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Lower urinary tract symptoms are common; however, it is important to acknowledge they are attributed to underlying mechanisms that vary widely. Overactive Bladder OAB , caused by uninhibited detrusor muscle contractions, or detrusor overactivity , is the usual cause of incontinence in the geriatric population. Stress Incontinence SI is the most common cause of incontinence in women who are in the reproductive years or early postmenopausal years.

SI occurs largely because of complications of childbirth and the development of atrophic urethritis—thinning of the estrogen-dependent lining of the outer urethra. Estrogen, taken systemically and locally Table 2 , helps maintain vaginal and urethral tissue even when relatively small doses are used. Resolution of urinary symptoms is often achieved by applying a small dab of estrogen cream locally to the urethra.

An automated version of Kegel exercises called pelvic floor electrical stimulation is available, using an electrical current that inhibits detrusor overactivity and contracts pelvic muscles. Treatment is initiated for mild symptoms with vaginal moisturizers and lubricants, a variety of which are available over the counter, to provide symptomatic relief for vaginal dryness and dyspareunia, respectively.

If these measures are ineffective, vaginal or systemic estrogen therapy is introduced to effectively relieve vaginal dryness and itchiness and to improve vaginal elasticity. While both routes of administration are effective, the safety of systemic hormone therapy continues to be a concern, especially in certain subgroups of women.

Sexual activity enhances blood flow to the vagina, which assists in maintaining healthy vaginal tissues. Sexuality and sexual behavior is a subject that is often overlooked or unaddressed by health care practitioners with regard to older adults. According to Northrup, sexual function is a complex, integrated phenomenon, reflecting the health and balance of the following: 1 the ovaries; 2 the hormones; 3 the cardiovascular system; 4 the brain; 5 the spinal cord; and 6 the peripheral nerves.

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According to Cooper and Smith, since the expression of sexuality has no age limit, early and late postmenopausal women alike should be offered a full spectrum of counseling and treatment where appropriate. The hormonal environment of the female body greatly influences not only the health of the vaginal lining, but of the urethral tissues as well.

Many women accept the symptoms associated with postmenopausal changes, which are often quite distressing, and believe that they are unavoidable signs of aging. Pharmacists can take a proactive role in guiding women through this time of change by providing information and guidance about therapeutic options to improve their urogenital health while helping to improve quality of life.

Gynecologic disorders in the elderly.

Pathophysiology and anatomical changes

Vaginal atrophy. September 17, Accessed August 17, Krychman ML. Vaginal estrogens for the treatment of dyspareunia.


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J Sex Med. Scudder L. Treating atrophic vaginitis. Medscape Nurse. Northrup C. The Wisdom of Menopause. New York, NY. Bantam Books; ,, Pearson T. Atrophic vaginitis. J Nurse Pract. Hohenhaus MH. Vulvovaginal atrophy: a common—and commonly overlooked—problem. The average age of onset is 30 years old.


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Men also tend to experience more severe joint pain than women. Bacterial infection of the urinary tract or intestines is the most common cause of reactive arthritis. The most common bacterium associated with reactive arthritis is Chlamydia trachomatis which is responsible for chlamydia infections. This bacterium usually spreads through sexual contact. Bacteria that cause food poisoning can also produce reactive arthritis symptoms. Examples of these bacteria include Shigella and Salmonella. Genetics may be a factor in whether or not you develop reactive arthritis.

However, not everyone with the HLA B27 gene will develop reactive arthritis if they get an infection. Musculoskeletal symptoms include joint pain and swelling.

Impact of Diet Quality and Nutrients on Chronic Pain

Reactive arthritis most often affects joints in your knees, ankles, and the sacroiliac joints of your pelvis. You may also experience joint pain, tightness, and swelling in your fingers, back, buttocks sacroiliac joints , or heels Achilles tendon area. A condition called urethritis causes urinary symptoms.

The urethra is the tube that carries urine from your bladder to the outside of your body. Urethritis is the inflammation of this tube. Symptoms can include pain or burning with urination and a frequent urge to urinate. Men may develop prostatitis as part of reactive arthritis.

Prostatitis is the inflammation of the prostate gland. Cervicitis is the inflammation of the cervix in females. It can also be a sign of reactive arthritis. Eye inflammation is one of the main symptoms of reactive arthritis. Reactive arthritis may also involve your skin and mouth. Conjunctivitis is the inflammation of the eye membranes. Symptoms include pain, itching, and discharge. Skin rashes, including keratoma blennorrhagica small pustules on the soles of the feet , may also occur.

Mouth sores are less common. However, they can accompany other symptoms of reactive arthritis. Your doctor will evaluate your medical history, perform a physical examination of your symptoms, and run blood tests to check for infection or inflammation. A blood test can also determine if you carry the HLA B27 gene that increases your likelihood of developing reactive arthritis.

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Pelvic & Urogenital Pain | The Royal College of Anaesthetists

Your doctor may run additional tests to rule out sexually transmitted infections if your symptoms indicate a chlamydia infection. Your doctor will swab the urethra in men and will perform a pelvic exam and cervical swab on women. Your doctor may also do an arthrocentesis, which involves removing the fluid in your joint with a needle. Tests are then done on this fluid. Treatment for reactive arthritis depends on the cause of the condition.

Reactive Arthritis

Your doctor will prescribe antibiotic medications to treat an underlying infection. They may prescribe additional medications for conjunctivitis, mouth ulcers, or skin rashes if needed. The goal of treatment once the underlying infection is under control turns to pain relief and management.

Corticosteroids are man-made drugs that mimic cortisol, a hormone that your body produces naturally. These drugs work by broadly suppressing inflammation in the body. You can take corticosteroids orally or inject them directly into the affected joints.

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Doxycycline Acticlate, Doryx has also been used for treatment, given its anti-inflammatory properties.