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Diabetes drug may delay prostate cancer progression
Among
older men, prostate cancer is the most common form of cancer.
Type
2 diabetes is a common condition as well — and it’s not uncommon
for
older men to have both diseases.
This
information set the stage for a recent analysis of men who had
prostate
cancer and diabetes and who frequently used a diabetes drug called
metformin
(Glucophage, Glumetza, Fortamet). About half the men in the
study
took metformin. Men taking metformin for their diabetes had a 24
percent
lower chance of dying of prostate cancer in the first six months of
metformin
use than did men taking other diabetes medications.
The
research, published in the Journal
of Clinic Oncology, was based on
past
medical records. In addition to a significantly reduced risk of dying of
prostate
cancer, men taking metformin for diabetes also experienced a 7
percent
reduction in risk of death by any cause over two years, compared
with
men who didn’t take the drug.
Mayo
Clinic doctors say that this intriguing analysis suggests the possibility
that
a relatively safe and inexpensive drug may be helpful in treating
prostate
cancer. However, the link in this study is merely an association.
More
robust research is necessary to determine true cause and effect. In addition,
other
questions remain, such as whether metformin may be helpful
in
those with prostate cancer who don’t have diabetes. It’s too early to recommend
metformin
for anyone with prostate cancer, but for those with prostate
cancer and type 2
diabetes, metformin may be a treatment choice
Nerve damage — Injury to nerves
that
sense stool in the rectum or that
control
the anal sphincters can lead to
fecal
incontinence. Damage may be
related
to childbirth, a habit of straining
to
pass stool, a spinal cord injury, a
stroke
and even certain diseases —
such
as diabetes and multiple sclerosis
—
that may affect these nerves.
■ Chronic
constipation — Ongoing
constipation
can lead to a mass of hard,
dry
stool in the rectum (impacted stool)
that’s
too hard to pass. As a result,
muscles
in the rectum and intestines
stretch,
eventually weakening and allowing
watery
stool from farther up to
leak
out around the hard mass. Nerves
in
the anus and rectum may become
less
responsive to the presence of stool
when there’s
chronic constipation.
Loss of storage capacity in the rectum
—
Changes in the rectum wall that cause
the
rectum to stiffen — such as may occur
from
radiation treatment, rectal surgery
or
inflammatory bowel disease —
reducing its
capacity to hold stool
Treatments vary
Once
fecal incontinence is diagnosed
and
the likely cause is identified,
your
doctor can discuss treatment options
that
may be best suited to your
situation.
It’s not unusual to use multiple
approaches
to treat fecal incontinence.
Among
the conservative options are:
■ Dietary
changes — What you eat
and
drink affects stool consistency and
how
fast it passes through your digestive
system.
If constipation is causing
fecal
incontinence, your doctor may
recommend
drinking plenty of fluids
and
gradually increasing your intake of
fiber-rich
foods. Getting adequate fiber
can
help with diarrhea, too, as it bulks
up stool, making
it less watery
Medications — Your doctor may
recommend
anti-diarrheal drugs or
laxatives,
depending on what’s causing
the
incontinence. Sometimes, medications
you’re
taking for other conditions
can
contribute to fecal incontinence. If
that’s
the case, your doctor can work
with
you to make appropriate medication
changes
to help reduce aggravation
of
fecal incontinence. With this in mind,
it’s
important that your doctor is aware
of
all prescription and nonprescription
drugs and
supplements you’re taking.
Biofeedback and pelvic floor exercises
—
Restoring pelvic floor muscle
strength
can improve anal sphincter
muscle
control and awareness of the
need
to have a bowel movement. Biofeedback
may
be used to help you learn
how
to properly squeeze and relax pelvic
floor
muscles. During biofeedback,
a
trained physiotherapist uses special
sensors
to measure bodily functions
that
help teach you what it feels like
when
you actively squeeze and relax
your pelvic floor
muscles
Sacral nerve stimulation
A
relatively new treatment option
is
electrical stimulation of the sacral
nerves.
This option may be considered
if
more-conservative measures
aren’t
successful.
Your
sacral nerves run from
your
spinal cord to muscles in your
pelvis.
These nerves regulate the
sensation
and strength of your rectal
and
anal sphincter muscles. The
device
is implanted in the upper
buttock
under the skin and delivers
continuous
small electrical impulses
to
the sacral nerves to help strengthen
muscles
in the bowel.
Sacral
nerve stimulation is much
less
invasive than are other surgical
approaches,
and it carries low risk
of
serious complications. Although
long-term
results are unknown at this
point,
multicenter studies of sacral
nerve
stimulation have reported
marked
and sustained improvement
in bowel control
