urinary%20incontinence
URINARY INCONTINENCE
Urinary incontinence is the complaint of involuntary urine leakage.
Stress urinary incontinence is the involuntary urine leakage on effort or exertion or when coughing or sneezing.
Urge urinary incontinence is the one associated with or immediately preceded by urgency.
Mixed urinary incontinence is the involuntary urine leakage associated with both urgency and with exertion, effort, coughing or sneezing.

Lifestyle Modification

Fluid Intake

  • Average amount of fluid needed per day is calculated based on patient’s lean body mass
  • Encourage patients to modify their fluid intake to produce a 24-hr urinary output between 1-2 L
    • A very large or small urine volume output can contribute to urinary incontinence

Diet

  • Certain foods contain stimulants that may exacerbate symptoms of incontinence
    • Heavy or hot spices
    • Fruits or juices w/ acidic pH
    • Corn syrup, sugar, honey
  • Use of artificial sweeteners may also contribute to urge incontinence

Caffeine

  • Studies suggest that decreasing caffeine may improve frequency & urgency
  • Eg coffee, tea, carbonated drinks & hot chocolate

Weight Loss

  • In morbidly obese women, massive (surgically induced) weight loss has been shown to significantly decrease incontinence
    • Should be considered as first-line treatment
  • Moderate weight loss may also decrease incontinence

Smoking Cessation

  • Smoking >20 cigarettes per day is considered to reinforce urinary incontinence

Use of Anti-incontinence Products

  • Pads & products that help contain urine loss may be beneficial
  • Absorbent products are temporary means to absorb urine & help protect skin & clothing
    • May also be used as adjunct to behavioral & pharmacological treatment
  • Urethral occlusive products
    • Artificial device inserted into or placed over urethral meatus
    • Keep patients drier, but more difficult & expensive to use compared to absorbent products
  • Catheters
    • Eg indwelling urethral catheters, suprapubic tubes & intermittent self-catheterization
    • Some patients improve w/ temporary continuous Foley catheterization wherein bladder capacity returns to normal & voluntary detrusor function improves
    • Intermittent catheterization is the best form of bladder draining for those who are not physically or mentally handicapped
  • Penile clamps for men
  • Intravaginal devices for women
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Erectile dysfunction (ED) is a common condition defined as the persistent inability to achieve or maintain an erection sufficient for satisfactory sexual performance.1 It is one of the most common complaints in men’s sexual medicine, affecting both physical and psychosocial health and having a significant impact on the patient and partner’s quality of life.1 Moreover, ED is commonly associated with other comorbid conditions, including hypertension, dyslipidaemia and diabetes mellitus.1

Evaluation of ED should include a detailed medical and sexual history of the patient. 1 A discussion of the patient and partner’s preference and treatment goals is essential to better tailor treatment and improve patient satisfaction and adherence to treatment.2 Lifestyle modification and management of risk factors should precede pharmacotherapy, while first-line treatment with oral phosphodiesterase type 5 inhibitors (PDE5i) is well established for the management of patients with ED.1