibbi is a complete system, encompassing all aspects and all fields of medical care, from nutrition and hygiene to psychiatric treatment.

Origins

The name unani-tibbi is something of a misnomer, as literally translated from the Arabic, it means Greek medicine. This is because the early Arab physicians took their basic knowledge from the Greeks.

At the time, Greek medical knowledge was the best to be had, particularly from Galen, the renowned second-century Greek physician who treated the gladiators and Emperor Marcus Aurelius.


However, from that point onwards, Islamic medical scholars were responsible for many developments and advancements that, at the time, placed Arabic medicine firmly in the vanguard of medical science.

There followed a steady stream of Muslim medical scholars, who not only upheld the high standards that came to be known of unani-tibbi, but carried on adding to and improving the basic pool of knowledge.

Some notable scholars of the science of unani-tibbi include:

• Al Tabbari (838–870)
• Al Razi (Rhazes) (841–926)
• Al Zahrawi (930–1013)
• Ibn Al Haitham (960–1040)
• Ibn Sina (Avicenna), (980–1037)
• Ibn Al Nafees (1213–1288)
• Ibn Khaldun (1332–1395)

Medical innovations introduced by unani-tibbi physicians included:

• Avicenna was the first to describe meningitis, so accurately and in such detail, that it has scarcely required additions after 1,000 years.
• Avicenna was the first to describe intubation (surgical procedure to facilitate breathing)—Western physicians began to use this method at the end of the eighteenth century.
• The use of plaster of Paris for fractures by the Arabs was standard practice—it was “rediscovered” in the West in 1852.
• Surgery was used by the Arabs to correct cataracts.
• Ibn Al Nafees discovered pulmonary blood circulation.
• A strict system of licensing for medical practitioners was introduced in Baghdad in 931, which included taking the Hippocratic oath, and specific periods of training for doctors.
• There was a system of inspection of drugs and pharmaceuticals—the equivalent of the Federal Drug Administration (FDA)—in Baghdad 1,000 years ago.
• The European system of medicine was based on the Arabic system, and even as recently as the early nineteenth century, students at the Sorbonne had to read the canon of Avicenna as a condition to graduating.
• Unani-tibbi hospitals were, from the beginning, free to all without discrimination on the basis of religion, sex, ethnicity, or social status.
• Their hospitals allocated different wards for each classification of disease.
• Hospitals had unlimited water supplies and bathing facilities.
• Before the advent of the printing press, there were extensive handwritten libraries in Baghdad, (80,000 volumes), Cordova, (600,000 volumes), Cairo, (two million volumes), and Tripoli, (three million volumes).
• All Unani-tibbi hospitals kept patient records.
• A hospital was established for lepers.
• In 830, nurses were brought from Sudan to work in the Qayrawan hospital in Tunisia.
• A system of fountain-cooled air was devised for the comfort of patients suffering from fever.
• Avicenna described the contamination of the body by “foreign bodies” prior to infection, and Ibn Khatima also described how “minute bodies” enter the body and cause disease—well in advance of Pasteur’s discovery of microbes.
• Al Razi was the first to describe smallpox and measles. He was accurate to such a degree that nothing has been added since.
• Avicenna described tuberculosis as being a communicable disease.
• Avicenna devised the concept of anesthetics. The Arabs developed a “soporific sponge,” (impregnated with aromatics and narcotics and held under the patient’s nose), which preceded modern anesthesia.
• The Arab surgeon, Al Zahrawi was the first to describe hemophilia.
• Al Zahrawi was also the first surgeon in history to use cotton, which is an Arabic word, as surgical dressings for the control of hemorrhage.
• Avicenna accurately described surgical treatment of cancer, saying that the excision must be radical and remove all diseased tissue, including amputation and the removal of veins running in the direction of the tumor. He also recommended cautery of the area if needed. This observation is relevant even today.
• Avicenna, Al Razi, and others formed a medical association for the purpose of holding conferences so that the latest developments and advancements in the field of medicine could be debated and passed on to others.

Benefits

What began as an advanced medical system that set world standards, has now come to be regarded as a system of folk medicine. This decline coincided with the decline of the Islamic Empire and the dissolution of the caliphate (spiritual head of Islam), as these were directly responsible for the direction and impetus of Islamic scientific scholars in all fields.

Unani-tibbi practitioners still treat people with herbal remedies and manipulation, for a variety of illnesses. In the Islamic world, many of the poorer people who cannot afford allopathic medicine still resort to this traditional medicine.

There are also people who prefer unani-tibbi to allopathic medicine, as indeed, the traditional unani-tibbi remedies do not bring with them the side effects commonly experienced with allopathic drugs.

Description

Similar to Greek humoral theory, unani-tibbi considers the whole human being, spiritual, emotional, and physical. Basic to the theory is the concept of the “four humors.” These are Dum (blood), Bulghum (phlegm), Sufra (yellow bile), and Sauda (black bile). Each is further categorized as being hot and moist (blood), cold and moist (phlegm), hot and dry (yellow bile), and cold and dry (black bile).

Every individual has his/her own unique profile of humors, which must be maintained in harmony to preserve health. If the body becomes weak, and this harmony is disrupted, a physician can be called upon to help restore the balance.

This restoration may be done using correct diet and nutrition and/or the unani-tibbi system of botanical therapy, cupping, bleeding, manipulation, and massage, among others, as treatments for all disease and ailments. Herbs or substances used to treat a patient will be matched to his humor type.

Unani-tibbi employs a detailed system of diagnosis, including observation of urine and stools, palpation of the body and pulse, and observation of the skin and eyes.

It also employs a system of prophylactics in order to preserve health and ward off disease. This includes the adherance to strict hygiene rules, protection of air, food and water from contamination or pollution, sufficient rest and exercise, and attention to spiritual needs. Certain herbs are also taken on a prophylactic basis, such as black cumin and sage.

In general, unani-tibbi treatment is not expensive, and it is certainly less expensive than allopathic medicine. However, charges vary according to area and practitioner. Fees should be discussed with a practitioner before treatment begins.

Preparations

Remedies are often provided by the practitioner or are obtained from a specialized herbalist. The ingredients are mainly herbs and honey. It must be noted that the honey used will be raw and unadulterated, rather than the type found in supermarkets, which is usually heat-treated.

A famous and widely used medicinal herb is black cumin (Nigella sativa), also known as Hab Al Baraka in Arabic, which means blessed seed. Black cumin has been cultivated since Assyrian times and it is beneficial for a very long list of ailments.

It is widely mixed with other herbs for greater beneficial effect and is said to strengthen the immune system when taken over a period of time. Research has proved that it has the ability to slow the division of cancer cells.

Precautions

The achievements of the unani-tibbi practitioners of today bear little resemblance to those of their illustrious predecessors, and some of those claiming to practice traditional medicine are woefully ill-equipped to practice.

However, many Arab and Muslim doctors, after qualifying in allopathic medicine, are still treating their patients with traditional remedies and are taking the trouble to educate themselves in this ancient art.

In India, where Islamic medicine is primarily known as unani-tibbi, the government has set up a Central Council for Research in Unani Medicine (CCRUM), which also has a licensing system for these traditional practitioners.

In the Arab countries, it is known as tibb-nabawi, or prophetic medicine, and mainly utilizes herbal remedies, honey, and other bee products.

Side effects

There are no known side effects of this form of treatment.

Research and general acceptance

The herbal remedies employed by unani-tibbi are chosen for their non-toxicity and absence of side effects.

Although unani-tibbi has not been the subject of a great deal of research by modern-day scientists, it still enjoys great popularity in Muslim countries. The records left by Islamic medical scholars become more remarkable in the light of modern medicine, when their achievements and theories still hold their own next to the latest in medical technology.

The CCRUM in India is conducting research into aspects of unani-tibbi that are likely to be of particular benefit to modern society. To cite one example, an examination of the substances that were originally used as safe forms of contraception, with none of the side effects of present-day chemical contraception.

Training and certification

There are two classifications of practitioners of unani-tibbi. There are the simple folk practitioners, dispensers of herbal remedies and so on, and the highly qualified doctors and scholars who are still conducting research.

Research is currently being conducted at the King Abdul Azeez University in Riyadh, Saudi Arabia, and the Sultan Qaboos University in Oman, among others, into the efficacy of traditional herbal remedies.

The CCRUM in India issues licenses to unani-tibbi practitioners and provides funds for research.