Stress incontinence: neuropharmacology and neurophysiology

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cocrgolfer
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Date Joined Oct 2009
Total Posts : 171
   Posted 12/7/2009 6:45 PM (GMT -6)   
Brothers,

As I continue my battle with incontinence, I noticed something odd. That the more full my bladder is, the easier it is to retain my urine. The following paragraphs of an article I found have a scientific explanation of why that may be. Also, another benefit of the Kegel exercises (and possibly a more important one?) is that in the act of "Kegeling" (contracting the pelvic floor muscles) a signal is sent to the muscle surrounding the bladder that inhibits its contractions and facillitates the retention of urine. The same article notes that some studies found a 71% improvement in stress incontinence by the use of ephedrine or phenylpropanolamine (found in common cold remedys). It has the effect of constricting the smooth muscle in the urethral sphincters. Has anyone tried that with any success?

http://www.springerlink.com/content/u676082762k02561/fulltext.pdf



1. Sympathetic detrusor inhibiting reflex. This is stimulated

by increasing tension in the muscle of the

detrusor wall. It originates in the detrusor musculature

and travels to the sacral "micturition area" of

the spinal cord; from there it returns to the detrusor

musculature to inhibit its contractility.

2. Sympathetic sphincter constrictor reflex. This is

also stimulated by increasing tension in the muscle of

the detrusor wall. It originates in the detrusor

musculature and travels to the sacral "micturition

area" of the spinal cord, but from there it travels

back to the internal smooth muscle of the urethral

sphincter to stimulate its contractility.

3. Perineodetrusor inhibitory reflex. This is stimulated

by increased voluntary tension in the perineal

and pelvic floor muscles. It thus travels from the

perineal and pelvic floor musculature to the micturition

area of the sacral cord, and from there it returns

to the detrusor muscle to inhibit its contractility.

4. Urethrosphincteric guarding reflex. This is stimulated

by increasing tension in the bladder trigone,

and/or by the presence of urine in the proximal

urethra. It travels to the "micturition area" of the

sacral cord, and from there it returns to the external

striated muscle part of the urethral sphincter and

stimulates its contraction.

Group H involves two reflexes which specifically

help to initiate voiding (Fig. 3):

1. Perineobulbar detrusor facilitative reflex. This is

stimulated by the contraction of abdominal and

diaphragmatic musculature and the corresponding

relaxation of the perineal and pelvic floor musculature.

It travels from the perineal and pelvic floor

musculature to the detrusor constrictor center in the

brain stem "micturition area." It is interconnected

with the adjoining detrusor relaxer center and then

proceeds to the sacral micturition areas; from there it

travels to the detrusor muscle to help initiate

detrusor

Steve

Worried Guy
Veteran Member


Date Joined Jul 2009
Total Posts : 3731
   Posted 12/7/2009 9:59 PM (GMT -6)   
Oh I like the way you think. I might give the ephedrine a try to see if it does anything. If it reduces my leak rate by even 5%, I'll know it.

By the way, which type is the "Nose blow" reflex? Everything lets loose when I give a good honk. I only do it while either standing in the shower or in front of the toilet since I am guaranteed a 30 ml squirt.
Jeff
DX Age 56. First routine PSA test on April 8th: 17.8.
May PSA: 22.6, 3 weeks later: PSA: 23.2.
Biopsy 6/10/09: 7/12 scores positive, Gleason 6=3+3. Bone scan and C/T scan negative.
RP DaVinci -7/21/2009 @ Univ of Roch Medical Center
Left nerve gone, right partial spared.
Catheter removed - 7/31/2009 Pathology report received:
Gleason 3+4=7 Tumor size: 2.5 x 1.8 cm location: both lobes and apex. No Malignancy in Seminal Vesicle, vasa deferentia, lymph nodes 0/13
Extraprostatic extension present; Perineural invasion: present, extensive
Prostate mass 56 grams. Pathologic Stage: pT3aN0MX
Post Surgery Status:
Potency - 10/31 3 months, Still no activity, nada, zip
Incontinence - 8/20 4 full pads per day
. 9/7 3-4 full pads per day (I'm going to try cutting down on fluids. Bad idea. I know.)
9/27 2 months: Still 3 pads per day.
11/14 4 month: Still 3 pads per day. 420ml/day, 91 um leak. At this rate I'll be fine in 2012.
Post Surgery PSA - 9/3 6 weeks- 0.05, 10/13 3 months- 0.04 undetectable.


cocrgolfer
Regular Member


Date Joined Oct 2009
Total Posts : 171
   Posted 12/8/2009 5:30 AM (GMT -6)   
Jeff,
WOuldn't that be the last paragrah, the perineobulbar detrusor facilitative reflex. That would also include farting, which for the incontinent now means not only polluting the ambient air quality but the certainty of an uncontrolled micturation.



Steve

Worried Guy
Veteran Member


Date Joined Jul 2009
Total Posts : 3731
   Posted 12/8/2009 5:55 AM (GMT -6)   
Steve,
Ahhh. Ok. My incontinence is now cured. It is my underwear that is suffering daily from hyper-micturition saturation. I think I'll try solving that by hooking a TENS unit to my brain stem detrusor constrictor center and injecting a pulsssssssssssssssssssssssssssssssssssss................

jEfF

Worried Guy
Veteran Member


Date Joined Jul 2009
Total Posts : 3731
   Posted 12/9/2009 8:55 AM (GMT -6)   
Interesting news.
I tried a full ounce of Top Care Nite Time Cold/Flu liquid and slept through the night with no wake up calls! First pee of the day was 400 ml and I managed to get it ALL into the measurement bowl with none on a pad. I will try that again tonight. Big progress!
A few more nights of this and my wife will start letting me wear big boy, Star Wars underpants!
Jeff

cocrgolfer
Regular Member


Date Joined Oct 2009
Total Posts : 171
   Posted 12/9/2009 10:25 AM (GMT -6)   
Hey Jeff,


Great! That is real progress. I just came back from the pharmacy with Sudafed, it has 120 mg of pseudoephedrine and I'm going to try it tomorrow morning. It's too late today and if I take it I'll be bouncing off the walls until midnight. How may mg of pseudoephedrine does you cold medicine have?



Steve

Worried Guy
Veteran Member


Date Joined Jul 2009
Total Posts : 3731
   Posted 12/9/2009 11:14 AM (GMT -6)   
Steve,
The Top Care Med is

1 - 15 ml TBSP has:
Acetaminophen 500 mg
Dextromethorphan HBr 15 mg
Doxylamine succinate 1.25 mg
Alcohol 1.5 ml
There was no ephedrine (Pseudo or straight)

I took 2 of those (30 ml) - the recommended adult dose.

So between your daytime drug study and my nighttime study we might come up with something useful.
Now I just have to figure out which costs more, a 28 cent pee pad or a single dose of cold medicine. Did it - 34 cents for the cold medicine. The nice sleep was worth the 6 cents.
I'll do it again tonight.
Jeff

Worried Guy
Veteran Member


Date Joined Jul 2009
Total Posts : 3731
   Posted 12/10/2009 8:02 AM (GMT -6)   
Steve,
I took the Nite time Cold medicine again and slept through the night beautifully.
It was freezing when I got up since I did not stoke and load the woodburner like I usually do during my midnight travels.
My total leak went from an average of 450 ml per day to 330ml for yesterday. That is a huge drop. Same number of pads but they were lighter.
I will continue this experiment.
Do you have the capability to weigh your pads? You need a good scale and a very understanding wife.
Just so we are consistent, I include the weight of the pads in my numbers. It is easier to measure and I figure it makes up for any leak that might have gone into my underwear.
Also the total pad mass is only about 30 gms - insignificant at this point.

Keep on taking data. I think maybe it was Descarte said who said, " I measure, therefore I am." ; "Measurito, ergo sum"
Jeff
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