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Suggest treatment for urine incontinence

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Posted on Mon, 2 Feb 2015
Question: Hi, This is XXXXX, of late I have been availing your services. Recently I underwent Ultrasonography for pelvic and abdomin for diagnosing prostate condition. The results are as below:

LIVER/GALL BLADDER/PANCREAS AND SPLEEN - no problems found.
KIDNEYS: Both kidneys normal in size and echotexture, cortical echogenicity is normal, CMD preserved, No hydronephrosis/calculi in right kidney. A CYST NOTED IN THE MIDPOLE OF RIGHT KIDNEY. A SMALL 3 MM CALCULUS NOTED IN UPPER POLE OF RIGHT KIDNEY.
PROSTATE: Mildly enlarged in size and shows normal echotexture measures 4.4 x 3.4 x 2.9 ( 22 cc)

IMPRESSION: Right renal cortical cyst
Non-obstructive small left renal calculi
Mild prostatomegaly

Recently underwent normal routine preventive check up: In the report the following are adverse:
AMYLASE = 157.8 AND LIPASE = 83.4 AND BARIUM = More than 50.

I am very particular about my food habits and lifestyle. Absolutely no alcohol, no smoking, pure vegetarian. Recently as Total cholestral and LDL were 217 and 155 respectively, doctor had presecribed medicines mentioned above. Very healthy and physically fit person, aged 55 years and 60 kgs weight. No BP/Sugar problem.

PRESENT MEDICINES TAKING BY ME:
Presently taking Thyroxin 25 mg for Hypothyroid and Ecosprin 75 mg and Rosutec 10 mg for Cholastral. Diagnosed with CS with Disk lesion at C4 and C5 level - no medication for this so far. Geristart 0.4 mg. Cystone taken for 15 days. Sibellium for migraine headache every night.

PROBLEM FACED: May be due to Prostate mild enlargement, I have urine dribbling problem. Flow is slow and even after emptying when I sit a few drops dribbles which is causing lot of inconvenience. Cystone tablets taken for 15 days has not helped. I want to get rid of this problem of residual urine drops dribbling later when I sit or bend, need smooth flow when urinating. No pain, burning sensation, etc while passing urine.

And also let me please me know any medicine for small stone found in kidney.

XXXXXX
doctor
Answered by Dr. Vivek Chail (50 minutes later)
Brief Answer:
Please find detailed answer below

Detailed Answer:
Hi XXXXXX,
Thanks for writing in to us.

I have read through your query in details.
Please find my observations below.

1. As seen on ultrasound, the cyst in interpolar region of right kidney (size not mentioned) is not a concern I guess.

2. The 3 mm stone in upper pole of ?right/ left kidney (one place mentioned right and at another place written left) is not causing any obstruction at present and does not require any specific medication in the absence of any symptoms. However you might choose to follow instructions below to avoid any more stones in your kidneys and to cause the 3 mm stone to disappear.

DOs for kidney stones
(i) Drinking as much as 1.5 to 2.5 liters) a day may help flush out your urinary system. This will also allow small stones to pass through.
(ii) Visit washrooms regularly and empty your bladder when you feel like doing urination.
(iii) Please take fruits like apple, papaya, watermelon, pineapple, mosambi, bananas and orange, vegetables like, white gourd, ladyfinger, pumpkin, pulses like toor dal, moong dal, bengal gram
(iv) If you are having pain and burning during passing urine then you can take ALKASOL syrup 15-30 ml twice or thrice daily, dissolved in water for one week. This will prevent acidic urine and stone formation.
(v) If you have sharp pain then you can take tablet containing hyoscine (eg HYOCIMAX 10 mg or HYSCOPAN 10 mg) twice a day for 2 to 3 days, till you have pain. Though side effects are rare, please consult your doctor and take these medications under strict supervision.

DONTs for kidney stones
(i) Please avoid holding urine for long intervals.
(ii) Please reduce foods containing oxalates like non veg, vegetables like spinach, tomato, cauliflower, brinjals, nuts like kaju, pista and almonds.
(iii) Decrease extra salt in foods.
(iv) Avoid spicy pickles.
(v) Do not neglect any pain and consult your doctors immediately.

3. For raised amylase and lipase, please do not fast or have long gaps between meals. Have your foods at proper times.

4. Medicines Thyroxin 25 mg, Ecosprin 75 mg, Rosutec 10 mg and Sibellium to be continued as per doctors orders.

5. For disc lesion at C 4 - C 5 level you can do physiotherapy and avoid making sudden neck movements. If comfortable then you can stop using pillw while sleeping. For mild pain you can use pain reliever and muscle relaxant ointment (Volini or Relaxyl) which is to be gently applied over the skin on your neck regions.

6. Geristart 0.4 mg is tamsulosin and given to patients with enlarged prostate. In my opinion, a 22 cc prostate is not something that should be causing significant symptoms. Many doctors give enlarged prostate only if it is more than 25 cc. The main problem with prostate enlargement is urinary retention and I wish your doctor who did ultrasound scan also measured the pre void urine and volume of urine remaining in urinary bladder after passing urine. This is more important to know as any symptoms can be explained this way.

Taking Geristart can cause side effects and you must take it only if you are having symptoms relating to urination and after consulting your urologist. However if there is dribbling of urine and incontinence then taking Geristart might be essential. Please have your medications reviewed every 3 months.

6. Cystone is a herbal medication to reduce potential kidney stone formation and it is not for symptoms due to an enlarged prostate. The ALKASOL mentioned earlier has got similar effects in reducing acidity of urine and preventing stone formations.

&. Please read the above details dos and donts to avoid kidney stones formation and so that the 3 mm stone also gets dissolved.

Hope this answers your question. Please feel free to correct any oversight in my interpretation of your problems and discuss them in detail as per your requirements.

Hope your query is answered.
Do write back if you have any doubts.

Regards,
Dr.Vivek
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Vivek Chail (28 minutes later)
Thanks doctor for ur quick response. Sorry, I left out the measurement of Kidney which reads as : RK measures 93 x 15 mm (PT), LK measures 92 x 16 (PT).

Regarding Urine Dribbling problem, tests for finding out remaining urine and pre void not done other than Ultra sound. My local family doctor has prescribed Geristart for my Urine Dribbling problem as I feel very uncomfortable for about 6 months. - SHOULD I CONTINUE THE SAME ? Will it solve urine dribbling problem.

I have not faced any pain or burning sensation while passing urine. DO I REQUIRE TO TAKE HYOSCINE OR ALKASOL ?

Rest of your observations and interpretations are excellent and very happy about your way of making me understand my problem.

XXXXXXX
doctor
Answered by Dr. Vivek Chail (22 minutes later)
Brief Answer:
Please find detailed answers below

Detailed Answer:
Hi XXXXXX,
Thanks for writing back with an update.

Nice to know that you accept my answers.
Please find my clarifications below.

1. The kidneys are normal in size and not a concern.

2. The dribbling problem must be investigated in detail. This is because I find a prostate volume of 22 cc not to be a big problem and pre void and post urination volumes are more important for you. Most of the time the prostate is blamed for urinary symptoms when the problems might be due to other causes of bladder outlet obstruction or due to a different reason like stricture in urethra. The urologist will do additional tests like uroflowmetry and cystoscopy if required and if they find that the prostate is the only reason then you can continue taking Geristart.

Taking Geristart can cause retrograde ejaculation and dizziness when taken in higher doses. Therefore its best taken under guidance of your urologist. I have due respect for your family doctor but certain issues need to be addressed at the specialist level.

3. Since you have a 3 mm stone in the kidney, it is possible that the stone can travel out of the kidney and in to the ureter along its natural way to the urinary bladder. You might have pain at this time which will disappear once the stone reaches the urinary bladder. When this happens you might experience severe sharp pain for few days and require pain killers for sometime. It is at this time HYOSCINE might be required to give you relief from the pains.

4. Taking ALKASOL usually helps when there is burning urine which is due to acidic urine. ALKASOL is to reduce acidity of urine and therefore chances of stone formation. You can take ALKASOL for a week and then stop it however it is not mandatory. After that you can continue with other instructions like having proper food and drinking adequate water. Please avoid holding your urine for long durations.

Hope your query is answered.
Do write back if you have any doubts.

Regards,
Dr.Vivek
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
Answered by
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Dr. Vivek Chail

Radiologist

Practicing since :2002

Answered : 6865 Questions

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Suggest treatment for urine incontinence

Brief Answer: Please find detailed answer below Detailed Answer: Hi XXXXXX, Thanks for writing in to us. I have read through your query in details. Please find my observations below. 1. As seen on ultrasound, the cyst in interpolar region of right kidney (size not mentioned) is not a concern I guess. 2. The 3 mm stone in upper pole of ?right/ left kidney (one place mentioned right and at another place written left) is not causing any obstruction at present and does not require any specific medication in the absence of any symptoms. However you might choose to follow instructions below to avoid any more stones in your kidneys and to cause the 3 mm stone to disappear. DOs for kidney stones (i) Drinking as much as 1.5 to 2.5 liters) a day may help flush out your urinary system. This will also allow small stones to pass through. (ii) Visit washrooms regularly and empty your bladder when you feel like doing urination. (iii) Please take fruits like apple, papaya, watermelon, pineapple, mosambi, bananas and orange, vegetables like, white gourd, ladyfinger, pumpkin, pulses like toor dal, moong dal, bengal gram (iv) If you are having pain and burning during passing urine then you can take ALKASOL syrup 15-30 ml twice or thrice daily, dissolved in water for one week. This will prevent acidic urine and stone formation. (v) If you have sharp pain then you can take tablet containing hyoscine (eg HYOCIMAX 10 mg or HYSCOPAN 10 mg) twice a day for 2 to 3 days, till you have pain. Though side effects are rare, please consult your doctor and take these medications under strict supervision. DONTs for kidney stones (i) Please avoid holding urine for long intervals. (ii) Please reduce foods containing oxalates like non veg, vegetables like spinach, tomato, cauliflower, brinjals, nuts like kaju, pista and almonds. (iii) Decrease extra salt in foods. (iv) Avoid spicy pickles. (v) Do not neglect any pain and consult your doctors immediately. 3. For raised amylase and lipase, please do not fast or have long gaps between meals. Have your foods at proper times. 4. Medicines Thyroxin 25 mg, Ecosprin 75 mg, Rosutec 10 mg and Sibellium to be continued as per doctors orders. 5. For disc lesion at C 4 - C 5 level you can do physiotherapy and avoid making sudden neck movements. If comfortable then you can stop using pillw while sleeping. For mild pain you can use pain reliever and muscle relaxant ointment (Volini or Relaxyl) which is to be gently applied over the skin on your neck regions. 6. Geristart 0.4 mg is tamsulosin and given to patients with enlarged prostate. In my opinion, a 22 cc prostate is not something that should be causing significant symptoms. Many doctors give enlarged prostate only if it is more than 25 cc. The main problem with prostate enlargement is urinary retention and I wish your doctor who did ultrasound scan also measured the pre void urine and volume of urine remaining in urinary bladder after passing urine. This is more important to know as any symptoms can be explained this way. Taking Geristart can cause side effects and you must take it only if you are having symptoms relating to urination and after consulting your urologist. However if there is dribbling of urine and incontinence then taking Geristart might be essential. Please have your medications reviewed every 3 months. 6. Cystone is a herbal medication to reduce potential kidney stone formation and it is not for symptoms due to an enlarged prostate. The ALKASOL mentioned earlier has got similar effects in reducing acidity of urine and preventing stone formations. &. Please read the above details dos and donts to avoid kidney stones formation and so that the 3 mm stone also gets dissolved. Hope this answers your question. Please feel free to correct any oversight in my interpretation of your problems and discuss them in detail as per your requirements. Hope your query is answered. Do write back if you have any doubts. Regards, Dr.Vivek