Reproductive And Urinary Tracts

The reproductive and urinary tracts are both subject to infection. Such infections (apart from those transmitted by sexual activity) are relatively uncommon in men because the long male urethra prevents bacteria and other organisms from passing easily to the bladder and upper urinary tract and to the male sex organs. The shorter female urethra allows infection of the urinary tract, especially of the bladder (cystitis) and of the urethra (urethritis), to occur commonly. The female reproductive tract is also vulnerable to infection, sometimes sexually transmitted.

Reproductive function may also be disrupted by hormonal disturbances that lead to reduced fertility. Women may be troubled by symptoms arising from normal activity of the reproductive organs, including menstrual disorders and problems associated with childbirth.

The most common urinary problems apart from infection are those related to bladder function. Urine may be released involuntarily (incontinence) or it may be retained in the bladder. Such disorders are usually the result of abnormal nerve signals to the bladder or sphincter muscle. The filtering action of the kidneys may be disrupted by alteration of the composition of the blood or the hormones that regulate urine production, or by damage (from infection or inflammation) to the filtering units themselves.

Medicaments to treat menstrual disorders

The menstrual cycle results from the actions of female sex hormones that each month cause ovulation (release of an egg) and thickening of the endometrium (lining of the uterus) in preparation for pregnancy. Unless the egg is fertilized, the endometrium is shed about two weeks later during menstruation.

The main problems associated with menstruation that may require medical treatment are excessive blood loss (menorrhagia), pain during menstruation (dysmenorrhea), and distressing symptoms prior to menstruation (premenstrual syndrome).

The medicaments most commonly used to treat the menstrual disorders include estrogens and progesterone (or synthetic progesterone medicaments known as progestins), danazol, and analgesics.

Medicaments used in menstrual disorders act in a variety of ways. Hormonal treatments are aimed at suppressing the pattern of hormonal changes that is causing troublesome symptoms. Contraceptive preparations override the normal menstrual cycle. Ovulation does not occur and the endometrium does not thicken normally. Bleeding that occurs at the end of a cycle is less likely to be abnormally heavy, to be preceded by distressing symptoms, or to be accompanied by severe discomfort.

Non-contraceptive progesterone preparations taken in the days prior to menstruation do not suppress ovulation. Increased progesterone during this time reduces premenstrual symptoms and prevents excessive thickening of the endometrium.

Danazol, a potent and expensive medicament, prevents the thickening of the endometrium, thereby correcting excessively heavy periods. Blood loss is reduced; in some cases menstruation ceases altogether during treatment.

Oral contraceptives

There are many different means of ensuring that conception and pregnancy do not follow sexual intercourse. For many women the oral contraceptive is a highly effective method. In addition to its contraceptive qualities, it is well tolerated, convenient, and unobtrusive during lovemaking.

There are two main types of oral contraceptive: the combined pill and the phased pill. Both types contain a natural or synthetic estrogen and a progestin (a synthetic form of the female sex hormone progesterone). Both types are taken on a cyclic basis.

Another type of oral contraceptive, the progestin-only pill, which was introduced in the 1970s, is rarely used today because of its relatively high failure rate and the frequent occurrence of troublesome side effects.

In a normal menstrual cycle, the ripening and release of an egg, and the preparation of the uterus for implantation of the fertilized egg, are the result of a complex interplay between the natural female sex hormones, estrogen and progesterone, and the pituitary hormones, follicle-stimulating hormone (FSH) and luteinizing hormone (LH). Estrogens and progestins contained in oral contraceptives act in a variety of ways to disrupt the normal cycle in such a way as to make conception less likely.

In combined and phased pills, levels of estrogen and progestin inhibit the production of FSH and LH, and thereby prevent the egg from ripening in the ovary and from being released.

All pills (combined, phased, and progestin-only) change cervical mucus and the lining of the uterus to interfere with the ability of sperm to fertilize the egg.

Each course of combined and phased pills lasts for 21 days, followed by a pill-free seven days during which menstruation occurs. Some brands contain seven additional inactive pills. This means that the new course directly follows the last, so that the habit of taking the pill daily is not broken. Progestin-only pills are taken for 28 days each month. Menstruation usually occurs during the last few days of the cycle.

Most women notice little change in their overall feeling of well-being with the newer types of oral contraceptive. Ten to 15 per cent of women may experience initial breakthrough bleeding, missed periods, mood changes, headaches, breast tenderness, weight gain, and/or nausea. Many of these troublesome side effects disappear after three months, and the majority of women can continue taking the pill. In some cases it may be necessary to switch to another formulation in order to reduce side effects. Many women find relief from painful, heavy, or prolonged menstrual periods while taking the pill.

All oral contraceptives need to be taken regularly for maximum protection against pregnancy. Contraceptive protection can be reduced by missing a pill. It may also be reduced by vomiting or diarrhea. If you suffer from either of these symptoms, it is advisable to act as if you had missed your last pill. Many medicaments may also affect the action of oral contraceptives, so it is essential to inform your physician that you are taking oral contraceptives before you take any additional medications.

Medicaments for infertility

Conception and establishment of pregnancy require a healthy reproductive tract in both partners. The man must produce sufficient numbers of healthy sperm; the woman must be able to produce a healthy egg that is able to pass freely down the fallopian tube to the uterus. The lining of the uterus must be in a condition that allows the implantation of the fertilized egg.

Although the cause of infertility sometimes remains undiscovered, in the majority of cases it is found to be due to one of the following factors: intercourse taking place at the wrong time during the menstrual cycle; the man producing too few or unhealthy sperm; the woman failing to ovulate (release an egg), or having blocked fallopian tubes as a result of previous pelvic infection. The production of female hormones necessary for ovulation and implantation of the egg in the uterus may be disturbed by physical illness or psychological stress.

Physicians do not usually begin to investigate the cause of failure to conceive until normal sexual intercourse without contraception has been taking place regularly for over a year. The first step is usually a thorough medical examination of both partners. If no simple explanation can be found, the man's semen will be analyzed to find out if he is producing healthy sperm in sufficient quantity. At the same time, the female partner will be investigated. Ovulation is monitored and blood tests may be performed to assess hormone levels throughout the menstrual cycle. If ovulation does not occur, the woman may be offered treatment with a fertility medicament.

Fertility medicaments increase the chance of ovulation by boosting the levels of LH and FSH, the pituitary hormones that govern ovulation. Clomiphene stimulates the pituitary gland to increase its output of these hormones. Menotropins acts to stimulate the ripening of the egg in the same way as natural FSH. HCG has an action similar to that of LH; it triggers the release of the egg and promotes the production of progesterone after ovulation has taken place.

Each of these medicaments may produce minor adverse effects. Clomiphene may cause hot flushes, nausea, and headache, while HCG can cause tiredness, headache, and mood changes. Menotropins can make the ovaries enlarge, producing abdominal discomfort that may continue for several days.

All these medicaments increase the likelihood of multiple births (usually twins). A less common adverse effect is an increased risk of ovarian cysts with clomiphene.

Medicaments used for urinary disorders

Urine is produced by the kidneys and stored in the bladder. As urine accumulates, the bladder walls stretch, and pressure within the bladder increases. Eventually, the stretching stimulates nerve endings that produce the urge to urinate. The ring of muscle (sphincter) around the bladder neck normally keeps the bladder closed until it is consciously relaxed, allowing urine to pass via the urethra out of the body.

A number of disorders can affect the urinary tract. The most common are infection in the bladder (cystitis) and urethra (urethritis), benign prostatic hyperplasia (BPH), and loss of reliable control over urination (urinary incontinence). A less common problem is inability to expel urine (urinary retention). Medicaments used to treat these problems include antibiotics, analgesics, and medicaments that act on nerve control over the muscles of the bladder and sphincter.

Medicaments for urinary infection
Bladder infections -generally due to bacteria -may cause the following symptoms: burning on urination, urge to urinate small amounts frequently, and sometimes lower abdominal pain.
Antibiotic medicaments are used to eradicate infection. Co-trimoxazole and amoxicillin, sometimes given in a single large dose or in longer courses, are among the most common treatments. Other antibiotics include the cephalosporins, the quinolones, and nitrofurantoin.
Symptoms may be relieved by a urinary analgesic, phenazopyridine, which concentrates in the urine and has a soothing effect on the lining of the bladder and urethra. It is often combined with an antibacterial medicament.
BPH is a non-cancerous enlargement of the prostate gland that commonly occurs in older men. Symptoms include weak or interrupted urinary stream, dribbling, inability to empty the bladder completely, delay or hesitation on starting urination and the need to urinate frequently. Whereas severe forms of BPH with blockage must be treated surgically, medicaments may help milder cases. Finasteride, a medicament that blocks the effect of androgen, works to reduce prostate size. Alpha-adrenergic blocking agents work by decreasing the tone of the muscles surrounding the prostate and bladder.

Medicaments for urinary incontinence
Urinary incontinence can occur for a number of reasons. A weak sphincter muscle allows the involuntary passage of urine when abdominal pressure is raised by coughing or physical exertion. This is known as stress incontinence and commonly affects women who have had children. Urgency -the sudden need to urinate -stems from increased sensitivity of the bladder muscle; small quantities of urine stimulate the urge to urinate frequently.
Incontinence can also occur due to loss of nerve control in neurological disorders such as multiple sclerosis. In children, inability to control urination at night (nocturnal enuresis) is also a form of urinary incontinence.
Medicament treatment is not necessary or appropriate for all forms of incontinence. In stress incontinence, exercises to strengthen the pelvic floor muscles or surgery to tighten stretched ligaments may be effective. In urgency, regular emptying of the bladder can often avoid the need for medical intervention. Incontinence caused by loss of nerve control can sometimes be helped by medicament therapy. Frequency of urination in urgency may be reduced by anticholinergic and antispasmodic medicaments. These reduce nerve signals from the muscles in the bladder, allowing greater volumes of urine to accumulate without stimulating the urge to pass urine. When a decision is made to treat childhood enuresis, desmopressin nasal spray -a synthetic derivative of antidiuretic hormone -is the preferred medicament. Tricyclic antidepressants are now rarely used for bedwetting, due to the risk of adverse effects.

Medicaments for urinary retention
Urinary retention is the inability to empty the bladder. This usually results from the failure of the bladder muscle to contract sufficiently to expel accumulated urine. Possible causes include an enlarged prostate gland or tumor or a longstanding neurological disorder.
Most cases of urinary retention need to be relieved by inserting a tube (catheter) into the urethra, and surgery may be needed to prevent a recurrence of the problem. Bethanechol, a para-sympathomimetic medicament which increases the strength of contraction of the bladder muscle, may relieve urinary retention following surgery. This medicament is not suitable for long-term therapy.

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