Urinary incontinence: behavioral modification therapy in older adult

Urinary Incontinence

Urinary incontinence is a common, often undertreated, condition that impacts millions of Americans. Primary care physicians are well equipped to diagnose and treat urinary incontinence. Key to successful treatment is accurately determining the type of incontinence that ails the patient and using patient-reported quality-of-life indicators to guide stepwise treatment.

The Novel and Minimally Invasive Treatment Modalities for Female Pelvic Floor Muscle Dysfunction; Beyond the Traditional

Pelvic floor dysfunction is a clinical entity that is prevalent among female patients. Determining the exact underlying cause of pelvic floor dysfunction is difficult, and surgical intervention for this clinical entity may be challenging. Pelvic floor dysfunction can affect the quality of life of the patient by causing stress urinary incontinence, pelvic organ prolapse, or both. Well-defined surgical treatment options, minimally invasive approaches, and novel techniques for the treatment of pelvic floor dysfunction have been recently introduced. Here, we evaluated the management options available for patients with stress urinary incontinence and pelvic organ prolapse. We searched Medline and EMBASE databases for relevant articles by using the keywords “pelvic floor dysfunction,” “minimally invasive procedures,” “stress urinary incontinence,” “pelvic organ prolapse,” and “novel techniques”. Traditional treatment options for stress urinary incontinence and pelvic organ prolapse are beyond the scope of our review. Laparoscopic and robotic surgical treatments for pelvic floor dysfunction continue to evolve and develop. These minimally invasive techniques will soon replace open procedures. Alternative novel treatment modalities have also been developed from novel human-compatible materials and are emerging as successful treatments for stress urinary incontinence. The development of these various treatment options has implications for future surgical practice in the field of uro-gynecology.

A retrospective study of neuromuscular electrical stimulation for treating women with post-stroke incontinence

This retrospective study evaluated the effect of using neuromuscular electrical stimulation (NMES) for the treatment of post-stroke urinary incontinence (PSUI) among female population in China.A total of 163 eligible patients with PSUI were included in this study. Of these, 103 patients were assigned to a treatment group, and 60 subjects were assigned to a control group. All patients in both groups received bladder training. In addition, patients in the treatment group also received NMES. All patients were treated for a total of 8 weeks. The outcome measurements included the amount of urine leakage, urinary symptoms and quality of life. The urinary symptoms were measured by the Bristol Female Urinary Symptoms Questionnaire (BFUSQ) score, and the quality of life was assessed by the International Consultation on Incontinence Questionnaire-Short Form (ICIQ-SF) score. In addition, adverse events were also documented in this study.After 4-week treatment, patients who received NMES did not exert better outcomes in the amount of urine leakage, urinary symptoms, measured by BFUSQ scale, and the quality of life, assessed by ICIQ-SF scale. However, after 8-week treatment, patients in the treatment group showed greater effect in reducing the amount of urine leakage (P < .01), enhancing urinary symptoms, as measured by BFUSQ scale (P < .01), and improving the quality of life, as assessed by ICIQ-SF scale (P < .01), compared with patients in the control group. In addition, no adverse event was recorded during the period of 8-week treatment in this study.The results of this study indicated that NMES may benefit for patients with PSUI after 8-week treatment. Future studies should focus on warranting the results of this study.

Pessary use in stress urinary incontinence: a review of advantages, complications, patient satisfaction, and quality of life

Stress urinary incontinnce (SUI) is a common condition among women. The usual approach to treatment of SUI is a stepwise plan from conservative to surgical procedures. A vaginal pessary is one of the commonly used conservative treatments that offer symptomatic improvement for women with incontinence. This review provides a critical analysis of the benefits and shortcomings offered by vaginal pessaries to patients affected by SUI, with a particular focus on indications, advantages, quality of life, patient satisfaction, and potential complications. To obtain the required information, an extensive search of PubMed and Cochrane databases was performed, covering the time frame from January 2000 to December 2016. We also surveyed the published guidelines of American Urological Association, Canadian Urological Association, American Urogynecological Society, National Institutes of Health (USA), and National Institute for Health and Care Excellence (UK). A total of 192 original research papers, review articles, and clinical trials were identified. The analysis of retrieved data provides evidence that vaginal pessaries constitute an effective nonsurgical option for SUI. The satisfaction rate with pessary use is high and only minor complications, if any, occur, vaginal discharge being the most common. The reviewed studies document that vaginal pessaries provide an adequate control of SUI if they are fit properly and managed by frequent replacements and regular checkups. They should be considered among the first line of treatment for SUI associated with exercise and increased intra-abdominal pressure.

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Zusammenfassung. OAB (overactive bladder syndrome) ist zwar ein häufiges Leiden, doch wird es oft nicht diagnostiziert und deshalb nicht behandelt. Die Behandlung erfolgt symptomatisch. Im Praxisalltag muss vorgängig eine Basis-(Ausschluss)-Diagnostik durchgeführt werden. Das Führen eines Blasentagebuchs ist sowohl für die Diagnostik als auch für den Verlauf wichtig. Eine urogynäkologische Abklärung mit Urodynamik empfiehlt sich in unklaren Situationen und beim Vorliegen einer gemischten Symptomatik mit Symptomen einer Belastungsinkontinenz oder bei gleichzeitigem Vorliegen einer Blasenentleerungsstörung. Die Therapie erfolgt Schritt für Schritt. Schon einfache Verhaltensänderungen und ein Blasen- und Beckenbodentraining können die Symptomatik deutlich verbessern. Viele Patientinnen profitieren aber zusätzlich von der medikamentösen Therapie. Jahrzehntelang standen dazu alleinig Anticholinergika zur Verfügung. Doch die Langzeitcompliance ist unter diesen Medikamenten gering. Neu erweitern β3-Adrenorezeptor-Agonisten das therapeutische Spektrum: Bei ähnlicher Wirkung unterscheidet sich das Nebenwirkungsprofil unter anderem durch das Fehlen von Mundtrockenheit. Bei therapierefraktärer OAB steht die intravesikale Injektion von Onabotulinumtoxin A als sehr effektive Therapie zur Verfügung. In seltenen Fällen ist auch eine Neuromodulation indiziert.

An Approach to Urinary Incontinence for Dermatologists

Incontinence-associated dermatitis (IAD) is a condition often encountered by dermatologists. IAD is an inflammatory skin condition secondary to prolonged urine exposure-it is a dermatologic sequela of urinary incontinence. Incontinence should not be dismissed simply as an age-related disorder; rather, it is due to a number of pathologic conditions that can be either reversible or manageable. It is thus critical to identify and treat the underlying causes of urinary incontinence. Clinical management of this common medical issue restores normality to patients' lives while also preventing future dermatologic complications. In this article, we aim to provide dermatologists with an overview of IAD and an approach to the diagnosis and initial management of urinary incontinence.

Pelvic floor muscle training for urinary incontinence in female stroke patients: a randomized, controlled and blinded trial

OBJECTIVE

To examine the effects of pelvic floor muscle training (PFMT) on the contractility of pelvic floor muscle and lower urinary tract symptoms in female stroke patients.

DESIGN

Randomized, single-blind controlled study.

SETTING

Outpatient rehabilitation hospital.

SUBJECTS

Thirty one female patients who were more than three months post-stroke and stress urinary incontinence.

INTERVENTIONS

The subjects were randomized to either a PFMT group (n = 16), or a control group (n = 15). Both groups received general rehabilitation exercise for 6 weeks, but the PFMT group additionally received PFMT for 6 weeks.

MAIN MEASURES

Vaginal function test using a perineometer (maximal vaginal squeeze pressure) and intra-vaginal electromyography (activity of pelvic floor muscle), and urinary symptoms and quality of life using a Bristol Female Lower Urinary Tract Symptom questionnaire.

RESULTS

After intervention, the maximal vaginal squeeze pressures for the PFMT and control groups were 18.35 (5.24) and 8.46 (3.50) mmHg, respectively. And the activities of pelvic floor muscle of the PFMT and control groups was 12.09 (2.24) ㎶ and 9.33 (3.40) ㎶, respectively. After intervention, the changes of scores for inconvenience in the activity of daily living of the PFMT and control groups were -15.00 (6.25) and -0.17 (1.59), respectively. In addition, the changes of score for lower urinary tract symptom was improved more in the PFMT group (-4.17 (4.00)) than in the control group (-0.25 (1.29)) (P < 0.05).

CONCLUSIONS

These findings suggest that PFMT is beneficial for the management of urinary incontinence in female stroke patients.

Meta-Analysis of Pelvic Floor Muscle Training

BACKGROUND

Although many studies have reported the effectiveness of pelvic floor muscle training (PFMT) for treating female urinary incontinence, the magnitude of the effect and the optimal configuration of the parameters of the training have not been clearly determined.

OBJECTIVES

The aims of this meta-analysis were: (a) to calculate the effect size of pelvic floor muscle training compared to no treatment on incontinent episodes, urine leakage amount, and perceived severity of urine loss, and (b) to identify parameters of PFMT and subjects' characteristics influencing the magnitude of the effects.

METHODS

The search for relevant literature published from 1980 to 2005 consisted of using several computerized databases, citation searching, and footnote chasing. Twelve studies met the inclusion criteria, and were reviewed and coded.

RESULTS

The overall mean weighted effect size on incontinent episodes, urine leakage amount, and perceived severity were -0.68 (Z = 5.89, p < .001), -1.48 (Z = 2.64, p = .008), and -1.66 (Z = 1.68, p = .092), respectively. The studies with women having stress urinary incontinence showed a mean weighted effect size of -0.77 (Z = 7.03, p < .001), whereas studies with women having any type of urinary incontinence showed a mean weighted effect size of -0.47 (Z = 4.40, p < .001). The mean weighted effect size for studies including subjects over 60 years mean age was -0.54 (Z = 6.21, p < .001), whereas that of studies in which the average age was younger than 60 years was -0.94 (Z = 6.58, p < .001).

DISCUSSION

The treatment effect of PFMT on the incontinent episodes may be greater in younger women with only stress urinary incontinence. It appears that the number of daily contractions and the length of training period are not related to effect sizes on the condition that training includes at least daily 24 contractions and keeps for at least 6 weeks.

Nursing Staff Beliefs and Expectations About Continence Care in Nursing Homes

OBJECTIVE

The purpose of this qualitative study was to consider the current beliefs of nursing assistants and directors of nursing about management of urinary incontinence (UI) among the residents in nursing homes.

DESIGN

This was a qualitative study using purposive sampling and a focus group methodology.

SETTING AND SUBJECTS

Three focus groups including 38 participants were held in 2 different regions. Two of the focus groups comprised nursing assistants and 1 comprised directors of nursing.

METHOD

The focus groups were facilitated by 2 different advanced practice nurses (BR and LJK), and 2 similar interview guides were used: 1 for the nursing assistants and 1 for the nurses. The interviews were tape recorded and transcribed verbatim; data were analyzed via content analysis.

RESULTS

Ten themes were identified from the data; 3 focused on resident factors that influence UI, 4 related to staff and family contributors to UI, and 3 focused on recommendations to improve UI management in the nursing home setting.

CONCLUSIONS

The findings from this study can be used to guide interventions to decrease or eliminate barriers to continence care and thereby facilitate the implementation of clinical practice guidelines and evidence-based interventions to improve urinary continence among nursing home residents.