Treatment Options For Urinary Incontinence Research Articles

Pelvic floor muscle training for urinary incontinence in older adults: a best practice implementation project.

This project aimed to implement best practices for pelvic floor muscle training to manage urinary incontinence among older women in long-term care in Kerala, India. Urinary incontinence is a prevalent and distressing condition that affects a significant proportion of older adults and is characterized by involuntary loss of urine, leading to social embarrassment, decreased quality of life, and increased health care costs. It is more prevalent in women and is associated with dementia, limited mobility, and other comorbidities in long-term care. Pelvic floor muscle training is a first-line treatment option for urinary incontinence in older adults, given its potential to improve quality of life and reduce health care costs. This project was based on the JBI Evidence Implementation Framework. A baseline audit was conducted to evaluate current practice against best practices. After identifying barriers and implementing strategies, follow-up audits were conducted after 3 and 6 months. The baseline audit showed 0% compliance with all best practices. Barriers such as lack of knowledge and practice of pelvic floor exercises for urinary incontinence among participants and nurses; unknown cognitive status; and health emergencies were identified. Strategies including video-assisted training of pelvic floor muscle exercises, training calendars, and flip charts with instructions. The follow-up audits showed significant improvements in compliance. This project reduced urinary incontinence in the participants. Although two of the audit criteria did not reach 100% compliance by the end of 6 months, the stakeholders of the long-term care facility understood the importance of pelvic floor muscle training, which will be beneficial for future residents with urinary incontinence. http://links.lww.com/IJEBH/A211.

Treating Urinary Incontinence with Electrical Stimulus: A Review

Urinary incontinence markedly affects women’s quality of life. There are several methods to mitigate or reduce this problem such as medication, surgery, or exercises. Of various types of urinary incontinence, overactive bladder consists of one category, which is often resistant to various treatments. Electrical stimulation methods have been considered a treatment option of overactive bladder. We here briefly summarize various treatment options for urinary incontinence, with special reference to the role of electrical stimulation methods for this disease. Electrical stimulation methods include vaginal electrical stimulation (VES), posterior tibial nerve stimulation (PTNS) and sacral nerve stimulation (SNS). The three methods have shown good results, and these findings will contribute to achieving a better quality of life for patients.

The Use of Sacral Nerve Stimulation in Treatment of Rectal Incontinence: A Rare Case Report

Rectal incontinence is the involuntary loss of solid or liquid feces and flatus. First step is to avoid foods with high quantities of fructose, lactose, and caffeine. Bulking agents like methylcellulose and antidiarrheal agents like loperamide are tried next to reduce stool consistency and frequency. If symptoms continue and anorectal manometry shows a weak anal sphincter, biofeedback therapy can be tried. Originally a treatment option for urinary incontinence and overactive bladder, minimally invasive sacral nerve stimulation (SNS) is now considered a therapeutic option in refractory rectal incontinence and has shown to provide relief of symptoms and have positive effects on quality of life. Presented is a case of a 79-year-old female with unresolved history of rectal incontinence since 2015. The initial symptom was minimal anal leakage while doing leisure activities such as gardening and shopping. She noted gradual increase in symptoms affecting daily life and causing social embarrassment, which forced her to wear diapers to disguise odor and staining. Diet change, bulking agents, and more recently, anal sphincteroplasty in 2017, failed to improve symptoms. She was warned that anal sphincteroplasty may not be effective due to her three vaginal deliveries and weak pelvic muscle function. Physical exam revealed incontinence during Valsalva. Digital rectal examination revealed weak pelvic muscles and poor anal tone. She has a remote smoking history of half a pack per day between the ages of 22 and 32 and admits to drinking 1-2 glasses of wine daily. She was offered sacral nerve stimulation. A temporary SNS electrode was implanted and she was told to keep a diary of her bowel movements for 4 weeks. She noted improvement and a permanent SNS device was placed. This case illustrates failed attempts of conservative treatments with the patient growing more ambivalent about controlling her symptoms in public. SNS is reserved for patients whose previous treatments have failed to alleviate symptoms. It involves placement of an electrode into the sacral foramen that sends low-grade electrical stimulations to the sacral nerve roots that innervate the anal sphincters and muscle wall. If a trial period with the temporary electrode relieves fecal incontinence, a permanent electrode is placed. It is because of the relationship of the anal sphincters and sacral innervation that candidates must have structurally intact anal sphincters for successful outcomes to be achieved.2945 Figure 1. Management Of Bowel Disorders

“Vascular Incontinence” and Normal-Pressure Hydrocephalus: Two Commonsources of Elderly Incontinence with Brain Etiologies

This paper reviewed two common sources of elderly incontinence with brain etiologies, “vascular incontinence” (a disorder of bladder control resulting from cerebral white matter disease) and normal-pressure hydrocephalus (NPH), from a neurological point of view. Both diseases manifest with gait disturbance, dementia, and urinary incontinence. Urinary frequency/ urgency (overactive bladder, OAB) often precedes urinary incontinence in both diseases, and in some patients may be the initial manifestation. While NPH is less common than vascular incontinence, at approximately one-tenth the prevalence, it is important because the symptoms can be reversed by shunt surgery or endoscopic third ventriculostomy. For vascular incontinence, early identification of risk factors and initiation of secondary prevention are necessary. Detrusor overactivity due to frontal hypofunction may underlie the bladder disorder in both diseases. Treatment options for urinary incontinence include anticholinergics, which do not easily penetrate the blood-brain barrier, or newer drugs that act on the adrenergic beta-3 receptor and other receptors.

Continence myths: the need for evidence-based practice

We all know that urinary incontinence is a hidden problem that causes many people embarrassment, and is not reported to a health professional by the vast majority of sufferers (Minassian et al, 2003). Myths and misconceptions abound among the public about the causes and treatment options for urinary incontinence, and many women, for example, believe that this is an inevitable consequence of child-bearing or ageing. Urinary incontinence affects one in four women, 25% of the female population (National Collaborating Centre for Women’s and Children’s Health, 2006), but is not a particularly ‘sexy’ subject. It affects more people than cancer or heart disease, and yet we don’t see incontinence splashed across the headlines—if you will pardon the pun—as a significant health issue affecting our population. This country is now officially the fattest nation in Europe (OECD, 2010), and there has been much debate in the media about the ‘obesity epidemic’ that is sweeping the land. I don’t know about you, but I haven’t spotted the public awareness campaign about the stress incontinence epidemic that could follow as a result of this obesity!

Autologous muscle precursor cell Transplantation for the treatment of Urinary Incontinence in Children with Classic Bladder Extrophy: One year follow up

PURPOSE The application of muscle derived stem cells is an area of active research that may represent an improved alternative for the treatment of urinary incontinence. We investigated the effectiveness of autologous muscle precursor cell transplantation as a treatment option for urinary incontinence due to sphincter incompetence in children with the bladder exstrophy/epispadias complex (BEEC). MATERIAL AND METHODS Twelve patients with BEEC (11 boys and 1 girl) with persistent urinary incontinence entered the study. All patients had undergone staged bladder repair and bladder neck reconstruction and all of them (except 1) had received 1-3 transurethral injections of bulking agents with minimal effects. Muscle precursor cells were isolated from each patient's abdominal skeletal muscle, and cultured before endourethral injection. The effectiveness of treatment was evaluated with particular emphasis on clinical outcome (based on a 24-hour voiding diary), cystometric and urodynamic studies. RESULTS Eight Patients had a mean follow-up of 11.3 (from 8 to 14 months), The remaining 4 cases with less than 6 months follow-up are not presented in this data. There was a significant time-dependent improvement in patients' urinary continence. At the final follow-up, all 7 (88%) boys were socially dry (day-time dryness >3 hours) – including 3 (38%) completely dry. Urodynamic studies revealed an increase in mean bladder capacity (p < 0.001) and leak point pressure (p < 0.001). Six months after injection, all 7 boys (versus 2 cases preoperatively) had normal micturition with demonstrable voiding detrusor contraction in presence of compliant, stable bladders (p < 0.05). These changes were accompanied by an increment in the average maximum urinary flow (p < 0.01). CONCLUSIONS Autologous myoblast transplantation may be a safe, effective and attractive alternative treatment option for structural urinary incontinence, with possible ability for functional regeneration of urethral sphincter.

Behavioral Treatment Options for Urinary Incontinence

Abstract Behavioral treatments improve bladder control by changing the incontinent patient's behavior, especially his or her voiding habits, and by teaching skills for preventing urine loss. These treatments are effective for most outpatient men and women with stress, urge, or mixed incontinence. The average reduction in the frequency of incontinence ranges from 57% to 86%. In long-term care settings, treatment is generally more challenging and yields more modest results. The advantages of behavioral interventions include the absence of side-effects, patient comfort, and high levels of patient satisfaction. Although most patients who receive behavioral treatment achieve significant improvement, most are not completely dry. Thus, there is a need for research to explore ways to enhance the effectiveness of these conservative therapies. Combining behavioral treatment with other treatments may have additive effects. Research is also needed to understand better the mechanisms of therapeutic change, the best methods for teaching pelvic floor muscle control, the optimal exercise regimens, the predictors of outcome, and the efficacy of behavioral treatments in men. Although behavioral interventions are more accepted today than 20 years ago, they are still not widely available or integrated into most clinical practices, and we know little of how effective they will be in these settings. Thus, it will be important to develop and evaluate creative modes of delivery, such as group intervention (especially by nonphysician providers), in a variety of clinical settings.

A description of health care provision and access to treatment for women with urinary incontinence in Europe — A five-country comparison

Background Female urinary incontinence is a prevalent condition, but only about one-third of women seek treatment. Objectives To describe the health care provision for women with urinary incontinence from a European perspective, selecting France, Germany, Spain, Sweden, and the United Kingdom as examples, and to investigate whether specific barriers for treatment exist. Methods Available health care system information, a literature review and clinical expert information identified patterns of treatment provision. Results In Spain, Sweden, and the UK, access to medical care in general is primarily through the general practitioners. However, in Spain and Sweden, women with urinary incontinence can directly visit specialists. In France and Germany, women have equal access to either general practitioners or specialists. Aside from general practitioners, gynaecologists play a major role in urinary incontinence care in all countries except the UK. In Germany, urologists are also involved in initial female urinary incontinence care; however, only in about 16% of women. There are no waiting lists in France and Germany for appointments with physicians or procedures, contrary to Spain, which has long waiting lists. Access to general practitioners in the UK is unrestricted whereas advanced diagnosis and treatment in secondary care requires long waits. A specific Swedish policy mandates that no woman is required to wait longer than 3 months for incontinence visits and related surgery. In Sweden and the UK, specialist nurses and other health care workers provide incontinence services. Almost all treatment options for urinary incontinence are at least in part reimbursed. However, various co-payments and fees in France, Germany, Spain and Sweden exist and constitute out-of-pocket expenses for women if no complementary additional private health insurance is available. In some countries, financial incentives for physicians to provide incontinence services are low, raising concerns about their interest to engage in continued patient care. Conclusions Information about service provision in Europe for women with urinary incontinence is limited and makes it difficult to understand barriers to treatment seeking. A broad European perspective may promote optimised treatment access in the future for this widespread and under-recognised condition.

Behavioral Treatment Options for Urinary Incontinence

No AccessJournal of UrologyUrological Survey: Voiding Function and Dysfunction, Bladder Physiology and Pharmacology, and Female Urology1 Jul 2005Behavioral Treatment Options for Urinary Incontinence Alan J. WeinM.D. Alan J. WeinAlan J. Wein More articles by this author View All Author Informationhttps://doi.org/10.1016/S0022-5347(05)60075-4AboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail "Behavioral Treatment Options for Urinary Incontinence." The Journal of Urology, 174(1), p. 218 © 2005 by American Urological Association, Inc.FiguresReferencesRelatedDetails Volume 174Issue 1July 2005Page: 218 Advertisement Copyright & Permissions© 2005 by American Urological Association, Inc.MetricsAuthor Information Alan J. Wein More articles by this author Expand All Advertisement PDF DownloadLoading ...

Pubovaginal Cutaneous Fascial Sling Procedure for Stress Urinary Incontinence: 10 Years’ Experience

Objectives: There is a considerable lack of consensus regarding indications and long-term efficacy of the many techniques for treating urinary stress incontinence. We report the long-term results of a modified pubovaginal sling procedure. Methods: From 1989 to 1998, 129 consecutive patients underwent a pubovaginal sling by two urologists. 86 of the subjects (67%) replied to a questionnaire designed to assess the outcome of the procedure and the subjective satisfaction with the operative result. During surgery we performed a modified sling procedure using a cutaneous strip strengthened by rectus fascia and placed with almost no tension. Special care was taken not to lacerate or damage but support the urethral musculature. We routinely did an anterior vaginoplasty, and posterior vaginoplasty if necessary. Results: Mean patient age was 56.8 years, mean follow-up 39 months, mean parity 2.1, previous surgery 0.4. Improvement rates were determined as follows (‘Are you satisfied with the operation?’): Significantly reduced incontinence (i.e. 50–100% improvement) was found in 65.2%, slight reduction (10–40% improvement) in 15.2%, no change in 17.4% and worsening in 2.2% of all 103 cases. The majority of all complications were wound infections. Conclusion: Despite the considerable failure rate, the substantial improvement in the quality of life of almost two thirds of the patients during a 3-year follow-up recommends a pubovaginal sling as a treatment option for urinary incontinence.

Behavioral treatment options for urinary incontinence

Behavioral treatments improve bladder control by changing the incontinent patient’s behavior, especially his or her voiding habits, and by teaching skills for preventing urine loss. These treatments are effective for most outpatient men and women with stress, urge, or mixed incontinence. The average reduction in the frequency of incontinence ranges from 57% to 86%. In long-term care settings, treatment is generally more challenging and yields more modest results. The advantages of behavioral interventions include the absence of side-effects, patient comfort, and high levels of patient satisfaction. Although most patients who receive behavioral treatment achieve significant improvement, most are not completely dry. Thus, there is a need for research to explore ways to enhance the effectiveness of these conservative therapies. Combining behavioral treatment with other treatments may have additive effects. Research is also needed to understand better the mechanisms of therapeutic change, the best methods for teaching pelvic floor muscle control, the optimal exercise regimens, the predictors of outcome, and the efficacy of behavioral treatments in men. Although behavioral interventions are more accepted today than 20 years ago, they are still not widely available or integrated into most clinical practices, and we know little of how effective they will be in these settings. Thus, it will be important to develop and evaluate creative modes of delivery, such as group intervention (especially by nonphysician providers), in a variety of clinical settings.

Medical management of urinary incontinence

Treatment options for urinary incontinence include behavioral techniques, pharmacologic agents, and surgical procedures. Caregivers use pharmacotherapy heavily because of its availability, immediacy of results, and convenience. However, only pharmacotherapy for urge incontinence has advanced to the level at which several drugs that have undergone rigorous scientific testing using randomized controlled trials have received FDA approval; these are the antimuscarinic and anticholinergic/direct smooth muscle relaxant drugs. However, promising new drugs targeting other receptors are under investigation. There is no FDA-approved drug for stress incontinence or overflow incontinence. Pharmacologic clinical trials for urinary incontinence are no different than pharmacologic trials in other areas. A randomized controlled trial is the best approach for documenting effectiveness and safety. A rigorous trial should include identification of primary and secondary outcomes. The measurement tools of outcomes must be reliable and validated. Preferably, the severity level of urinary incontinence should be established, and measurement of effectiveness must include durability. Not only must side effects be identified, but their impact on the quality of life must be quantified. An exciting area in pharmacologic treatment of urinary incontinence is the method of drug delivery. In addition to sustained release oral medication, the transdermal patch and the intravaginal route are starting to be used in clinical practice. The intravesical route is still in the investigational phase. Pharmacologic research for urinary incontinence is now entering an exciting time because technologic advances are creating new agents with more precise targeting and more sophisticated methods of delivery are being developed and tested.

1125. Ex-Vivo Gene Transfer Using Skeletal Muscle Derived Cells Offers a Long-Term Treatment Option for Urinary Incontinence

1125. Ex-Vivo Gene Transfer Using Skeletal Muscle Derived Cells Offers a Long-Term Treatment Option for Urinary Incontinence

Continence consultation for the rural homebound.

Because an estimated 10 million Americans have urinary incontinence, home care continence services are in demand. In March 1992, the Agency on Health Care Policy and Research recommended behavioral therapy as a first step in treatment options for urinary incontinence. Nurses are best prepared to meet the challenges of providing behavioral therapy to people who are incontinent and are being cared for in their homes. This article describes the development of a nursing practice that provides assessment and treatment of urinary incontinence to people who are homebound in rural Northern Vermont.