一种令人惊讶的治疗尿失禁的方法:注射肉毒杆菌
多发性硬化症(MS)的诊断改变了苏珊·布朗的生活. For years, 她曾在旧金山市中心的希尔顿酒店担任宴会经理, 为了管理每天为数千名顾客提供食物的团队,他花了很长时间,在酒店的餐厅里跑来跑去. 但多发性硬化症让她越来越难以行走,迫使她在2015年退休.
Still, Brown found ways to work around her illness. 她调整了对活动的预期,学会了使用助行器和滑板车. 但有一个问题似乎无法解决:她的尿失禁越来越严重.
“膀胱问题或多或少是立即开始的,并逐渐恶化," Brown, now 56, recalls. 她每天晚上要起来小便三四次,白天要上无数次厕所. 想要小便的感觉变得越来越强烈和难以控制, 这种情况被称为急迫性尿失禁或急迫性尿失禁. Unlike stress incontinence, where pressure on the bladder (such as from laughing, sneezing or physical activity) causes leakages, urge incontinence 发生是因为膀胱肌肉痉挛或收缩. 结果是:突然的、无法控制的小便需要,接着是不希望的尿液释放.
Unfortunately, 布朗与尿失禁的斗争在多发性硬化症患者中很常见, 因为这种情况的典型脊髓损伤会干扰大脑和控制膀胱的神经之间的信号. 超过80%的多发性硬化症患者会出现某种类型的膀胱功能障碍.
布朗说,事情到了这样的地步:“我甚至没有五秒钟的时间去洗手间. It was instant.她开始依靠卫生巾和一次性吸水内衣,每次出门都要带上一套换洗的衣服. 对发生事故的焦虑使她感到足不出户.
布朗感到绝望,因为MS缩小了她的生活, 尿失禁的恶化会让它变得更小. But then her neurologist referred her to urologist Dr. Anne Suskind at the UCSF Women's Center for Bladder and Pelvic Health. 他是布朗所患失禁类型的专家, Suskind understood what she was going through.
“尿失禁是一种非常麻烦的状况,”苏斯金德说. “它不会危及生命,但肯定会改变你的生活. A lot of people self-isolate; they don't go out or socialize. 它会影响他们的活动,他们的人际关系,所以这可能是一个大问题."
It's also a condition that can be hard to talk about. 该中心的使命之一是创造一个安全和温馨的环境,让患者在寻求他们需要的护理时感到舒适.
该中心提供全面的治疗急迫性尿失禁, 从强化骨盆底的行为策略和锻炼,到安抚膀胱过度活动的药物,再到肉毒杆菌毒素(Botox)和骶神经调节等更具侵入性的干预措施, 通过骶骨(尾骨上方)植入一个装置来刺激通往膀胱的神经.
该中心的十大赌博平台排行榜致力于与患者合作,确定正确的治疗方法. After discussing the various options, 苏斯金德和布朗决定从药物和针灸疗法开始,这种疗法已经被FDA批准用于治疗急迫性尿失禁. 但经过六个月的治疗,布朗的病情并没有好转.
接下来,苏斯金德建议注射肉毒杆菌毒素,也就是俗称的肉毒杆菌素. Surprisingly, 这种被认为可以抚平皱纹的药物也可以缓解急迫性尿失禁——通过同样的机制:它可以放松肌肉. 就像在额头注射肉毒杆菌素可以放松面部肌肉,软化皱纹一样, 在膀胱内注射肉毒杆菌可以缓解尿失禁引起的肌肉痉挛, giving the patient time to reach the bathroom. 苏斯金德说,这种疗法对大约70%的患者有效.
Brown came to Suskind's clinic for the procedure. The nurses began by inserting a thin, 一根叫做导尿管的软管穿过布朗的尿道,进入她的膀胱,局部滴入利多卡因,作为一种麻木药. 然后抽干利多卡因,苏斯金德插入一个膀胱镜(一种带有微型摄像头的薄设备),看看在哪里注射肉毒杆菌. 她通过膀胱镜给整个膀胱打了多次针. For Brown, each felt like a mild poke or pinch. 她很感激苏斯金德和护士们在整个过程中帮助她放松和舒适, which lasted only a few minutes. “这真的是你必须处理的最不舒服的事情之一. But everyone there was wonderful," Brown says. The whole visit took less than an hour.
The treatment can cause mild cramping, bleeding or difficulty urinating, but Brown experienced no side effects. 虽然通常需要一到两周的时间才能开始注射, Brown began feeling the effect that very day. 她很激动:“我当时想,‘天哪,这太棒了!'"
Suskind is used to that reaction. “我的肉毒杆菌患者是我最快乐的患者之一,”她说. "It really can be a game changer."
It is, however, temporary. 肉毒杆菌毒素的效果会在3到12个月内消失,所以必须定期重复治疗. Since her first round of shots, Brown has had three more, 只要她觉得尿急又开始了就安排治疗.
Botox, says Brown, "just changed my life.现在,她陪朋友们去海滩郊游, 博物馆和金门公园,不用担心事故. 她说,患有多发性硬化症,“我失去了对很多事情的控制. This gave me back a sense of control in my life."