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Severe Incontinence (severe + incontinence)
Selected AbstractsType 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] Health interventions and satisfaction with services: a comparative study of urinary incontinence sufferers living in two health authorities in EnglandJOURNAL OF CLINICAL NURSING, Issue 5 2000Brenda Roe PhD, FRSH ,,This comparative study found that significantly more people with severe incontinence had contacted a health professional than had those with slight to moderate incontinence (P=0.00008). There was a significant linear trend towards people with severe incontinence seeing a health professional (P=0.00007). ,,The majority of people who were incontinent had not been asked to complete a bladder chart, which is an essential requirement for assessment and diagnosis of the type of incontinence and the subsequent health interventions that are offered. ,,Significantly more people in the health authority with an established continence advisory service had completed a bladder chart, had received physiotherapy and currently undertook pelvic floor muscle exercises than did those in the health authority without a continence service. ,,The majority of sufferers did not use any aids or appliances. Of those who did use incontinence aids, a majority bought their own. There was a significant linear trend for increased pad usage with increasing severity of incontinence (P=0.0003). ,,Significantly more people in the health authority with the continence service were satisfied with their healthcare and services, while more of those in the health authority without a service were unsatisfied (P=0.005). Significantly more people in the health authority without a service felt that healthcare and services could be improved (P=0.00001). ,,Significantly more people with severe incontinence were dissatisfied with services than were those with slight to moderate incontinence (P=0.01). [source] Dynamic graciloplasty for fecal incontinenceMICROSURGERY, Issue 6 2001Cor G.M.I. Baeten M.D. Fecal incontinence is a socially incapacitating condition with associated high treatment costs. The most common cause of fecal incontinence is trauma during childbirth followed by surgical interventions. After unsuccessful conventional treatment, muscle transposition is the next treatment option. Two local muscles are used for this purpose: the gluteus and the gracilis muscles. With both muscles, long-term muscle contractions are difficult to maintain due to muscle fatigue. The gracilis muscle, however, is technically much easier to transfer and most activities of daily living and even sports are still possible. Experimental studies have shown that electrical stimulation of skeletal muscles can transform fatigue-prone muscles into fatigue-resistant muscles. In 1986, we started to perform graciloplasty procedures with intramuscular electrodes connected to an electrical stimulator. To date, 200 patients have been treated in our institution using dynamic graciloplasty. All patients had severe incontinence without control of liquid or solid feces, most of them had previously received unsuccessful treatment using other techniques. The mean age was 48 years, the average time that patients had been incontinent was 12.4 years, and the cause of incontinence were trauma (n = 99), congenital (n = 28), pudendopathy (n = 58), and low motor neurological lesions (n = 15). Of these patients, 76% were considered to have successful outcomes. Patients whose cause of incontinence was trauma or pudendopathy tended to respond better to this treatment than patients with anal atresia. © 2001 Wiley-Liss, Inc. MICROSURGERY 21:230,234 2001. [source] Asymmetric sphincter innervation is associated with fecal incontinence after anal sphincter trauma during childbirthNEUROUROLOGY AND URODYNAMICS, Issue 1 2007Beate M. Wietek Abstract Aims Functional asymmetry of pelvic floor innervation has been shown to exist in healthy subjects, and has been proposed to be a predictor of increased risk for fecal incontinence in case of trauma. However, this remains to be shown for different clinical conditions such as traumatic childbirth. Methods A conventional surface EMG system was used to assess the innervation of the external anal sphincter. A symmetry index was used to define the relative EMG amplitude asymmetry of the external anal sphincter between 0 (symmetric) and 1 (asymmetric). Three cohorts were studied: 40 nulliparous women in the third trimester (Study 1), 15 primiparous women within 6 months following vaginal delivery without clinically apparent anal sphincter trauma (Study 2), and 50 women after childbirth-related third or fourth degree perineal tear 6,12 months postpartum (Study 3). Furthermore, all women underwent conventional anorectal manometry. Results Sixteen or forty nulliparous women reported signs of fecal incontinence; however, relative asymmetry was not correlated to symptom severity (P,=,0.345), and not to manometric measures (Study 1). In Study 2, Women who had suffered clinically apparent anal sphincter trauma (P,=,0.07) tended to have a stronger association between incontinence and asymmetry. In Study 3, 19/50 women reported moderate to severe incontinence. Asymmetry and symptom severity were significantly correlated (P,<,0.001). Patients with incontinence had a significantly higher asymmetry score than their continent counterparts. Conclusion Functional asymmetry of anal sphincter innervation is significantly associated with incontinence symptoms, but only after childbirth-related sphincter injuries and therefore, should be regarded as an additional risk factor. Neurourol. Urodynam. © 2006 Wiley-Liss, Inc. [source] Baseline abdominal pressure and valsalva leak point pressures-correlation with clinical and urodynamic dataNEUROUROLOGY AND URODYNAMICS, Issue 1 2003Shahar Madjar Abstract Aims: To characterize the factors contributing to changes in baseline abdominal pressure (Pabd) and the correlation between ,VLPP, VLPPtot, and other clinical and urodynamic variables. Methods: Two hundred sixty-four female patients who had undergone an anti-incontinence procedure between February 1994 and October 1999 were retrospectively reviewed. The urodynamics performed for each patient included abdominal and vesical pressures measured in a standardized manner with the patient sitting upright and the pressure sensors maintained at the level of the symphysis pubis. VLPP was determined at bladder volumes of 200 mL during a gradually increasing Valsalva maneuver. Results: Baseline Pabd varied between 10 and 55 cm H2O (mean, 32.7,±,8.8) and were significantly correlated with patient weight (P<0.001) and with patient body mass index (P<0.001). Baseline Pabd was not found to be correlated with patient age, Baden and Walker Classification of the grading of pelvic floor prolapse, degree of incontinence (determined by the number of pads used per day), or prior surgical procedures for stress incontinence. Higher baseline Pabd were significantly correlated with the peak abdominal pressure reached during the Valsalva maneuver (P<0.0001) and with VLPPtot (P<0.0001) but not with ,VLPP. Higher VLPPtot significantly correlated with decreased age (P=0.004), less severe incontinence (P=0.004), higher peak Valsalva pressure (P<0.0001), and the ability to increase abdominal pressure for a longer period of time (time to peak Pabd during Valsalva). VLPPtot and ,VLPP had similar statistical correlation with all the clinical variables examined and neither could predict the outcome of any anti-incontinence surgery. By using a VLPP of 60 cm H2O as a cutoff to differentiate severe ISD from GSUI, 211 (67.4%) of the patients would be categorized as having ISD according to their ,VLPP compared with only 106 (40.1%) by using the VLPPtot. Conclusions: Baseline Pabd varies considerably among patients, is correlated with patient weight and habitus. In addition, it varies with both the ability to be increased for longer periods of time and with VLPPtot. Looking at VLPPtot and ,VLPP will result in a different categorization of the type of incontinence in at least 25% of patients and, thus, affect the physician's selection of an anti-incontinence procedure for an individual patient. Neurourol. Urodynam. 22:2,6, 2003. © 2003 Wiley-Liss, Inc. [source] Assessment of the intrinsic urethral sphincter component function in postprostatectomy urinary incontinenceNEUROUROLOGY AND URODYNAMICS, Issue 3 2002Christian Pfister Abstract Postprostatectomy incontinence remains a disabling condition. Sphincter injury, detrusor instability, and decreased bladder compliance have been previously reported as major factors. The aim of this study was to evaluate the urethral sphincter intrinsic component, which may provide passive continence. A urodynamic evaluation was performed in 20 patients undergoing a radical retropubic prostatectomy in the preoperative period and 3 months after surgery. Patients with disabled urinary incontinence underwent a new urodynamic evaluation 6 months later. The urethral pressure profile was measured just before, then 10, 20, and 30 minutes after the injection of 0.5 mg/kg moxisylyte chlorhydrate, an alpha adrenergic blocker. Three different pressure components were defined in urethral sphincter capacity: baseline, adrenergic, and voluntary. A postoperative intrinsic urethral sphincter pressure component was found in 17 patients and its value was under 6 cm H2O in five cases of severe incontinence. No significant difference was observed for these patients on urethral profile components 6 months later. In contrast, in cases of significant intrinsic component value, no incontinence was observed in most patients. Passive continence after radical prostatectomy should be a matter of concern and may also explain paradoxical incontinence, despite high voluntary urethral pressure obtained after reeducation. A follow-up evaluation of the intrinsic sphincter component is suggested, by using an alpha receptor blockage test during urodynamic studies in the management of patients with postprostatectomy incontinence. Neurourol. Urodynam. 21:194,197, 2002. © 2002 Wiley-Liss, Inc. [source] ORIGINAL RESEARCH,MEN'S SEXUAL HEALTH: Orgasmic Dysfunction After Open Radical Prostatectomy: Clinical Correlates and Prognostic FactorsTHE JOURNAL OF SEXUAL MEDICINE, Issue 3 2010Yvette Dubbelman MD ABSTRACT Introduction., Erectile function after radical retropubic prostatectomy (RRP) is extensively discussed in literature. However, less is known about orgasm after RRP. Aim., To analyze sexual function, in particularly orgasmic function, in men before and after RRP. Methods., Between 1977 and 2007 a RRP was performed in 1,021 men. All men were interviewed by their follow-up physician using a standardized interview about sexual function before and after RRP at regular intervals during a 2-year follow-up. The questions were related to sexual interest, sexual activity, spontaneous erections, and orgasmic function. Main Outcome Measures., Sexual function, in particularly orgasmic function, before and after RRP. Factors potentially influencing orgasmic function, such as patients age, type of operation, pathological stage and continence status were analyzed for their predictive value. Results., Information about preoperative and postoperative sexual activity and spontaneous erection was available in 596 and 698 men, respectively. Additional questions were asked on sexual interest (N = 425) and orgasmic function (N = 458). Pre-operatively, sexual interest, sexual activity, spontaneous erections and orgasmic function were normal in 99%, 82.1%, 90.0% and 90% of men, respectively. After operation these values decreased to 97.2%, 67.3%, 29.4% and 66.8%, respectively. Orgasmic function was preserved in 141 of 192 men (73.4%) after a bilateral nerve sparing procedure, in 90 out of 127 men (70.9%) after a unilateral nerve-sparing procedure and in 75 of 139 men (54.0%) after non-nerve sparing technique. Postoperatively, orgasm was present in 123 (77.4%) men below the age of 60 years and in 183 (61.2%) men of 60 years and older (P < 0.0001). Orgasmic function was significantly affected by age ,60 years, non-nerve sparing procedure and severe incontinence (more than two pads/day). Conclusions., After RRP, orgasmic function is still present in the majority of men. A non-nerve sparing operation, age, and severe urinary incontinence are risk factors for orgasmic dysfunction after RRP. Dubbelman Y, Wildhagen M, Schröder F, Bangma C, and Dohle G. Orgasmic dysfunction after open radical prostatectomy: Clinical correlates and prognostic factors. J Sex Med 2010;7:1216,1223. [source] Anal incontinence in women with third or fourth degree perineal tears and subsequent vaginal deliveriesAUSTRALIAN AND NEW ZEALAND JOURNAL OF OBSTETRICS AND GYNAECOLOGY, Issue 3 2000M. R. Sangalli SUMMARY We contacted 208 women 13 years after they suffered an obstetrical anal sphincter tear in order to estimate the effect of subsequent vaginal deliveries on anal continence. Among the 177 eligible responders, 129 sustained a partial or complete 3rd degree and 48 a 4th degree tear; 114 women had subsequent vaginal deliveries. Anal incontinence was more common in women with 4th (25.0%) than with 3rd degree tears (11.5%, p = 0.049). Subsequent vaginal deliveries were associated with a higher prevalence of severe incontinence in women with 4th degree tears (p = 0.023). No aggravation or increase in prevalence of incontinence was observed in women with 3rd degree tears. These results suggest that in a subsequent pregnancy, careful evaluation is necessary and an abdominal delivery may be advisable for women with previous major sphincter trauma. [source] | ||||||||||