Involuntary Loss Of Urine Research Articles

Lessons learned: Impact of a continence promotion activity for older community‐dwelling women

Few studies have documented the effectiveness of continence promotion programs targeting older incontinent women. We sought to evaluate the impact of an interactive continence workshop on changing participants' attitudes, knowledge and skills in relation to self-managing or seeking care for incontinence. A quasi-experimental prospective cohort study with repeated measures was carried out on a population of 90 incontinent women aged 55-87 participating in a continence promotion workshop. Inclusion criteria were a weekly average of one or more episodes of involuntary urine loss during the preceding 3 months and having never sought help for this problem. Incontinence-related knowledge, attitudes, skills and intentions for seeking care were assessed immediately prior and subsequent to the workshop. Three- and 6-month telephone follow-ups were conducted to determine rates of healthcare seeking and reasons for not seeking care. Improvements in incontinence-related knowledge and attitudes occurred in up to 94% participants. Forty-three percent of the study participants initiated and were satisfied with self-treatment, and an additional 42% consulted a health care professional. Interactive continence workshops promote self-management and consultation seeking among older women with incontinence. Further testing of different strategies for promoting continence awareness needs to occur in larger studies with more sensitive instruments, a control group, and better specification of the goals, process and outcomes of the health promotion activity being tested.

Incontinência urinária entre estudantes de educação física

Urinary incontinence (UI) is seen as a problem that affects older multiparous women. Little attention has been given to identifying UI in groups of younger or nulliparous women. This study verified the prevalence of UI and the characteristics of urinary loss among young nulliparous female physical education students. Data collection was performed using a questionnaire. Of all 95 students, 61.1% answered the questionnaire. The average age was 21.4 years and 20.7% stated having presented involuntary urine loss. In 75% of cases, urinary loss occurred during sports activities. The students who had experienced urinary loss rated the problem with a 2.3 average score (ranging form 0 to 6), with 0 being no problem and 10 being a serious problem. It is concluded that urinary loss during exercise, though relatively frequent, is not considered a relevant issue for the physical education students.

Prevalence and risk factors of female urinary incontinence in eastern Turkey

To evaluate the prevalence of urinary incontinence (UI) and determine risk factors for its development in women living in eastern Turkey. A cross-sectional study was conducted on 2275 women aged between 17 and 80 years. A questionnaire examining demographic characteristics, parity and pelvic organ prolapse was given. Presence and types of incontinence were examined using a validated form of the Turkish version of the urogenital distress inventory questionnaire-short form (UDI-6). A total of 1054 (46.3%) women reported involuntary loss of urine. Stress UI was present in 46% of women, whereas urge UI was detected in 43% of them. Mean age of patients with and without UI were 44.57 + 11.04 and 35.04 + 9.51, respectively. Age, total number of pregnancies and number of deliveries were shown to be significantly different in patients with and without any type of UI. Multiple logistic regression analysis of the factors revealed that age, total delivery number, pelvic organ prolapse and difficult labor were significantly associated with the presence of UI. This is the first study examining the prevalence of UI in women living in eastern Turkey. By using a validated questionnaire, several risk factors for the development of UI were determined. Pelvic organ prolapse and increased number of births were found to be two most significant ones.

PROSTATE CANCER AND URINARY INCONTINENCE

INTRODUCTION AND OBJECTIVES: Urinary incontinence (UI) following prostate cancer (PCa) is common, and may vary depending on type of PCa treatment. Our objectives were to determine the proportion of UI occurring in men diagnosed with PCa, and to determine if type of PCa treatment was associated with UI. We examined these questions using data from the Olmsted County Study of Urinary Symptoms and Health Status among Men. METHODS: In 1990, a randomly selected cohort of white men, ages 40-79 years, from Olmsted County, Minnesota was assembled (55% participation; n=2447). Men were followed via biennial questionnaires through 2007. UI was classified as answering yes to questions on urinary leakage, use of bladder control items, diagnosis of incontinence, involuntary loss of urine, and/or a history of chronic UI. Community medical records were also reviewed to determine onset of biopsy-confirmed PCa and type of initial treatment for PCa. The proportion of PCa patients who reported incontinence was calculated for first and last follow-up following PCa diagnosis. Odds ratios (ORs) were calculated to assess the association between type of treatment (surgical vs non-surgical) and UI. Patients who had reported UI prior to their PCa diagnosis were excluded from the analyses. RESULTS: Overall, 225 (9%) men developed PCa, and 143 (64%) did not report UI prior to development of PCa and had questionnaire information available both preand post-cancer diagnosis. Of these men, 60 (42%) reported UI at the first follow-up after PCa diagnosis (median follow-up:1.0 years, interquartile range (IQR): 0.3, 1.6). At the last follow-up after PCa diagnosis, 51 (36%) reported UI (median followup: 6.1 years, IQR: 2.6, 9.4). Surgical treatment (n=77, 54%) was not significantly associated with UI at the first follow-up (age-adjusted OR: 1.2, 95% Confidence Interval (CI): 0.6, 2.7). However, surgical treatment was associated with UI after the last follow-up (age-adjusted OR: 2.5; 95% CI: 1.2, 5.3). CONCLUSIONS: These data indicate that urinary incontinence is indeed significant in patients after a diagnosis of PCa. Additionally, UI remains common even several years after PCa diagnosis, and is associated with surgical treatment. Appropriate management options therefore need to be actively discussed with these patients.

Preservation of Lateral Prostatic Fascia is Associated with Urine Continence after Robotic-Assisted Prostatectomy

BackgroundAmong several clinical factors, nerve or prostatic fascia preservation is associated with an improved continence outcome in several studies. ObjectiveWe study the clinical aspects associated with urine continence after prostatectomy, paying special attention to the extent and location of fascia preservation. Design, setting, and participantsEuropean Organisation for Research and Treatment of Cancer (EORTC) Quality of Life – Core 30 (QLQ-C30) and Prostate Cancer Module (PR25) questionnaires were used to evaluate quality-of-life (QoL) parameters prior to and at 6 and 12 mo after surgery for 151 men treated with robot-assisted laparoscopic prostatectomy (RALP) for localised prostate cancer. Fascia preservation was scored at 12 locations around the circumference of the prostate. Any involuntary urine loss showed a strong correlation with several domains of the EORTC QLQ-C30 and was therefore chosen as the definition of urine incontinence. InterventionRobot-assisted laparoscopic prostatectomy (RALP). MeasurementsAny urine incontinence. Results and limitationsOf the preoperative and intraoperative characteristics, a low fascia preservation (FP) score and a higher score for preoperative voiding complaints (EORTC QLQ-P25 domain 1) were associated with an increased risk of urine incontinence and pad use at 6 and 12 mo postoperatively. In the multivariate binary logistic regression analysis, the extent of fascia preservation at the lateral aspects of the prostate as assessed by the FP score was the best predictor of urine continence at 6 and 12 mo postoperatively. The odds ratio for urine incontinence in men with preservation of the lateral prostatic fascia was 0.378 (95% CI, 0.121–0.624) and 0.289 (95% CI, 0.201–0.524) for preservation at the right and left aspects, respectively. This is a retrospective analysis not containing pad-test data. ConclusionsFascia preservation at the lateral aspect of the prostate was the best predictor of urine continence after RALP. These data suggest that preservation of fascial support lateral rather than dorsolateral to the urethra and prostate may protect neurovascular structures important to improving postprostatectomy urine continence.

Urethral sphincter mechanism incompetence in spayed bitches: new insights into the pathophysiology and options for treatment.

Incidence of USMI after ovariectomy Urinary incontinence is the involuntary loss of urine [1]. In intact bitches urinary incontinence is rare (0-1 %) [2], whereas in spayed bitches the incidence is up to 20% [3]. The underlying pathophysiological mechanism is mainly an acquired insuffi cient closure of the urethra after spaying [4]. Therefore urinary incontinence after spaying is called urethral sphincter mechanism incompetence (USMI). Within one year after spaying the urethral closure pressure is signifi cantly reduced. Because many bitches may only become incontinent years after surgery it took a long time until the causal relationship between ovariectomy and the occurrence of incontinence was proven [5]. In one study, 83 of 412 (20%) bitches became incontinent 3 to 10 years after surgery [3]. As long as 40 years ago urinary incontinence was described as a rare side effect of spaying [6]. However, it took 20 years to verify the causal relationship between the removal of the ovaries and urinary incontinence [5]. The triggering mechanism is still unclear. Neuronal damage can most likely be disregarded, as the risk of urinary incontinence is the same in ovariectomised and ovariohysterectomised bitches [3].

Combined Medical and Behavioral Therapy for Urge Urinary Incontinence in Women

Urge incontinence (involuntary urine loss associated with a strong urge to void) in women is a common and vexing condition. Antimuscarinic agents such

Large vesicovaginal fistula in women with pelvic organ prolapse: the role of colpocleisis revisited

Successful repair of large vesicovaginal fistulas poses a significant challenge in surgically unfit older women with pelvic organ prolapse. Two women, at ages of 85 and 93, referred for involuntary urine loss were found to have neglected pessaries resulting in large vesicovaginal fistulas. After the removal of the pessary, fistula repair and LeFort colpocleisis were done with success. At 12 months postoperatively, the patients were free of leakage and prolapse. For frail, elderly women with large vesicovaginal fistula and pelvic organ prolapse, addition of LeFort colpocleisis to the repair provides an effective treatment for both.

Effects of acupuncture on abdominal leak point pressure and c-Fos expression in the brain of rats with stress urinary incontinence

Stress urinary incontinence leads to the involuntary loss of urine during abdominal strain caused by sneezing, laughing, and coughing. Acupuncture has been widely used for the treatment and prevention of a variety of diseases in traditional medicine. Acupuncture has also been used to relieve the symptoms of functional disorders of the lower urinary tract. In the present study, we investigated the effect of acupuncture at the Sanyinjiao (SP6) acupoint on stress urinary incontinence in rats. The present results showed that abdominal leak point pressure was decreased in rats with stress urinary incontinence, while acupuncture at the SP6 acupoint significantly enhanced the abdominal leak point pressure. The expression of c-Fos in the pontine micturition center (PMC), ventrolateral periaqueductal gray (vlPAG), and medial preoptic nucleus (MPA) regions was increased by the induction of stress urinary incontinence, and acupuncture at the SP6 acupoint significantly decreased c-Fos expression in these areas. In the present study, we showed that acupuncture has therapeutic effect on the symptoms of stress urinary incontinence, and this effect of acupuncture is associated with modulation of c-Fos expression in the brain.

Correlates of Urinary, Fecal, and Dual Incontinence in Older African‐American and White Men and Women

To determine prevalence and correlates of urinary (UI), fecal (FI), and dual (DI) incontinence in community-dwelling older adults. Cross-sectional, population-based in-home survey. Three rural and two urban Alabama counties (1999-2001). Stratified random sample of 1,000 Medicare beneficiaries aged 65 and older: 25% African-American men, 25% white men, 25% African-American women, 25% white women. UI defined as involuntary urine loss at least monthly; FI defined as "In the past year, have you had any loss of control of your bowels, even a small amount that stained the underwear?" Independent variables were sociodemographics, medical history, and activities of daily living (ADLs) excluding toileting. Multinomial logistic regression models were constructed using UI, FI, and DI as dependent variables. UI, FI, and DI prevalences were 27%, 6%, and 6%, respectively. White women had higher prevalence of UI (41.1% vs 24.6%, P<.001) and DI (18.5% vs 8.0%, P=.07) but not FI (4.4% vs 3.8%, P=.83) than African-American women. Men had no racial differences in prevalence (UI 22.2%, FI 7.7%, DI 4.6%). In women, UI, FI, and DI correlates included higher Charlson comorbidity score and depressive symptoms and greater ADL difficulty for UI and DI. In men, UI was associated with prostate disease and depressive symptoms; FI with chronic diarrhea, history of transient ischemic attack (TIA), and poor self-perceived health; and DI with history of TIA, foot and leg swelling, and depressive symptoms. Women had racial differences as well as similar correlates of incontinence subtypes, whereas men did not.

Agents for Treatment of Overactive Bladder: A Therapeutic Class Review

Overactive bladder (OAB) is a medical syndrome defined by symptoms of urgency, with or without urge urinary incontinence (any involuntary loss of urine), usually with frequency and nocturia. Although anticholinergic agents have been the first-line treatment for OAB for many years, the efficacious pharmacologic management of this condition has been compromised by concerns regarding tolerability. Flavoxate was the first anticholinergic and antispasmodic agent approved by the Food and Drug Administration (FDA) to treat symptoms of OAB but is not routinely used today since newer agents are more effective. The more recent drugs, oxybutynin and tolterodine, have appeared to be equally efficacious in treating the symptoms of OAB in clinical trials; however, tolterodine has proven to be better tolerated with fewer adverse effects. In 2004, the FDA approved the three newest agents for the class: darifenacin, solifenacin, and trospium. Compared with oxybutynin and tolterodine, these agents have a more favorable side effect profile, which can enhance tolerability and patient compliance. Side effects are reduced in part because of the drugs' greater tissue selectivity for inhibiting the bladder muscle contraction over other anticholinergic receptors in the body. In recent clinical trials, darifenacin, solifenacin, and trospium have shown superiority to placebo and efficacy comparable to that of oxybutynin and tolterodine.

Conservative therapy for overactive bladder: Pelvic floor exercises

The original purpose of pelvic floor exercises was to restore tone and function to the atrophied pelvic muscles with the rationale that this helps control involuntary loss of urine with physical activity such as coughing, sneezing, or laughing. The aim of pelvic floor muscle exercises in the treatment of overactive bladder is to inhibit involuntary detrusor contractions. Although their efficacy in the treatment of stress urinary incontinence has been well established and understood, the use of pelvic floor muscle exercises to inhibit detrusor contractions has not been well studied. This article reviews the literature pertaining to the role of pelvic floor muscle exercises in the treatment of overactive bladder symptoms.

Shades of Dry — Curing Urinary Stress Incontinence

Urinary incontinence is a common condition affecting 20 to 40% of older women.1 The two most common types of urinary incontinence are stress incontinence, the involuntary loss of urine resulting from increased abdominal pressures (such as with a cough or Valsalva's maneuver), and urge incontinence, the involuntary loss of urine after an unwanted contraction of the detrusor muscle.2 Some patients have mixed incontinence with both types of conditions. The frequency of both types of urinary incontinence increases with age, with peaks in prevalence around menopause and after the age of 65 years.3,4 Obesity and multiparity are recognized risk factors . . .

Maternal Morbidity Associated With Obstetrical Maneuvers in Shoulder Dystocia

Complications from shoulder dystocia during birth can result in morbidity for both the mother and infant, although past studies have largely focused only on risk factors for dystocia and perineal tears. This case-control study was done to learn whether the obstetrical maneuvers used to relieve shoulder dystocia and dystocia itself have adverse effects on the perineum or on the immediate postpartum outcome. A total of 140 cases of shoulder dystocia were compared with 280 control cases. All were singleton, vertex, full-term vaginal deliveries. Shoulder dystocia was more than twice as frequent in women having spontaneous vaginal delivery than in those having instrumental delivery. One type of direct fetal manipulation was needed to relieve shoulder dystocia in 29% of cases, and two types in 34%. Indirect fetal manipulation, usually the McRobert maneuver and/or suprapubic pressure, was used in 74 (53%) cases. Direct fetal manipulation, most often in the form of posterior arm delivery, was performed in 66 (47%) patients. Macrosomia was diagnosed in 42% of cases of shoulder dystocia and in 5% of control cases. Episiotomy was performed significantly less often in parturients with shoulder dystocia (55%) than in the control group (72%). Obstetrical maneuvers did not influence rates of postpartum urinary or vaginal infection. The risk of a third-degree perineal tear appeared unrelated to the number of obstetrical maneuvers carried out. The one anal sphincter rupture occurred in a case of shoulder dystocia where fetal manipulation was not necessary. Mean hemoglobin values were nearly identical in the two groups. Postpartum hospital time averaged 4½ days in both the case and control groups. The incidence of involuntary urine loss was 4.7% when fetal manipulation was carried out and 3.7% in control cases. These findings suggest that neither shoulder dystocia itself nor the fetal manipulations needed to relieve it increase maternal morbidity. Specifically, fetal manipulation did not increase the risk of urinary incontinence, fecal incontinence, or anal sphincter damage.

Çocuklarda idrar enkontinansı Çağrılı Editör

Urinary incontinence which is defined as the involuntary loss of urine is a very common clinical problem in childhood Its etiology includes delayed bladder control effects of environmental and social factors on toilet training urinary tract infection anatomic abnormalities of lower urinary tract and neurogenic disorders The more common cause of childhood urinary incontinence is non neurogenic abnormalities classified as anatomic abnormalities or bladder dysfunction Voiding dysfunction is associated with vesicoureteral reflux and urinary infection Diagnostic evaluation is essential to differentiate the causes of urinary incontinence and to determine the best therapy nbsp; Turk Arch Ped 2007; 42: 133 5 Key words: Childhood enuresis urinary incontinence

The Application of Evidence-Based Principles of Care in Older Persons (Issue 6): Urinary Incontinence

Over 50% of nursing home residents are incontinent of urine, resulting in increased burden of illness from psychological, physical, medical, and financial cost. Despite the large number of studies of nonpharmacologic and pharmacologic treatment interventions, relatively little quality evidence exists to guide therapeutic decision making in incontinent nursing home residents. Clinicians and the lay public are deluged with pharmaceutical marketing and advertising activities for drugs of modest proven value. Prompted voiding and other toileting programs are effective but labor intensive and difficult to consistently implement successfully in the nursing home setting. The sixth issue of this series applies principles of evidencebased decision making in elderly nursing home residents with urinary incontinence. In the management of urinary incontinence, reducing the burden of illness not only necessitates increasing the number of hours per day that residents are “dry” as well as reducing incontinence episodes, the incidence of pressure ulcers, and urinary tract infections resulting from conditions related to or as a complication of incontinence, but preventing the appearance of treatment-related adverse events. Strategies to improve care of residents with urinary incontinence is a focus of the Centers for Medicare and Medicaid Services’ National Nursing Home Quality Measures, as well as the survey process and is pivotal to quality nursing home care. Urinary incontinence is an involuntary loss of urine that occurs when bladder pressure exceeds resistance to outflow. Incontinence among nursing home residents has been associ-

La incontinencia urinaria

Urinary incontinence, understood as any involuntary loss of urine, constitutes an important medical and social problem. It can be classified as stress urinary incontinence, urgent urinary incontinence or mixed urinary incontinence. The proportions of these three types of urinary incontinence are difficult to establish and vary notably between sources, but they might be about 40, 33 and 20% respectively. Its diagnosis requires a correct clinical history and physical exploration, together with some complementary explorations. The first therapeutic step consists of hygienic-dietary measures and behaviour modification techniques. Pharmacological treatment is specific for each type of urinary incontinence, using anticholinergics and inhibitors of serotonin reuptake. Finally, different surgical techniques have a role in cases where conservative treatments fail or when dealing with severe urinary incontinence.

Is an Anal Plug Useful in the Treatment of Fecal Incontinence in Children With Spina Bifida or Anal Atresia?

We evaluated the efficacy and tolerance of the Conveen anal plug in children with spina bifida or anal atresia with persistent fecal incontinence necessitating diapers despite bowel management. Seven 4 to 12-year-old patients with high congenital imperforate anus and 9 who were 6 to 13 years old with spina bifida, no mental retardation and no involuntary urine loss on clean intermittent catheterization were included in the study. During a prospective, 6-week crossover descriptive study after a test period to find the most comfortable plug with a diameter of 37 or 45 mm patients and parents completed a diary with the number of soiling episodes, stool frequency, stool consistency and the number of diapers used during 3 weeks without and with the plug, respectively. They provided a final assessment of the device. Two of the 7 patients with congenital imperforate anus discontinued use because of pain and discomfort, 1 had a decrease in soiling episodes and 4 achieved full continence and needed no diapers while using 2 plugs daily (range 1 to 4). All patients preferred the smaller plug. Two of the 9 patients with spina bifida always lost the plug within 1 hour after introduction, 5 had a decrease in soiling episodes but continued to need diapers and 2 achieved full continence using 2 plugs daily (range 1 to 4). All patients preferred the larger plug. The Conveen anal plug is an adjuvant treatment option for fecal incontinence in children with congenital imperforate anus or spina bifida, enabling a minority to stop using diapers. The Conveen anal plug is not a universal solution for fecal incontinence problems in these patients.

Nocturnal enuresis and overactive bladder in children: An epidemiological study

To investigate the prevalence and characteristics of nocturnal enuresis (NE) and to examine the prevalence of overactive bladder (OAB) symptoms in primary schoolchildren. After conducting an anonymous questionnaire survey about voiding habits and bowel habits in primary schoolchildren, a total of 6917 schoolchildren belonging to 11 primary schools were randomly enrolled in the survey. According to the International Continence Society, we defined NE as any involuntary loss of urine during sleep, occurring more frequently than once per month. Children with NE were subdivided into two groups, monosymptomatic NE (MNE) and enuretic syndrome (ES). To evaluate the characteristic differences of MNE and ES, we assessed the relationships between NE and voiding habits, and episodes of cystitis and constipation. Overactive bladder was defined as increased daytime frequency and/or urge urinary incontinence, and its prevalence was investigated. The response rate to the questionnaire was 76.4%. The prevalence of NE was 5.9% and was inversely related to increasing age. Monosymptomatic NE comprised 59.4% of NE cases. The annual spontaneous resolution rate of MNE was higher than that of ES. Increased daytime frequency, a history of cystitis and infrequent bowel habits were not related to MNE, but were significantly related to ES. The prevalence of OAB was 17.8%. Children with a history of cystitis had a significantly higher rate of OAB than children without it. Overall, NE and OAB were detected in 5.9% and 17.8% of primary schoolchildren, respectively. The link between NE and OAB symptoms, urinary tract infections and constipation deserves more attention.

Negative impact of urinary incontinence on quality of life, a cross‐sectional study among women aged 49–61 years enrolled in the GAZEL cohort

The aim of the study was to analyze the relations between severity of urinary incontinence (UI), defined as involuntary loss of urine considered to be a hygienic or social problem, and quality of life (QoL) among middle-aged French working women enrolled in a cohort study, while taking into account characteristics that may affect this relation. Data came from self-administered mail questionnaires completed by 2,640 women aged 49-61 years in the GAZEL cohort of utility company employees. The analysis considered social and demographic characteristics, lifestyle, hormone status, and body mass index. We used bivariate and multivariate analysis to study the associations between UI severity (measured by SANDVIK's index) and QoL scales (Contilife, specific for UI, and the generic Nottingham Health Profile). The sample included 556 women (21%) with UI. QoL alterations associated with UI severity were observed for all six Contilife dimensions (daily and effort activities, self-image, emotional impact, sexuality, and well-being) and two dimensions of the NHP (pain and physical mobility). These results remain after adjustment for age, BMI, and living arrangements. UI affects QoL even among women from a nonclinical population, and the more severe the UI, the more harmful the effect. These results raise the question of whether UI in its severe forms should be considered a disability because of its negative effects on mobility in daily life.