Urinary incontinence is the unintentional passing of urine. It's a common problem thought to affect millions of people. There are several types of urinary incontinence, including:

Stress Incontinence  when urine leaks out at times when your bladder is under pressure; for example, when you cough or laugh.
Urge Incontinence  when urine leaks as you feel a sudden, intense urge to pass urine, or soon afterwards.
Overflow Incontinence (chronic urinary retention)  when you're unable to fully empty your bladder, which causes frequent leaking.
Total Incontinence  when your bladder can't store any urine at all, which causes you to pass urine constantly or have frequent leaking.
It's also possible to have a mixture of both stress and urge urinary incontinence.

What causes urinary incontinence in men?

Urinary incontinence in men results when the brain does not properly signal the bladder, the sphincters do not squeeze strongly enough, or both. The bladder muscle may contract too much or not enough because of a problem with the muscle itself or the nerves controlling the bladder muscle. Damage to the sphincter muscles themselves or the nerves controlling these muscles can result in poor sphincter function. These problems can range from simple to complex.

A man may have factors that increase his chances of developing UI, including

birth defects problems with development of the urinary tract
a history of prostate cancer surgery or radiation treatment for prostate cancer can lead to temporary or permanent UI in men
UI is not a disease. Instead, it can be a symptom of certain conditions or the result of particular events during a man s life. Conditions or events that may increase a man s chance of developing UI include

benign prostatic hyperplasia (BPH) a condition in which the prostate is enlarged yet not cancerous. In men with BPH, the enlarged prostate presses against and pinches the urethra. The bladder wall becomes thicker. Eventually, the bladder may weaken and lose the ability to empty, leaving some urine in the bladder. The narrowing of the urethra and incomplete emptying of the bladder can lead to UI.
chronic coughing long-lasting coughing increases pressure on the bladder and pelvic floor muscles.
neurological problems men with diseases or conditions that affect the brain and spine may have trouble controlling urination.
physical inactivity decreased activity can increase a man s weight and contribute to muscle weakness.
obesity extra weight can put pressure on the bladder, causing a need to urinate before the bladder is full.
older age bladder muscles can weaken over time, leading to a decrease in the bladder s capacity to store urine.
Treating Urinary Incontinence

Initially, your GP may suggest some simple measures to see if they help improve your symptoms. These may include:

lifestyle changes   such as losing weight and cutting down on caffeine and alcohol
pelvic floor exercises   exercising your pelvic floor muscles by squeezing them, taught by a specialist 
bladder training   where you learn ways to wait longer between needing to urinate and passing urine, guided by a specialist
You may also benefit from the use of incontinence products, such as absorbent pads and handheld urinals.
Medication may be recommended if you're still unable to manage your symptoms.
Surgery may also be considered. The specific procedures suitable for you will depend on the type of incontinence you have.
Surgical treatments for stress incontinence, such as tape or sling procedures, are used to reduce pressure on the bladder or strengthen the muscles that control urination.
Operations to treat urge incontinence include enlarging the bladder or implanting a device that stimulates the nerve that controls the detrusor muscles.

Men Urinary Incontinence Treatment

As life expectancy is increasing so is the incidence of vertebral body (VB) fractures now being the commonest fracture of the body. PVP is an established interventional technique in which bone cement is injected under local anaesthesia via a needle into a fractured VB with imaging guidance providing instant pain relief, increased bone strength, stability, decreasing analgesic medicines, increased mobility with improved quality of life and early return to work in days.

In this era of minimally access surgery replacing open surgeries, PVP is a novel procedure & should be in the first line of management in place of conservatism or major spine surgery for painful uncomplicated compression fracture spine.

Morbidity & consequences of spinal fracture:

Traumatic VB is a painful condition requiring bed rest restricting daily activities markedly
Left untreated it can cause DVT, increase osteoporosis, loss of VB height, respiratory & GI disturbances, emotional & social problems secondary to unremitting pain, loss of independence with high cost of rehabilitation.
High risk of primary or consequential damage to neural, bony or disc element
Increased wedging, deformity & increase incidence of adjacent VB
Chronic pain of altered spine mechanics
Uncomfortable braces & sleep disturbance because of pain & discomfort with its sequels.
Cost of surgery and hospital treatment
Cost of implants
Phobia of surgery
Prolonged recovery period & Extensive rehabilitation
Changed spinal mechanics & transition syndrome
Major surgery & anesthesia with its own complications
Results / Outcome

PVP is a novel procedure with high benefit to risk ratio, which is highly underutilized in relation to the high prevalence of the vertebral.
Different studies show an immediate pain relief in (85   90)% of patients with low complication rate ranging from (1-5)% depending upon the type of lesion.
PVP does augment height of VB but ideal would be kyphoplasty
Patient is either off medicine or on reduced doses.
Patient feels so well that he almost forgets if he had VB

Percutaneous Vertebroplasty (PVP) is an emerging interventional technique in which surgical polymethyl methacrylate bone cement is injected under local anaesthesia via a large bore needle into a vertebral body (VB) under imaging guidance providing increased bone strength, stability, pain relief, decreased analgesics, increased mobility with improved QOL and early return to work. Started in 1984 by Galibert PVP is done in host of indications.

Senile osteoporotic compression remains the commonest Indication. Other indications are Metastatic VB, Multiple myeloma VB, VB haemangioma, Vertebral osteonecrosis & for strengthening VB before major spinal surgery. The benefit has been extended to the traumatic stable uncomplicated VB compression (VCF) which is commoner in younger age group with active life profile and prime of their career where strict bed rest and acute or chronic pain are unacceptable and they are more demanding for proactive treatment approach so as to be back to work ASAP.

Discovering the fact that VB is the commonest of body, its incidence >the hip, it becomes imperative to take it more seriously. With increasing life-span there is more of aged osteoporotic population, more so due to sedentary indoor lifestyle and post menopausal osteoporosis. Diabetics, smokers & alcoholics are at higher risk of developing osteoporosis. I have seen such alcoholic patient developing six spine fractures in just three months time from a single fracture being on complete bed rest.

Quick fix of fracture spine makes patient walk back same day instead of bed rest of months together avoiding morbidity & mortality of prolonged bed rest, making bedridden patient walk, in a way bringing patient back to normal life.

In this era of MAS replacing open surgeries, PVP is a novel procedure & should be in the first line of management in place of conservatism or major spine surgery for painful uncomplicated compression.

Morbidity & consequenses of spinal 

Traumatic VB is a painful condition requiring bed rest restricting daily activities markedly.
Left untreated it can cause DVT, increase osteoporosis, loss of VB height, respiratory &
GI disturbances, emotional & social problems secondary to unremitting pain, loss of independence with high cost of rehabilitation.
High risk of primary or consequential damage to neural, bony or disc elements.
Increased wedging, deformity & increase incidence of adjacent VB
Chronic pain of altered spine mechanics.
Uncomfortable braces & sleep disturbance because of pain & discomfort with its sequels.
Morbidity and complication of spinal surgery 

Cost of surgery and hospital treatment
Cost of implants
Phobia of surgery
Prolonged recovery period & Extensive rehabilitation
Changed spinal mechanics & transition syndrome
Major surgery & anesthesia with its own complications
Preparation & Procedure:
X-ray spine in a/p & lat view. CT is more informative of bone & morphology. MRI is good for soft tissue injuries. Ask for pedicle size in all dimensions and construct a 3D image aiming needle placement and cement filling in scan room itself as rehearsal of PVP. This reduces operative time & gives better results. Conventionally PVP is done by hammering the vertebroplasty needle through the bone. Here we use light weight drill to bore through the vertebra. It is important to set the needle at exact entry site & side with right trajectory aiming the defects.

In lateral view needle should go through middle of the pedicle going up to anterior 1/3 of VB. In P/A view the needle can be in midline or paramedian depending upon & if uni/bipedicular approach is planned. Approach varies as per location of vertebra, anterolateral in cervical, costotransverse/parapedicular in thoracic & transpedicular in lumbar vertebra.

Do bone biopsy if there is any doubt about lession. Do dye test (vertebral venography). Make cement more radiopaque by adding barium /or tungsten. Inject cement with 1or2 ml luerlock syringes strictly under fluoroscope in lateral view & cross checking in P/A view. Stop injecting either there is adequate filling or at the first sight of ectopic cement leak. Keep sample cement to see for hardening. Remove needle with rotational movement before cement hardens.

Pain relief is by virtue of different mechanisms postulated :

Cementing of fragments.
Thermal neurolysis of VB nerve ending due to heat of polymerization.
Washing away of nociceptor chemicals.
Neurolytic action of liquid monomer.
By allowing early ambulation decreasing pains of immobility & bed rest.
Complications 

PVP is generally safe with low risk.
Ectopic cement leak is frequent but generally inconsequential.
Outcome 

PVP is a novel procedure with high benefit to risk ratio, which is highly underutilized in relation to the high prevalence of the vertebral
Different studies show an immediate pain relief in (85   90)% of patients with low complication rate ranging from (1-5)% depending upon the type of lesion.
PVP does augment height of VB but ideal would be kyphoplasty.
Patient is either off medicine or on reduced doses.
Patient feels so well that he almost forgets if he had VB

Vertebroplasty (PVP) / Kyphoplasty - Approach To Management Of Vertebral Body Fractures!

Osteoporosis is a condition of porous bones that makes your bones weak and fragile. There are 3 thing you can do to avoid falling prey to Osteoporosis:
*Consult your doctor to figure what's the optimum amount of Calcium you should be taking. Pregnant women, for instance, need more calcium than normal people.
*Take Sun-bath daily to ensure adequate amount of Vitamin D for your body. There are other sources of Vitamin D too. Consult your doctor to find out what are those sources and what's the right amount.
*Regular exercise is extremely necessary for good bone health. Make a plan and stick to it

3 Important Things to do to Avoid Osteoporosis

There is a contrast between intimacy satisfaction and intimacy happiness. Happiness tends to be a byproduct of the relationship. Therefore, while it just takes one partner to be sexually satisfied, it takes two to make the conditions for sexual happiness. A key indication of sexual bliss in a relationship is a couple's capacity to endlessly rejuvenate the sexual energy between them. Consequently, the term sexual happiness depicts couples who can revive, reestablish and extend their sexual desire with each other for a very long time or even forever. Here are a few ways through which one can integrate happiness and sexuality:

Since sexual happiness is a result of the relationship, both the partners need to be happy with each other in general to achieve happiness rather than satisfaction.
Staying in shape can be very beneficial. Being sound and fit promotes better sex. Not just are fit individuals perform better sexually, but also it is proven that healthier and fit individuals have a more noteworthy longing for sex. There are numerous reasons behind this. Healthy, fit individuals are not only more joyful, but also physiologically, they are capable of producing more sex hormones due to a number of other health factors.
Enthusiasm is not found in sex; it is found in individuals. To completely grasp sexual enthusiasm, you should be completely present in the moment. As such, you should bring your psyche, body, and soul to your partner. This implies being conscious, aware, and present mentally as well as emotionally.
Decreasing or managing sex levels can also help one integrate happiness and sexuality. Life is clearly unpleasant many times, and our reaction to all the anxiety can be devastating when it comes to sexual experiences. Not only does a lot of stress or anxiety decrease the yearning for sex, it also additionally hinders sexual performance. Hence, one should vent out to their partners or try therapy or yoga for stress release.
Routine tend to repel romance and consistency cools the flames of sexual excitement and energy. To neutralize these twin constrains, you should deliberately plan and design different rituals of sexual pleasure. Indulge in customs of joy and particular actions, thoughts, activities, and exercises like back rub, animate, and stimulation of the sexual and emotional pleasures.
Being happy in general is very important. Being cheerful and idealistic is the establishment of numerous parts of a successful life. Inquiring about actions that make your partner happy are more advantageous, beneficial, and have better connections, including better and more continuous sex.
Sex is very important in a relationship for knowing and feeling that your partner still fancies you, yet having sex once a week is a practical and an achievable objective for people who tend to be very busy. A study demonstrates that regular sex additionally makes individuals more joyful than a high income.

Sexual Happiness and Satisfaction - How You Can Integrate Them?

The causes and symptoms of chronic lower back pain

Lower back pain is characterized by a feeling of pain around the lumbar region (curve of the back connecting the upper back and glutes- muscles in the buttock that are responsible for thigh movement) caused by muscle or ligament injury. The spinal area is most likely to be affected by lower pain as it may impair routine activities like walking and standing. Any lower back pain that lasts for more than ninety days can be considered as chronic.

Causes of lower back pain

There are plenty of causes for lower back pain. Anything that exposes the lumbar area of the spine to a level of stress beyond its capacity can cause lower back pain. These causes are-

1. Disorders of the discs

The spinal area in the lower back comprises of small bones called the vertebra, which are connected to each other by pieces of cartilage known as discs. These discs act as shock absorbers, and when exposed to excessive shock can cause the disc to bulge, resulting in herniated discs. Wear and tear of the discs can also occur.

2. Spinal stenosis

Spinal stenosis occurs when the area around the spine becomes narrow. It may affect the nerves surrounding the lower back, resulting in pain.

3. Wear and tear of the joints and ligaments

Normal wear and tear of the joints and ligaments cause difficulties in holding the spine in its proper position and this progresses with age. This may cause a vertebra to slide over another and affect the nerve endings, giving rise to pain.

Symptoms of lower back pain

The symptoms of lower back pain are usually a dull or excruciating pain in the lower back. It can also affect other parts of the body such as the hips and the legs. In case of severe pain, simple activities like walking, bending and sitting will be impaired.



The Causes and Symptoms of Chronic Lower Back Pain

Panic disorder is a condition that strikes without reason or caution and can be serious. Indications of panic disorder usually include sudden attacks of panic and anxiety, in addition to physical side effects, such as sweating and a pounding heart. During a fit of panic, the reaction is based on the circumstances, which may not be threatening in general, but triggers a feeling of panic. After some time, a person with a panic disorder builds up a consistent fear of having another fit of anxiety, which can influence the every day functioning and lifestyle in general. Panic disorder usually occurs alongside other conditions like depression, liquor abuse, or drug abuse.

You might experience the ill effects of a panic disorder if you:

Encounter frequent, unforeseen fits of anxiety that are not attached to a particular circumstance or event
Stress over having another fit of anxiety
Are trying to avoid the places of your precious panic attacks
The most common symptoms of a panic disorder are as follows:

Trouble relaxing and feeling uneasy most of the time
Beating heart or abdominal pain with a feeling of nervousness
Serious irrational and emotional fear
Feeling as if you are out of breath
Feeling as if you are being choked or smothered
Dizzy spells
Trembling or shaking
Sweating constantly
Feeling nauseous or having a stomach ache
Shivering or numbness in the fingers and toes
Sudden chills or hot flashes
A fear that you are losing control or are about to die
While a single panic attack may just last a couple of minutes, the impact of the experience can leave a long lasting impression and make you susceptible to more such attacks. In case you have this issue, the repetitive fits of panic take an emotional toll. The memory of the fear that you felt during these attacks can affect your self-confidence and cause interruption to your regular day-to-day existence. In the end, this prompts to the following panic disorder effects:

Expectant uneasiness: Instead of feeling like yourself in the middle of panic attacks, you feel tensed and on edge. This uneasiness originates from a dread of having future attacks of anxiety. This fear is seen more often than not, and can be extremely disabling at times.
Phobic avoidance: You start to stay away from specific circumstances or situations. This might happen since you are maintaining a strategic distance because of your previous panic attack. On the other hand, you may stay away from areas where escape would be troublesome or help would be inaccessible in case you had a fit of panic.
Medicines: Medicines can be used to control or decrease a majority of the side effects of panic disorder. Even if medicines do not form a part of the main treatment, when combined with other treatments, medicines are very effective. Eg. therapy and lifestyle changes.

Panic Disorder - 12 Signs You Are Suffering From it!

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