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Incontinence
Kinds of Incontinence Terms modified by Incontinence Selected AbstractsTHE USE OF DULOXETINE FOR STRESS INCONTINENCE AFTER PROSTATECTOMYBJU INTERNATIONAL, Issue 4 2006Matthew R. Hotston No abstract is available for this article. [source] Incontinence in the aged: contact dermatitis and other cutaneous consequencesCONTACT DERMATITIS, Issue 4 2007Miranda A. Farage Urinary and faecal incontinence affects a significant portion of the elderly population. The increase in the incidence of incontinence is not only dependent on age but also on the onset of concomitant ageing issues such as infection, polypharmacy, and decreased cognitive function. If incontinence is left untreated, a host of dermatological complications can occur, including incontinence dermatitis, dermatological infections, intertrigo, vulvar folliculitis, and pruritus ani. The presence of chronic incontinence can produce a vicious cycle of skin damage and inflammation because of the loss of cutaneous integrity. Minimizing skin damage caused by incontinence is dependent on successful control of excess hydration, maintenance of proper pH, minimization of interaction between urine and faeces, and prevention of secondary infection. Even though incontinence is common in the aged, it is not an inevitable consequence of ageing but a disorder that can and should be treated. Appropriate clinical management of incontinence can help seniors continue to lead vital active lives as well as avoid the cutaneous sequelae of incontinence. [source] Systemic adverse events following botulinum toxin A therapy in children with cerebral palsyDEVELOPMENTAL MEDICINE & CHILD NEUROLOGY, Issue 2 2010KRISHANT NAIDU Aim, We studied the incidence of incontinence and respiratory events in children with cerebral palsy who received injections of botulinum toxin A (BoNT-A). Method, We used multivariable logistic regression to investigate relationships between (BoNT-A) dose, Gross Motor Function Classification System (GMFCS) level, and the incidence of bladder or bowel incontinence, unplanned hospital admission, emergency department consultation or prescription of antibiotics for respiratory symptoms, and diagnosis of upper respiratory tract infection. Results, Of 1980 injection episodes in 1147 children (mean age 4y 7mo, SD 1y 10mo, range 9mo,23y), 488 (25%) were in children with unilateral involvement and 1492 (75%) in children with bilateral involvement. At the time of injection 440 (22.2%) of children were at GMFCS level I, 611 (30.9%) were at level II, 330 (16.7%) were at level III, 349 (17.6%) were at level IV, and 250 (12.6%) were at level V. The incidence of serious adverse events was low, with 19 episodes of incontinence (1% of injection episodes) and 25 unplanned hospital admissions due to respiratory symptoms (1.3%). Incontinence typically resolved spontaneously 1 to 6 weeks after injection. The incidence of adverse events was associated with GMFCS level and dose of BoNT-A. Interpretation, The incidence of serious adverse events was low but suggests systemic spread as well as a procedural effect. We recommend reviewing upper dose limits for children at all GMFCS levels, particularly those at levels IV and V with a history of aspiration and respiratory disease. In these children, alternatives to mask anaesthesia may be particularly important. [source] Incontinence: Managed or mismanaged in hospital settings?INTERNATIONAL JOURNAL OF NURSING PRACTICE, Issue 6 2008Joan Ostaszkiewicz RN MNurs This paper reports the results of a survey of inpatients to determine the prevalence of their continence status and the overall management of their incontinence. A survey of 447 hospitalized adults was conducted and an audit of their medical records. Twenty-two per cent of patients reported urinary incontinence, 10% faecal incontinence, 78% nocturia, 23% urinary urgency and 11% trouble passing urine. Pre-existing bladder and bowel problems were reported by 34% and 26% of patients respectively. Sixty per cent of patients were using a continence product or device. There was a lack of documentation in the medical records about patients' continence status and about their pre-admission bowel and bladder status. The findings reveal that the management of incontinence in acute and subacute settings is suboptimal. There is a need to raise clinical awareness about incontinence in hospital settings and to implement a structured approach to its assessment and management. Furthermore, as the costs associated with the management or mismanagement of incontinence in hospital settings are not fully understood, there is a need for further research on this issue. [source] Incontinence: prevalence, management, staff knowledge and professional practice environment in rehabilitation unitsINTERNATIONAL JOURNAL OF OLDER PEOPLE NURSING, Issue 1 2009Geraldine McCarthy MSc Background., Bladder and bowel incontinence is a major health care problem, which adversely affects the lives of many individuals living at home or in health service facilities. Current approaches to continence care emphasize comfort, safety and reduction of risk, rather than detailed individualized assessment and management. The literature illustrates a gap between evidence and actual practice and emphasizes the context of care as being a key element for successful implementation of evidence based practice. Aims., To identify prevalence of bowel and bladder incontinence and its management, investigate continence knowledge and describe the professional practice environment within a rehabilitation unit for older people. Method., An integrated evaluation of continence prevalence, staff knowledge and the work environment was adopted. Results., Findings revealed a high incidence of incontinence (60% urinary, 3% faecal, 37% mixed) a lack of specific continence assessment and specific rationale for treatment decisions or continuation of care. The focus was on continence containment rather than on proactive management. Staff demonstrated a reasonable knowledge of incontinence causation and treatment as measured by the staff knowledge audit. The evaluation of the work environment indicated a low to moderate perception of control over practice (2.39), autonomy in practice (2.87), nurse doctor relationship (2.67) and organizational support (2.67). [source] Evaluating the context within which continence care is provided in rehabilitation units for older peopleINTERNATIONAL JOURNAL OF OLDER PEOPLE NURSING, Issue 1 2007Jayne Wright Aim., This paper presents the first phase of an all Ireland 2-year study between the University of Ulster and University College Cork, to determine the contextual indicators that enable or hinder person centred continence care and management in rehabilitation settings for older people. The primary outcome of the study was the development of a tool to enable practitioners to assess the practice context within which continence care is provided. The main focus of this paper is the value of understanding practice ,context' (culture, leadership and evaluation) and its impact to the provision of person centred continence care. Background., The literature highlights the effect of continence problems on the quality of life of older people. Incontinence is often seen by health care professionals and older people as an inevitable consequence of ageing and difficult to treat. Furthermore, health care professionals do not always have the necessary skills and knowledge of best practice in continence care and treatments. The Promoting Action on Research Implementation in Health Services (PARIHS) framework utilized in the study proposes that successful implementation of evidence in practice is dependent on the inter-relationship of three key elements; the nature of the evidence, the quality of the context and expert facilitation. Kitson et al. propose that for successful implementation, evidence needs to be robust, the context receptive to change and appropriate facilitation is needed. Consequently understanding practice ,context' and its impact on the provision of person centred continence care is of value. Methods., Case study methodology with several data collection methods was utilized to measure all aspects of ,context' as identified by the PARIHS framework. Methods include: Royal College of Physicians Audit Scheme, Staff Knowledge questionnaire, semi-structured observation of practice and multidisciplinary focus groups. Findings., The data were analysed in two stages. Stage 1 using both qualitative and quantitative (SPSS 12) methods. Stage 2 analysed all the data utilizing the characteristics of context from the PARIHS framework in order to identify the strong and weak characteristics of the context within which continence care was provided. Continence care and management in this study was found to be focused on continence containment rather than proactive management. The evidence suggests that the context (leadership, culture and evaluation) was weak and not conducive to person centred continence care and management. Conclusion., An analysis of the data using the context framework provided a picture of the context within the units and the identification of the specific contextual issues hindering and enabling the delivery of person centred continence care. This process has thus, added to our understanding of the importance of context to the provision of person-centred care. [source] Levels of comfort and ease among patients suffering from urinary incontinenceINTERNATIONAL JOURNAL OF UROLOGICAL NURSING, Issue 2 2007Michal Rassin Abstract Urinary incontinence is a common phenomenon among women, which harms social ties and is perceived as embarrassing and incurable. Despite its prevalence, there are few studies that have examined how those affected by this syndrome feel. The goal of this study was to examine the personal characteristics and levels of comfort among women suffering from urinary incontinence. The study included 50 women who had been diagnosed as suffering from urinary incontinence. The participants answered the Urinary Incontinence and Frequency Comfort Questionnaire, which examines levels of physical, mental, social and environmental comfort. , reliability has been found to be high in previous studies (,= 0·82). Our findings indicated that urinary incontinence occurred among the patients from several times a day to several times a week caused by sneezing, coughing and laughing. Most participants delayed treatment for up to 3 years. The general level of comfort was identified as medium low (SD = 0·04, M= 2·95) from a possible range of 1,6. Particularly low levels of comfort were recorded on items such as ,I feel clean and fresh,',finding a toilet in close proximity is a worrisome issue when I exit the house' and ,I fear having sex due to the urinary incontinence problem'. Identifying patients' needs and understanding their emotions are a useful basis for nursing intervention in promoting quality of life. [source] Guidelines for management of urinary incontinenceINTERNATIONAL JOURNAL OF UROLOGY, Issue 10 2008Osamu Nishizawa In Japan, only the following two guidelines are available: ,Guidelines on Urinary Incontinence in the Elderly' based on research funded by the Longevity Sciences Research Grant (chief investigator: Kikuo Okamura) and ,Guidelines on Urinary Incontinence in Women' based on ,Research on Treatment Standardization in the Urological Field' funded by the Health Sciences Research Grant (group leader: Osamu Nishizawa). This paper is an English translation of these two guidelines originally published in Japanese. [source] Randomized, Placebo-Controlled Trial of the Cognitive Effect, Safety, and Tolerability of Oral Extended-Release Oxybutynin in Cognitively Impaired Nursing Home Residents with Urge Urinary IncontinenceJOURNAL OF AMERICAN GERIATRICS SOCIETY, Issue 5 2008Thomas E. Lackner PharmD OBJECTIVES: Determine the cognitive effect, safety, and tolerability of oral extended-release oxybutynin in cognitively impaired older nursing home residents with urge urinary incontinence. DESIGN: Randomized, double-blinded, placebo-controlled trial. SETTING: Twelve skilled nursing homes. PARTICIPANTS: Fifty women aged 65 and older with urge incontinence and cognitive impairment. INTERVENTION: Four-week treatment with once-daily oral extended-release oxybutynin 5 mg or placebo. MEASUREMENTS: Withdrawal rates and delirium or change in cognition from baseline at 1, 3, 7, 14, 21, and 28 days after starting treatment using the Confusion Assessment Method (CAM), Mini-Mental State Examination (MMSE), and Severe Impairment Battery (SIB). The Brief Agitation Rating Scale, adverse events, falls incidence, and serum anticholinergic activity change with treatment were also assessed. RESULTS: Participants' mean age ±standard deviation was 88.6±6.2, and MMSE baseline score was 14.5±4.3. Ninety-six percent of subjects receiving oxybutynin (n=26) and 92% receiving placebo (n=24) completed treatment (P=.50). The differences in mean change in CAM score from baseline to all time points were equivalent between the oxybutynin and placebo groups. Delirium did not occur in either group. One participant receiving oxybutynin was withdrawn because of urinary retention, which resolved without treatment. Mild adverse events occurred in 38.5% of participants receiving oxybutynin and 37.5% receiving placebo (P=.94). CONCLUSION: Short-term treatment using oral extended-release oxybutynin 5 mg once daily was safe and well tolerated, with no delirium, in older female nursing home participants with mild to severe dementia. Future research should investigate different dosages and long-term treatment. [source] Type 2 Diabetes Mellitus and Risk of Developing Urinary IncontinenceJOURNAL OF AMERICAN GERIATRICS SOCIETY, Issue 11 2005Karen L. Lifford MD Objectives: To evaluate the association between type 2 diabetes mellitus (DM) and development of urinary incontinence in women. Design: Prospective, observational study. Setting: The Nurses' Health Study cohort. Participants: Eighty-one thousand eight hundred forty-five women who reported information on urinary function in 1996. Measurements: Self-reported, physician-diagnosed DM was ascertained using questionnaire from 1976 to 1996 and confirmed using standard criteria. Self-reported urinary incontinence, defined as leakage at least weekly, was ascertained in 1996 and 2000. Logistic regression models were used to calculate multivariate-adjusted relative risks (RRs) and 95% confidence intervals (CIs) for the relationship between DM (as of 1996) and prevalent and incident incontinence. Results: The risk of prevalent incontinence (multivariate RR=1.28, 95% CI=1.18,1.39) and incident incontinence (multivariate RR=1.21, 95% CI=1.02,1.43) was significantly greater in women with DM than women without. Using a validated severity index, risk of developing severe incontinence was even more substantial in women with DM than in those without (multivariate RR=1.40, 95% CI=1.15,1.71 for leakage enough to wet the underwear; RR=1.97, 95% CI=1.24,3.12 for leakage enough to wet the outer clothing). In addition, risk of incontinence increased with duration of DM (P -trend=.03 for prevalent incontinence; P=.001 for incident incontinence). Conclusion: DM independently increases risk of urinary incontinence in women. Because risk of incontinence appeared associated with longer duration of DM, even delaying the onset of DM could have important public health implications. [source] Prevalence and Correlates of Fecal Incontinence in Community-Dwelling Older AdultsJOURNAL OF AMERICAN GERIATRICS SOCIETY, Issue 4 2005Patricia S. Goode MD Objectives: To determine prevalence and correlates of fecal incontinence in older community-dwelling adults. Design: A cross-sectional, population-based survey. Setting: Participants interviewed at home in three rural and two urban counties in Alabama from 1999 to 2001. Participants: The University of Alabama at Birmingham Study of Aging enlisted 1,000 participants from the state Medicare beneficiary lists. The sample was selected to include 25% black men, 25% white men, 25% black women, and 25% white women. Measurements: The survey included sociodemographic information, medical conditions, health behaviors, life-space assessment (mobility), and self-reported health status. Fecal incontinence was defined as an affirmative response to the question "In the past year, have you had any loss of control of your bowels, even a small amount that stained the underwear?" Severity was classified as mild if reported less than once a month and moderate to severe if reported once a month or greater. Results: The prevalence of fecal incontinence in the sample was 12.0% (12.4% in men, 11.6% in women; P=.33). Mean age±standard deviation was 75.3±6.7 and ranged from 65 to 106. In a forward stepwise logistic regression analysis, the following factors were significantly associated with the presence of fecal incontinence in women: chronic diarrhea (odds ratio (OR)=4.55, 95% confidence interval (CI)=2.03,10.20), urinary incontinence (OR=2.65, 95% CI=1.34,5.25), hysterectomy with ovary removal (OR=1.93, 95% CI=1.06,3.54), poor self-perceived health status (OR=1.88, 95% CI=1.01,3.50), and higher Charlson comorbidity score (OR=1.29, 95% CI=1.07,1.55). The following factors were significantly associated with fecal incontinence in men: chronic diarrhea (OR=6.08, 95% CI=2.29,16.16), swelling in the feet and legs (OR=3.49, 95% CI=1.80,6.76), transient ischemic attack/ministroke (OR=3.11, 95% CI=1.30,7.41), Geriatric Depression Scale score greater than 5 (OR=2.83, 95% CI=1.27,6.28), living alone (OR=2.38, 95% CI=1.23,4.62), prostate disease (OR=2.29, 95% CI=1.04,5.02), and poor self-perceived health (OR=2.18, 95% CI=1.13,4.20). The following were found to be associated with increased frequency of fecal incontinence in women: chronic diarrhea (OR=6.39, 95% CI=2.25,18.14), poor self-perceived health (OR=5.37, 95% CI=1.75,16.55), and urinary incontinence (OR=4.96, 95% CI=1.41,17.43). In men, chronic diarrhea (OR=5.38, 95% CI=1.77,16.30), poor self-perceived health (OR=3.91, 95% CI=1.39,11.02), lower extremity swelling (OR=2.86, 95% CI=1.20,6.81), and decreased assisted life-space mobility (OR=0.73, 95% CI=0.49,0.80) were associated with more frequent fecal incontinence. Conclusion: In community-dwelling older adults, fecal incontinence is a common condition associated with chronic diarrhea, multiple health problems, and poor self-perceived health. Fecal incontinence should be included in the review of systems for older patients. [source] Urinary Incontinence and Psychological Distress in Community-Dwelling Older African Americans and WhitesJOURNAL OF AMERICAN GERIATRICS SOCIETY, Issue 11 2004Hillary R. Bogner MD Objectives: To compare the association between urinary incontinence (UI) and psychological distress in older African Americans and whites. Design: A population-based longitudinal survey. Setting: Continuing participants in a study of community-dwelling adults who were initially living in East Baltimore in 1981. Participants: African Americans and whites aged 50 and older at follow-up interviews performed between 1993 and 1996 for whom complete data were available (n=747). Measurements: Participants were classified as incontinent if any uncontrolled urine loss within the 12 months before the interview was reported. Psychological distress was assessed using the General Health Questionnaire (GHQ). Results: African Americans with UI were more likely to experience psychological distress as measured using the GHQ than were African Americans without UI (unadjusted odds ratio=4.22, 95% confidence interval=1.72,10.39). In multivariate models that controlled for age, sex, education, functional status, cognitive status, and chronic medical conditions, this association remained statistically significant. The association between UI and psychological distress did not achieve statistical significance in whites. Conclusion: The effect of UI on emotional well-being may be greater for African Americans than for whites. [source] Informal Caregiving Time and Costs for Urinary Incontinence in Older Individuals in the United StatesJOURNAL OF AMERICAN GERIATRICS SOCIETY, Issue 4 2002Kenneth M. Langa MD OBJECTIVES: To obtain nationally representative estimates of the additional time, and related cost, of informal caregiving associated with urinary incontinence in older individuals. DESIGN: Multivariate regression models using data from the 1993 Asset and Health Dynamics Study, a nationally representative survey of people aged 70 and older (N = 7,443). SETTING: Community-dwelling older people. PARTICIPANTS: National population-based sample of community-dwelling older people. MEASUREMENTS: Weekly hours of informal caregiving, and imputed cost of caregiver time, for community-dwelling older people who reported (1) no unintended urine loss, (2) incontinence that did not require the use of absorbent pads, and (3) incontinence that required the use of absorbent pads. RESULTS: Thirteen percent of men and 24% of women reported incontinence. After adjusting for sociodemographics, living situation, and comorbidities, continent men received 7.4 hours per week of care, incontinent men who did not use pads received 11.3 hours, and incontinent men who used pads received 16.6 hours (P < .001). Women in these groups received 5.9, 7.6, and 10.7 hours (P < .001), respectively. The additional yearly cost of informal care associated with incontinence was $1,700 and $4,000 for incontinent men who did not and did use pads, respectively, whereas, for women in these groups, the additional yearly cost was $700 and $2,000. Overall, this represents a national annual cost of more than $6 billion for incontinence-related informal care. CONCLUSIONS: The quantity of informal caregiving for older people with incontinence and its associated economic cost are substantial. Future analyses of the costs of incontinence, and the cost-effectiveness of interventions to prevent or treat incontinence, should consider the significant informal caregiving costs associated with this condition. [source] Tolterodine: A Safe and Effective Treatment for Older Patients with Overactive BladderJOURNAL OF AMERICAN GERIATRICS SOCIETY, Issue 6 2001James G. Malone-Lee MD OBJECTIVE: To investigate the clinical safety and efficacy of two dosages of tolterodine in older patients with symptoms attributable to overactive bladder. DESIGN: Randomized, double-blind, placebo-controlled, parallel-group, multinational, phase III study. SETTING: Incontinence, older care, urological, and urogynecological clinics in the United Kingdom, France, and the Republic of Ireland. PARTICIPANTS: One hundred and seventy-seven older patients (age ,65 years) with symptoms of urinary urgency, increased frequency of micturition (,8 micturitions/24 hours), and/or urge incontinence (,1 episode/24 hours). INTERVENTION: Tolterodine 1 mg or 2 mg twice daily (bid), or placebo, for 4 weeks. MEASUREMENTS: Safety and tolerability were evaluated through spontaneously reported adverse events, electrocardiogram, and blood pressure measurements. Efficacy was assessed using micturition diary variables: mean change from baseline in frequency of micturition and number of incontinence episodes/24 hours. RESULTS: The mean age of the patient population was 75 years. Overall, ,87% of patients completed the study. Neither dosage of tolterodine was associated with serious drug-related adverse events during the study. No cardiac arrythmogenic events were noted. Dry mouth (mild to moderate intensity) was the most common adverse event in both the placebo and tolterodine treatment groups. Three percent of patients in the tolterodine 2 mg bid group discontinued treatment because of dry mouth, compared with 2% of placebo-treated patients. Compared with placebo, statistically significant decreases in micturition frequency were apparent in both tolterodine treatment groups. Furthermore, patients treated with tolterodine 2 mg bid had statistically significant decreases in urge incontinence episodes/24 hours and increases in volume voided per micturition compared with placebo. CONCLUSION: Tolterodine (taken for 4 weeks) is safe and shows efficacy, particularly at a dosage of 2 mg bid, in the treatment of older patients with urinary symptoms attributable to overactive bladder. J Am Geriatr Soc 49:700,705, 2001. [source] Elimination disorders in people with intellectual disabilityJOURNAL OF INTELLECTUAL DISABILITY RESEARCH, Issue 10 2008E. Van Laecke Incontinence in children with intellectual and physical disabilities is an underestimated problem in paediatric urology. Literature is scarce, often limited to the incidence and urodynamics, and seldom focused on treatment and prevention. Lack of interest and knowledge of this population are the major reasons why urologists know so little. Very often continence difficulties are accepted and even expected in children with intellectual disabilities. The published prevalence of urinary incontinence in children with intellectual and physical disabilities varies between 23% and 86%. In our experience the prevalence ranges from 60% to 65%. The vast majority of these children have bladder dysfunction, showing overactive detrusor and sphincter dyssynergia on video-urodynamic examination. The uroflow pattern is disturbed in over 65% of these children but is not correlated with the degree of urinary incontinence. Over 70% of the children have reduced bladder capacity. This is due to low bladder compliance and restricted fluid intake which effects urinary incontinence and is an important cause of constipation. Constipation is a common problem in intellectual and physical disabled children and there is a correlation between constipation and urinary incontinence. Children with intellectual disability, particularly those with a greater degree of disability need more time to become continent than typically developing children. Children with mild intellectual disability do not differ significantly from typically developing children with regard to nocturnal enuresis and faecal continence but they are more prone to urinary incontinence during the day. Greater mobility is associated with a higher incidence of continence. Some factors that influence continence, such as intellectual and motor capacity cannot easily be influenced but others, such as bladder capacity, detrusor overactivity and fluid intake, are treatable. It is importance that children with intellectual and physical disabilities suffering urinary incontinence are referred for assessment and treatment to increase their quality of life. [source] Urinary Incontinence in Pregnancy and the PuerperiumJOURNAL OF OBSTETRIC, GYNECOLOGIC & NEONATAL NURSING, Issue 6 2001Charlotte E. Spellacy MS Objective: To describe the incidence of urinary incontinence (UI) during pregnancy and the puerperium and to identify potential contributing factors. Design: A descriptive correlational design, using participant interviews and reviews of the existing medical records to determine the incidence of UI in pregnancy and the puerperium and to examine relationships between and among several variables. The variables included parity, episiotomy, use of forceps/vacuum extractor, type of anesthesia, prolonged Stage II labor, and race. Data were collected via two personal interviews and review of medical records. The first interview was conducted during the recruitment of each participant; the second was a telephone interview conducted 4 to 6 weeks postpartum. Data collected from the medical records included obstetric history, weeks of gestation, and estimated date of delivery. Data were entered into data files for analysis with SPSS 8.0 and summarized with descriptive statistics. Setting: A secluded area of a university teaching hospital prenatal clinic. Participants: A convenience sample of 50 pregnant women, at least 18 years old, who received their care at a large university hospital prenatal clinic in the southeastern part of the United States. Results: First Interview (N= 50). More than half (62%; n= 31) of the sample reported some degree of involuntary urine loss during their pregnancy. The racial distribution of those reporting UI was the following: white (70%; 21 out of 30); African American (44%; 8 out of 18); Hispanic/Asian (100%; n= 2). Among the participants who experienced UI (n= 31), 76% (n= 23) reported that their health care provider never asked if they were experiencing any UI symptoms. Second Interview (n= 24). Only 48% of the initial participants could be contacted for the second interview because of changes in residence or telephones being disconnected with no forwarding number. Of the women in this sample who reported UI during the first interview (59%; n= 14), 7 (50%) continued to experience UI 4 to 6 weeks postpartum. The 2 remaining participants who reported UI 4 to 6 weeks postpartum (22%) had not experienced UI during pregnancy. Of the participants experiencing postpartum UI, 77% (n= 7) were white. Almost half of the participants with postpartum UI were ages 35 or older (44%; n= 4). Among the participants reporting episiotomy (n= 4), 3 (75%) reported having UI 4 to 6 weeks postpartum. Conclusions: Study results support the conclusion that childbirth, specifically vaginal birth, is a major factor in developing UI in the early postpartum period. Age, race, and use of episiotomy appear to be contributing risk factors. [source] The Importance of Screening, Assessing, and Managing Urinary Incontinence in Primary CareJOURNAL OF THE AMERICAN ACADEMY OF NURSE PRACTITIONERS, Issue 3 2003FAANArticle first published online: 24 MAY 200, Mikel Gray PhD Purpose To present evidence that routine screening for urinary incontinence is justified because it is a clinically relevant and prevalent disorder that responds to treatment, resulting in improved outcomes for many patients managed by the nurse practitioner (NP). Data Source Selected scientific literature. Conclusions The prevalence of urinary incontinence and success of treatment options justify routine screening, individualized assessment, and treatment. Implications for Practice Routine screening for urinary incontinence by NPs is uncommon. Based on the relative risk, the potential success of treatment and improved quality-of-life outcomes after treat-ment, NPs should regularly screen and assess for incontinence. [source] Muscle-derived Stem Cell Therapy for Stress Urinary IncontinenceLUTS, Issue 2009Shing-Hwa LU The aim of the present article is to overview the potential of muscle-derived stem cells and other cellular therapy for urethral regeneration and to review the clinical experiences of its application in patients with stress urinary incontinence. [source] Lower urinary tract symptoms following neurological illness may be influenced by multiple factors: Observations from a neurorehabilitation service in a developing country,,NEUROUROLOGY AND URODYNAMICS, Issue 3 2010Jalesh N. Panicker Abstract Aims To evaluate the pattern of lower urinary tract dysfunction (LUTD) in patients with neurological disease in the setting of a rehabilitation service in a developing country, and analyze causes for unexpected lower urinary tract symptoms (LUTS). Methods Patients with neurological disorders and having significant LUTS were prospectively evaluated. Level of neurological lesion was localized by neurological examination and investigations. LUTD was evaluated by symptom analysis, bladder diaries and ultrasonography. Storage symptoms were managed using antimuscarinic medications and voiding dysfunction, when significant, was managed by catheterization and patients were regularly followed up. Patients with symptoms that had not been expected based upon their level of neurological lesion were further evaluated. Results Fifty patients (mean age 43.5,±,18.3 years) were included and according to neurological localization, were categorized into suprapontine (n,=,9; 18%), infrapontine/suprasacral (n,=,25; 50%) or infrasacral (n,=,16; 32%) groups. Incontinence was more common in patients with suprapontine and infrapontine/suprasacral lesions (n,=,20) (P,<,0.03), hesitancy more common with infrapontine/suprasacral lesions (n,=,20) (P,=,0.004) and retention more with infrasacral lesions (n,=,13) (P,<,0.001). Patients belonging to suprapontine and infrapontine/suprasacral groups more likely showed improvement at follow up (P,=,0.008). Fourteen patients (28%) had unexpected LUTS and this was due to urological causes (n,=,6) or multiaxial neurological involvement (n,=,8). Potentially treatable factors were managed, resulting in symptom relief. Conclusion LUTS in neurological disease may be at variance with the pattern expected based upon level of neurological lesion. Such patients may require further evaluation and consideration should be given to concomitant urological conditions and multiaxial neurological involvement. Neurourol. Urodynam. 29:378,381, 2010. © 2009 Wiley-Liss, Inc. [source] Executive Summary: The International Consultation on Incontinence 2008,Committee on: "Dynamic Testing"; for urinary incontinence and for fecal incontinence. part 1: Innovations in Urodynamic Techniques and Urodynamic Testing for signs and symptoms of urinary incontinence in female patients,,NEUROUROLOGY AND URODYNAMICS, Issue 1 2010Peter F.W.M. Rosier Abstract Aims The members of The International Consultation on Incontinence 2008 (Paris) Committee on Dynamic Testing' provide an executive summary of the chapter ,Dynamic Testing' that discusses (urodynamic) testing methods for patients with signs and or symptoms of urinary incontinence. Testing of patients with signs and or symptoms of faecal incontinence is also discussed. Methods Evidence based and consensus committee report. Results The chapter ,Dynamic Testing' is a continuation of previous Consultation-reports added with a new systematic literature search and expert discussion. Conclusions, based on the published evidence and recommendations, based on the integration of evidence with expert experience and discussion are provided separately, for transparency. Conclusion This first part of a series of three articles summarizes the committees recommendations about the innovations in urodynamic study techniques ,in general', about the test characteristics and normal values of urodynamic studies as well as the assessment of female with signs and or symptoms of incontinence and includes only the most recent and relevant literature references. Neurourol. Urodynam. 29: 140,145, 2010. © 2009 Wiley-Liss, Inc. [source] Urinary Incontinence in Spayed Bitches: New Insights into the Pathophysiology and Options for Medical TreatmentREPRODUCTION IN DOMESTIC ANIMALS, Issue 2009S Arnold No abstract is available for this article. [source] Coital Incontinence: The Tip of the Iceberg?THE JOURNAL OF SEXUAL MEDICINE, Issue 6 2010Maurizio Serati MD No abstract is available for this article. [source] Short-term Impact of Tension-free Vaginal Tape Obturator Procedure on Sexual Function in Women with Stress Urinary IncontinenceTHE JOURNAL OF SEXUAL MEDICINE, Issue 4pt1 2010Hui-Hsuan Lau MD ABSTRACT Introduction., The tension-free vaginal tape obturator (TVT-O) procedure is one of the most commonly used anti-incontinence surgeries, but little is known about its impact on sexual function. Aim., To evaluate sexual function after the TVT-O procedure at 6 months postoperatively. Methods., Fifty-six sexually active women who underwent the TVT-O procedure for severe stress urinary incontinence (SUI) were evaluated using the short form of the Pelvic Organ Prolapse/Urinary Incontinence Sexual Questionnaire (PISQ-12) before and 6 months after surgery. The perception of incontinence-related quality-of-life were also evaluated by the short form of the Urogenital Distress Inventory (UDI-6) and the Incontinence Impact Questionnaire (IIQ-7) to assess the effect of surgery on incontinence. Main Outcome Measures., Total score and score for each PISQ-12 item. Results., The mean total PISQ-12 score did not differ significantly before (24.0 ± 12.2) and after (23.0 ± 13.2) (P = 0.194) the TVT-O procedure. Scores for individual items on the PISQ-12 varied, with incontinence-related items improving but others, such as the frequency of achieving orgasm deteriorating for some women. The scores of UDI-6 and IIQ-7 were significantly improved by 6-month follow-up, indicating that the operation successfully resolved the incontinence. Conclusion., Despite successful amelioration of SUI by the TVT-O procedure, sexual function does not necessarily improve in the first 6 months after surgery. Lau H-H, Su T-H, Su C-H, Lee M-Y, and Sun FJ. Short-term Impact of tension-free vaginal tape obturator procedure on sexual function in women with stress urinary incontinence. J Sex Med 2010;7:1578,1584. [source] ORIGINAL RESEARCH,WOMEN'S SEXUAL HEALTH: Biofeedback, Electrical Stimulation, Pelvic Floor Muscle Exercises, and Vaginal Cones: A Combined Rehabilitative Approach for Sexual Dysfunction Associated with Urinary IncontinenceTHE JOURNAL OF SEXUAL MEDICINE, Issue 6 2009Massimo Rivalta MD ABSTRACT Introduction., Urinary incontinence (UI) is often associated with sexual dysfunction. We present our preliminary experience with a combined rehabilitative approach consisting of biofeedback, functional electrical stimulation, pelvic floor muscle exercises, and vaginal cones. Aim., The potential impact of such practice on UI and sexual function was analyzed in our case series and discussed. Main Outcome Measures and Methods., We evaluated three women affected by UI and sexual dysfunction. The patients underwent combined pelvic floor rehabilitation (PFR), kept voiding diaries, and filled out the Female Sexual Function Index (FSFI questionnaire) before and after the completion of PFR. We evaluated each domain score, including desire, arousal, lubrication, orgasm, satisfaction, and pain. Results., After the combined rehabilitation program, none of them had UI requiring pad use or referred urine leakage during sexual activity, including intercourse. Before PFR, FSFI score ranged from 16 to 21; after treatment, the FSFI score ranged from 22.1 to 29.3. There was an improvement in patients regarding desire, arousal, lubrication, orgasm, satisfaction, and pain. Conclusions., A complete rehabilitation can provide a beneficial effect on sexual function. A larger trial, on a more extended female population, is currently in progress, in order to confirm our findings. The effectiveness of a complete PFR scheme, together with the lack of side effects, makes it a suitable approach to sexual dysfunction that is associated with UI. Rivalta M, Sighinolfi MC, De Stefani S, Micali S, Mofferdin A, Grande M, and Bianchi G. Biofeedback, electrical stimulation, pelvic floor muscle exercises, and vaginal cones: A combined rehabilitative approach for sexual dysfunction associated with urinary incontinence. J Sex Med 2009;6:1674,1677. [source] Female Urinary Incontinence During Intercourse: A Review on an Understudied Problem for Women's SexualityTHE JOURNAL OF SEXUAL MEDICINE, Issue 1 2009Maurizio Serati MD ABSTRACT Introduction., Coital urinary incontinence is a frequently underreported symptom, with a relevant impact on women's sexuality and quality of life. Aim., This article will review the available evidence on incidence, pathophysiology, and treatment of coital urinary incontinence with the attempt to present the current state of the art. Methods., PubMed was searched for reports about coital urinary incontinence that were published from 1970 to 2008, and the most relevant articles were reviewed. Main Outcome Measures., Review on epidemiology, pathophysiology, diagnosis, and treatment of coital incontinence. Results., The incidence of coital incontinence in incontinent women has been reported to range between 10% and 27%. At present, some evidence suggests an association between urinary leakage at penetration and urodynamic stress (USI) incontinence as well as urinary leakage during orgasm and detrusor overactivity (DO). When treatment for these conditions are based upon urodynamic findings, pelvic floor muscle training, surgery, and pharmacotherapy show satisfactory cure rates. Conclusions., Coital urinary incontinence deserves much more attention in clinical practice: women should be specifically interviewed for this disturbance because it has a very negative impact on their sexuality. If a reliable urodynamic diagnosis is made, coital urinary incontinence at penetration can be cured in more than 80% of cases by surgery in the presence of USI. The form of coital incontinence during orgasm is curable by antimuscarinic treatment in about 60% of cases when associated with DO. Serati M, Salvatore S, Uccella S, Nappi RE, and Bolis P. Female urinary incontinence during intercourse: A review on an understudied problem for women's sexuality. J Sex Med 2009;6:40,48. [source] New postnatal urinary incontinence: obstetric and other risk factors in primiparaeBJOG : AN INTERNATIONAL JOURNAL OF OBSTETRICS & GYNAECOLOGY, Issue 2 2006CMA Glazener Objective, To identify obstetric and other risk factors for urinary incontinence that occurs during pregnancy or after childbirth. Design, Questionnaire survey of women. Setting, Maternity units in Aberdeen (Scotland), Birmingham (England) and Dunedin (New Zealand). Population, A total of 3405 primiparous women with singleton births delivered during 1 year. Methods, Questionnaire responses and obstetric case note data were analysed using multivariate analysis to identify associations with urinary incontinence. Main outcome measures, Urinary incontinence at 3 months after delivery first starting in pregnancy or after birth. Results, The prevalence of urinary incontinence was 29%. New incontinence first beginning after delivery was associated with older maternal age (oldest versus youngest group, OR 2.02, 95% CI 1.35,3.02) and method of delivery (caesarean section versus spontaneous vaginal delivery, OR 0.28, 95% CI 0.19,0.41). There were no significant associations with forceps delivery (OR 1.18, 95% CI 0.92,1.51) or vacuum delivery (OR 1.16, 95% CI 0.83,1.63). Incontinence first occurring during pregnancy and still present at 3 months was associated with higher maternal body mass index (BMI > 25, OR 1.68, 95% CI 1.16,2.43) and heavier babies (birthweight in top quartile, OR 1.56, 95% CI 1.12,2.19). In these women, caesarean section was associated with less incontinence (OR 0.39, 95% CI 0.27,0.58) but incontinence was not associated with age. Conclusions, Women have less urinary incontinence after a first delivery by caesarean section whether or not that first starts during pregnancy. Older maternal age was associated with new postnatal incontinence, and higher BMI and heavier babies with incontinence first starting during pregnancy. The effect of further deliveries may modify these findings. [source] Recent advances in Urogynaecology: Proceedings of the Joint RCOG/BSUG Meeting on Incontinence and Prolapse, RCOG 16,19 June 2003BJOG : AN INTERNATIONAL JOURNAL OF OBSTETRICS & GYNAECOLOGY, Issue 2004Article first published online: 1 DEC 200 No abstract is available for this article. [source] Female Urinary Incontinence in PracticeBJU INTERNATIONAL, Issue 1 2007Harriette Scarpero No abstract is available for this article. [source] Sacral nerve stimulation for neurogenic faecal incontinenceBRITISH JOURNAL OF SURGERY (NOW INCLUDES EUROPEAN JOURNAL OF SURGERY), Issue 6 2007B. Holzer Background: Sacral nerve stimulation (SNS) has emerged as a promising technique for the treatment of faecal incontinence. This study assessed the outcome of SNS in a cohort of patients with incontinence of neurological aetiology. Methods: Thirty-six patients were included in a trial of SNS. Twenty-nine subsequently had a permanent implant. Evaluation consisted of a continence diary, anal manometry, saline retention testing and quality of life assessment. Results: After a median follow-up of 35 (range 3,71) months, 28 patients showed a marked improvement in or complete recovery of continence. Incontinence to solid or liquid stool decreased from a median of 7 (range 4,15) to 2 (range 0,5) episodes in 21 days (P = 0·002). Saline retention time increased from a median of 2 (range 0,5) to 7 (range 2,15) min (P = 0·002). Maximum resting and squeeze anal canal pressures increased compared with preoperative values. Quality of life on all scales among patients who received a permanent implant increased at 12 and 24 months after operation. Conclusion: SNS is of value in selected patients with neurogenic faecal incontinence. Copyright © 2007 British Journal of Surgery Society Ltd. Published by John Wiley & Sons, Ltd. [source] Incontinence following sphincter division for treatment of anal fistulaCOLORECTAL DISEASE, Issue 7Online 2010S. Bokhari Abstract Objective, Management of anal fistula poses problems because of competing goals of cure and maintenance of continence. There is increasing recognition of significant rates of incontinence after sphincter-dividing anal surgery. We aimed to determine cure and continence status in a cohort of anal fistula patients managed by both sphincter-dividing and conserving approaches. Method, Data on fistula, healing and continence status were gathered by patient questionnaire (Cleveland Clinic incontinence questionnaire), telephone interview and chart review. Fistulae were defined as simple (low risk of incontinence) or complex (high risk). Surgery was defined as sphincter conservation and sphincter division. Incontinence was graded by traditional severity scale (minor/major). Fistula healing was defined as absence of acute or chronic sepsis symptoms from surgery to date of last follow-up. Results, One hundred and twenty-eight patients were evaluated (out of whom 71% were male subjects, age range 17,82, median age 45 years). Fifty-two percent of the fistulae were complex and 48% were simple, of which 51% and 85% underwent sphincter division respectively. Healing rates were higher for sphincter division than conservation (87%vs 73%, P = 0.06). Complex fistulae undergoing sphincter division led to a higher rate of major incontinence (13%) than sphincter conservation (0%) (P = 0.03). For simple fistulae treated by sphincter division, major (5%) and minor incontinence (11%) was not inconsiderable. Conclusion, Though cure rates are excellent, incontinence rates remain unacceptably high following sphincter division for complex fistulae and are not insignificant even for simple fistulae. More sphincter conservation should be undertaken. [source] | ||||||||||||||||||||||||||||||||||||||||