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Incontinent Women (incontinent + woman)

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Medical Sciences	100%

Selected Abstracts

Is physical activity influenced by urinary incontinence?

BJOG : AN INTERNATIONAL JOURNAL OF OBSTETRICS & GYNAECOLOGY, Issue 5 2004
Beata Stach-Lempinen
Objective To evaluate physical activity among urinary incontinent women seeking treatment and to assess the change of physical activity after treatment. Design Part of a prospective observational intervention study to examine the factors influencing the severity of urinary incontinence. Setting Tampere University Hospital,referral unit. Population Eighty-two urinary incontinent women were evaluated in the baseline and 69 (84%) one year (mean 13 months, range 6,21) after treatment. Methods Physical activity was measured by self-report questionnaire and electronic motion sensor: Caltrac accelerometer worn by women for one week. The diagnosis and severity of urinary incontinence was estimated on the basis of urodynamics, pad test, diary and incontinence-specific quality of life measures. Treatment outcome was assessed according to objective parameters and patients satisfaction. Main outcome measures Physical activity at work, leisure and sport expressed in MET (metabolic unit) and kilocalories, change in physical activity after treatment. Results Twenty-one (25.6%) of all women reported exercise of more than three times per week. Incontinent women with the highest leisure time activity ,6 MET (n= 23, above 75th centile) were younger; they had less body mass index and greater urine leakage than others. One year after treatment, there was no change in any parameters of physical activities. Also exercise habits among women who were completely dry (n= 37) after treatment were not changed. Conclusion Urinary incontinent women who seek treatment are as physically active as the normal population. Even after successful incontinence treatment, exercise habits do not change. [source]

Prevalence of incontinence and incontinence-specific quality of life impairment in women with cystic fibrosis,,

NEUROUROLOGY AND URODYNAMICS, Issue 8 2009
M. Vella
Abstract Aims Cystic fibrosis (CF) is the commonest autosomal recessive disorder in Caucasians. With advancing medical technology, the life expectancy has more than double in the last twenty years. This has led to new unforeseen health problems like urinary incontinence. The aim was to establish the prevalence, symptomatic typology, and quality of life impact of incontinence in a population of women with CF. Methods Women were recruited from two London tertiary referral centres for CF. They were asked to fill in a self- completed anonymous King's Health Questionnaire (KHQ) for assessment of symptoms and quality of life Impairment. Their age was also noted. Descriptive statistics are reported. Correlation was assessed using Pearson's Product Moment Correlation Coefficient (r). Results One hundred and forty six women were approached for enrolment. 98(67%) consented to take part in study. Their mean age was 28. Seventy three (74%) reported symptoms of urinary incontinence, which in all cases was perceived as stress urinary incontinence. Of these 44(60%) reported mild stress incontinence, 16(22%) moderate stress incontinence and 13(18%) severe stress incontinence. Continent and incontinent women perceived their general health to be similarly poor (mean score 40 vs 44 points). Strong positive correiations were found between age and stress urinary incontinence severity (r=0.742; P <0.001) and between age and total King's Health Questionnaire score (r=0.828; P <0.001). Conclusions Women with CF have a higher prevalence of stress urinary incontinence than the general population, with both the prevalence and associated quality of life impairment increasing with age. Neurourol. Urodynam. 28:986,989, 2009. © 2009 Wiley-Liss, Inc. [source]

Comparison of sensation-related voiding patterns between continent and incontinent women: A study with a 3-day sensation-related bladder diary (SR-BD),,

NEUROUROLOGY AND URODYNAMICS, Issue 6 2008
Irina Naoemova
Abstract Aim To describe and compare voiding patterns on a 3-day sensation-related bladder diary (SR-BD) in women with urinary incontinence (UI) and healthy volunteers. Methods A total of 251 women (224 incontinent patients and 27 healthy volunteers) who recorded a 3-day SR-BD and underwent standard cystometry participated in the study. Parameters from the 3-day SR-BD were compared between incontinent patients and healthy volunteers. Results Compared to continent women, all groups of incontinent women noted a significantly higher 24 hr voiding frequency, a greater voiding frequency per liter diuresis, a smaller mean voided volume for different degrees of bladder sensation with more voids made with higher intensity of desire to void. The smallest mean voided volumes for different degrees of desire to void and the highest voiding frequency per liter diuresis were observed in the urge incontinence group. Conclusions There were different sensation-related voiding patterns on the 3-day SR-BD from incontinent women and healthy volunteers. All incontinence groups had increased bladder sensation compared to healthy volunteers. The most severe increase of bladder sensation was observed in the patients with urgency incontinence. Neurourol. Urodynam. 27:511,514, 2008. © 2007 Wiley-Liss, Inc. [source]

Postural response of the pelvic floor and abdominal muscles in women with and without incontinence,

NEUROUROLOGY AND URODYNAMICS, Issue 3 2007
Michelle D. Smith
Abstract Aims To determine whether activity of the pelvic floor (PF) and abdominal muscles differs between continent and incontinent women in response to a postural perturbation with a moderately full or empty bladder. Methods Electromyographic (EMG) activity of the PF and abdominal muscles was recorded with surface electrodes prior to and after a postural perturbation in which a 1 kg weight was dropped 30 cm into a bucket held by the subject. Perturbations were applied to the trunk in trials in which the timing of the weight drop was unknown (unexpected) or predictable (expected). Trials were performed with the bladder empty, and when the subject reported a sensation of moderate bladder fullness after drinking between 200 and 1,000 ml of water. Results Women with incontinence demonstrated increased PF EMG compared to continent women both prior to and during the postural response associated with unexpected loading. In addition, obliquus externus abdominis EMG was increased in incontinent women during these trials. When the bladder was moderately full, PF EMG decreased, whereas abdominal muscle EMG tended to increase. Conclusions These data suggest that women with incontinence have increased PF and abdominal muscle activity associated with postural perturbations. This finding challenges the clinical assumption that incontinence is associated with reduced PF muscle activity, and suggests that training control and coordination of abdominal muscle activity may be important in treatment of this condition. The contrasting effects of increased bladder volume on PF and abdominal muscle EMG are likely to present further challenges to the maintenance of continence. Neurourol. Urodynam. 26:377,385, 2007. © 2007 Wiley-Liss, Inc. [source]

Predicting implantation with a neuromodulator using two different test stimulation techniques: A prospective randomized study in urge incontinent women,

NEUROUROLOGY AND URODYNAMICS, Issue 1 2007
Kristy M. Borawski MD
Abstract Aims The purpose of this study was to determine whether a percutaneous needle electrode (PNE) technique or a surgical first stage lead placement (FSLP) better predicted whether a patient would progress to implantation of a pulse generator (IPG) in older urge incontinent women. Methods Thirty subjects ,55 years with refractory urge incontinence who had been selected to undergo a test stimulation procedure were randomized to either PNE or FSLP. Thirteen underwent PNE placement and seventeen underwent FSLP placement. If during the test stimulation period subjects had greater than 50% improvement in their incontinence parameters they qualified for permanent lead and/or IPG implantation of the Interstim® device. Results Twenty-one subjects (70%) responded to the test stimulation and underwent implantation, 15/17 (88%) in the FSLP group and 6/13 (46%) in the PNE group. Subjects who were randomized to the FSLP group were significantly more likely to proceed to implantation of the IPG (P,=,0.02) than those in the PNE group. There was no significant difference in demographics, pre-test stimulation incontinence parameters or post-stimulation visual analog pain scores between the randomized groups or between test stimulation responders and non-responders. When comparing FSLP and PNE responders, there was no significant difference in the percent improvement in 24-hr pad weight, daily pad usage, or daily incontinence. Conclusion FSLP better predicted progression to implantation of the IPG than a test stimulation with a PNE in an older urge incontinent cohort. Neurourol. Urodynam. © 2006 Wiley-Liss, Inc. [source]

The tension free vaginal tape operation for women with mixed incontinence: Do preoperative variables predict the outcome?

NEUROUROLOGY AND URODYNAMICS, Issue 1 2007
Sigurd Kulseng-Hanssen
Abstract Aims The aims of our study were (1) to investigate subjective and objective outcomes after tension free vaginal tape (TVT) operations in mixed incontinent women, (2) to detect if preoperative subjective and objective variables predict the outcome, and (3) to evaluate whether the surgical outcome is different for women who preoperatively find stress incontinence, urge incontinence, or urge and stress incontinence equally the predominant bother. Methods A prospective cohort study was performed on 450 mixed incontinent women. A short-form disease-specific validated questionnaire, 24-hr pad test, standardized stress test, residual urine, and maximum urinary flow were used before and after a TVT operation. "Cure" was defined as a condition where the women were very satisfied with the TVT operation and had negative stress- and 24 hr pad tests. Results Preoperatively 69% had stress incontinence, 7% urge incontinence, and 24% urge and stress incontinence equally as the predominant bother. Cure rates were 80%, 52%, and 60%, respectively, in these groups. Postoperatively 43% of the women had no urge incontinence, while 49% were less, and only 8% were more bothered by urge incontinence. A higher preoperative urge incontinence index was correlated with significantly higher postoperative bother for all indices and leakage during 24-hr pad test. Conclusions Mixed incontinent women with predominant stress incontinence had a better cure rate than those with predominant urge incontinence and those who were equally bothered by urge and stress incontinence. This point needs to be addressed when informing mixed incontinent women before a TVT operation. Neurourol. Urodynam. © 2006 Wiley-Liss, Inc. [source]

Clinical evaluation of pelvic floor muscle function in continent and incontinent women

NEUROUROLOGY AND URODYNAMICS, Issue 3 2004
Annemie Devreese
Abstract Aims The aim of the study was to investigate the reliability of a scoring system for the investigation of voluntary and reflex co-contractions of abdominal and pelvic floor muscles in lying, sitting, and standing positions in continent and incontinent women. Methods A visual inspection and digital (strength, tone, speed, and endurance) palpation scale was developed to measure the coordination of the lower abdominal and pelvic floor muscles. Inter-observer reliability of the scales was investigated in 40 continent and 40 incontinent women. Differences between the continent and incontinent group were analysed. Results Inter-observer reliability for the visual inspection scale showed kappa values between 0.91 and 1.00, for tone percentage of agreement ranged from 95 to 100% (superficial) and 95 to 98% (deep muscle). Weighted Kappa (Kw) varied from 0.77 to 0.95 for strength and 0.75 to 0.98 for the inward movement of superficial and deep pelvic floor muscles. Kw for coordination between the superficial and deep part of the pelvic floor muscles groups was from 0.87 to 0.88 and 0.97 to 1.00 for endurance and global speed of the pelvic floor contraction. The continent women exhibited significantly better coordination between the pelvic floor and lower abdominal muscles during coughing in all three positions. Also the superficial part of the inward movement, the feeling and the coordination of the pelvic floor muscles were significantly better in the continent group. Conclusions Visual inspection and digital tests are easy and reliable methods by which insight can be gained into the multi-muscular activity and coordination of the pelvic floor and lower abdominal muscles in continent and incontinent women. Neurourol. Urodynam. 23:190,197, 2004. © 2004 Wiley-Liss, Inc. [source]

Female Urinary Incontinence During Intercourse: A Review on an Understudied Problem for Women's Sexuality

THE JOURNAL OF SEXUAL MEDICINE, Issue 1 2009
Maurizio 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]

Is physical activity influenced by urinary incontinence?

Randomised controlled trial of total compared with subtotal hysterectomy with one-year follow up results

BJOG : AN INTERNATIONAL JOURNAL OF OBSTETRICS & GYNAECOLOGY, Issue 12 2003
Helga Gimbel
Objective To compare total abdominal hysterectomy and subtotal abdominal hysterectomy performed for benign uterine diseases. Design Randomised, controlled, unblinded trial with central, computer-generated randomisation. Setting Danish trial performed in 11 departments of gynaecology. Population Women referred for benign uterine diseases were randomised to total abdominal hysterectomy (n= 158) or subtotal abdominal hysterectomy (n= 161). One-year follow up questionnaires had a response rate of 87%. Methods Patients were followed by strict data collection procedures, including postal questionnaires. The results after one year of follow up were analysed by intention-to-treat analyses. Main outcome measures (1) Primary: urinary incontinence and (2) secondary: post-operative complications, quality of life (SF-36), constipation, prolapse of the vaginal vault/cervical stump, satisfaction with sexual life, pelvic pain and vaginal bleeding. Results A significantly (P= 0.043) smaller proportion of women had urinary incontinence one year after total abdominal hysterectomy compared with subtotal abdominal hysterectomy [9%vs 18% (OR 2.08, 95% CI 1.01,4.29)]. The lower proportion of incontinent women in the total abdominal hysterectomy group was a result of a higher proportion of symptom relief (total abdominal hysterectomy: 20/140, subtotal abdominal hysterectomy: 14/136) as well as a lower proportion of women with new symptoms (total abdominal hysterectomy: 3/140, subtotal abdominal hysterectomy: 10/137). Twenty-seven women (20%) from the subtotal abdominal hysterectomy group had vaginal bleeding and two of them had to have their cervix removed. No other clinically important differences were found between the two hysterectomy methods. Conclusions A smaller proportion of women suffered from urinary incontinence after total abdominal hysterectomy than after subtotal abdominal hysterectomy one year post-operatively. [source]

Introital ultrasonography: a comparison of women with stress incontinence due to urethral hypermobility and continent women

BJU INTERNATIONAL, Issue 4 2006
Jordi Cassadó
OBJECTIVE To determine if there is a variable on introital ultrasonography (IUS) that can be used to distinguish between women with stress urinary incontinence (SUI) due to urethral hypermobility (UH) and continent women. PATIENTS AND METHODS This single-centre, prospective, blind, cohort, observational study comprised 383 women (245 continent and 138 incontinent) who were all appropriately informed volunteers selected according to the inclusion criteria. IUS with a convex probe was performed on all women; the measurement plane was standardized and coordinates were obtained at rest and on straining. Several distances were measured to determine if any provided an objective distinction between continent and incontinent women. RESULTS Among all the IUS variables assessed, sliding (calculated as the difference between the distance urethra-bladder neck, U-BN, at rest and under stress) was the best for distinguishing continent and incontinent women. The receiver operating characteristic curves showed that with a threshold of 8 mm, sliding had a sensitivity of 92% and a specificity of 79.6% for detecting SUI due to UH. The distances symphysis-urethra (S-U) and U-BN at rest could also discriminate, but with lower significance. CONCLUSIONS IUS is an important tool for diagnosing SUI; there are three independent variables, one dynamic (sliding) and two static (distances S-U and U-BN), that can be used to distinguish between continent women and those with SUI due to UH. Sliding is the most reliable, as it has the highest sensitivity and specificity. We think that the simplicity, low financial cost and reliability of IUS could allow it to be a routine procedure for physicians working in incontinence units. [source]

Prevalence of urinary incontinence in women with cystic fibrosis

BJU INTERNATIONAL, Issue 1 2001
M. Cornacchia
Objective To determine the prevalence of urinary incontinence (UI) in female patients (aged 15 years) attending a cystic fibrosis (CF) centre, in whom stress UI could be common, as chronic coughing and sputum production are frequent symptoms associated with progressive lung disease in these patients. Patients and methods An anonymous questionnaire was completed by 176 women with CF (mean age 24.6 years, sd 5.8) during routine assessments as outpatients. Results In all, 72 patients (41%) were classified as never incontinent; occasional UI was reported in 61 women (35%). Regular UI, occurring twice or more a month for at least two consecutive months in the last year, was reported in 43 patients (24%). Regular UI was associated with increasing age and a lower mean (sd) forced expiratory volume/s (of that predicted) than in women with no urinary symptoms, at 26.9 (6.5) years and 53.5 (23.5)%, and 23.1 (5.4) years and 65.5 (23.2)%, respectively (P < 0.01 and P < 0.05, respectively). All incontinent women recorded stress UI; coughing, laughing and physical activity were associated with UI in 92%, 33% and 21% of the patients, respectively. Conclusion Stress UI is a common symptom in women with CF. As urine loss can be under-reported to the healthcare providers, women should be asked about incontinence as part of their routine follow-up. Pelvic floor muscle exercises are effective in treating stress UI and should be considered for those with CF and regular UI. [source]