Diseases

Rheumatic fever

Rheumatic fever is an inflammatory disease that may affect many connective tissues of the body, especially those of the heart, joints, brain or skin. It usually starts out as a strep throat (streptococcal) infection. Anyone can get acute rheumatic fever, but it usually occurs in children between the ages of 5 and 15 years. About 60% of people with rheumatic fever develop some degree of subsequent heart disease.

Every part of the heart, including the outer sac (the pericardium), the inner lining (the endocardium) and the valves may be damaged by inflammation caused by acute rheumatic fever. However, the most common form of rheumatic heart disease affects the heart valves, particularly the mitral valve. It may take several years after an episode of rheumatic fever for valve damage to develop or symptoms to appear.

Antibiotics can prevent streptococcal infection from developing into rheumatic fever. Any child with a persistent sore throat should have a throat culture to check for strep infection. Penicillin or another antibiotic will usually prevent strep throat from developing into rheumatic fever.

Symptoms

Symptoms of heart valve problems, which are often the result of rheumatic heart disease, can include: chest pain, excessive fatigue, heart palpitations (when the heart flutters or misses beats), a thumping sensation in the chest, shortness of breath, and swollen ankles, wrists or stomach.

Treatment of rheumatic heart disease

If heart damage from rheumatic fever is identified in childhood or young adulthood, daily antibiotics may be required until the age of 25 or 30, to help prevent recurrence of rheumatic fever and avoid the development of infective bacterial endocarditis, an infection of the heart valves or lining of the heart. Additional treatment will depend on the type of heart damage.

Hypertensive heart disease
High blood pressure of unknown origin (primary hypertension) or caused by (secondary hypertension) certain specific diseases or infections, such as tumor in the adrenal glands, damage to or disease of the kidneys or their blood vessels. High blood pressure may overburden the heart and blood vessels and cause disease. 

Narrowing of the Arteries

Coronary arteries transport blood to your heart muscle. When high blood pressure causes the blood vessels to become narrow, blood flow to the heart can slow or stop. This condition is known as coronary heart disease (CHD), also called coronary artery disease.

CHD makes it difficult for your heart to function and supply the rest of your organs with blood. It can put you at risk for heart attack from a blood clot that gets stuck in one of the narrowed arteries and cuts off blood flow to your heart.

Thickening and Enlargement of the Heart

High blood pressure makes it difficult for your heart to pump blood. Just like other muscles in your body, regular hard work causes your heart muscles to thicken and grow. This alters the way the heart functions. These changes usually happen in the main pumping chamber of the heart, the left ventricle. The condition is known as left ventricular hypertrophy (LVH).

CHD can cause LVH and vice versa: When you have CHD, your heart must work harder. If your heart is enlarged because of LVH, it can compress the coronary arteries.

Complications

Both CHD and LVH can lead to:

·         heart failure: your heart is unable to pump enough blood to the rest of your body

·         arrhythmia: your heart beats abnormally

·         ischemic heart disease: your heart doesn’t get enough oxygen

·         heart attack: blood flow to the heart is interrupted

·         sudden cardiac arrest: your heart suddenly stops working, you stop breathing, and you lose consciousness

·         stroke and sudden death

Treating Hypertensive Heart Disease

Treatment for hypertensive heart disease depends on the seriousness of your illness, your age, and your medical history.

Medication

Medications help your heart in a variety of ways. The main goals are to prevent your blood from clotting, improve the flow of your blood, and lower your cholesterol.

Examples of common heart disease medications include:

·         water pills to help lower blood pressure

·         nitrates to treat chest pain

·         statins to treat high cholesterol

·         beta-blockers to lower blood pressure and reduce the amount of oxygen used by the heart

·         aspirin to prevent blood clots

Coronary heart disease

Coronary heart disease is the term that describes what happens when your heart's blood supply is blocked or interrupted by a build-up of fatty substances in the coronary arteries.

Over time, the walls of your arteries can become furred up with fatty deposits. This process is known as atherosclerosis and the fatty deposits are called atheroma.

Atherosclerosis can be caused by lifestyle factors and other conditions, such as:

• smoking
• high cholesterol
• high blood pressure (hypertension)
• diabetes

Diagnosing coronary heart disease

If your doctor feels you're at risk of CHD, they may carry out a risk assessment. This involves asking about your medical and family history, your lifestyle and taking a blood test.

Further tests may be needed to confirm a diagnosis of CHD, including:

• an MRI scan
• a CT scan
• coronary angiography

Treating coronary heart disease

Coronary heart disease can't be cured but treatment can help manage the symptoms and reduce the chances of problems such as heart attacks.

Treatment can include lifestyle changes, such as regular exercise andstopping smoking, as well as medication and surgery.

Read more about treating coronary heart disease.

Recovery

If you have problems, such as a heart attack or heart surgery, it's possible to eventually resume a normal life.

Advice and support is available to help you deal with aspects of your life that may have been affected by CHD.

Prevention

You can reduce your risk of getting CHD by making some simple lifestyle changes. These include:

• eating a healthy, balanced diet 
• being physically active
• giving up smoking
• controlling blood cholesterol and sugar levels

Keeping your heart healthy will also have other health benefits, such as helping reduce your risk of stroke and dementia.

Read more about preventing coronary heart disease.

Addison’s disease is an uncommon autoimmune disease, characterized by chronic and insufficient functioning of the outer layer of the adrenal gland. The adrenal glands are located atop each kidney and produce vital glucocorticoid hormones. Because of this chronic under-functioning of the adrenal glands, persons with Addison’s disease have a deficiency in the production of glucocorticoid hormones. Glucocorticoid hormones are involved in how the body utilizes and stores carbohydrates, protein, fat and blood sugar.

Causes of adrenal failure

Thomas Addison first identified the disease in 1855 while working at Guy’s Hospital in London. At that time, the main cause of the disease was as a complication of tuberculosis. TB still remains an important cause of Addison’s in Third World countries. HIV (AIDS) is now becoming another significant infectious disease causing adrenal failure among third world population.

In more affluent countries, the most frequent cause of Addison’s disease is destructive atrophy whereby an over-active immune system starts attacking the body’s own organs; in this case, the adrenals. This accounts for around 70% of all cases and affects more women than men. In common with most other autoimmune diseases, the exact reason for the atrophy is unknown.

Other, much rarer causes of Addison’s include certain fungal infections, adrenal cancer and adrenal haemorrhage (for example, following a car accident).

Symptoms

Addison’s disease is not usually apparent until over 90% of the adrenal cortex has been destroyed, so that very little adrenal capacity is left. This can take months to years and is known as primary adrenal insufficiency. Symptoms of the disease, once advanced, can include severe fatigue and weakness, loss of weight, increased pigmentation of the skin, faintness and low blood pressure, nausea, vomiting, salt cravings and painful muscles and joints. Because of the rather non-specific nature of these symptoms and their slow progression, they are often missed or ignored until, for example, a relatively minor infection leads to an abnormally long convalescence which prompts an investigation. Frequently, it is not until a crisis is precipitated that attention is turned to the adrenals.

Secondary failure

Secondary adrenal insufficiency is sometimes described as “Addison’s”, although it has a very different cause. It mostly occurs when a pituitary tumour (such as an adenoma) forms, although autoimmune destruction of the pituitary gland is also known. In secondary adrenal insufficiency, the pituitary gland no longer triggers the adrenals to produce cortisol, and DHEA production is also believed to decline.  In most cases of secondary adrenal insufficiency, however, aldosterone is still produced, as its production is stimulated by other hormonal regulatory systems.  The pituitary hormone which triggers cortisol production is called ACTH; it is responsible for the extra pigmentation found in primary Addison’s.  People with secondary adrenal failure do not experience the extra pigmentation found in primary Addison’s, because their ACTH levels are declining.

Long term use of high doses of steroid drugs to treat other illnesses (for example high–dose prednisone for bowel disease or asthma) can also cause temporary or permanent loss of adrenal function.  This is often referred to as secondary adrenal suppression.

Agammaglobulinemia is an immune disorder related to antibody deficiency (hypogammaglobulinemia) and is manifested in a variety of immune deficiency disorders in which the immune system is compromised. This group of immune deficiencies may be the consequence of an inherited condition, an impaired immune system from known or unknown cause, a relation to autoimmune diseases, or a malignancy.

Symptoms
XLA often becomes apparent in infancy due to recurrent and severe bacterial infections including:
• Ear infections
• Sinusitis
• Pneumonia
• Diarrhea due to a parasite called Giardia

When a baby is first born, it is protected from infection by IgG antibodies that are passed through the placenta from the mother. This maternal IgG only lasts for several months, and then the infant needs to start producing antibodies on its own. When affected by XLA, the infant cannot do this on his own, and becomes susceptible to these recurrent infections.

Diagnosis
XLA can be detected through screening tests that measure immunoglobulin levels or the number of B cells in the blood.

Treatment & Management

There is no cure for XLA, but the condition can be successfully treated. Immunoglobulin replacement therapy is a life-long and life-saving treatment that restores some of the missing antibodies. In addition, some people benefit from a daily course of oral antibiotics to prevent or treat infections.

Most individuals with XLA who receive immunoglobulin on a regular basis can lead relatively normal lives.

Live viral vaccines, such as those for polio, measles, mumps or rubella, are not considered safe for people with XLA. Though rare, these vaccines can infect the recipient with the very disease they were intended to prevent. This is true for most B and T cell immune defects.

Ankylosing spondylitis is an autoimmune disease and is a type of arthritis of the spine. It causes swelling between your vertebrae, which are the disks that make up your spine, and in the joints between your spine and pelvis. The disease is more common and more severe in men. It often runs in families. Early symptoms include back pain and stiffness. These problems often start in late adolescence or early adulthood. Over time, ankylosing spondylitis can fuse your vertebrae together, limiting movement. Symptoms can worsen or improve or stop altogether. The disease has no cure, but medicines can relieve the pain, swelling and other symptoms. Exercise can also help.

Symptoms of Ankylosing Spondylitis

The most common early symptoms of ankylosing spondylitis include:

·         Pain and stiffness. Constant pain and stiffness in the low back, buttocks, and hips that continue for more than three months. Spondylitis often starts around the sacroiliac joints, where the sacrum (the lowest major part of the spine) joins the ilium bone of the pelvis in the lower back region.

·         Bony fusion. Ankylosing spondylitis can cause an overgrowth of the bones, which may lead to abnormal joining of bones, called "bony fusion." Fusion affecting bones of the neck, back, or hips may impair a person's ability to perform routine activities. Fusion of the ribs to the spine or breastbone may limit a person's ability to expand his or her chest when taking a deep breath.

·         Pain in ligaments and tendons. Spondylitis also may affect some of the ligaments and tendons that attach to bones. Tendonitis (inflammation of the tendon) may cause pain and stiffness in the area behind or beneath the heel, such as the Achilles tendon at the back of the ankle.

Causes Ankylosing Spondylitis?

Although the cause of ankylosing spondylitis is unknown, there is a strong genetic or family link. Most, but not all, people with spondylitis carry a gene called HLA-B27. Although people carrying this gene are more likely to develop spondylitis, it is also found in up to 10% of people who have no signs of the condition.

Ankylosing Spondylitis Diagnosed?

The diagnosis of ankylosing spondylitis is based on several factors, including:

·         Symptoms

·         Findings of a physical exam

·         X-rays of the back and pelvis

·         Measurements of the chest when breathing

·         Results of lab tests

Autoimmune hepatitis is a chronic inflammatory autoimmune disease of the liver. It usually occurs by itself, but it can coexist with other autoimmune diseases. The male/female ratio is 8:1, and it most often occurs in persons of Northern European extraction. It is usually classified as Type I or Type II. Type I is the most common and occurs at any age, most commonly in women. Type II is less common, affecting mostly girls between the ages of two to fourteen, although adults can have it too.

Signs and symptoms

Autoimmune hepatitis may present as acute or chronic hepatitis or as well-established cirrhosis, although in rare cases it presents as fulminant hepatic failure.

Symptoms and physical examination findings may stem from extrahepatic diseases associated with autoimmune hepatitis. Common symptoms include the following:

·         Fatigue

·         Upper abdominal discomfort

·         Mild pruritus

·         Anorexia

·         Myalgia

·         Diarrhea

·         Cushingoid features

·         Arthralgias

·         Skin rashes (including acne)

·         Edema

·         Hirsutism

·         Amenorrhea

·         Chest pain from pleuritis

·         Weight loss and intense pruritus (unusual)

Diagnosis

Laboratory studies

Laboratory findings in autoimmune hepatitis include the following:

·         Elevated serum aminotransferase levels (1.5-50 times reference values)

·         Elevated serum immunoglobulin levels, primarily immunoglobulin G (IgG)

·         Seropositive results for antinuclear antibodies (ANAs), smooth-muscle antibodies (SMAs), or liver-kidney microsomal type 1 (LKM-1) or anti–liver cytosol 1 (anti-LC1) antibodies

·         Hypoalbuminemia and prolongation of prothrombin time – Markers of severe hepatic synthetic dysfunction, which may be observed in active disease or decompensated cirrhosis

Other hematologic abnormalities may include the following:

·         Mild leukopenia

·         Normochromic anemia

·         Coombs-positive hemolytic anemia

·         Thrombocytopenia

·         Elevated erythrocyte sedimentation rate

·         Eosinophilia (uncommon)

Behcet’s disease is a chronic, multisystem autoimmune disease involving inflammation of blood vessels, called vasculitis, throughout the body. It is a rare disease, most commonly found in the Eastern Mediterranean countries and in eastern Asia. It affects more young men than women in those countries, but in the US it affects more women, most often in their 20s and 30s. The central nervous system, heart, and intestinal tract may be involved. Because this disease is so rare and it’s symptoms overlap those of other diseases, it may be very difficult to diagnose. Spontaneous remission may occur, which can add to the difficulty in diagnosis.

Signs and symptoms

The inflammation associated with Behçet's disease can affect blood vessels located within tissues throughout the body. It can therefore cause a wide range of symptoms.

Common symptoms include:

• genital and mouth ulcers
• red, painful eyes and blurred vision
• acne-like spots
• headaches
• painful, stiff and swollen joints

In severe causes, there is also a risk of serious and potentially life-threatening problems, such as permanent vision loss and strokes.

Read more about the symptoms of Behçet's disease.

Behçet's disease is treated

There is no cure for Behçet's disease, but it is often possible to control the symptoms with medicines that reduce the inflammation in the affected parts of the body.

These medications include:

• corticosteroids – powerful anti-inflammatory medications
• immunosuppressants – medications that reduce the activity of the immune system
• biological therapies – medications that target the biological processes involved in the process of inflammation

Your healthcare team will create a specific treatment plan for you depending on your symptoms.

Chagas disease

Chagas disease is caused by the parasite Trypanosoma cruzi, which is transmitted to animals and people by insect vectors that are found only in the Americas (mainly, in rural areas of Latin America where poverty is widespread). Chagas disease (T. cruziinfection) is also referred to as American trypanosomiasis.

It is estimated that as many as 8 million people in Mexico, Central America, and South America have Chagas disease, most of whom do not know they are infected. If untreated, infection is lifelong and can be life threatening.

How do people get Chagas disease?

People can become infected in various ways. In Chagas disease-endemic areas, the main way is through vectorborne transmission. The insect vectors are called triatomine bugs. These blood-sucking bugs get infected by biting an infected animal or person. Once infected, the bugs pass T. cruzi parasites in their feces. The bugs are found in houses made from materials such as mud, adobe, straw, and palm thatch. During the day, the bugs hide in crevices in the walls and roofs. During the night, when the inhabitants are sleeping, the bugs emerge. Because they tend to feed on people's faces, triatomine bugs are also known as "kissing bugs. " After they bite and ingest blood, they defecate on the person. The person can become infected if T. cruzi parasites in the bug feces enter the body through mucous membranes or breaks in the skin. The unsuspecting, sleeping person may accidentally scratch or rub the feces into the bite wound, eyes, or mouth.

People also can become infected through:

·         congenital transmission (from a pregnant woman to her baby);

·         blood transfusion;

·         organ transplantation;

·         consumption of uncooked food contaminated with feces from infected bugs; and

·         accidental laboratory exposure.

It is generally considered safe to breastfeed even if the mother has Chagas disease. However, if the mother has cracked nipples or blood in the breast milk, she should pump and discard the milk until the nipples heal and the bleeding resolves.

Chagas disease is not transmitted from person-to-person like a cold or the flu or through casual contact with infected people or animals.

Chagas disease treated?

There are two approaches to therapy, both of which can be life saving:

·         antiparasitic treatment, to kill the parasite; and

·         symptomatic treatment, to manage the symptoms and signs of infection.

Antiparasitic treatment is most effective early in the course of infection but is not limited to cases in the acute phase. In the United States, this type of treatment is available through CDC. Your health care provider can talk with CDC staff about whether and how you should be treated. Most people do not need to be hospitalized during treatment.

Symptomatic treatment may help people who have cardiac or intestinal problems from Chagas disease. For example, pacemakers and medications for irregular heartbeats may be life saving for some patients with chronic cardiac disease.

Crohn's Disease

Crohn's disease is a chronic inflammatory disease of the digestive tract. Symptoms include abdominal pain and diarrhea, sometimes bloody, and weight loss. Crohn's treatment consists of lifestyle changes, such as exercise and a healthy diet, as well as over-the-counter antidiarrhetics and prescription anti-inflammatory medication.

Crohn’s disease is an inflammatory autoimmune bowel disease characterized by severe and persistent inflammation of the lining or wall of the gastrointestinal tract. Crohn’s is sometimes referred to as chronic ileitis, regional enteritis, or granulomatous colitis. The part of the gastrointestinal tract most commonly affected is the segment between the ileum and the rectum. Although Crohn’s disease can be difficult to manage and live with, it is usually not life threatening.

Crohn’s can affect anyone, although persons of Jewish descent are afflicted three to six times more frequently than others. The disease usually involves young adults between the ages of 15-35, but it can be seen in children and the elderly. Males and females are equally affected. There is a genetic predisposition to develop the disease, and up to 25% of persons with the disease are likely to have a close relative with either Crohn’s or ulcerative colitis. WHile an auto-reactive antibody hasn’t yet been found in Crohn’s, it is generally accepted that autoimmunity is the underlying cause.

Diagnosing Crohn's Disease

There isn't any one test that can tell you whether or not you have Crohn's disease. And Crohn's disease has many possible symptoms that are the same as symptoms for other health problems. So, to make a diagnosis of Crohn's disease, your doctor is likely to gather information from multiple sources. You'll probably go through a combination of exams, lab tests, and imaging studies with these goals in mind:

• Rule out other health problems that have similar symptoms
• Make a clear diagnosis of Crohn's disease
• Determine exactly which part of the digestive tract is affected

Dysuria

Symptoms

Depending on the cause of dysuria, there may be other symptoms in addition to pain when urinating. Symptoms can include:

·         Lower urinary tract infection (cystitis) — Frequent urination, an intense urge to urinate, loss of bladder control, pain in the lower front portion of the abdomen (near the bladder), cloudy urine that may have a strong odor, bloody urine

·         Upper urinary tract infection (pyelonephritis) — Pain in the upper back, high fever with shaking chills, nausea and vomiting, cloudy urine, frequent urination, an intense urge to urinate

·         Urethritis — A discharge from the urethra, redness around the opening of the urethra, frequent urination, vaginal discharge. Partners of people with urethritis that comes from a sexually transmitted disease often will not have any symptoms.

·         Vaginitis — Pain, soreness or itching in the vagina, an abnormal or foul-smelling vaginal discharge or odor, pain or discomfort during sexual intercourse

Treatment

Treatment of dysuria depends on its cause:

·         Cystitis and pyelonephritis — These infections, usually caused by bacteria, can be cured with antibiotics taken by mouth. Antibiotics may be given into a vein (intravenously) for severe pyelonephritis with high fever, shaking chills and vomiting.

·         Urethritis — Urethritis is treated with antibiotics. The type of antibiotic used depends on which infection causes the urethritis.

·         Vaginitis — Trichomoniasis and bacterial vaginosis are treated with antibiotics. Yeast infections are treated with antifungal drugs, either as a pill by mouth or as a suppository or cream inserted into the vagina.

If you are sexually active and are being treated for dysuria caused by a sexually transmitted disease, your sex partners must be treated, too.

Polyuria

Symptom

As well as being one of the symptoms of undiagnosed diabetes, polyuria can also occur in people with diagnosed diabetes if blood glucose levels have risen too high.

If blood glucose levels become too high, the body will try to remedy the situation by removing glucose from the blood through the kidneys. When this happens, the kidneys will also filter out more water and you will need to urinate more than usual as a result.

If you are frequently experiencing an increased need to urinate, it could be a sign that your sugar levels are too high. If you have access to blood glucose testing strips, you may wish to test your sugar levels if you are urinating more often than normal.

If you have diabetes but don’t have blood glucose testing supplies, you may wish to note down how often you are urinating and discuss this with your health team.

Your health team should be able to advise whether the problem may be related to diabetes and any remedial action you can take.

The most common sign of polyuria is producing abnormally large volumes of urine at regular intervals throughout the day and at night.

If you are concerned about the amount you urinate and think you may have polyuria, you should make a note each day of how much you drink; how often you urinate and how much urine you produce every time you go to the toilet.

Treatment

Treatment varies by cause.

Depending on the cause of the polyuria, the adequate treatment should be afforded. According to NICE, decompress in can be considered for nocturnal polyuria, which can be caused by diabetes mellitus, if other medical treatments have failed. The recommendation had no studies that met the criteria for consideration.

Frequent urination

Symptom

Frequent urination is not the same as urinary incontinence, which is where there is no voluntary control of bladder function, reminiscent of the infant's involuntary reflex. However, urinary incontinence can be a cause of frequent urination, and/or the two can occur together.

When doctors assess urinary symptoms, they try to distinguish among several possibilities, such as nocturia, daytime frequent urination, urinary incontinence, obstructive symptom (such as poor, intermittent stream or terminal dribble), and irritative symptoms (such as urgency, burning sensation).

There are also other considerations, such as when is the symptom not something to worry about? For instance, in men it is so common to have a little "leakage" at the end of the stream (the post-micturition dribble), that it does not count as an abnormality.

Also, many women leak a little urine on coughing.

So one of the ways to decide if a seemingly harmless urinary symptom is an issue, is to establish the extent to which it impacts quality of life.

If urinary frequency is affecting your quality of life, or you also have other unexplained symptoms such as back or side pain, vomiting, fever, chills, fatigue, bloody or cloudy urine, or discharge from the vagina or penis, or an increase in appetite or thirst, then it is important to seek medical attention promptly.

For instance, one cause of frequent urination is kidney infection, and this requires prompt attention. If not treated, a kidney infection can permanently damage the kidneys, or the bacteria can infect the bloodstream and become life-threatening.

Treatment for Frequent Urination

Treatment for frequent urination will address the underlying problem that is causing it. For example, if diabetes is the cause, treatment will involve keeping blood sugar levels under control.

The treatment for overactive bladder should begin with behavioral therapies, such as:

·         Bladder retraining. This involves increasing the intervals between using the bathroom over the course of about 12 weeks. This helps retrain your bladder to hold urine longer and to urinate less frequently.

·         Diet modification. You should avoid any food that appears to irritate your bladder or acts as a diuretic. These may include caffeine, alcohol, carbonated drinks, tomato-based products, chocolate,artificial sweeteners, and spicy foods. It's also important to eat high-fiber foods, because constipation may worsen the symptoms ofoveractive bladder syndrome.

·         Monitoring fluid intake. You should drink enough to prevent constipation and over-concentration of urine, but you should avoid drinking just before bedtime, which can lead to nighttime urination.

·         Kegel exercises. These exercises help strengthen the muscles around the bladder and urethra to improve bladder control and reduce urinary urgency and frequency. Exercising pelvic muscles for five minutes three times a day can make a difference in bladder control.

Urinary incontinence

Symptoms

Some people experience occasional, minor leaks of urine. Others wet their clothes frequently.

Types of urinary incontinence include:

·         Stress incontinence. Urine leaks when you exert pressure on your bladder by coughing, sneezing, laughing, exercising or lifting something heavy.

·         Urge incontinence. You have a sudden, intense urge to urinate followed by an involuntary loss of urine. You may need to urinate often, including throughout the night. Urge incontinence may be caused by a minor condition, such as infection, or a more severe condition such as neurologic disorder or diabetes.

·         Overflow incontinence. You experience frequent or constant dribbling of urine due to a bladder that doesn't empty completely.

·         Functional incontinence. A physical or mental impairment keeps you from making it to the toilet in time. For example, if you have severe arthritis, you may not be able to unbutton your pants quickly enough.

·         Mixed incontinence. You experience more than one type of urinary incontinence.

Treatment

Treatment for urinary incontinence depends on the type of incontinence, its severity and the underlying cause. A combination of treatments may be needed. Your doctor is likely to suggest the least invasive treatments first and move on to other options only if these techniques fail.

Behavioral techniques

Your doctor may recommend:

·         Bladder training, to delay urination after you get the urge to go. You may start by trying to hold off for 10 minutes every time you feel an urge to urinate. The goal is to lengthen the time between trips to the toilet until you're urinating only every two to four hours.

·         Double voiding, to help you learn to empty your bladder more completely to avoid overflow incontinence. Double voiding means urinating, then waiting a few minutes and trying again.

·         Scheduled toilet trips, to urinate every two to four hours rather than waiting for the need to go.

·         Fluid and diet management, to regain control of your bladder. You may need to cut back on or avoid alcohol, caffeine or acidic foods. Reducing liquid consumption, losing weight or increasing physical activity also can ease the problem.

Pelvic floor muscle exercises

Your doctor may recommend that you do these exercises frequently to strengthen the muscles that help control urination. Also known as Kegel exercises, these techniques are especially effective for stress incontinence but may also help urge incontinence.