I'm 51, overweight at 5'6" and 250 lbs, I've gained 70 lbs in 3 years since menapause. for the last 3 years I seem to be loosing sphincter control. Hope I'm saying that right, what I mean is that the physiolocal devices that are supposed to hold things in, seem to be wholeheartedly abandoning me. I have horrible acid reflux, wear incontinence pads because I cant seem to hold my urine and at least once per month cant hold my bowel long enough to get to the toilet. It seems awful extreme for someone only 51. Is there anything that might tie these three things together? Is it likely just a coincidence?
Person's Gender: Female
Person's Age: 51
daily prilosec, but i've been drinking raw milk and seem to be able to cut back on the prilosec. i wear incontinence pads and dont get too far away from a bathroom. i never try to 'hold it' anymore.
Greetings.The urinary incontinence and bowel incontinence can be related as these are regulated by the pelvic floor and lower spinal nerves (back nerves). To evaluate the condition; you need an investigation called as video urodynamics which tells about the integrity of muscles of bladder and sphincters of bladder. A pelvic floor electromyography and MRI of the lower back/spine may also be sometimes needed. These investigations guide for the exact treatment protocol. Following is the treatment;
A. Behavioral modifications;
a) timed voiding,
b) bladder training,
c) Kegel exercises
B. Electrical stimulation:This is a procedure in which small electrodes are placed in pelvic floor. The electrodes produce electric pulses that cause contraction of the muscles of the pelvis and the urethra. This strengthens these muscles to help reduce the incidence of urge incontinence.
c) propantheline (Pro-Banthine) and
D. Surgical treatments for urge incontinence; Implanting the InterStim electronic device.
Normal continence of bowel involves the coordinated interaction between multiple different nerve pathways and the pelvic and perineal musculature. Many other factors, like systemic disease, emotional effect, bowel motility, stool consistency, evacuation efficiency, pelvic floor stability, and sphincter integrity, play a role in normal regulation of the anal sphincter. Failure at any level may result in an impaired ability to control gas or stool (especially if the motion is liquid). Following investigations are needed for the identifying the cause;
1) Endoanal ultrasound,
4) Anorectal manometry
5) Anorectal electrophysiology testing
The treatment entails;
1) Biofeedback; Pelvic floor exercises with biofeedback are beneficial when combined with the addition of dietary modifications. Biofeedback educates regarding pelvic floor coordination, recognition of sensory thresholds, and conditioning of the pelvic musculature, and it helps develop improved pelvic floor habits.
2) Dietary modification: a food diary may be useful to detect offensive items, such as citrus or spicy foods, caffeine, and alcohol, that may be associated with incontinence. Avoiding these may decrease the irritant load to the rectum.
3) Medications; The two most commonly used drugs are loperamide and diphenoxylate with atropine. Loperamide is currently the treatment of choice because it not only thickens the stool but also has been shown to increase anal sphincter tone and improve continence mechanisms.
4) Anal sphincteroplasty; it is a surgical procedure and is done when the above medical treatment fails and if the injury of the sphincter of anus is demonstrated.
5) Artificial sphincters
6) Sacral nerve stimulation
Acid reflux / food reflux is not related to the above. Following comprehensive measures are helpful for the GERD (gastroesophageal reflux disease);
1) antacids; Maalox
2) acid blocker; Prilosec
3) loosing weight, if overweight.
4) avoiding alcohol, citrus fruits and juices, chocolate, and tomato based products
5) avoiding large meals. Eat 5 small meals in a day.
6) wait three hours after the meal before you sleep.
7) elevate head end of the bed by 8 inches.
For acid reflux (GERD), following also would be helpful;A. Herbs;1) Cranberry2) PeppermintB. Homeopathy1) Nux Vomica2) PulsatillaC. Nutrition and supplements;1) Multivitamin; vitamins A, C, E, the B vitamins, and trace minerals, such as magnesium, calcium, zinc, and selenium. 2) Probiotic supplement3) Omega 3 fatty acid4) Avoid; cookies, crackers, cakes, French fries, onion rings, donuts, processed foods, and margarine.5) Also avoid; white breads, pastas, and especially sugar, red meats,6) Eat lean meats, cold water fish, tofu, beans, olive oil.
A weight reduction may be helpful in all the above medical issues.
I would be happy to assist you further, if you need any more information.
MBBS, MS (General Surgery), Fellowship in Sports Medicine