Pathophysiology Of Incontinence Research Articles

Outlet Procedures in Female Cancer Survivors for the Treatment of Stress Incontinence: Differences in Indications, Technique, and Outcome for the Cancer Survivor

This article reviews the literature published over the past 5 years to provide an update regarding outlet procedures in female cancer survivors for the treatment of stress urinary incontinence (SUI), with note made of any specific considerations in terms of indications, surgical technique, and outcomes. Treatment options for SUI depend on the pathophysiology of incontinence and should be performed after cancer treatment is completed. Multidisciplinary considerations are important. Urethral bulking agents may be of benefit in mild incontinence; sling procedures effective in moderate to severe incontinence. For refractory SUI, AUS can be considered but has a high failure rate in irradiated patients; urinary diversion with or without bladder neck closure is also an option. More studies regarding management of SUI in this increasingly prevalent group of female cancer survivors are warranted.

Chapter 19 - Lower urinary tract dysfunction in patients with parkinsonism and other neurodegenerative disorders

Progressive neurodegenerative disorders are devastating diseases with often fatal outcomes. Lower urinary tract symptoms (LUTS) add to morbidity and increase the risk of becoming dependent on the help of others (e.g., nursing-home referral). In Parkinson's disease (PD), the specific loss of dopaminergic neurons in the substantia nigra and possibly also in the ventral tegmental area induces loss of neurogenic bladder control through dysfunction of a complex network in which selective disinhibition of bladder reflexes is lost. In PD, more than 60% of patients have troublesome bladder symptoms, and 30% experience incontinence, though not daily. In atypical parkinsonism, including multiple system atrophy, LUTS are highly prevalent, and the onset of LUTS in comparison to other autonomic symptoms and motor symptoms may serve as a diagnostic marker. Less is known about the pathophysiology of incontinence in Alzheimer's disease, but higher cognitive function including attention and self-management may play a role. Incontinence is a major risk factor for loss of independence. The complex pathophysiologic mechanisms of neurodegenerative disorders and hence complex symptoms play important roles in LUTS and patient quality of life. Nocturia, incontinence, and urgency as well as poor bladder emptying are the most common symptoms. These symptoms may interact with the core symptoms of the disorders, increasing the risk of incontinence and infection. In rarer neurogenerative disorder LUTS may be present, most commonly in disorders with spinal cord involvement. The systematic and careful tracking of symptoms, evaluation using non-invasive techniques, and conservative management including pharmacologic treatments can often markedly improve the lives of patients and their caregivers.

Erectile Dysfunction and Urinary Incontinence After Prostate Cancer Treatment

To review the current knowledge and treatment of incontinence and erectile dysfunction after treatment of localized prostate cancer. Journal and research articles. The unique aspects of each treatment lends to different considerations in treatment techniques that mitigate incontinence and impotence. Although the pathophysiology of incontinence and impotence after various treatments can be different, the treatments can be similar in many ways. Nursing care of men undergoing treatment of prostate cancer begins at the time of diagnosis and continues throughout the management of the two main adverse effects of treatment: erectile dysfunction and urinary incontinence. Nursing care focuses heavily on psychosocial support and education to help patients to live with the aftermath of prostate cancer.

Coexistence of constipation and incontinence in children and adults

The coexistence of constipation and fecal incontinence has long been recognised in paediatric and geriatric populations, but is grossly underappreciated in the rest of the adult population. In children, functional fecal incontinence is usually associated with constipation, stool retention and incomplete evacuation, and is frequently allied to urinary incontinence. Pathophysiology of the incontinence is incompletely understood, although both in children and adults, it is thought to be secondary to overflow, while in adults it may also be related to pelvic floor dysfunction and denervation. Incontinence has an important impact on quality of life and daily functioning, and in children may be associated with behaviour problems. The treatment of underlying constipation usually results in improvement in incontinence. This review broadly addresses the epidemiology and pathophysiology of coexistent constipation and incontinence in both children and adults, and also reviews clinical presentation and treatment response in pediatrics.

The puborectalis muscle

The role of the levator ani and puborectalis muscle in preserving continence has been underestimated in the past, due predominantly to technical difficulties to investigate its proper function in healthy subjects, and its dysfunction as in patients with incontinence problems. This has recently been overcome by applying new investigational procedures such as a perineal dynamometer which measures the traction exerted by the levator ani on an intrarectal balloon catheter, or by multi-electrode arrays recording the generation of motor unit action potentials from various parts of the puborectalis muscle sling via intrarectal surface electrodes. Both techniques have the potential to provide new insights into the physiology of defecation and the pathophysiology of incontinence and constipation.

Medikament�se Therapie der weiblichen Harninkontinenz

Drug treatment for female urinary incontinence requires a thorough knowledge of the differential diagnosis and pathophysiology of incontinence as well as of the pharmacological agents employed. Pharmacotherapy has to be tailored to suit the incontinence subtype and should be carefully balanced according to efficacy and side effects of the drug. Women with urge incontinence require treatment that relaxes or desensitizes the bladder (antimuscarinics, estrogens, alpha-blockers, beta-mimetics, botulinum toxin A, resiniferatoxin, vinpocetine), whereas patients with stress incontinence need stimulation and strengthening of the pelvic floor and external sphincter (alpha-mimetics, estrogens, duloxetine). Females with overflow incontinence need reduction of outflow resistance (baclofen, alpha-blockers, intrasphincteric botulinum toxin A) and/or improvement of bladder contractility (parasympathomimetics). If nocturia or nocturnal incontinence are the major complaints, control of diuresis is obtained by administration of the ADH analogue desmopressin. Future developments will help to further optimize the pharmacological therapy for female urinary incontinence.

URINARY INCONTINENCE IN THE OLDER MAN

Older men experience UI less often than older women, but the disruption and bother they experience because of UI is significant. Several anatomic differences between men and women account for different pathophysiology of incontinence. In men, overflow incontinence and detrusor instability predominate; stress incontinence is seen only in cases in which men have had prostate surgery. Reported symptoms of urgency and urge incontinence may be particularly difficult to interpret clinically in men because they might indicate detrusor instability or bladder outlet obstruction causing uninhibited contractions. The medical evaluation of UI is similar for men and women; men being evaluated for UI need a postvoid residual. Noninvasive measurement of urine flow may add to the diagnostic accuracy of detecting bladder outlet obstruction, but the results may not agree with results obtained by pressure-flow studies. Prostate surgery can result in UI, and biofeedback can be an effective treatment. Near-continual leakage after prostate surgery seems to be most responsive to artificial sphincter implantation. Male nursing home patients with UI present a different challenge in that mental and physical dysfunction must be addressed. Staff-dependent interventions are the most appropriate.

Urinary incontinence: a review.

Urinary incontinence is underestimated in occurrence, overemphasized in relation to gender and age, and lacks clarity in terms of classification and treatment. This article provides a review of the literature concerning the concept of urinary incontinence, including a comprehensive description of the mechanisms involved in the physiology of continence and pathophysiology of incontinence. The psychosocial and economic effects of urinary incontinence are addressed, as well as urinary dysfunction in selected populations with cognitive or neurologic impairments.

Volume-interval relationship of incontinence episodes in elderly inpatient men

Urinary incontinence is an immense source of personal distress for older people. The characteristics of urinary incontinence in older people that contribute to understanding the pathophysiology of incontinence have not been studied extensively. In this study, 66 elderly inpatients were monitored for incontinence characteristics of incontinence volume and time interval between episodes. There was no correlation between incontinence volume and time between episodes of incontinence. This supports a previous observation that the occurrence of urinary incontinence in elderly inpatient men is not determined by the accumulated volume of urine in the bladder.

Telemetric electromyographic monitoring in elderly incontinent men

AbstractUrinary incontinence is a serious social, psychological, economic, and medical problem for elderly people. However, the pathophysiology of incontinence in the elderly is unclear. Previous studies have shown an irregular occurrence of incontinence events regarding incontinence volume, time between episodes, and residual urine volume. In this study, telemetric monitoring of external anal electromyography (EMG), rectus abdominis EMG, bladder pressure, and incontinence detection were done. Involuntary detrusor contractions occurred which were associated with an increase in sphincteric EMG activity and followed by either continence or incontinence. A fall in sphincteric EMG activity was associated with incontinence, while a fall in detrusor pressure was associated with continence. A detrusorsphincter activity interaction appears to exist during involuntary detrusor contractions which may result in either continence or incontinence, depending upon whether the detrusor or the sphincter activity is predominant. The irregular detrusor‐sphincter activity represents a possible etiology of the irregular occurrence of urinary incontinence patterns in elderly patients. © 1992 Wiley‐Liss, Inc.

The pathophysiology of urinary incontinence among institutionalized elderly persons.

Although 1 million institutionalized elderly persons have urinary incontinence, little is known about the causes of this problem. We conducted clinical and physiologic studies to determine the causes of established incontinence in a representative sample of 605 institutionalized elderly persons (mean age, 89 years), of whom 40 percent were chronically incontinent of urine. Detailed urodynamic studies in 94 of the 245 incontinent patients (77 women and 17 men; 38 percent) showed that detrusor overactivity was the predominant cause in 61 percent, with concomitant impaired detrusor contractility present in half these patients. Other causes among women were stress incontinence (21 percent), underactive detrusor (8 percent), and outlet obstruction (4 percent). Among the relatively few men in this sample, outlet obstruction accounted for 29 percent of the cases. In 35 percent of the patients, at least two coexisting probable causes of incontinence were identified. Diagnoses among patients with impaired mobility or mentation differed little from those in unimpaired patients. We conclude that the pathophysiology of incontinence in this population is complex; that detrusor hyperreflexia with normal contractility ("uninhibited bladder") accounts for the minority of cases (29 percent), even among patients with dementia; and that the causes of incontinence are as diverse in severely impaired elderly persons as in those who are unimpaired.