Thursday, October 29, 2009

Can Marijuana Potentially Treat Overactive Bladder?

First, a disclaimer. This blog post does not endorse the use of marijuana as it is illegal; however I recently read several studies of interest on this topic.

THC, tretrahydrocannabinol, is the major active ingredient in the marijuana and well known for inducing euphoria and relaxation, as well as sedation and drowsiness. It has been used for treating nerve pain, or neuropathic pain, cancer pain and even convulsions seen with multiple sclerosis.

AJA, Ajulemic acid, is the synthetic equivalent to THC, and is a strong pain reliever an anti-inflammatory but does not have the mind altering effects the THC has. In lab studies, it mimics many of the same properties as the popular anti-inflammatories known as NSAIDs, such a motrin or naproxen. In studies on neuropathic pain and volunteers, AJA did not cause dependency after withdrawal at the end of a one-week treatment period.

So, how would AJA potentially treat overactive bladder? A recent study on rats showed that AJA was able to suppress normal bladder activity and urinary frequency induced by bladder irritants. The researchers believe that AJA blocks the outgoing pain signal from the bladder by one of the receptors it and THC can bind to in the bladder. In the experiment, two different bladder irritants were administered to rats. Bladder pressure and contractions were measured. After injection of AJA, the bladder muscle contraction intervals and bladder pressures were blocked reversing the effect of the irritants.

So what does this mean? AJA is a promising compound that can have potentially broad application in treating the pain and overactivity symptoms that occur in many bladder conditions such as overactive bladder, interstitial cystitis, and perhaps even the bladder pain after surgery or urinary tract infections. One wonders if it many also be effective in not only treating the pain or symptoms after they occur but also given before to prevent them as well. Hmm….

Saturday, October 17, 2009

Are Women with Pelvic Organ Prolapse at Risk for Other Hernias Elsewhere in Their Bodies?

This is such as interesting question, because when I see patients who present with a cystocele, vaginal vault prolapse or rectocele, I will often help describe it as a “bladder hernia” or “rectum hernia”. In essence it is, since a hernia is a defect in muscle or fascia (connective tissue) that when sufficiently weak will allow another organ usually to push out or through. We think classically of a male groin hernia, after lifting a heavy box. The fascia in the groin will tear or become weak, allowing the small intestine to push through creating pain and a bulge.

The same can be said of pelvic organ prolapse. Muscle weakness and fascia injury from hysterectomy, childbirth or age/menopause develop and will allow the pelvic organs to push down on the various vaginal walls creating a bulge. The more severe the hernia/prolapse, the more bulge/pain and symptoms are created, whether urinary, defecatory, or with sex.
The next question is: if hernias are more common in women with POP (pelvic organ prolapse), where in the body should we look out for it, and why is this happening in the first place?

A recently published study addresses at least the first question, but a lot of research in the past 5 years has addressed the second question. Researchers in Israel performed quite a simple chart review of 60 patients they had treated surgically for POP and compared them to 60 controls. They found that the total prevalence of hernias in the POP group was significantly higher vs. those without POP. Nearly 32% in the POP had hernias elsewhere in the body vs. only 5% in controls. This was a huge difference! Women with POP were more likely to have hiatal hernias (16.6% vs. 1.6%), as well as inguinal (groin) hernias (15% vs. 3.3%). [Hiatial hernias can lead to gastric reflux).

Collagen is the substance of connective tissue in the body and there are many collagen types. Some are stronger than others. There is mounting evidence that certain proteins which degrade collagen faster or at higher levels in women with POP. These proteins are often regulated by estrogen which can affect the balance of destruction of old collagen and production of new collagen. Add childbirth, menopause, and hysterectomy and you’ve got a “golden recipe” for POP (and stress incontinence). This logically suggests that weaker collagen is not just a pelvic problem but a problem of collagen throughout the body wherever collagen is relied upon to confer strength to an organ or tissue.

Of course most women do not undergo surgery for POP or incontinence, in fact just over 10% do over the course of their lifetime. However, POP and incontinence do run in families and now we are finding out why. So now you ask your mother, aunt or grandmother if they have pelvic floor problems to see what your risk factors are, but also ask them about other hernias as well.

Monday, October 12, 2009

What Else Can Lead to Pelvic Organ Prolapse Besides Childbirth?

It is widely known and accepted that even just one vaginal birth is the most common risk factor for pelvic organ prolapse (POP) such as cystocele, rectocele, uterine prolapse and urinary incontinence. There are some women who can develop POP even in the absence of vaginal birth. POP is usually blamed on torn or stretched connective tissue (fascia) that invests/supports the pelvic floor muscles (levator ani), in addition to injury to nerves r blood supply to the organs in question. Are there other concomitant conditions that may call attention to the risk of developing POP?

Interestingly, and per common sense, POP conditions and urinary incontinence often co-exist in women. A huge study from Kaiser in 2008 surveyed more than 4000 women, with a mean age of 56, to see what kind of pelvic floor disorders they have. The prevalence is as follows:

Stress Incontinence 15%
Overactive Bladder 13%
Pelvic Organ Prolapse 6%
Anal Incontinence 25%

Not surprisingly, 48-80% of women with one disorder reported having at least another disorder. 60% of women had at least something.
An even larger population based study of women from Stockholm of 8000 recently reported their findings of the non-obstetric risks for developing POP. They are:

History of conditions suggesting connective tissue defects (hernia, varicose veins, hemmorhoids)
Family history of POP
Heavy lifting at work

Saturday, October 3, 2009

Vaccine for Urinary Tract Infections?

For several decades, scientists have been attempting to develop a vaccine for the common UTI. The only problem is, that UTIs are caused by more than one type of bacteria and there are many risk factors for developing UTIs. UITs affect more than 50% of women at least once in their lives. This leads to a lot of medical costs, lost work days and emergency room visits.

Escherchia coli (E. coli) is the most common pathogen leading to UTIs. There are many types of E coli that exist. Certain bacteria express certain proteins that act as anchors that allow them to easily attach to urogenital mucosa and creep into the urethra and bladder. Recently, researchers at Univ. Michigan developed a vaccine against E coli using certain iron receptors on the bacteria against which the patient’s immune system can react. The vaccine is administered in the nose and is currently in phase 1 trials.