Continence Difficulties Research Articles

The challenges of COVID-19 for people with dementia with Lewy bodies and family caregivers.

The challenges of COVID-19 for people with dementia with Lewy bodies and family caregivers.

Effect of a strong desire to void on walking speed in individuals with multiple sclerosis and urinary disorders.

Lower urinary tract symptoms, especially overactive bladder, are frequent and disabling in individuals with multiple sclerosis (IwMS). An association with gait disorders is common, which could aggravate continence difficulties and affect quality of life. The association between the need to void and walking has never been studied in this population. The primary aim of this study was to assess the effect of a strong desire to void (SDV) on walking speed in IwMS and lower urinary tract symptoms. The secondary aim was to identify clinical or urodynamic factors associated with walking speed impairment at SDV in this population. We included IwMS with urinary disorders and Expanded Disability Status Scale score<7 in this observational study. Individuals underwent 3 10-m walk tests (10MWT) and one Timed Up and Go (TUG) test at SDV and at post-void (PV). Among the 72 IwMS included (mean [SD] age 50.6 [11.6] years; 46 [64%] females), the mean (SD) speed for 10MWT was 1.00 (0.31) m.s-1 at SDV and 1.07 (0.30) m.s-1 at PV (P<0.0001). Time for TUG was also increased when individuals felt SDV: mean 11.53 (4.6) sec at SDV versus 10.77 (3.8) sec at PV (P=0.004). No predictors of greater impairment of walking speed at SDV were identified. This study suggests a clinical impact of bladder sensation on walking speed in IwMS and urinary disorders. None of the individual characteristics could predict greater decrease in gait velocity at SDV.

Towards the development of the psychosocial impact of assistive devices scale for continence (C-PIADS)

© 2014 - IOS Press and the authors. All rights reserved. BACKGROUND: Current outcome measures for continence management devices do not adequately address psychosocial impact. The PIADS is an assessment tool that has been shown to reliably predict the adoption and use of assistive technology devices, but it is not widely used for continence devices.OBJECTIVE: To explore whether the PIADS requires modification to address the particular needs of continence device users and to inform any subsequent item development.METHODS: The study used interpretive methods in which qualitative information from semi-structured interviews was combined with the findings from cognitive interviews for questionnaire pre-testing. A total of 40 participants in UK and Canada were interviewed.CONCLUSIONS: The PIADS appears to fundamentally address many, but not all, of the important psychosocial concerns of adults who have continence difficulties. A version for continence, the C-PIADS, will require modification of the PIADS and is likely to contain some new items.RESULTS: Few participants had difficulty in understanding or relating to the majority of PIADS items. Several items were not considered relevant to continence and some areas for potential new items were uncovered. Embarrassment and concealment of urinary incontinence from others were common topics.

Reducing Urine Leakage After Radical Retropubic Prostatectomy: Pelvic Floor Exercises, Magnetic Innervation or No Treatment? A Quasi-Experimental Study

In Italy, nurses can use pelvic floor muscle exercises (PFMEs) and extracorporeal magnetic innervation (ExMI) to treat urinary incontinence after radical retropubic prostatectomy (RRP). The efficacy of these treatments remains unclear. To compare PFMEs, ExMI, in the management of post-RRP urinary incontinence. This study compared PFMEs versus no treatment in reducing bladder continence difficulties, and PFMEs versus ExMI in reducing urine leakage. A total of 87 patients were treated with PFMEs, 23 with ExMI; 22 refused rehabilitation (control group). Three months after RRP, both interventions reduced the International Prostate Symptom Score, when compared to control group. After 6months, no significant differences between the treatments were found (p=.8346). After a complete ExMI treatment (6weeks), 63.88% lost less than 10 grams of urine per day (32.73% in the PFMEs group, p<.0001). PFMEs are useful up to the 3rd month after surgery; ExMI reduces leakages faster than PFMEs.

Elimination disorders in people with intellectual disability

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.

Urinary continence difficulties in adolescence

Bedwetting and daytime wetting are embarrassing problem for children of all ages, but they can be especially hard for teenagers. The school nurse has an important role to play in the treatment of adolescent urinary continence difficulties.

Toilet training children with learning difficulties: what the literature tells us.

Nurses and health visitors are the professional group most likely to be involved in advising and supporting parents of children with disabilities (Bliss and Watson, 1992). Little research has been done into assessing and treating urinary continence difficulties of children with learning difficulties and many questions remain unanswered: what is the extent of the problem; what specific intervention do children with learning difficulties require to attain toileting skills; what expectation can the parent and clinician have that children with learning difficulties can be toilet trained and who is best placed to promote toileting skills? The main findings from the literature will support health and education professionals and carers who are involved in toilet training children with learning difficulties.

End-of-life plan should be nationwide

Let us hope that the programme devised in Lancashire and South Cumbria that encourages patients who have terminal illnesses to record where they would like to die (features March 24) is rolled out across the UK in the near future. The primary care trust, in which I am a district nursing sister, relies heavily on the expertise of the nursing staff for hands-on palliative care. Although Macmillan nurses are available for telephone advice and support, the day-to-day management of terminally ill patients and their families is within the remit of the community nurse team. We deal with syringe driver maintenance, emotional support, dressings, equipment and continence difficulties. Hand holding and just ‘being there’ is an equally important part of our role. The small team that 1 work in consistently delivers high quality care to all family members. Improved training would be immensely valuable to us, as would funding for more staff to enhance our service. Perhaps then more people who choose to die at home would be able to.

The further development of the active urine collection device: a novel continence management system.

Continence difficulties affect the lives of a substantial minority of the population. Women are far more likely than men to be affected by urinary incontinence but the range of management options for them is limited. There has been considerable interest in developing an external urine collection system for women but without success to date. This paper describes the development and preliminary clinical testing of an active urine collection device (AUCD), which could provide a solution for sufferers. The device uses stored vacuum, protected by a high bubble point filter, to remove urine as quickly as it is produced. This allows a small battery-operated pump to provide the required vacuum, enabling the device to be portable. Two different types of non-invasive patient/device interface were developed, and tested by volunteers: urinal and small pad. The slimline urinal was popular with users although liquid noise was a problem. The pad interface was successful on occasions but further work is necessary to produce a reliable pad. This study has successfully demonstrated that a prototype AUCD liquid handling system can remove urine at clinically relevant flowrates. While further development is required, volunteer tests have shown that the AUCD could be a useful advance in continence management.

Choosing continence products for children.

A wide variety of continence products are available, and the range is changing constantly. Selecting products for children with continence difficulties requires sound knowledge, thorough assessment, regular review, and involvement of the child and family. This article provides some guidance on the products available and how to make an informed choice.

The active urine collection device: a novel continence management system focusing particularly on the needs of disabled women

Purpose : This paper introduces a novel incontinence management system which applies space technology to the problem of urinary incontinence. The purpose of this paper is to invite comments and suggestions from professionals in the disability and rehabilitation field. Method : Severe urinary incontinence is a distressing condition for which there are few satisfactory management solutions. We have been able to develop a compact liquid handling system that can cope with the initial surge of urine which characteristically reaches a high flow rate of around 25 ml/sec. By using a sophisticated system of filters, the device can cope with mixed streams of urine and air which are inevitable when a non-invasive patient/device interface is used. The next phase of the project is to develop prototype devices with the aid of users to produce an effective appliance that users and carers find practical and acceptable to use. Conclusion : With the aid of users, carers and rehabilitation experts we hope to develop an excellent user-friendly product. We believe this device can make a positive contribution to the quality of life of disabled people with continence difficulties.