Mpenzi wangu anakojoa Kitandani, nifanyeje aache?

Mpenzi wangu anakojoa Kitandani, nifanyeje aache?

pathfinder_tz

pathfinder_tz

JF-Expert Member
Joined
Mar 4, 2018
Posts
356
Reaction score
377
Dah! Huwa nasikia tu kuna watu wazima wanakojoa kitandani but sijawahi kukutana nae mpaka week iliyopita ndio nikaprove.

Kuna bidada mmoja tumetokea kupendana sana but tulikuwa hatujawahi kula tunda huwa ananipiga sana kalenda bila kuwa na sababu za msingi.

Kila nikimwambia babe njoo ntakufa na kihoro ananipga chenga.

Visingizio kibaooo heh mpaka nikahisi kuna mtu ananisaidia kazi huko kwao.

Ndipo nilipohoji kwanini napigwa kalenda bila sababu za msingi au haujanipenda!

Kama mnavyojua mahusiano ya siku hizi yalivyo bila kujamiiana unaona hakuna mapenzi na wakati mwingine unaweza sema mwenzio anakucheat

Basi mwenzangu akajawa na mawazo pasi kujua nini cha kufanya nilimuuliza tatizo nini but still hakuwa muwazi.

Basi maisha yakaendelea siku iliyofuata akaaga kwao anaenda kwenye sherehe atalala kwa rafiki yake. Ndipo akaja kwangu tukpiga stori tukapiga kilaji tukabanjuka amri ya sita tukalala.

Asubuhi kuamka mhhh nasikia harufu ya mkojo nikajipapasa maungoni kwangu nikajiona mzima sio mimi.Nikapapasa upande aliolala mwenzangu doohhh kalibwandaaa kojo jingii.

Alivyoamka alivyoona hali ile ikabid aseme jana alikunywa sana akaptiwa.. sio kesi mzee baba nikajfanya sina akili nikaanika godoro bahati nzuri nyumba ya fens.

Sasa cha ajabu juzi kaja tena tumelala kakojoa tena na wala hatukunywa ndo ikabid nihoj kulikoni.

Akaniambia huwa anaota yupo chooni anakojoa ndio analimwaga na huwa inamtokea mara kwa mara na kwa usiku mmoja anaweza kukojoa hata mara mbili.

Dah nikamuuliza kama kuna tiba tutafute akaniambia kwao wamehangaika sana na madawa kibao ya mitshamba lakini wapi.

Sasa jamani ushauri wenu kwa wale wnye utaalam na hivi vitu tusaidiane.

Shemeji na wifi yenu ndo yupo hivyo jamani na kumfukuza siwezi na hata kuachana nae sijawahi kufikiria.

Sasa tunamsaidiaje huyu mtu..!??
 

Attachments

  • FB_IMG_1522526271521.jpeg
    FB_IMG_1522526271521.jpeg
    151.4 KB · Views: 93
Huyo inabidi uende nae kama wale watoto wadogo wanaokojoa kitandani

Chakufanya uwe unaweka ata alarm kama kweli anakojoa hadi mara 2 basi kama waga mnalala sa 5 uck basi juu chini fanya sa 8 umuamshe akakojoe kama ukikuta sa 8 kashafanya yake basi unapunguza saa 1 na kuanza kumuamsha sa 7

Then sa 11 alfajiri tena unaumuasha ya mwisho maana huo muda ndio waga mda mzuri wa vikojozi kufanya yao na pia ndio waga mzuri wa zile ndoto za ajabu ajabu

Hapo amesha athirika kisaikolojia so ata umwambie asiwe anakunywa maji usiku still atakojoa tu so baada ya hiyo project kwenda kwa takribani mwezi mmja ye mwenyewe ata anza kubadilika kisaikolojia na atakuwa anaamka mwenyewe na mwisho wa siku atakuwa hakojoi kabisa
 
mtafutie nailoni uiweke mtindo wa pampas kama huduma ya kwanza kisha mlete nimtibu
 
Mtembeze mtaani huku unamuimba
Kindumbwendumbwe
Chaliaaaa
Kikojozi
Na nguo
Tumchomee moto
Huyoooooooo

Hatorudia tena na hiyo aibu atakayoipata
 
Huyo ana tatizo kwenye mfumo wa neva kwenye ubongo. Kuna vidonge vya amitriptyline vitafute awe ana vimeza angalau kimoja kwa siku. Ila vinaleta usingizi mkali. So awe anameza usiku.
 
Ukipenda boga penda Na UA lake( joking)

Hiyo hali huwa unahuzunisha sana! Umenikumbusha mtu flani......
Hebu Mwambie ajaribu kunywa maji mapema ili angalau kupunguza presha kwenye kibofu usiku!
Na vile vile jitahidi kumwamsha usiku huenda atafika mahali itakaa sawa!
 
Other medicines helpful in controlling the bladder muscles and sphincter are hyoscyamine (Levsin), amitriptyline(elavil), imipramine (tofranil), and flovoxate (urispas). As an adjunct to pelvic floor training and medication, biofeedback modalities are often helpful for managing urgency and urgeincontinence.
 
This site is intended for healthcare professionals



Drugs & Diseases > Urology
Urinary Incontinence Medication
Updated: Dec 12, 2017
  • Author: Sandip P Vasavada, MD; Chief Editor: Edward David Kim, MD, FACS
  • Midodrine[/paste:font]
    The active metabolite of midodrine, desglymidodrine, is an alpha1-agonist that may increase bladder outlet resistance.


    Pseudoephedrine hydrochloride (Sudafed, Genaphed, SudoGest)
    Pseudoephedrine helps stress incontinence. The subjective improvement and cure rates are similar to that of phenylpropanolamine, which was recalled from the US market. Pseudoephedrine stimulates vasoconstriction by directly activating alpha-adrenergic receptors.


    Phenylpropanolamine
    Recalled from US market. Epinephrine stores are released under phenylpropanolamine stimulation and produce alpha- and beta-adrenergic stimulation. These effects may increase bladder outlet resistance.



    Anticholinergic Agents
    Class Summary
    These agents represent first-line medicinal therapy in women with urge incontinence. These agents are useful in treating urinary incontinence associated with urinary frequency, urgency, and nocturnal enuresis.


    Anticholinergic agents inhibit the binding of acetylcholine to the cholinergic receptor, thereby suppressing involuntary bladder contraction of any etiology. In addition, they increase the urine volume at which first involuntary bladder contraction occurs, decrease the amplitude of the involuntary bladder contraction, and may increase bladder capacity.


    All anticholinergic drugs have a similar performance profile and toxicity. Potential adverse effects of all anticholinergic agents include blurred vision, dry mouth, heart palpitations, drowsiness, and facial flushing. When anticholinergic drugs are used in excess, the bladder may go into acute urinary retention.


    All drugs with anticholinergic effects or side effects are contraindicated if patients have documented narrow-angle glaucoma. Wide-angle glaucoma is not a contraindication to their use.


    Other contraindications to anticholinergic use are urinary retention, bowel obstruction, ulcerative colitis, myasthenia gravis, and severe heart diseases. Because of the potential for drowsiness—especially when combined with alcohol, sedatives, or hypnotic drugs—these agents may impair the patient's ability to perform hazardous activities, such as driving or operating heavy machinery.


    Dicyclomine hydrochloride (Bentyl)
    An anticholinergic agent with smooth muscle relaxant properties, dicyclomine blocks the action of acetylcholine at parasympathetic sites in secretory glands and smooth muscle.


    Darifenacin (Enablex)Darifenacin is an extended-release product eliciting competitive muscarinic receptor antagonistic activity. It reduces bladder smooth muscle contractions. Darifenacin has high affinity for M3 receptors involved in bladder and GI smooth muscle contraction, saliva production, and iris sphincter function. It is indicated for overactive bladder with symptoms of urge incontinence, urgency, and frequency. Swallow whole; do not chew, divide, or crush.


    Solifenacin succinate (VESIcare)
    Solifenacin elicits competitive muscarinic receptor antagonist activity, which results in anticholinergic effects and inhibition of bladder smooth muscle contraction. This agent is indicated for overactive bladder with symptoms of urgency, frequency, and urge incontinence. It must be swallowed whole; do not crush or chew.


    Hyoscyamine sulfate (Levsin/SL, Levsin, Levsinex, Cystospaz-M, Levbid)
    Hyoscyamine blocks the action of acetylcholine at parasympathetic sites in smooth muscle, secretory glands, and the CNS, which in turn has antispasmodic effects. Hyoscyamine is absorbed well by the GI tract. Food does not affect absorption of this drug. Hyoscyamine is available in sublingual form (Levsin SL, Symax SL), conventional tablets (Levsin), and extended-release tablets (Levbid).


    Propantheline (Pro-Banthine)
    A prototypical anticholinergic agent, propantheline blocks action of acetylcholine at postganglionic parasympathetic receptor sites.


    Tolterodine (Detrol and Detrol LA)
    Competitive muscarinic receptor antagonist for overactive bladder. However, it differs from other anticholinergic types in that it has selectivity for urinary bladder over salivary glands. Exhibits a high specificity for muscarinic receptors, has minimal activity or affinity for other neurotransmitter receptors and other potential targets such as calcium channels. In clinical studies, the mean decrease in urge incontinence episodes was 50% and the mean decrease in urinary frequency was 17%. The mean decrease in urge incontinence episodes per wk was 53% for Detrol LA 4 mg qd.


    Trospium (Sanctura)
    Quaternary ammonium compound that elicits antispasmodic and antimuscarinic effects. Antagonizes acetylcholine effect on muscarinic receptors. Parasympathetic effect reduces smooth muscle tone in the bladder. Indicated to treat symptoms of overactive bladder (eg, urinary incontinence, urgency, frequency).


    Fesoterodine (Toviaz)Competitive muscarinic receptor antagonist. Antagonistic effect results in decreased bladder smooth muscle contractions. Indicated for symptoms of overactive bladder (eg, urinary urge incontinence, urgency, and frequency). Available as 4- or 8-mg extended-release tab.



    Antispasmodic Drugs
    Class Summary
    These agents relax the smooth muscles of the urinary bladder. By exerting a direct spasmolytic action on the smooth muscle of the bladder, these medications have been reported to increase bladder capacity and effectively decrease or eliminate urge incontinence.


    The adverse effect profile of antispasmodic drugs is similar to that of anticholinergic agents. These drugs may impair the ability to perform activities requiring mental alertness and physical coordination. Drinking alcohol and using sedatives in combination with these antispasmodic drugs is contraindicated.


    In 2001, Appell et al reported the results of the Overactive Bladder: Judging Effective Control and Treatment (OBJECT) trial. This was a large double-blind, multicenter, prospective, randomized controlled study that compared the efficacy and tolerability of oxybutynin (Ditropan XL) (n = 160) with that of tolterodine (Detrol) (n = 170) in men and women with symptoms of overactive bladder. The study concluded that oxybutynin 10 mg was statistically superior to tolterodine 2 mg bid in terms of efficacy. However, both drugs had similar adverse-effect profiles. [Oxybutynin chloride (Ditropan IR, Ditropan XL, Gelnique)[/paste:font]
    Both the immediate-release and the extended-release forms of oxybutynin have both an anticholinergic and a direct smooth muscle relaxant effect on the urinary bladder. In addition, oxybutynin provides a local anesthetic effect on the irritable bladder.


    The human detrusor has M2 and M3 muscarinic receptors. The M3 receptor mediates contractile response of human detrusor. Oxybutynin has greater affinity for the M3 receptor. Urodynamic studies have shown oxybutynin increases bladder size, decreases frequency of symptoms, and delays initial desire to void.


    Ditropan XL has an innovative drug delivery system: oral osmotic delivery system (OROS). The Ditropan XL tablet has a bilayer core that contains a drug layer and a "push layer" that contains osmotic components. The outer tablet is composed of a semipermeable membrane with a precision laser-drilled hole that allows the drug to be released at a constant rate.


    When the drug is ingested, the aqueous environment in the gastrointestinal tract causes water to enter the tablet via semipermeable membrane at a constant rate. The introduction of water inside the tablet liquefies drug and causes the push layer to swell osmotically. As the push layer swells, it forces the drug suspension out the hole at a constant rate over a 24-h period.


    Ditropan XL achieves steady-state levels over a 24-h period. It avoids first pass metabolism in liver and upper gastrointestinal tract to avoid cytochrome P450 enzymes. It has excellent efficacy, with minimal adverse effects.


    Flavoxate (Urispas)
    Flavoxate is used for symptomatic relief of dysuria, urgency, nocturia, and incontinence, as may occur in cystitis, prostatitis, urethritis, and urethrocystitis/urethrotrigonitis. It exerts a direct relaxant effect on smooth muscles via phosphodiesterase inhibition. It provides relief for a variety of smooth muscle spasms.



    Tricyclic Antidepressants
    Class Summary
    Historically, these drugs were used to treat major depression; however, TCAs have an additional use in the treatment of bladder dysfunction. They function to increase norepinephrine and serotonin levels. In addition, they exhibit an anticholinergic and direct muscle relaxant effect on the urinary bladder.


    Imipramine hydrochloride (Tofranil)
    A typical TCA, imipramine facilitates urine storage by decreasing bladder contractility and increasing outlet resistance. It has an alpha-adrenergic effect on the bladder neck and an antispasmodic effect on the detrusor muscle. Imipramine also has a local anesthetic effect on bladder mucosa.


    Amitriptyline hydrochloride (Elavil)
    A TCA with sedative properties, amitriptyline increases the circulating levels of norepinephrine and serotonin by blocking their reuptake at nerve endings. It ineffective for use in urge incontinence but is extremely effective in decreasing symptoms of urinary frequency in women with pelvic floor muscle dysfunction. Amitriptyline restores serotonin levels and helps break the cycle of pelvic floor muscle spasms. It is well tolerated and effective in the majority of women with urinary frequency.



    Estrogens
    Class Summary
    Conjugated estrogens increase the tone of urethral muscle by up-regulating the alpha-adrenergic receptors in the surrounding area, and they enhance alpha-adrenergic contractile response to strengthen the pelvic muscles, which is important in urethral support (ie, prevents urethral hypermobility). Mucosal turgor of periurethral tissue from proper nourishment enhances urethral mucosal coaptation.


    The result is an improved mucosal seal effect, which is important in urethral function (ie, it prevents intrinsic sphincter deficiency). Estrogen supplementation appears to be the most effective in postmenopausal women with mild-to-moderate incontinence. Both types of stress incontinence improve with estrogen fortification.


    Conjugated estrogen (Premarin)
    Conjugated estrogen may be used as an adjunctive pharmacologic agent for postmenopausal women with stress or mixed incontinence. Oral or vaginal form of estrogen may be used. The usual oral dose is 0.3-1.25 mg taken daily in a cyclic regimen.


    When oral estrogens are needed, prescribe 0.625-mg pills. To prevent overstimulation of the uterus, conjugate estrogen is taken once a day for 21 consecutive days, followed by 7 days without the drug (eg, 3 wk on and 1 wk off). This regimen is repeated as necessary and tapered or discontinued at 3- to 6-month intervals.


    Conjugated estrogen vaginal cream is available in a package with a plastic applicator and a tube that contains 42.5 grams of conjugated estrogens. Each gram contains 0.625 mg of conjugated estrogens. When vaginal cream is used, 2-4 g (0.5-1 applicator) of the cream may be administered intravaginally daily in the usual cyclic regimen.


    Estrogen cream is readily absorbed through the skin and mucous membranes. When this cream is used for treatment of atrophic vaginitis, it may be placed intravaginally or applied topically around the vaginal tissues.


    When estrogen is used long term in women with an intact uterus, the addition of progestin therapy is recommended to prevent endometrial hyperplasia. Medroxyprogesterone 2.5-10 mg/d is needed for 10-13 days to provide maximum maturation of endometrium and to eliminate any hyperplastic changes. Medroxyprogesterone may be administered continuously or intermittently.


    Treatment with estrogen derivatives results in few cures (0-14%) but may cause subjective improvement in 29-66% of women. Limited evidence suggests that oral or vaginal estrogen therapy may benefit some women with stress and mixed urinary incontinence. Other potential beneficial effects of estrogen use include decreased bone loss and resolution of hot flashes during menopause.


    Routinely prescribing conjugated estrogens to premenopausal women is not recommended. Use this medication in postmenopausal women who are incontinent and who have had a hysterectomy. For postmenopausal women with an intact uterus, cautiously recommend a short-term low-dose of conjugated estrogen and monitor frequently.



    Antidepressants, Serotonin/Norepinephrine Reuptake Inhibitors
    Class Summary
    Some agents in this class may improve stress incontinence


    Duloxetine (Cymbalta)
    Duloxetine is a potent inhibitor of neuronal serotonin and norepinephrine reuptake. Its antidepressive action is theorized to be due to serotonergic and noradrenergic potentiation in the CNS.



    Alpha-Adrenergic Blockers
    Class Summary
    These agents have been used to decrease bladder overactivity. They have shown some success in patients who have decentralized or autonomous bladders as the result of myelodysplasia, spinal cord injury, or radical pelvic surgery.


    Phenoxybenzamine (Dibenzyline)
    This agent decreases bladder contractions through long-lasting, noncompetitive, alpha-adrenergic blockade of postganglionic synapses at smooth muscle and exocrine glands.


    Prazosin (Minipress)
    Prazosin decreases internal sphincter tone and can improve the flow of urine, improving emptying of bladder. Although doses greater than 20 mg/d usually do not increase efficacy, a few patients may benefit from dose as high as 40 mg/d. If an increase in dose is needed, give first dose of each increment at bedtime to reduce syncopal episodes.



    Botulinum Toxins
    Class Summary
    Intradetrusor injections with botulinum toxin are a novel treatment modality that has been shown to decrease episodes of urinary leakage in patients who have failed pharmacological therapy.


    OnabotulinumtoxinA (BOTOX)
    Neurotoxin from Clostridium botulinum; prevents ACh release from presynaptic membrane. Indicated for urinary incontinence in patients with neurologic conditions (eg, spinal cord injury, multiple sclerosis) in adults who have an inadequate response to or are intolerant of an anticholinergic medication.


TOOLS
Most Popular Articles
According to Urologists
  1. Little Evidence Supports Use of Digital Rectal Exam
  2. Pass on Kidney Stone Meds, Study Suggests
  3. Fast Five Quiz: Test Your Knowledge of Varicoceles
  4. Suicide Rates Higher for Patients With Urologic Cancers
  5. Biopsy Decisions Guided by New Predictor
View More



mscp-logo.png

FIND US ON

ABOUT
About MedscapePrivacy PolicyTerms of UseAdvertising PolicyHelp Center
MEMBERSHIP
Become a MemberEmail NewslettersManage My Account
APPS
MedscapeMedPulse NewsCME & Education
WEBMD NETWORK
WebMDMedicineNeteMedicineHealthRxListWebMD Corporate
EDITIONS
EnglishDeutschEspañolFrançaisPortuguês
All material on this website is protected by copyright, Copyright © 1994-2018 by WebMD LLC. This website also contains material copyrighted by 3rd parties.
 
pathfinder_tz said:
Dah! Huwa nasikia tu kuna watu wazima wanakojoa kitandani but sijawahi kukutana nae mpaka week iliyopita ndio nikaprove.

Kuna bidada mmoja tumetokea kupendana sana but tulikuwa hatujawahi kula tunda huwa ananipiga sana kalenda bila kuwa na sababu za msingi.

Kila nikimwambia babe njoo ntakufa na kihoro ananipga chenga.

Visingizio kibaooo heh mpaka nikahisi kuna mtu ananisaidia kazi huko kwao.

Ndipo nilipohoji kwanini napigwa kalenda bila sababu za msingi au haujanipenda!

Kama mnavyojua mahusiano ya siku hizi yalivyo bila kujamiiana unaona hakuna mapenzi na wakati mwingine unaweza sema mwenzio anakucheat

Basi mwenzangu akajawa na mawazo pasi kujua nini cha kufanya nilimuuliza tatizo nini but still hakuwa muwazi.

Basi maisha yakaendelea siku iliyofuata akaaga kwao anaenda kwenye sherehe atalala kwa rafiki yake. Ndipo akaja kwangu tukpiga stori tukapiga kilaji tukabanjuka amri ya sita tukalala.

Asubuhi kuamka mhhh nasikia harufu ya mkojo nikajipapasa maungoni kwangu nikajiona mzima sio mimi.Nikapapasa upande aliolala mwenzangu doohhh kalibwandaaa kojo jingii.

Alivyoamka alivyoona hali ile ikabid aseme jana alikunywa sana akaptiwa.. sio kesi mzee baba nikajfanya sina akili nikaanika godoro bahati nzuri nyumba ya fens.

Sasa cha ajabu juzi kaja tena tumelala kakojoa tena na wala hatukunywa ndo ikabid nihoj kulikoni.

Akaniambia huwa anaota yupo chooni anakojoa ndio analimwaga na huwa inamtokea mara kwa mara na kwa usiku mmoja anaweza kukojoa hata mara mbili.

Dah nikamuuliza kama kuna tiba tutafute akaniambia kwao wamehangaika sana na madawa kibao ya mitshamba lakini wapi.

Sasa jamani ushauri wenu kwa wale wnye utaalam na hivi vitu tusaidiane.

Shemeji na wifi yenu ndo yupo hivyo jamani na kumfukuza siwezi na hata kuachana nae sijawahi kufikiria.

Sasa tunamsaidiaje huyu mtu..!??
Click to expand...
Nime wahi kusikia maji yaliyo osha Michele husaidia
 
Aonge maji ya ukoko wa ugali, ukipika ugali ambao umeupakua bila kutumia mwiko yaan sufuria ukalbwaga kwa sahan au senia... Weka maji kwa sufuria bdae aoge hayo!
 
Nichumu Nibebike said:
Huyo ana tatizo kwenye mfumo wa neva kwenye ubongo. Kuna vidonge vya amitriptyline vitafute awe ana vimeza angalau kimoja kwa siku. Ila vinaleta usingizi mkali. So awe anameza usiku.
Click to expand...
huo usingizi mkali ndio tatizo yani mtu ukishakuwa Uncoscious mambo mengi mwili unaweza kufanya mtu usijue,

kwa ushauri tu mm naona jamaa akae na mpenzi wake wajaribu kutrain ubongo wa bidada akilala asilale usingizi wa kutojitambua.....zaidi wakamuone mtaalamu wa saikolojia.

sio tatizo kubwa sana kama yupo tayari kulishinda.
 
Nichumu Nibebike said:
This site is intended for healthcare professionals



Drugs & Diseases > Urology
Urinary Incontinence Medication
Updated: Dec 12, 2017
  • Author: Sandip P Vasavada, MD; Chief Editor: Edward David Kim, MD, FACS
  • Midodrine[/paste:font]
    The active metabolite of midodrine, desglymidodrine, is an alpha1-agonist that may increase bladder outlet resistance.


    Pseudoephedrine hydrochloride (Sudafed, Genaphed, SudoGest)
    Pseudoephedrine helps stress incontinence. The subjective improvement and cure rates are similar to that of phenylpropanolamine, which was recalled from the US market. Pseudoephedrine stimulates vasoconstriction by directly activating alpha-adrenergic receptors.


    Phenylpropanolamine
    Recalled from US market. Epinephrine stores are released under phenylpropanolamine stimulation and produce alpha- and beta-adrenergic stimulation. These effects may increase bladder outlet resistance.



    Anticholinergic Agents
    Class Summary
    These agents represent first-line medicinal therapy in women with urge incontinence. These agents are useful in treating urinary incontinence associated with urinary frequency, urgency, and nocturnal enuresis.


    Anticholinergic agents inhibit the binding of acetylcholine to the cholinergic receptor, thereby suppressing involuntary bladder contraction of any etiology. In addition, they increase the urine volume at which first involuntary bladder contraction occurs, decrease the amplitude of the involuntary bladder contraction, and may increase bladder capacity.


    All anticholinergic drugs have a similar performance profile and toxicity. Potential adverse effects of all anticholinergic agents include blurred vision, dry mouth, heart palpitations, drowsiness, and facial flushing. When anticholinergic drugs are used in excess, the bladder may go into acute urinary retention.


    All drugs with anticholinergic effects or side effects are contraindicated if patients have documented narrow-angle glaucoma. Wide-angle glaucoma is not a contraindication to their use.


    Other contraindications to anticholinergic use are urinary retention, bowel obstruction, ulcerative colitis, myasthenia gravis, and severe heart diseases. Because of the potential for drowsiness—especially when combined with alcohol, sedatives, or hypnotic drugs—these agents may impair the patient's ability to perform hazardous activities, such as driving or operating heavy machinery.


    Dicyclomine hydrochloride (Bentyl)
    An anticholinergic agent with smooth muscle relaxant properties, dicyclomine blocks the action of acetylcholine at parasympathetic sites in secretory glands and smooth muscle.


    Darifenacin (Enablex)Darifenacin is an extended-release product eliciting competitive muscarinic receptor antagonistic activity. It reduces bladder smooth muscle contractions. Darifenacin has high affinity for M3 receptors involved in bladder and GI smooth muscle contraction, saliva production, and iris sphincter function. It is indicated for overactive bladder with symptoms of urge incontinence, urgency, and frequency. Swallow whole; do not chew, divide, or crush.


    Solifenacin succinate (VESIcare)
    Solifenacin elicits competitive muscarinic receptor antagonist activity, which results in anticholinergic effects and inhibition of bladder smooth muscle contraction. This agent is indicated for overactive bladder with symptoms of urgency, frequency, and urge incontinence. It must be swallowed whole; do not crush or chew.


    Hyoscyamine sulfate (Levsin/SL, Levsin, Levsinex, Cystospaz-M, Levbid)
    Hyoscyamine blocks the action of acetylcholine at parasympathetic sites in smooth muscle, secretory glands, and the CNS, which in turn has antispasmodic effects. Hyoscyamine is absorbed well by the GI tract. Food does not affect absorption of this drug. Hyoscyamine is available in sublingual form (Levsin SL, Symax SL), conventional tablets (Levsin), and extended-release tablets (Levbid).


    Propantheline (Pro-Banthine)
    A prototypical anticholinergic agent, propantheline blocks action of acetylcholine at postganglionic parasympathetic receptor sites.


    Tolterodine (Detrol and Detrol LA)
    Competitive muscarinic receptor antagonist for overactive bladder. However, it differs from other anticholinergic types in that it has selectivity for urinary bladder over salivary glands. Exhibits a high specificity for muscarinic receptors, has minimal activity or affinity for other neurotransmitter receptors and other potential targets such as calcium channels. In clinical studies, the mean decrease in urge incontinence episodes was 50% and the mean decrease in urinary frequency was 17%. The mean decrease in urge incontinence episodes per wk was 53% for Detrol LA 4 mg qd.


    Trospium (Sanctura)
    Quaternary ammonium compound that elicits antispasmodic and antimuscarinic effects. Antagonizes acetylcholine effect on muscarinic receptors. Parasympathetic effect reduces smooth muscle tone in the bladder. Indicated to treat symptoms of overactive bladder (eg, urinary incontinence, urgency, frequency).


    Fesoterodine (Toviaz)Competitive muscarinic receptor antagonist. Antagonistic effect results in decreased bladder smooth muscle contractions. Indicated for symptoms of overactive bladder (eg, urinary urge incontinence, urgency, and frequency). Available as 4- or 8-mg extended-release tab.



    Antispasmodic Drugs
    Class Summary
    These agents relax the smooth muscles of the urinary bladder. By exerting a direct spasmolytic action on the smooth muscle of the bladder, these medications have been reported to increase bladder capacity and effectively decrease or eliminate urge incontinence.


    The adverse effect profile of antispasmodic drugs is similar to that of anticholinergic agents. These drugs may impair the ability to perform activities requiring mental alertness and physical coordination. Drinking alcohol and using sedatives in combination with these antispasmodic drugs is contraindicated.


    In 2001, Appell et al reported the results of the Overactive Bladder: Judging Effective Control and Treatment (OBJECT) trial. This was a large double-blind, multicenter, prospective, randomized controlled study that compared the efficacy and tolerability of oxybutynin (Ditropan XL) (n = 160) with that of tolterodine (Detrol) (n = 170) in men and women with symptoms of overactive bladder. The study concluded that oxybutynin 10 mg was statistically superior to tolterodine 2 mg bid in terms of efficacy. However, both drugs had similar adverse-effect profiles. [Oxybutynin chloride (Ditropan IR, Ditropan XL, Gelnique)[/paste:font]
    Both the immediate-release and the extended-release forms of oxybutynin have both an anticholinergic and a direct smooth muscle relaxant effect on the urinary bladder. In addition, oxybutynin provides a local anesthetic effect on the irritable bladder.


    The human detrusor has M2 and M3 muscarinic receptors. The M3 receptor mediates contractile response of human detrusor. Oxybutynin has greater affinity for the M3 receptor. Urodynamic studies have shown oxybutynin increases bladder size, decreases frequency of symptoms, and delays initial desire to void.


    Ditropan XL has an innovative drug delivery system: oral osmotic delivery system (OROS). The Ditropan XL tablet has a bilayer core that contains a drug layer and a "push layer" that contains osmotic components. The outer tablet is composed of a semipermeable membrane with a precision laser-drilled hole that allows the drug to be released at a constant rate.


    When the drug is ingested, the aqueous environment in the gastrointestinal tract causes water to enter the tablet via semipermeable membrane at a constant rate. The introduction of water inside the tablet liquefies drug and causes the push layer to swell osmotically. As the push layer swells, it forces the drug suspension out the hole at a constant rate over a 24-h period.


    Ditropan XL achieves steady-state levels over a 24-h period. It avoids first pass metabolism in liver and upper gastrointestinal tract to avoid cytochrome P450 enzymes. It has excellent efficacy, with minimal adverse effects.


    Flavoxate (Urispas)
    Flavoxate is used for symptomatic relief of dysuria, urgency, nocturia, and incontinence, as may occur in cystitis, prostatitis, urethritis, and urethrocystitis/urethrotrigonitis. It exerts a direct relaxant effect on smooth muscles via phosphodiesterase inhibition. It provides relief for a variety of smooth muscle spasms.



    Tricyclic Antidepressants
    Class Summary
    Historically, these drugs were used to treat major depression; however, TCAs have an additional use in the treatment of bladder dysfunction. They function to increase norepinephrine and serotonin levels. In addition, they exhibit an anticholinergic and direct muscle relaxant effect on the urinary bladder.


    Imipramine hydrochloride (Tofranil)
    A typical TCA, imipramine facilitates urine storage by decreasing bladder contractility and increasing outlet resistance. It has an alpha-adrenergic effect on the bladder neck and an antispasmodic effect on the detrusor muscle. Imipramine also has a local anesthetic effect on bladder mucosa.


    Amitriptyline hydrochloride (Elavil)
    A TCA with sedative properties, amitriptyline increases the circulating levels of norepinephrine and serotonin by blocking their reuptake at nerve endings. It ineffective for use in urge incontinence but is extremely effective in decreasing symptoms of urinary frequency in women with pelvic floor muscle dysfunction. Amitriptyline restores serotonin levels and helps break the cycle of pelvic floor muscle spasms. It is well tolerated and effective in the majority of women with urinary frequency.



    Estrogens
    Class Summary
    Conjugated estrogens increase the tone of urethral muscle by up-regulating the alpha-adrenergic receptors in the surrounding area, and they enhance alpha-adrenergic contractile response to strengthen the pelvic muscles, which is important in urethral support (ie, prevents urethral hypermobility). Mucosal turgor of periurethral tissue from proper nourishment enhances urethral mucosal coaptation.


    The result is an improved mucosal seal effect, which is important in urethral function (ie, it prevents intrinsic sphincter deficiency). Estrogen supplementation appears to be the most effective in postmenopausal women with mild-to-moderate incontinence. Both types of stress incontinence improve with estrogen fortification.


    Conjugated estrogen (Premarin)
    Conjugated estrogen may be used as an adjunctive pharmacologic agent for postmenopausal women with stress or mixed incontinence. Oral or vaginal form of estrogen may be used. The usual oral dose is 0.3-1.25 mg taken daily in a cyclic regimen.


    When oral estrogens are needed, prescribe 0.625-mg pills. To prevent overstimulation of the uterus, conjugate estrogen is taken once a day for 21 consecutive days, followed by 7 days without the drug (eg, 3 wk on and 1 wk off). This regimen is repeated as necessary and tapered or discontinued at 3- to 6-month intervals.


    Conjugated estrogen vaginal cream is available in a package with a plastic applicator and a tube that contains 42.5 grams of conjugated estrogens. Each gram contains 0.625 mg of conjugated estrogens. When vaginal cream is used, 2-4 g (0.5-1 applicator) of the cream may be administered intravaginally daily in the usual cyclic regimen.


    Estrogen cream is readily absorbed through the skin and mucous membranes. When this cream is used for treatment of atrophic vaginitis, it may be placed intravaginally or applied topically around the vaginal tissues.


    When estrogen is used long term in women with an intact uterus, the addition of progestin therapy is recommended to prevent endometrial hyperplasia. Medroxyprogesterone 2.5-10 mg/d is needed for 10-13 days to provide maximum maturation of endometrium and to eliminate any hyperplastic changes. Medroxyprogesterone may be administered continuously or intermittently.


    Treatment with estrogen derivatives results in few cures (0-14%) but may cause subjective improvement in 29-66% of women. Limited evidence suggests that oral or vaginal estrogen therapy may benefit some women with stress and mixed urinary incontinence. Other potential beneficial effects of estrogen use include decreased bone loss and resolution of hot flashes during menopause.


    Routinely prescribing conjugated estrogens to premenopausal women is not recommended. Use this medication in postmenopausal women who are incontinent and who have had a hysterectomy. For postmenopausal women with an intact uterus, cautiously recommend a short-term low-dose of conjugated estrogen and monitor frequently.



    Antidepressants, Serotonin/Norepinephrine Reuptake Inhibitors
    Class Summary
    Some agents in this class may improve stress incontinence


    Duloxetine (Cymbalta)
    Duloxetine is a potent inhibitor of neuronal serotonin and norepinephrine reuptake. Its antidepressive action is theorized to be due to serotonergic and noradrenergic potentiation in the CNS.



    Alpha-Adrenergic Blockers
    Class Summary
    These agents have been used to decrease bladder overactivity. They have shown some success in patients who have decentralized or autonomous bladders as the result of myelodysplasia, spinal cord injury, or radical pelvic surgery.


    Phenoxybenzamine (Dibenzyline)
    This agent decreases bladder contractions through long-lasting, noncompetitive, alpha-adrenergic blockade of postganglionic synapses at smooth muscle and exocrine glands.


    Prazosin (Minipress)
    Prazosin decreases internal sphincter tone and can improve the flow of urine, improving emptying of bladder. Although doses greater than 20 mg/d usually do not increase efficacy, a few patients may benefit from dose as high as 40 mg/d. If an increase in dose is needed, give first dose of each increment at bedtime to reduce syncopal episodes.



    Botulinum Toxins
    Class Summary
    Intradetrusor injections with botulinum toxin are a novel treatment modality that has been shown to decrease episodes of urinary leakage in patients who have failed pharmacological therapy.


    OnabotulinumtoxinA (BOTOX)
    Neurotoxin from Clostridium botulinum; prevents ACh release from presynaptic membrane. Indicated for urinary incontinence in patients with neurologic conditions (eg, spinal cord injury, multiple sclerosis) in adults who have an inadequate response to or are intolerant of an anticholinergic medication.


TOOLS
Most Popular Articles
According to Urologists
  1. Little Evidence Supports Use of Digital Rectal Exam
  2. Pass on Kidney Stone Meds, Study Suggests
  3. Fast Five Quiz: Test Your Knowledge of Varicoceles
  4. Suicide Rates Higher for Patients With Urologic Cancers
  5. Biopsy Decisions Guided by New Predictor
View More



mscp-logo.png

FIND US ON

ABOUT
About MedscapePrivacy PolicyTerms of UseAdvertising PolicyHelp Center
MEMBERSHIP
Become a MemberEmail NewslettersManage My Account
APPS
MedscapeMedPulse NewsCME & Education
WEBMD NETWORK
WebMDMedicineNeteMedicineHealthRxListWebMD Corporate
EDITIONS
EnglishDeutschEspañolFrançaisPortuguês
All material on this website is protected by copyright, Copyright [emoji767] 1994-2018 by WebMD LLC. This website also contains material copyrighted by 3rd parties.
Click to expand...
hii technical/professional language imetumika hapa sio rahisi kuielewa aseee unless uwe kwenye hii field ya afya.
 
You must log in or register to reply here.

Our Community

Regional Communities

Back
Top Bottom
Menu
Forums
New posts
Log in
Register