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Talebi E, Nobahar M, Foroughan M, Asgari MR. The Concerns of Community-Dwelling Older Women Living with Urinary Incontinence: Qualitative Research. Int Urogynecol J 2024:10.1007/s00192-024-05810-7. [PMID: 38739289 DOI: 10.1007/s00192-024-05810-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2023] [Accepted: 04/12/2024] [Indexed: 05/14/2024]
Abstract
INTRODUCTION AND HYPOTHESIS The world including Iran is facing population aging. Urinary incontinence (UI) is one of the most common health concerns of older women that can be accompanied by an increased sense of loneliness, social restrictions, and disruption in activities of daily living in addition to the regular challenges of old age. This study was aimed at explaining the concerns of community-dwelling older women living with UI. METHODS This study used the conventional, qualitative, content analysis approach with purposive sampling. Twenty interviews were conducted with 18 participants, including 15 community-dwelling older women with UI and three family members (a husband and two daughters), over the span of 14 months (from August 2021 to October 2022). The data were collected via semi-structured, face-to-face interviews until data saturation was achieved, and were analyzed using Graneheim and Lundman's method. RESULTS The findings revealed that the concerns of older women with UI include the impasse of UI, being powerless in life, distorted social identity, and marital frustration, which fell under the main theme of sense of inadequacy. CONCLUSIONS Recognizing the concerns of older women with UI can make health care teams more sensitive to the importance of resolving these concerns and can offer some insight into how best to provide targeted training, support, and counseling services at individual, family, and society levels, to eventually resolve the older adult's sense of inadequacy.
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Affiliation(s)
- Elnaz Talebi
- Student Research Committee, Semnan University of Medical Sciences, Semnan, Iran
| | - Monir Nobahar
- Nursing Care Research Center, Semnan University of Medical Sciences, Semnan, 3513138111, Iran.
- Department of Nursing, Faculty of Nursing and Midwifery, Semnan University of Medical Sciences, Semnan, Iran.
| | - Mahshid Foroughan
- Iranian Research Center On Aging, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | - Mohammad Reza Asgari
- Nursing Care Research Center, Semnan University of Medical Sciences, Semnan, 3513138111, Iran
- Department of Nursing, Faculty of Nursing and Midwifery, Semnan University of Medical Sciences, Semnan, Iran
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Charette M, Pacheco-Brousseau L, Poitras S, Ashton R, McLean L. Management of urinary incontinence in females by primary care providers: a systematic review. BJU Int 2024; 133:498-512. [PMID: 38037509 DOI: 10.1111/bju.16234] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2023]
Abstract
OBJECTIVE To describe primary care provider (PCP) practices for the assessment and management of females with urinary incontinence (UI), and appraise these practices relative to recommendations made in high-quality clinical guidelines. METHODS Studies were searched in four databases (MEDLINE, EMBASE, CINAHL, Web of Science) from their respective inception dates to 6 March 2023. All studies describing UI evaluation and management practices used by PCPs for female patients were eligible. Two reviewers independently selected studies assessed their quality and extracted data. A narrative synthesis of included studies was performed to describe practices. Relevant evaluation and management practices were then compared to recommendations that were consistent across current high-quality UI guidelines. Pharmacotherapy, referrals, and follow-ups were reported descriptively only. RESULTS A total of 3475 articles were retrieved and, among those, 31 were included in the review. The majority reported a poor-moderate adherence to performing a pelvic examination (reported adherence range: 23-76%; based on eight studies), abdominal examination (0-87%; three studies), pelvic floor muscle assessment (9-36%; two studies), and bladder diary (0-92%; nine studies), while there was high adherence to urine analysis (40-97%; nine studies). For the conservative management of UI, studies revealed a poor-moderate adherence to recommendations for pelvic floor muscle training (5-82%; nine studies), bladder training (2-53%; eight studies) and lifestyle interventions (1-71%; six studies). Regarding pharmacotherapy, PCPs predominantly prescribed antimuscarinics (2-46%; nine studies) and oestrogen (2-77%; seven studies). Lastly, PCPs referred those reporting UI to medical specialists (5-37%; 14 studies). Referrals were generally made <30 days after diagnosis with urologists being the most sought out professional to assess and treat UI. CONCLUSION This review revealed poor-moderate adherence to clinical practice guideline recommendations. While these findings reflect high variability in reporting, the key message is that most aspects of patient care for female UI provided by PCPs needs to improve.
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Affiliation(s)
- Marylène Charette
- Population Health, Interdisciplinary School of Health Sciences, Faculty of Health Sciences, University of Ottawa, Ottawa, Ontario, Canada
| | - Lissa Pacheco-Brousseau
- School of Rehabilitation Sciences, Faculty of Health Sciences, University of Ottawa, Ottawa, Ontario, Canada
| | - Stéphane Poitras
- School of Rehabilitation Sciences, Faculty of Health Sciences, University of Ottawa, Ottawa, Ontario, Canada
| | - Rosalind Ashton
- Department of Family Medicine, University of Ottawa, Ottawa, Ontario, Canada
- Rideau Friel Medical Centre, Ottawa, Ontario, Canada
| | - Linda McLean
- School of Rehabilitation Sciences, Faculty of Health Sciences, University of Ottawa, Ottawa, Ontario, Canada
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Weinstein MM, Dunivan GC, Guaderrama NM, Richter HE. A Motion-based Device Urinary Incontinence Treatment: A Longitudinal Analysis at 18 and 24 Months. Int Urogynecol J 2024; 35:803-810. [PMID: 38252280 PMCID: PMC11052829 DOI: 10.1007/s00192-023-05721-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2023] [Accepted: 12/14/2023] [Indexed: 01/23/2024]
Abstract
INTRODUCTION AND HYPOTHESIS There are sparse data regarding the long-term efficacy of pelvic floor muscle training (PFMT) for the treatment of urinary incontinence (UI). The objective of this study was to evaluate the impact of an 8-week PFMT program guided by a motion-based intravaginal device versus a standard home program over 24 months. METHODS Between October 2020 and March 2021, a total of 363 women with stress or stress-predominant mixed UI were randomized and completed an 8-week PFMT program using a motion-based intravaginal device (intervention group) or a home program following written/video instructions (control group). Participants were not asked to continue training after the 8-week program. At 18 and 24 months' follow-up, the Urogenital Distress Inventory, short-form (UDI-6) and Patient Global Impression of Improvement (PGI-I) were collected. In the original trial, a total of 139 participants in each arm were needed to detect a 0.3 effect size (alpha = 0.05, power 0.8, one-tailed t test) in the difference in UDI-6 scores. RESULTS A total of 231 participants returned 24-month data. Mean age at 24 months was 51.7 ± 14.5 years, and mean BMI was 31.8 ± 7.4 kg/m2. Mean change in UDI-6 scores from baseline to 24 months was greater in the intervention group than the control group (-21.1 ± 24.5 vs -14.8 ± 19.4, p = 0.04). Reported improvement using PGI-I was greater in the intervention group than in the control group at 24 months (35% vs 22%, p = 0.03, OR 1.95(95% CI 1.08, 3.57). CONCLUSIONS Pelvic floor muscle training guided by a motion-based prescription intravaginal device yielded durable and significantly greater UI symptom improvement than a standard home program, even in the absence of continued therapy.
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Affiliation(s)
- Milena M Weinstein
- Department of Obstetrics, Gynecology and Reproductive Biology, Division of Female Pelvic Medicine and Reconstructive Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
| | - Gena C Dunivan
- University of Alabama at Birmingham, Birmingham, AL, USA
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Perrier ET, Aumont L. Pelvic Floor Muscle Training Using the Perifit Device for the Treatment of Urinary Incontinence: A Pragmatic Trial Using Real-World Data. WOMEN'S HEALTH REPORTS (NEW ROCHELLE, N.Y.) 2024; 5:250-258. [PMID: 38516650 PMCID: PMC10956527 DOI: 10.1089/whr.2023.0172] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Accepted: 02/08/2024] [Indexed: 03/23/2024]
Abstract
Introduction There is a need for home-based alternatives for women to self-manage urinary incontinence (UI). Using a real-world data approach, the aim of this analysis was to evaluate whether training with the Perifit device was effective in reducing UI symptoms. Materials and Methods A total of 6060 women (45 ± 10 years) with UI who purchased the Perifit device, completed a validated symptoms questionnaire before training (T1) and again at one or several predefined timepoints during training: T2, after completing 40-60 games; T3, after 90-120 games; and/or T4, after 280-300 games. Results UI symptom score decreased progressively from 8.4 ± 4.8 points at T1; to 6.3 ± 4.7 points, 5.5 ± 4.5 points, and 4.6 ± 4.5 points at T2, T3, and T4, respectively (all p < 0.001). The percentage of respondents reporting objective improvement in UI symptoms increased from 71%, to 79%, to 85% at T2, T3, and T4, respectively. Effect size was medium (T2) to large (T3, T4). Higher symptom score at baseline was associated with higher likelihood of improvement. There was no effect of other characteristics including respondent age, menopausal status, time since childbirth, prolapse, or baseline strength on symptom improvement. Conclusions This analysis of responses from over 6000 real-world users suggests that home training with the Perifit may be an effective way to reduce UI symptoms in women of all ages. Given the quality of life, economic, and social burdens of living with UI symptoms, home-based pelvic floor muscle training with the Perifit may be a promising tool to allow women to self-manage UI.
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Affiliation(s)
- Erica T. Perrier
- Department of Research & Development, X6 Innovations, Paris, France
| | - Louise Aumont
- Department of Research & Development, X6 Innovations, Paris, France
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Ryhtä I, Axelin A, Parisod H, Holopainen A, Hamari L. Effectiveness of exercise interventions on urinary incontinence and pelvic organ prolapse in pregnant and postpartum women: umbrella review and clinical guideline development. JBI Evid Implement 2023; 21:394-408. [PMID: 37849316 PMCID: PMC10715701 DOI: 10.1097/xeb.0000000000000391] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2023]
Abstract
INTRODUCTION AND AIMS Dysfunction related to pelvic floor muscles (PFM) is common among pregnant and postpartum women and can cause symptoms such as urinary incontinence or pelvic organ prolapse (POP). As part of developing a nationwide clinical practice guideline for nursing in Finland, the aim of this umbrella review is to summarize the existing evidence about the effectiveness of exercise interventions on urinary incontinence and POP in pregnant and postpartum women. To promote knowledge translation, recommendations for health care professionals are presented. METHODS We conducted an umbrella review to summarize the existing evidence. The JBI methodology for umbrella reviews was used to guide the review. The level of evidence was evaluated using the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) approach, and recommendations based on the evidence were formulated by a clinical guideline working group. RESULTS Altogether, 9 systematic reviews, reporting findings from 89 original studies, were included. The methodological quality of the reviews was evaluated using JBI's checklist. The highest level of evidence was found for preventing the symptoms of postpartum urinary incontinence through exercise and pelvic floor muscle training (PFMT) during pregnancy. Moderate-level evidence showed that exercise and PFMT are likely to reduce the symptoms and severity of urinary incontinence, but the level of evidence was low on PFMT reducing the symptoms of POP. CONCLUSION We recommend encouraging and guiding pregnant and postpartum women to exercise and train PFM. We also recommend identifying pregnant and postpartum women with symptoms of PFM dysfunction and directing them to a physiotherapist or other health care professional specializing in pelvic floor function.
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Affiliation(s)
- Iina Ryhtä
- Department of Nursing Science, Faculty of Medicine, University of Turku, Turku, Finland
| | - Anna Axelin
- Department of Nursing Science, Faculty of Medicine, University of Turku, Turku, Finland
- Department of Obstetrics and Gynaecology, Turku University Hospital, Turku, Finland
| | - Heidi Parisod
- Department of Nursing Science, Faculty of Medicine, University of Turku, Turku, Finland
- Nursing Research Foundation, Helsinki, Finland
- The Finnish Centre for Evidence-Based Health Care: JBI Centre of Excellence, Helsinki, Finland
| | - Arja Holopainen
- Nursing Research Foundation, Helsinki, Finland
- The Finnish Centre for Evidence-Based Health Care: JBI Centre of Excellence, Helsinki, Finland
- WHO Collaborating Centre for Nursing, Helsinki, Finland
| | - Lotta Hamari
- Department of Nursing Science, Faculty of Medicine, University of Turku, Turku, Finland
- Nursing Research Foundation, Helsinki, Finland
- The Finnish Centre for Evidence-Based Health Care: JBI Centre of Excellence, Helsinki, Finland
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Toye F, Dixon S, Izett-Kay M, Keating S, McNiven A. Exploring the experiences of people with urogynaecology conditions in the UK: a reflexive thematic analysis and conceptual model. BMC Womens Health 2023; 23:431. [PMID: 37580761 PMCID: PMC10426194 DOI: 10.1186/s12905-023-02592-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Accepted: 08/08/2023] [Indexed: 08/16/2023] Open
Abstract
BACKGROUND Urogynaecological conditions, such as pelvic organ prolapse, urinary incontinence, and urinary tract infection, can have a profound impact on people's lives. The Independent Medicines and Medical Devices Safety Review highlights missed opportunities to prevent harm when patient voices are not incorporated into healthcare policy and practice. This resonates with the Women's Health Strategy for England. The National Institute for Health and Care Research (NIHR) Policy Research Programme funded this in-depth qualitative exploration of people's experiences of living with urogynaecological conditions, and of seeking healthcare treatment, to inform health and social care improvements in the UK. METHODS We conducted in-depth interviews online or by telephone (April 2021-December 2021) and used reflexive thematic analysis to develop themes that cut across urogynaecological conditions. RESULTS We spoke to seventy-four adults aged 22-84 across a range of backgrounds and lived experiences of urogynaecological conditions, including pelvic organ prolapse, urinary incontinence and persistent or recurring urinary tract infection. Eight themes were developed: [1] I get no respite from my own body; [2] I feel confined and separated; [3] I can no longer be 'me'; [4] I am constrained by stigma, shame and silence; [5] I feel fragmented and lost in the healthcare system; [6] I need to be heard, believed, and valued; [7] I need respect as an equal partner in healthcare; and [8] (Re)connected to a more open community. CONCLUSIONS High quality care focuses on the whole person rather than their body parts. Openness and candour support a shared decision-making model of care. A culture of shame can have a negative impact on access to health care and recovery.
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Affiliation(s)
- F Toye
- Physiotherapy Research Unit, Oxford University Hospitals NHS Foundation Trust, Oxford, OX37HE, UK.
| | - S Dixon
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, OX2 6GG, UK
| | - M Izett-Kay
- Department of Urogynaecology, Oxford University Hospitals NHS Foundation Trust, Oxford, OX3 9DU, UK
| | - S Keating
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, OX2 6GG, UK
| | - A McNiven
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, OX2 6GG, UK
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Li J, Li T, Huang S, Chen L, Cai W. Motivations, psychosocial burdens, and decision-making modes of post-partum women with stress urinary incontinence engaging in pelvic floor physical therapy: a qualitative research. Int Urogynecol J 2023; 34:1803-1813. [PMID: 36745133 DOI: 10.1007/s00192-023-05466-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2022] [Accepted: 01/02/2023] [Indexed: 02/07/2023]
Abstract
INTRODUCTION AND HYPOTHESIS This qualitative research explores the motivations, psychosocial burdens, and decision-making modes of post-partum women with stress urinary incontinence (SUI) engaging in pelvic floor physical therapy (PFPT). METHODS This study was conducted face-to-face in a treatment room using qualitative semi-structured interviews with post-partum women who received PFPT for SUI between May and October 2022. Participant interviews were transcribed verbatim and thematically analyzed using NVivo software, which is most commonly used for qualitative data analysis. RESULTS Themes that impacted participants' decisions to receive PFPT included avoiding deterioration of SUI symptoms, believing that the sooner it is treated the better, being unable to adhere to home exercise programs, and dissatisfaction with quality of life. Some participants experienced psychosocial burdens when receiving PFPT, including impact on daily activities, worries about the baby, financial burdens, and uncertainty about the effect. There were two modes of decision making, which brought different experiences. Some participants preferred participant-provider shared decision making and reported effective doctor-patient communication, and striving for autonomous decisions. Other participants preferred their clinicians to decide on PFPT protocols in view of their trust in their midwives, institutional reputation, and lacking knowledge of PFPT. CONCLUSIONS We discovered that participants had both motivations and psychosocial burdens when receiving therapy. Some participants preferred participant-provider shared decision making, whereas others preferred their midwives to make decisions. Further more standardized studies with more robust samples are needed.
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Affiliation(s)
- Jie Li
- Department of Nursing, Shenzhen Hospital, Southern Medical University, Number 1333, Xinhu Road, Baoan District, Shenzhen, 518101, Guangdong, China
- School of Nursing, Southern Medical University, Guangzhou, 510515, Guangdong, China
| | - Tiantian Li
- Department of Nursing, Shenzhen Hospital, Southern Medical University, Number 1333, Xinhu Road, Baoan District, Shenzhen, 518101, Guangdong, China
| | - Shurong Huang
- Department of Nursing, Shenzhen Hospital, Southern Medical University, Number 1333, Xinhu Road, Baoan District, Shenzhen, 518101, Guangdong, China
| | - Ling Chen
- Department of Nursing, Shenzhen Hospital, Southern Medical University, Number 1333, Xinhu Road, Baoan District, Shenzhen, 518101, Guangdong, China
| | - Wenzhi Cai
- Department of Nursing, Shenzhen Hospital, Southern Medical University, Number 1333, Xinhu Road, Baoan District, Shenzhen, 518101, Guangdong, China.
- School of Nursing, Southern Medical University, Guangzhou, 510515, Guangdong, China.
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Moradinasab S, Iravani M, Mousavi P, Cheraghian B, Molavi S. Effect of cognitive-behavioral therapy on sexual self-esteem and sexual function of reproductive-aged women suffering from urinary incontinence. Int Urogynecol J 2023; 34:1753-1763. [PMID: 36715741 PMCID: PMC9885913 DOI: 10.1007/s00192-023-05460-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Accepted: 12/24/2022] [Indexed: 01/31/2023]
Abstract
INTRODUCTION Patients with urinary incontinence may fear sexual activity due to the unpredictability of urine leakage during intercourse. Given the effective role of cognitive-behavioral therapy in correcting negative thoughts and attitudes, this study was aimed to investigate the effect of cognitive-behavioral therapy on sexual self-esteem and sexual function of reproductive-aged women suffering from urinary incontinence. METHODS This study was a randomized controlled clinical trial conducted on 84 reproductive-aged women (18 to 45 years old) with urinary incontinence who referred to Health Centers of Dezful, Iran. After random allocation, the participants were divided into two groups of intervention and control (n = 42). The intervention group attended eight 45-min sessions of cognitive-behavioral therapy, while the control group received only routine interventions. The International Consultation on Incontinence Questionnaire-Short Form (ICIQ-SF), the Scale of Self-Esteem Index for Women-Short-form (SSEL-W-SF), and the Pelvic Organ Prolapse/Urinary Incontinence Sexual Function Questionnaire (PISQ-12) were completed before, immediately after, and 4 weeks after the end of the intervention by patients in both groups. RESULTS The overall scores of sexual self-esteem and sexual function immediately and 4 weeks after the end of the intervention showed a statistically significant difference in the intervention group compared to the control group (p < 0.001). Also, the results showed that in women with urinary incontinence, an increase in the sexual self-esteem score is associated with an increase in the sexual function score (r = 0.9), p < 0.001). CONCLUSION Cognitive-behavioral therapy was found to increase sexual self-esteem and improve sexual function in reproductive-aged women suffering from urinary incontinence.
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Affiliation(s)
- Salimeh Moradinasab
- Midwifery Department, Nursing and Midwifery School, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Mina Iravani
- Reproductive Health Promotion Research Center, Midwifery Department, Nursing and Midwifery School, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Parvaneh Mousavi
- Midwifery Department, Nursing and Midwifery School, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Bahman Cheraghian
- Department of Biostatistics and Epidemiology, School of Health, Alimentary Tract Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Shahla Molavi
- Health Psychology, Nursing and Midwifery School, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
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Fu Y, Jackson C, Nelson A, Iles-Smith H, McGowan L. Exploring support, experiences and needs of older women and health professionals to inform a self-management package for urinary incontinence: a qualitative study. BMJ Open 2023; 13:e071831. [PMID: 37400236 DOI: 10.1136/bmjopen-2023-071831] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/05/2023] Open
Abstract
OBJECTIVES Many women attempt to manage urinary incontinence (UI) independently with variable success while health professionals may be unaware of their needs. This study aimed to (1) understand older women's experiences of UI, their self-management strategies and support needs; (2) explore health professionals' experiences of supporting women and providing relevant services and (3) combine their experiences contribute to development of a theory-based and evidence-based self-management package for UI. DESIGN Qualitative semi-structured interviews were conducted with 11 older women with UI and 11 specialist health professionals. Data were analysed independently using the framework approach, then synthesised in a triangulation matrix to identify implications for content and delivery of the self-management package. SETTING Community centres, community continence clinic and urogynaecology centre of a local teaching hospital in northern England. PARTICIPANTS Women aged 55 years and over who self-reported symptoms of UI and health professionals delivering UI services. RESULTS Three overarching themes emerged. Older women see UI as a 'fact of life' but many struggle with it: women typically considered UI as part of ageing yet expressed annoyance, distress, embarrassment and had made significant lifestyle changes. Access to information and limited high-quality professional support: health professionals provided specialist UI care and information. Yet less than half of women accessed specialist services, those who had, highly valued these services. 'Trial and error' with different self-management strategies: women had tried or were using different strategies (continence pads, pelvic floor exercises, bladder management and training, fluid management and medication), with mixed success. Health professionals provided evidence-based, personalised support and motivation. CONCLUSIONS Findings informed the content of the self-management package that focused on providing facts, acknowledging challenges of living with/self-managing UI, sharing others' experiences, using motivational strategies and self-management tools. Delivery preferences were independent use by women or working through the package with a health professional.
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Affiliation(s)
- Yu Fu
- Department of Primary Care and Mental Health, University of Liverpool, Liverpool, UK
| | | | - Andrea Nelson
- School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, UK
| | - Heather Iles-Smith
- School of Health and Society, University of Salford, Salford, UK
- Corporate Nursing, Northern Care Alliance NHS Group, Salford, UK
| | - Linda McGowan
- School of Healthcare, University of Leeds, Leeds, UK
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Blanco Gutiérrez V, Hundley VA, Way S. The Experience of Women From Underrepresented Groups With Urinary Incontinence: A Systematic Review. J Transcult Nurs 2023; 34:288-300. [PMID: 37199465 PMCID: PMC10265309 DOI: 10.1177/10436596231172205] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/19/2023] Open
Abstract
INTRODUCTION Urinary incontinence (UI) in women is a global public health issue. However, there is a limited understanding of the experience of women from underrepresented groups suffering from UI. The purpose of this systematic review was to examine current evidence regarding the experience of women with UI from these groups. METHODOLOGY A systematic search was undertaken to retrieve research studies that answered the research question. Four qualitative research studies were included. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses guided this review. RESULTS Four themes emerged from this review: the perceived origin of UI, the physical, psychological, and social impact of UI, the impact of culture and religion on UI, and vice versa, and the interaction of women with health services. DISCUSSION Social determinants of health, such as religion and culture, need to be considered by professionals providing care if women from underrepresented groups experiencing UI are to receive optimal care.
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Mahfouz IA, Blanker MH, Asali F, Mehaisen LA, Mahfouz SA, Siyam S, Al-Attar M. Seeking consultation for urinary incontinence: Behaviours and barriers among Jordanian women. Neurourol Urodyn 2023. [PMID: 37186396 DOI: 10.1002/nau.25189] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Revised: 04/07/2023] [Accepted: 04/10/2023] [Indexed: 05/17/2023]
Abstract
INTRODUCTION The rates of seeking consultation for urinary incontinence (UI) and the barriers against consultations vary among countries and study populations and are influenced by various factors such as embarrassment, perception of illness, resources and culture. OBJECTIVES To study healthcare-seeking behaviours and barriers among Jordanian women. METHODS Between 1 March 2020 and 15 April 2020, we conducted a cross-sectional online survey among women 18 years of age or more who have UI and have access to the internet. We collected women's characteristics, UI types, severity, bother, seeking consultation behaviours and barriers. Logistic regression analyses were used to study the variables associated with seeking consultation. RESULTS The data of 1454 women with a mean age (SD) of 41.5 (11.5) years were analysed. Mixed UI was the most common type (56.3%), while 43.8% of the participants sought consultation, and 33.8% waited 1 year before seeking consultation. The most common barriers were embarrassment (52.2%), considering UI as a normal occurrence with ageing (41.5%), and limited expectations of improvement from treatment (42.0%). The most common barriers vary according to UI type. Embarrassment was the most commonly reported barrier by women with mixed UI (29.4%), UI as normal with ageing was mostly considered by women with stress UI (11.5%) and treatment for UI is going to be expensive was expressed by women with mixed UI (19.4%). Seeking consultation decreased among women with more educational achievement (adjusted odds ratio [aOR]: 0.62; 95% confidence interval [CI]: 0.44-0.87) with university graduates doing so less than women with high school or less educational achievement. Additionally, seeking consultation was more among women who were aware of a family member with UI (aOR: 1.44; 95% CI: 1.03-2.01) compared to women who were not. Also, multiparous women (aOR: 1.8; 95% CI: 1.19-2.77) sought consultation more than nulliparous women. Seeking a consultation was more among women who were bothered by the impact of UI on various daily activities, namely, household activities (aOR: 1.42; 95% CI: 0.85-2.37), prayers (aOR: 1.7; 95% CI: 1.07-2.71) and sex life (aOR: 2.48; 95% CI: 1.45-4.21) compared to women who were not bothered. Seeking a consultation was less among women who reported embarrassment as a barrier (aOR: 0.534; 95% CI: 0.34-0.84) compared to women who were not embarrassed. CONCLUSION Four in 10 women with UI sought care, but with a considerable delay between the onset of symptoms and actual care seeking. These outcomes could be explained by the impact of various barriers. Additionally, barriers might vary in different cultures and countries, so culture-sensitive questionnaires should be considered when healthcare-seeking consultations and barriers are studied.
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Affiliation(s)
- Ismaiel Abu Mahfouz
- Department of Obstetrics and Gynaecology, Al Balqa Applied University, Al Salt, Jordan
| | - Marco H Blanker
- Department of Primary and Longterm Care, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Fida Asali
- Department of Obstetrics and Gynaecology, The Hashemite University, Al Zarka, Jordan
| | - Lama Al Mehaisen
- Department of Obstetrics and Gynaecology, Al Balqa Applied University, Al Salt, Jordan
| | | | - Samaa Siyam
- Department of Obstetrics and Gynaecology, The Speciality hospital, Amman, Jordan
| | - Mais Al-Attar
- Department of Obstetrics and Gynaecology, The Speciality hospital, Amman, Jordan
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The effectiveness of eHealth interventions on female pelvic floor dysfunction: a systematic review and meta-analysis. Int Urogynecol J 2022; 33:3325-3354. [PMID: 35616695 PMCID: PMC9135393 DOI: 10.1007/s00192-022-05222-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2022] [Accepted: 05/01/2022] [Indexed: 11/22/2022]
Abstract
INTRODUCTION AND HYPOTHESIS eHealth interventions represent a promising novel strategy in pelvic floor management for women. Nevertheless, the effectiveness of eHealth interventions among women with or at risk of pelvic floor dysfunction (PFD) has not been adequately discussed to date. This study aimed to determine the effectiveness of eHealth interventions in preventing and treating PFD among women. METHODS Eleven electronic databases were searched for randomized controlled trials (RCTs) from inception until August 28, 2021. RESULTS Twenty-four RCTs were included in this meta-analysis that included 3691 women. The meta-analysis showed that eHealth interventions were not only vital for preventing PFD (pregnant women: pooled OR = 0.25, 95% CI: 0.14 to 0.45, p < 0.001; postnatal women: pooled OR = 0.19, 95% CI: 0.06 to 0.60, p = 0.005), but also for reducing the severity of PFD (pooled SMD = -0.63, 95% CI: -1.20 to -0.06, p = 0.031). In addition, compared with traditional care, eHealth interventions showed significant positive effects on several outcome indicators, including quality of life (pooled SMD = 0.49, 95% CI: 0.19 to 0.80, p = 0.002), pelvic floor type I muscle strength (pooled OR = 1.92, 95% CI: 1.30 to 2.82, p = 0.001), pelvic floor type II muscle strength (pooled OR = 2.04, 95% CI: 1.38 to 3.01, p < 0.001), sexual function (pooled SMD = 0.51, 95% CI: 0.29 to 0.73, p < 0.001), satisfaction (pooled OR = 3.93, 95% CI: 2.73 to 5.66, p < 0.001), and self-efficacy (pooled SMD = 2.62, 95% CI: 2.12 to 3.13, p < 0.001). CONCLUSIONS eHealth interventions are an effective emerging treatment and preventive modality for female PFD. Higher quality, larger scale, and strictly designed RCTs are warranted to evaluate the effectiveness of eHealth interventions on female pelvic floor management.
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Brady SS, Bavendam TG, Bradway CK, Conroy B, Dowling-Castronovo A, Epperson CN, Hijaz AK, Hsi RS, Huss K, Kim M, Lazar J, Lee RK, Liu CK, Loizou CN, Miran S, Mody L, Norton JM, Reynolds WS, Sutcliffe S, Zhang N, Hokanson JA. Noncancerous Genitourinary Conditions as a Public Health Priority: Conceptualizing the Hidden Burden. Urology 2022; 166:39-49. [PMID: 34536410 PMCID: PMC8924010 DOI: 10.1016/j.urology.2021.08.040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Revised: 08/07/2021] [Accepted: 08/30/2021] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To provide a conceptual framework to guide investigations into burdens of noncancerous genitourinary conditions (NCGUCs), which are extensive and poorly understood. METHODS The National Institute of Diabetes and Digestive and Kidney Diseases convened a workshop of diverse, interdisciplinary researchers and health professionals to identify known and hidden burdens of NCGUCs that must be measured to estimate the comprehensive burden. Following the meeting, a subgroup of attendees (authors of this article) continued to meet to conceptualize burden. RESULTS The Hidden Burden of Noncancerous Genitourinary Conditions Framework includes impacts across multiple levels of well-being and social ecology, including individual (ie, biologic factors, lived experience, behaviors), interpersonal (eg, romantic partners, family members), organizational/institutional (eg, schools, workplaces), community (eg, public restroom infrastructure), societal (eg, health care and insurance systems, national workforce/economic output), and ecosystem (eg, landfill waste) effects. The framework acknowledges that NCGUCs can be a manifestation of underlying biological dysfunction, while also leading to biological impacts (generation and exacerbation of health conditions, treatment side effects). CONCLUSION NCGUCs confer a large, poorly understood burden to individuals and society. An evidence-base to describe the comprehensive burden is needed. Measurement of NCGUC burdens should incorporate multiple levels of well-being and social ecology, a life course perspective, and potential interactions between NCGUCs and genetics, sex, race, and gender. This approach would elucidate accumulated impacts and potential health inequities in experienced burdens. Uncovering the hidden burden of NCGUCs may draw attention and resources (eg, new research and improved treatments) to this important domain of health.
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Affiliation(s)
- Sonya S Brady
- Division of Epidemiology and Community Health, University of Minnesota School of Public Health, Minneapolis, MN.
| | - Tamara G Bavendam
- Division of Kidney, Urologic, and Hematologic Diseases, National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, MD
| | - Christine K Bradway
- Department of Biobehavioral Health Sciences, University of Pennsylvania School of Nursing, Philadelphia, PA
| | - Britt Conroy
- Urology Institute, University Hospitals Cleveland Medical Center, Case Western Reserve University School of Medicine, Cleveland, OH
| | | | - Cynthia Neill Epperson
- Department of Psychiatry, University of Colorado School of Medicine, Anschutz Medical Campus, Aurora, CO
| | - Adonis K Hijaz
- Urology Institute, University Hospitals Cleveland Medical Center, Case Western Reserve University School of Medicine, Cleveland, OH
| | - Ryan S Hsi
- Department of Urology, Vanderbilt University Medical Center, Nashville, TN
| | - Karen Huss
- Division of Extramural Science Programs, Symptom Science and Genetics, Self-Management Office, National Institute of Nursing Research, Bethesda, MD
| | - Michelle Kim
- Department of Urology, Massachusetts General Hospital, Boston, MA
| | - Jason Lazar
- Department of Medicine, SUNY Downstate Health Sciences University, New York, NY
| | - Richard K Lee
- Department of Urology, Weill Cornell Medical College, New York, NY
| | - Christine K Liu
- Section of Geriatrics, Division of Primary Care and Population Health, Stanford University School of Medicine, Stanford, CA; Geriatric Research and Education Clinical Center, Palo Alto VA Health Care System, Palo Alto, CA; Section of Geriatrics, Department of Medicine, Boston University, Boston, MA
| | | | - Saadia Miran
- Division of Kidney, Urologic, and Hematologic Diseases, National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, MD
| | - Lona Mody
- Division of Geriatric and Palliative Medicine, University of Michigan Medical School, Ann Arbor, MI and VA Ann Arbor Healthcare System, Ann Arbor, MI
| | - Jenna M Norton
- Division of Kidney, Urologic, and Hematologic Diseases, National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, MD
| | | | - Siobhan Sutcliffe
- Department of Surgery, Division of Public Health Sciences, Washington University School of Medicine, St. Louis, MO
| | - Nicole Zhang
- The Valley Foundation School of Nursing, College of Health and Human Sciences, San Jose State University, San Jose, CA
| | - James A Hokanson
- Department of Biomedical Engineering, Medical College of Wisconsin, Milwaukee, WI
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Experiences and impact of living with incontinence associated stigma: A protocol for a systematic review and narrative synthesis of qualitative studies. PLoS One 2022; 17:e0270885. [PMID: 35802573 PMCID: PMC9269749 DOI: 10.1371/journal.pone.0270885] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2021] [Accepted: 06/14/2022] [Indexed: 11/19/2022] Open
Abstract
Introduction Incontinence is global health and social issue, with urinary incontinence alone affecting over 400 million people. Incontinence can lead to physical harms such as skin damage, but it also commonly causes social and psychological harms, including those associated with stigma. For many people, treatment to cure incontinence does not work or is not suitable and they live with the long-term consequences of incontinence. At the moment, no stigma reduction interventions (increasingly used with other conditions such as mental health problems and HIV) have been developed for people living with incontinence. As a starting point for developing such an intervention, this review will address the questions 1) What are the incontinence (urinary or faecal) associated experiences of stigma of people living with incontinence? 2) What is the impact of incontinence associated stigma on their lives? Methods The reviewers will search Embase, Medline, PsychINFO and the Cumulative Index to Nursing and Allied Health Literature using controlled vocabulary and relevant search terms. Articles assessed to meet inclusion criteria will be included. Once duplicates have been removed, titles and abstracts will be screened and full texts of selected research articles will be reviewed. An adapted Joanna Briggs Institute Data Extraction Form will be used to collect the data and quality will be assessed using the Joanna Briggs Institute checklist for qualitative research appraisal tool. A framework approach (using the Revised Framework for Understanding Non-communicable Disease Related Stigma) will be used to organise, integrate, interpret and summarise findings from included articles. The review will be reported in accordance with the Enhancing Transparency in reporting the synthesis of qualitative research statement. Prospero registration number CRD42021259065. Discussion The systematic review described in this protocol will provide the first in-depth, comprehensive understanding of people’s experiences of the stigma associated with incontinence and the impact that it has on their lives. It will identify broader influences of contextual variables such as age, sex, cause and type of incontinence, socio-economic culture and geographical location. The review aims to provide insights to support the development of incontinence associated stigma reduction interventions.
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15
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Pan LC, Datar M, McKinney JL, Keyser LE, Goss TF, Pulliam SJ. Adherence to professional society guidelines among women with stress or mixed urinary incontinence. Neurourol Urodyn 2022; 41:1489-1497. [PMID: 35731185 PMCID: PMC9542296 DOI: 10.1002/nau.24986] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Revised: 03/15/2022] [Accepted: 05/19/2022] [Indexed: 11/15/2022]
Abstract
Aims The objective of this analysis was to describe longitudinal adherence with recommended urinary incontinence (UI) evaluation and treatment guidelines over a 2‐year period in patients newly diagnosed with stress (SUI) or mixed UI (MUI), and average 2‐year cost associated with initial treatment. Methods A retrospective claims analysis using the IBM MarketScan database was conducted. Women diagnosed with SUI/MUI between July 1, 2014 and June 30, 2016 were identified using the International Classification of Diseases (ICD) 9 and 10 codes for SUI or MUI. Newly diagnosed SUI/MUI patients who did not have a UI‐related diagnosis for at least 1 year before their index date were assessed. Results 103 813 patients with newly diagnosed SUI or MUI were identified. Of those, 96.15% (99 821/103 813) received an initial evaluation in accordance with professional guidelines (e.g., patient history, physical examination, urinalysis). Only 6.8% (5086/74 925) and 7.7% (2229/28 888) of patients with SUI and MUI, respectively, received a first‐line behavioral treatment (e.g., pelvic floor muscle exercises, bladder training), according to guidelines. The 2‐year average UI‐related medical costs associated with guideline adherence for SUI were $5770.93 ± $9454.81 and for MUI, $4416.16 ± $7401.53. Nonadherence was observed in 59.2% (44 382/74 925) of SUI and 64.1% (18 530/28 888) of MUI patients. Two‐year average UI‐related medical costs for the nonadherent group were $8568.00 ± $11 275.52 for SUI and $6986.66 ± $10 765.55 for MUI, significantly more than the adherent group (p < 0.0001). Conclusion The majority of SUI or MUI patients do not receive a documented behavioral intervention as their first‐line treatment, which is a recommendation by professional society guidelines. This was found to affect the cost burden for payers; those that were nonadherent had significantly higher costs 2‐year postindex.
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Affiliation(s)
- Li-Chen Pan
- Boston Healthcare Associates, Inc., Boston, Massachusetts, USA
| | - Manasi Datar
- Boston Healthcare Associates, Inc., Boston, Massachusetts, USA
| | - Jessica L McKinney
- Renovia, Inc., Boston, Massachusetts, USA.,School of Rehabilitation Sciences, Andrews University, Berrien Springs, Michigan, USA
| | - Laura E Keyser
- Renovia, Inc., Boston, Massachusetts, USA.,Department of Physical Therapy and Rehabilitation Science, University of California San Francisco, San Francisco, CA
| | - Thomas F Goss
- Boston Healthcare Associates, Inc., Boston, Massachusetts, USA
| | - Samantha J Pulliam
- Renovia, Inc., Boston, Massachusetts, USA.,Tufts Medical Center, Boston, Massachusetts, USA
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16
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Toma G, Carolan A, Buckner-Petty S, Vargas L, Wolter C, Khan A. The role of in-person focus groups in the management of urinary incontinence in women from a mixed-methods, randomized pilot study. Arch Gynecol Obstet 2022; 306:1539-1545. [PMID: 35652933 DOI: 10.1007/s00404-022-06633-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Accepted: 05/14/2022] [Indexed: 11/26/2022]
Abstract
PURPOSE To assess the quantitative and qualitative components of in-person focus groups as a potential intervention for female patients with urinary incontinence. METHODS Women over the age of 18 seeking treatment for UI were randomized to standard care with focus group participation or to standard care alone. All participants completed validated questionnaires: MESA, UDI-6, OAB-SAT-q, PGI-S, PGI-I, SQoL-F, PHQ-9, IPAQ at the beginning and conclusion of the study. Questionnaires were analyzed with repeated measures of ANOVA models in an intention-to-treat manner. Three moderated focus group sessions were held and audio recorded. Recordings were transcribed and categorized by frequency into themes using grounded theory methodology. RESULTS A total of ten control and eight intervention participants agreed to participate. Seven women attended all three focus group sessions and were included in the final analysis. Transcripts from focus group sessions observed women identified most with (1) urinary incontinence (UI) as a chronic disease, (2) shame managing UI, and (3) social constraints of toileting. Participants self-reported appreciation of focus group participation and desire for on-going sessions. Analysis of the questionnaires did not demonstrate statistically significant differences. CONCLUSION Data ascertained from questionnaires were unable to demonstrate a meaningful effect in improved treatment outcomes for control and intervention participants. Grounded theory analysis of transcripts identified four primary themes: (1) appreciation of the focus group, (2) UI as a gendered issue, (3) lack of public awareness, and (4) history of negative provider interactions. All focus group participants self-reported interest in attending future focus group sessions.
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Affiliation(s)
- Gina Toma
- Mayo Clinic Arizona, 5777 E Mayo Blvd, Phoenix, Arizona, 85054, USA.
- Arizona State University, Phoenix, Arizona, USA.
| | | | - Skye Buckner-Petty
- Department of Research Administration, Mayo Clinic Arizona, Phoenix, Arizona, USA
| | - Laura Vargas
- Department of Research Administration, Mayo Clinic Arizona, Phoenix, Arizona, USA
| | | | - Aqsa Khan
- Division of Urology, Mayo Clinic, Phoenix, Arizona, USA
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17
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Urinary Incontinence and Its Association with Physical and Psycho-Cognitive Factors: A Cross-Sectional Study in Older People Living in Nursing Homes. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19031500. [PMID: 35162524 PMCID: PMC8835480 DOI: 10.3390/ijerph19031500] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Revised: 01/24/2022] [Accepted: 01/26/2022] [Indexed: 02/01/2023]
Abstract
Urinary incontinence (UI) is a common geriatric syndrome affecting bladder health and is especially prevalent in nursing homes (NHs). The aim of the study was to determine the prevalence of UI and its associated factors in five Spanish NHs. UI (measured with Minimum Data Set 3.0), sociodemographic, and health-related variables were collected. Chi-square (or Fisher's) or Student's t-test (or Mann Whitney U) for bivariate analysis were used, with Prevalence Ratio (PR) as an association measure. The prevalence of UI was 66.1% (CI:95%, 53.6-77.2) in incontinent (n = 45, mean age 84.04, SD = 7.7) and continent (n = 23, mean age 83.00, SD = 7.7) groups. UI was significantly associated with frailty (PR = 1.84; 95%CI 0.96-3.53), faecal incontinence (PR = 1.65; 95%CI 1.02-2.65), anxiety (PR = 1.64; 95%CI 1.01-2.66), physical performance (PR = 1.77; 95%CI 1.00-3.11), and cognitive state (PR = 1.95; 95%CI 1.05-3.60). Statistically significant differences were found between incontinent and continent NH residents for limitations in activities of daily living (ADL), mobility, quality of life, sedentary behaviour, and handgrip strength. It can be concluded that two out of three of the residents experienced UI, and significant associated factors were mainly physical (sedentary behaviour, frailty, physical performance, ADL limitations, mobility, faecal incontinence, and handgrip strength) followed by psycho-cognitive factors (cognition, anxiety, and quality of life).
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18
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Culleton-Quinn E, Bø K, Fleming N, Mockler D, Cusack C, Daly D. Elite female athletes' experiences of symptoms of pelvic floor dysfunction: A systematic review. Int Urogynecol J 2022; 33:2681-2711. [PMID: 36040507 PMCID: PMC9477953 DOI: 10.1007/s00192-022-05302-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Accepted: 07/10/2022] [Indexed: 02/05/2023]
Abstract
INTRODUCTION AND AIMS Pelvic floor dysfunction (PFD) is a collection of signs, symptoms and conditions affecting the pelvic floor and urinary incontinence (UI) is the most common type of PFD. Recent systematic reviews have indicated a higher prevalence of UI among female athletes compared to their non-athletic counterparts. To date, no review has been undertaken to investigate female athletes' experiences of PFD. This review aims to offer insight and understanding, through aggregation, summary, synthesis and interpretation of findings from studies that report elite female athletes' experiences of symptoms of PFD. METHODS The review protocol was registered in PROSPERO in August 2020. A systematic search was conducted in Embase, MEDLINE (OVID), Cochrane Library, CINAHL, PsycINFO and Web of Science for studies published in the English language reporting elite female athletes' experiences of symptoms of PFD. This review included primary research studies that involved elite female athletes of any age or ethnicity. RESULTS Of the 1922 citations retrieved in the search, 32 studies met the methodological criteria for data extraction and analysis. Five main themes emerged: (1) triggers for symptoms of PFD; (2) strategies adopted by athletes to manage/mitigate symptoms of PFD; (3) impact on QOL/daily life; (4) impact on performance; (5) impact on emotions. CONCLUSIONS The findings of this review suggest a need to further explore the experiences of PFD among elite female athletes and it is suggested that future research should adopt qualitative methods or incorporate a qualitative component.
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Affiliation(s)
- Elizabeth Culleton-Quinn
- School of Medicine, Trinity College, Dublin, Ireland ,Discipline of Physiotherapy and Discipline of Occupational Therapy, Trinity College, Dublin, Trinity Centre for Health Sciences, James’s St., Dublin, D08W9RT Ireland
| | - Kari Bø
- Department of Sports Medicine, Norwegian School of Sports Sciences, Oslo, Norway ,Department of Obstetrics and Gynaecology, Akershus University Hospital, Lørenskog, Norway
| | - Neil Fleming
- School of Medicine, Trinity College, Dublin, Ireland
| | | | - Cinny Cusack
- Physiotherapy Department, Rotunda Hospital, Dublin, Ireland
| | - Déirdre Daly
- School of Nursing and Midwifery, Trinity College, Dublin, Ireland
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19
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Grotenhuis N, Schreuder MC, van den Bos TWL, van der Worp H, Blanker MH. Association of Supply Source with Continence Product and Care Satisfaction in Patients with Urinary Incontinence. Patient Prefer Adherence 2022; 16:2115-2123. [PMID: 35996726 PMCID: PMC9391932 DOI: 10.2147/ppa.s359960] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Accepted: 05/27/2022] [Indexed: 11/23/2022] Open
Abstract
PURPOSE We aimed to examine how supply source affects satisfaction with continence products and care among individuals with urinary incontinence (UI). Supply source was compared among pharmacies, national suppliers, and shops. The secondary aim was to compare participant characteristics between the three groups. PATIENTS AND METHODS A survey questionnaire was distributed via social media between April and June 2020. This included the international consultation on incontinence questionnaire (ICIQ) UI short form (ICIQ-UI-SF), the ICIQ-PadPROM, and the ICIQ-LUTSqol, together with questions about respondent characteristics and satisfaction with continence products. RESULTS Of the 1045 respondents, 706 fully completed and 339 partially completed the survey. Among these, 322 (45.6%), 199 (28.1%), and 185 (26.2%) made purchases from shops, national suppliers, and pharmacies, respectively. The mean ICIQ-UI-SF sum scores were comparable for the pharmacy (13.3 ± 3.7) and national supplier (13.8 ± 3.5) groups, but were significantly lower for the shop group (12.0 ± 3.3). Mean sum scores for satisfaction with continence products and satisfaction with continence care were also significantly lower in the shop group (7.9 ± 2.6 and 6.4 ± 2.7, respectively) compared with the pharmacy (9.1 ± 2.7 and 7.9 ± 2.6, respectively) and national supplier (9.3 ± 2.6 and 8.1 ± 3.0, respectively) groups. There were no statistically significant differences in the ICIQ-PadPROM and ICIQ-LUTSqol scores. Respondents' characteristics were similar, apart from the significantly lower number of males in the shop group. CONCLUSION Satisfaction with continence products and continence care is lower for people with UI who purchase materials from a shop than from a pharmacy or national supplier.
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Affiliation(s)
- Nina Grotenhuis
- Department of General Practice and Elderly Care Medicine, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Miranda C Schreuder
- Department of General Practice and Elderly Care Medicine, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
- Correspondence: Miranda C Schreuder, Department of General Practice and Elderly Care medicine, University Medical Center Groningen, University of Groningen, FA21, PO Box 196, Groningen, 9700AD, the Netherlands, Tel +31 625647144, Email
| | | | - Henk van der Worp
- Department of General Practice and Elderly Care Medicine, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Marco H Blanker
- Department of General Practice and Elderly Care Medicine, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
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Esmaeili S, Madani A, Chafjiri F, Madani Z, Leili E. Efficacy and safety of Pulsed Electromagnetic Field (PEMF) stimulation in the treatment of urinary symptoms in women with urinary incontinence. UROLOGICAL SCIENCE 2022. [DOI: 10.4103/uros.uros_123_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/05/2022] Open
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21
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Senturk Erenel A, Cicek Ozdemir S. Evaluation of features associated with urinary incontinence in women. INTERNATIONAL JOURNAL OF UROLOGICAL NURSING 2021. [DOI: 10.1111/ijun.12298] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
| | - Sevil Cicek Ozdemir
- Nursing Department, Faculty of Health Sciences Kutahya Health Sciences University Kutahya Turkey
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22
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McKinney JL, Keyser LE, Pulliam SJ, Ferzandi TR. Female Urinary Incontinence Evidence-Based Treatment Pathway: An Infographic for Shared Decision-Making. J Womens Health (Larchmt) 2021; 31:341-346. [PMID: 34747662 PMCID: PMC8972010 DOI: 10.1089/jwh.2021.0266] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
Objectives: Urinary incontinence (UI) is a highly prevalent burdensome condition among adult females in the United States, yet rates of care-seeking, evaluation, and treatment are nonoptimal. Components of evaluation and treatment are informed by research and professional society guidelines; however, a visual representation of this guidance does not exist. The objectives of this study are to review the literature regarding female UI care and to synthesize this information into a graphical format to facilitate health education, health care delivery, and shared decision-making. Methods: We reviewed published society guidelines, position statements, and associated references from the American College of Obstetrics and Gynecology, the Women's Preventive Services Initiative, American Academy of Family Physicians, American College of Physicians, the Society of Urodynamics and Female Urology, the American Urological Association, and the American Urogynecologic Society, and searched PubMed for related literature. We synthesized these findings into an evidence-based infographic depicting female UI risk factors, influences on care-seeking and provision, screening, evaluation, and a stepwise treatment approach. Results: This study summarizes current evidence and professional guidelines related to female UI into a compelling visual format and accompanying narrative. The infographic is intended as a tool for patient education, clinical practice, and research to facilitate shared decision-making and health care delivery. Conclusions: Female UI is highly prevalent, yet diagnosis and treatment are suboptimal. Use of an evidence-based infographic may positively impact patient knowledge and certainty about UI treatment and support health care provider counseling and decision-making.
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Affiliation(s)
- Jessica L McKinney
- School of Rehabilitation Sciences, Andrews University, Berrien Springs, Michigan, USA.,Renovia, Inc., Boston, Massachusetts, USA
| | - Laura E Keyser
- School of Rehabilitation Sciences, Andrews University, Berrien Springs, Michigan, USA.,Renovia, Inc., Boston, Massachusetts, USA
| | - Samantha J Pulliam
- Renovia, Inc., Boston, Massachusetts, USA.,Tufts Medical Center, Boston, Massachusetts, USA
| | - Tanaz R Ferzandi
- Urogynecology and Pelvic Reconstructive Surgery, Keck School of Medicine at University of Southern California, Los Angeles, California, USA
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23
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Moossdorff-Steinhauser HFA, Berghmans BCM, Spaanderman MEA, Bols EMJ. Prevalence, incidence and bothersomeness of urinary incontinence between 6 weeks and 1 year post-partum: a systematic review and meta-analysis. Int Urogynecol J 2021; 32:1675-1693. [PMID: 34142179 PMCID: PMC8295150 DOI: 10.1007/s00192-021-04877-w] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Accepted: 05/20/2021] [Indexed: 11/30/2022]
Abstract
Introduction and hypothesis Urinary incontinence (UI) is a common complaint for post-partum women. Reported prevalence and incidence figures show a large range due to varying study methodology. The crude prevalence of post-partum UI may differ when accounting for bother. Precise prevalence and incidence figures on (bothersome) UI are of relevance for health care providers, research planning, and policy makers. Therefore, we conducted a systematic review and meta-analysis to investigate the prevalence and incidence of UI in post-partum women in the Western world for relevant subgroups and assessed experienced bother in relation to UI. Methods Observational studies, published between January 1998 and March 2020 and reporting on prevalence and incidence between 6 weeks and 1 year post-partum, were included, regardless of type of UI or setting. We used a random effects model with subgroup analyses for post-partum period, parity and subtype of UI. Results The mean (weighted) prevalence based on 24 included studies, containing a total of 35.064 women, was 31.0%. After an initial drop in prevalence at 3 months post-partum, prevalence rises up to nearly the same level as in the third trimester of pregnancy at 1 year post-partum (32%). Stress UI (54%) is the most prevalent type. UI prevalence is equal among primi- and multiparous women. Experienced bother of UI is heterogeneously assessed and reported to be mild to moderate. Conclusions Post-partum UI is highly prevalent in women in the Western world. After an initial drop it rises again at 1 year post-partum. Experienced bother is mild to moderate. Supplementary Information The online version contains supplementary material available at 10.1007/s00192-021-04877-w.
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Affiliation(s)
- Heidi F A Moossdorff-Steinhauser
- Faculty of Health, Medicine and Life Sciences, Department of Epidemiology, Care and Public Health Research Institute (CAPHRI), Maastricht University, P.O. Box 616, 6200, MD, Maastricht, The Netherlands.
| | - Bary C M Berghmans
- Pelvic care Center Maastricht, CAPHRI, Maastricht University Medical Centre (MUMC+), Maastricht, The Netherlands
| | | | - Esther M J Bols
- Faculty of Health, Medicine and Life Sciences, Department of Epidemiology, Care and Public Health Research Institute (CAPHRI), Maastricht University, P.O. Box 616, 6200, MD, Maastricht, The Netherlands
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Woodley SJ, Hay-Smith EJC. Narrative review of pelvic floor muscle training for childbearing women-why, when, what, and how. Int Urogynecol J 2021; 32:1977-1988. [PMID: 33950309 DOI: 10.1007/s00192-021-04804-z] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2021] [Accepted: 04/12/2021] [Indexed: 02/06/2023]
Abstract
INTRODUCTION AND HYPOTHESIS Urinary incontinence (UI) is prevalent during pregnancy and postpartum. UI in pregnancy strongly predicts UI postpartum and later in life. UI reduces women's wellbeing and quality of life and presents a significant burden to healthcare resource. METHODS A narrative review summarizing quantitative and qualitative evidence about pelvic floor muscle training (PFMT) for prevention and treatment of UI for childbearing women. RESULTS There are clinically important reductions in the risk of developing UI in pregnancy and after delivery for pregnant women who start PFMT during pregnancy, and PFMT offers additional benefits preventing prolapse and improving sexual function. If women develop UI during pregnancy or postpartum then PFMT is an appropriate first-line treatment. For novice exercisers, a programme comprising eight contractions, with 8-s holds, three times a day, 3 days a week, for at least 3 months is a reasonable minimum and 'generic' prescription. All women need clear accurate verbal instruction in how to do PFMT. Incontinent women, and women who cannot do a correct contraction, require referral for pelvic floor rehabilitation. Behavioural support from maternity care providers (MCPs)-increasing women's opportunity, capability, and motivation for PFMT-is as important as the exercise prescription. CONCLUSION PFMT is effective to prevent and treat UI in childbearing women. All pregnant and postpartum women, at every contact with a MCP, should be asked if they are continent. Continent women need exercise prescription and behavioural support to do PFMT to prevent UI. Incontinent women require appropriate referral for diagnosis or treatment.
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Affiliation(s)
- Stephanie J Woodley
- Department of Anatomy, School of Biomedical Sciences, University of Otago, Dunedin, New Zealand
| | - E Jean C Hay-Smith
- Rehabilitation Teaching and Research Unit, Department of Medicine, University of Otago, Wellington, New Zealand.
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Sorrilha FB, Mazzei LG, Lopes LC, Barberato-Filho S, Castro J, Castro A, Vélez CM, de Cássia Bergamaschi C. Treatment of urinary incontinence: a critical appraisal of clinical practice guidelines with the AGREE II instrument. Int Urogynecol J 2021; 32:2647-2656. [PMID: 33704538 DOI: 10.1007/s00192-021-04729-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Accepted: 02/06/2021] [Indexed: 11/26/2022]
Abstract
INTRODUCTION AND HYPOTHESIS This systematic review evaluated the rigor of the development of clinical practice guidelines (CPG). METHODS The searched sources were MEDLINE, EMBASE, Web of Science, Scopus, and specific databases of CPG. Reviewers, organized in triplicate and independently, selected the studies and assessed the quality of the guidelines using the Appraisal of Guidelines Research and Evaluation (AGREE II) instrument, which contains six domains for classification. The classification of the CPGs prioritized the domain 3 (developmental rigor) considering: high (score > 60%), moderate (score 30-60%), or low quality (score < 30%). The results were checked for discrepancies and decided by consensus. The interventions were described. Descriptive statistics presented the results. RESULTS Of the ten CPGs evaluated, five were of high methodological quality, three were of moderate quality, and two of low quality. Three documents were not recommended for use. The domains with the highest scores were scope and purpose (mean = 90.1%) and clarity of presentation (mean = 88.9%). The domains of editorial independence (mean = 41.4%) and applicability (mean = 29.3%) were those with the lowest score. The most cited interventions in CPGs were the nonpharmacological, such as lifestyle interventions, bladder training, or re-education and pelvic floor muscle training. CONCLUSION Most guidelines showed rigor in development and were recommended for use; however, editorial independence and applicability were domains that need to be improved in these documents. Our findings can guide the choice of CPG for the treatment of urinary incontinence.
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Affiliation(s)
- Flávia Blaseck Sorrilha
- Graduate Program in Pharmaceutical Sciences, University of Sorocaba, Sorocaba, São Paulo, Brazil
| | - Lauren Giustti Mazzei
- Graduate Program in Pharmaceutical Sciences, University of Sorocaba, Sorocaba, São Paulo, Brazil
| | - Luciane Cruz Lopes
- Graduate Program in Pharmaceutical Sciences, University of Sorocaba, Sorocaba, São Paulo, Brazil
| | - Silvio Barberato-Filho
- Graduate Program in Pharmaceutical Sciences, University of Sorocaba, Sorocaba, São Paulo, Brazil
| | - Juliana Castro
- Graduate Program in Pharmaceutical Sciences, University of Sorocaba, Sorocaba, São Paulo, Brazil
| | - Analaura Castro
- Graduate Program in Pharmaceutical Sciences, University of Sorocaba, Sorocaba, São Paulo, Brazil
| | | | - Cristiane de Cássia Bergamaschi
- Graduate Program in Pharmaceutical Sciences, University of Sorocaba, Sorocaba, São Paulo, Brazil.
- Universidade de Sorocaba (UNISO), Rodovia Raposo Tavares, Km 92.5, Sorocaba, São Paulo, 18.023-000, Brazil.
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Patient Perceptions of a Group-Based Lifestyle Intervention for Overweight Women with Urinary Incontinence: A Qualitative Descriptive Study. Healthcare (Basel) 2021; 9:healthcare9030265. [PMID: 33801476 PMCID: PMC8001695 DOI: 10.3390/healthcare9030265] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2021] [Revised: 02/18/2021] [Accepted: 02/22/2021] [Indexed: 12/05/2022] Open
Abstract
Urinary incontinence (UI) affects many women and impacts quality of life. Group-based interventions may be an effective and efficient method for providing UI care; however, interventions must be acceptable to patients to have an impact. This study aimed to explore patients’ perceptions of an exercise training and healthy eating group program (ATHENA) for overweight and obese women with UI. This qualitative descriptive study involved semi-structured interviews with a subset of participants sampled from a feasibility study of ATHENA. The ATHENA intervention was co-developed with end-users and implemented in Women’s Health Physiotherapy services at an Australian hospital. Interviews were recorded, transcribed and analysed thematically. Eleven female patients participated (mean ± SD age 54.2 ± 9.9 years; body mass index 30.5 ± 3.25 kg/m2). Participants found ATHENA highly acceptable, with three themes emerging from interviews: (1) Participants’ journey of change through ATHENA, describing the shifts in knowledge, attitudes, behaviours and symptoms participants experienced; (2) High satisfaction with ATHENA, including educational content, exercise components and delivery style; and (3) Group setting integral to ATHENA’s success, with participants providing support, building friendships, and facilitating each other’s learning. Overall, ATHENA was acceptable to participants, who provided each other with peer support; an unexpected moderator to ATHENA’s success.
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Hage-Fransen MAH, Wiezer M, Otto A, Wieffer-Platvoet MS, Slotman MH, Nijhuis-van der Sanden MWG, Pool-Goudzwaard AL. Pregnancy- and obstetric-related risk factors for urinary incontinence, fecal incontinence, or pelvic organ prolapse later in life: A systematic review and meta-analysis. Acta Obstet Gynecol Scand 2020; 100:373-382. [PMID: 33064839 DOI: 10.1111/aogs.14027] [Citation(s) in RCA: 52] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2019] [Revised: 09/05/2020] [Accepted: 10/08/2020] [Indexed: 01/13/2023]
Abstract
INTRODUCTION Risk factors for pelvic floor disorders are often related to pregnancy and delivery. Consistent evidence is needed to develop prevention strategies targeting risk factors. The objective of this study is to identify which pregnancy- and/or obstetric-related risk factors can predict urinary incontinence, fecal incontinence, or pelvic organ prolapse later in life by means of a systematic review and meta-analysis. MATERIAL AND METHODS Systematic review Prospero number: CRD42019131758. Literature searches of PubMed, EMBASE, CINAHL, and Cochrane Library were conducted according to PRISMA guidelines (April 2020). Prospective cohort studies describing more than two pregnancy- and/or obstetric-related risk factors on urinary incontinence, fecal incontinence (including flatal incontinence), or pelvic organ prolapse were eligible. Risk of bias was assessed (using Quality In Prognosis Studies [QUIPS]). Studies with high risk of bias were excluded. Data were extracted and checked for accuracy with the CHARMS checklist. Sub-groups were used to distinguish between a short- and long-term follow-up period: <18 months (shortterm) and >18 months (long-term) postpartum. Odds ratios were calculated from reported prevalence rates. Log odds ratios were calculated using SPSS v.24. Variables were pooled using RevMan5. RESULTS Data were extracted from nineteen studies for urinary incontinence, nine for fecal incontinence, and two for pelvic organ prolapse. Multivariate analysis was not possible because of the heterogeneity of the population and outcome measures. Pooled univariate risk factors for urinary incontinence were: urinary incontinence during pregnancy, instrumental vaginal delivery, episiotomy, tears, and constipation. Pooled univariate risk factors for fecal incontinence were: fecal incontinence during pregnancy, maternal age over 35 years, prenatal body mass index over 30 kg/m2 , instrumental vaginal delivery, a spontaneous vaginal delivery, oxytocin augmentation, and when the weight of the newborn was more than 4000 g. Both studies for pelvic organ prolapse had a short-term follow-up period and cesarean section was the only risk factor that could be pooled. CONCLUSIONS Pregnancy- and obstetric-related risk factors predicting pelvic floor disorders postpartum are multifactorial and differ between pelvic floor disorders. The strongest risk factor for incontinence later in life was incontinence during pregnancy. Better quality research with long-term follow up is needed on this topic.
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Affiliation(s)
| | - Maaike Wiezer
- Physical Therapy Practice Fysi-Unique, Amersfoort, the Netherlands
| | - Amy Otto
- Faculty of Behavior Human Movement Sciences, Amsterdam Movement Sciences, VU University Amsterdam, Amsterdam, the Netherlands
| | | | | | | | - Annelies L Pool-Goudzwaard
- Faculty of Behavior Human Movement Sciences, Amsterdam Movement Sciences, VU University Amsterdam, Amsterdam, the Netherlands.,Somt University of Physiotherapy, Amersfoort, the Netherlands
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Williams BR, Vargo K, Newman DK, Yvette Lacoursiere D, Mueller ER, Connett J, Low LK, James AS, Smith AL, Schmitz KH, Burgio KL. It's About Time: The Temporal Burden of Lower Urinary Tract Symptoms Among Women. UROLOGIC NURSING 2020; 40:10.7257/1053-816x.2020.40.6.277. [PMID: 33642840 PMCID: PMC7906293 DOI: 10.7257/1053-816x.2020.40.6.277] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
This secondary analysis studied 50 transcripts of women who shared day-to-day experiences of lower urinary tract symptoms (LUTS) and characterized temporal (time-associated) features of living with LUTS. Findings revealed two overarching time-associated themes: The Complexity of LUTS and The Quest for Empowerment over LUTS. Findings suggest that the temporal burden of LUTS is the accumulated impact of symptoms and symptom management on women's daily lives within multiple contexts across the life course. Increasing nurses' knowledge of the temporal context of LUTS may heighten awareness and improve symptom detection and management.
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Affiliation(s)
- Beverly Rosa Williams
- University of Alabama at Birmingham School of Medicine, Department of Veterans Affairs, Birmingham, AL
| | - Keith Vargo
- University of Minnesota School of Public Health
| | - Diane K Newman
- Division of Urology, Department of Surgery, University of Pennsylvania, Perelman School of Medicine
| | | | | | | | | | - Aimee S James
- Washington University in St. Louis School of Medicine
| | | | | | - Kathryn L Burgio
- University of Alabama at Birmingham School of Medicine, Department of Veterans Affairs, Birmingham, AL
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Burgio KL, James AS, LaCoursiere DY, Mueller ER, Newman DK, Low LK, Weinfurt KP, Wyman JF, Cunningham SD, Vargo K, Connett J, Williams BR. Views of Normal Bladder Function Among Women Experiencing Lower Urinary Tract Symptoms. Urology 2020; 150:103-109. [PMID: 32841655 DOI: 10.1016/j.urology.2020.08.021] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Revised: 07/28/2020] [Accepted: 08/10/2020] [Indexed: 12/14/2022]
Abstract
OBJECTIVE To explore the perspectives of normal bladder function among women with lower urinary tract symptoms. METHODS This was a secondary analysis of qualitative data from structured interviews with 50 adult women with lower urinary tract symptoms. A directed content analysis of the transcripts explored women's perspectives on normal bladder function. RESULTS Participants' descriptions of "normal" took many forms and were based on several aspects of bladder function. A prominent feature of normal was that voiding occurred as a seamless process, beginning with an urge sensation, followed by voiding with ease and to completion, and then "being done." Descriptions of normal were based largely on concepts of voiding regularity, including voiding frequency, intervals, and patterns during the day and night. Another aspect of normal bladder function was the notion of having control in terms of not leaking urine, as well as the ability to hold urine and defer urination. Views of normal bladder function extended to the absence of symptoms and the impact of being symptom-free on day-to-day life, including not having to think about or worry about the bladder or limit daily activities. CONCLUSION Women's perspectives on normal bladder function are multifaceted, reflecting attributes most salient to each individual and likely informed by their personal experience with symptoms and their influence on daily life. This work has implications for how clinicians might engage women in discussing bladder symptoms and can inform future research and public health messaging about normal bladder function.
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Affiliation(s)
- Kathryn L Burgio
- University of Alabama at Birmingham School of Medicine, Birmingham, AL; Department of Veterans Affairs, Birmingham/Atlanta Geriatric Research, Education, and Clinical Center, Birmingham, AL.
| | - Aimee S James
- Washington University School of Medicine, St. Louis, MO
| | | | | | - Diane K Newman
- University of Pennsylvania, Perelman School of Medicine, Philadelphia, PA
| | - Lisa Kane Low
- University of Michigan School of Nursing, Ann Arbor, MI
| | | | - Jean F Wyman
- University of Minnesota, School of Nursing, Minneapolis, MN
| | | | - Keith Vargo
- University of Minnesota School of Public Health, Minneapolis, MN
| | - John Connett
- University of Minnesota School of Public Health, Minneapolis, MN
| | - Beverly Rosa Williams
- University of Alabama at Birmingham School of Medicine, Birmingham, AL; Department of Veterans Affairs, Birmingham/Atlanta Geriatric Research, Education, and Clinical Center, Birmingham, AL
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- National Institutes of Health (NIH), National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), Bethesda, MD
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The Impact of Urinary Incontinence on Sexual Function: A Systematic Review. Sex Med Rev 2020; 8:393-402. [DOI: 10.1016/j.sxmr.2019.06.009] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2019] [Revised: 06/08/2019] [Accepted: 06/11/2019] [Indexed: 11/20/2022]
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Ural ÜM, Gücük S, Ekici A, Topçuoğlu A. Urinary incontinence in female university students. Int Urogynecol J 2020; 32:367-373. [PMID: 32514750 DOI: 10.1007/s00192-020-04360-y] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2020] [Accepted: 05/18/2020] [Indexed: 10/24/2022]
Abstract
INTRODUCTION AND HYPOTHESIS We aimed to determine the prevalence of urinary incontinence (UI) in nulliparous female university students and to provide an overview of risk factors associated with urinary continence. METHODS A total of 1,397 female university students aged 18-28 years were enrolled into this cross-sectional questionnaire study. The self-administered questionnaires, the International Consultation on Incontinence Questionnaire Short Form (ICIQ-SF), Overactive Bladder V8 (OAB-V8), demographics, and general characteristics were recorded. The frequency, type, and severity of urinary incontinence and related factors were evaluated. RESULTS The mean age of the students was 20.27 ± 1.69 years. The prevalence of UI in female university students was 18.4% (n = 258). ICIQ-SF total score was 0.85 ± 2.11 (0-14). OAB-V8 total score was 5.97 ± 5.35 (0-40) and 27.0% of participants had scores of ≥8. Elevated BMI, childhood enuresis, constipation, exercising, positive family history for UI, accommodation in a dormitory, and holding urine at school are risk factors associated with UI in female university students. CONCLUSION We demonstrated that UI is a common condition among female university students. The identification of the associated risk factors will help to further raise the knowledge and awareness of the problem, and preventive strategies may be proposed to young women to improve the quality of life and psychological well-being.
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Affiliation(s)
- Ülkü Mete Ural
- Department of Obstetrics and Gynecology, School of Medicine, Bolu Abant İzzet Baysal University, 14030, Gölköy, Bolu, Turkey.
| | - Sebahat Gücük
- Department of Family Medicine, School of Medicine, Bolu Abant İzzet Baysal University, Bolu, Turkey
| | - Ayhan Ekici
- Department of Obstetrics and Gynecology, School of Medicine, Bolu Abant İzzet Baysal University, 14030, Gölköy, Bolu, Turkey
| | - Ata Topçuoğlu
- Department of Obstetrics and Gynecology, School of Medicine, Bolu Abant İzzet Baysal University, 14030, Gölköy, Bolu, Turkey
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Sumarsono B, Jong JJ, Wang JY, Liao L, Lee KS, Yoo TK, Liu SP, Chuang YC. The prevalence of urinary incontinence in men and women aged 40 years or over in China, Taiwan and South Korea: A cross-sectional, prevalence-based study. Low Urin Tract Symptoms 2020; 12:223-234. [PMID: 32207219 DOI: 10.1111/luts.12308] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2019] [Revised: 02/19/2020] [Accepted: 02/24/2020] [Indexed: 12/16/2022]
Abstract
OBJECTIVES To assess prevalence of urinary incontinence (UI), including urgency UI (UUI), stress UI (SUI) and mixed UI (MUI) in individuals aged ≥40 years in China, Taiwan and South Korea. METHOD This was a post hoc analysis of a cross-sectional, questionnaire-based internet survey. Participants were asked questions relating to urinary symptoms, health-related quality of life (HRQoL) and mental health (using the HRQoL 12-item short form health survey mental health and physical domains, and the Hospital Anxiety and Depression Scale), visits to healthcare professionals (HCPs) for any reason or for urinary symptoms, treatments for urinary symptoms and treatment satisfaction. RESULTS Of 8284 survey participants, 1818 (22%) reported any UI (men 17.3%, women 26.4%). MUI was the most prevalent (overall 9.7%, men 6.8%, women 12.6%) followed by SUI (overall 7.9%, men 5.1%, women 10.7%) and UUI (overall 4.3%, men 5.5%, women 3.2%). HRQoL, anxiety and depression scores were poor in all participants with UI; MUI was associated with the worst scores. Of the participants with UI, 46.9% visited HCPs for urinary symptoms (highest proportion [62.7%] among participants with MUI). Approximately 80% of participants with UI followed treatment, with prescribed medicine being the most common form (38.1%). Over half of participants (59.6%) were somewhat, very, or extremely satisfied with their treatment. MUI was associated with least satisfaction. CONCLUSION UI was associated with substantial problems, including an adverse impact on HRQoL. Medication failed to satisfy many individuals with UI. Efforts to educate the public and physicians about the impact of UI could improve diagnosis and treatment rates.
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Affiliation(s)
| | - Jar Jar Jong
- Astellas Pharma Singapore Pte. Ltd, Singapore, Singapore
| | - Jian-Ye Wang
- Department of Urology, Beijing Hospital, Beijing, China
| | - Limin Liao
- Department of Urology, Beijing Hospital, Beijing, China.,Department of Urology, China Rehabilitation Research Center, Capital Medical University, Beijing, China
| | - Kyu-Sung Lee
- Department of Urology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Tag Keun Yoo
- Department of Urology, Eulji General Hospital, Seoul, Republic of Korea
| | - Shih-Ping Liu
- Department of Urology, National Taiwan University Hospital and College of Medicine, Taipei, Taiwan
| | - Yao-Chi Chuang
- Department of Urology, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan
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Toye F, Barker KL. A meta-ethnography to understand the experience of living with urinary incontinence: 'is it just part and parcel of life?'. BMC Urol 2020; 20:1. [PMID: 31941470 PMCID: PMC6964106 DOI: 10.1186/s12894-019-0555-4] [Citation(s) in RCA: 40] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2019] [Accepted: 11/08/2019] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND Urinary incontinence (UI) is highly prevalent and affects the lives of many men and women. We aimed to conduct a qualitative evidence synthesis (QES) to explore the experience of living with UI and to develop a conceptual model that can help us to understand this experience, and the potential barriers to appropriate healthcare. METHODS We used the methods of meta-ethnography developed by Noblit and Hare and recently refined for larger studies. Meta-ethnography involves identifying concepts from the studies and abstracting these concepts into a line of argument. We searched for studies that explored the experience of adults with UI. We used the GRADE-CERQual framework to assess confidence in review findings. RESULTS We screened 2307 titles, 429 abstracts, 107 full texts and included 41 studies (36 unique samples) in the synthesis. We organised the concepts into 26 conceptual categories, which we further abstracted into 6 themes: (1) Am I ill or is this normal? (2) It effects who I am and how I feel; (3) I feel stigmatised, ashamed and guilty; (4) talking can be difficult but it can help; (5) keeping incontinence under control; (6) have I got to the point that I need help? Our model conceptualises living with UI as navigating antagonists: Is UI normal or am I ill? Do I need help or am I managing? Do I keep UI to myself (and manage alone) or do I tell other people (and get the support that I need)? Do I use control strategies that focus on concealing (avoid risky situations, wear pads) versus, I use strategies that focus on improving the bodily function to improve continence. Our model highlights the experience of stigma, shame and guilt which exert a pull towards concealment. CONCLUSIONS The culture of secrecy and profound sense of shame is barrier to seeking help. An environment which reduces the shame and stigma of UI may help people to switch the focus to strategies that will improve continence, rather than conceal incontinence.
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Affiliation(s)
- Francine Toye
- Nuffield Orthopaedic Centre, Oxford University Hospitals NHS Foundation Trust, Windmill Road, Oxford, OX3 7HE UK
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences (NDORMS), University of Oxford, Oxford, UK
| | - Karen L. Barker
- Nuffield Orthopaedic Centre, Oxford University Hospitals NHS Foundation Trust, Windmill Road, Oxford, OX3 7HE UK
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences (NDORMS), University of Oxford, Oxford, UK
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Living with Urinary Incontinence: Potential Risks of Women's Health? A Qualitative Study on the Perspectives of Female Patients Seeking Care for the First Time in a Specialized Center. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16193781. [PMID: 31597365 PMCID: PMC6801418 DOI: 10.3390/ijerph16193781] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/20/2019] [Revised: 10/02/2019] [Accepted: 10/04/2019] [Indexed: 01/21/2023]
Abstract
Background: Urinary incontinence (UI) represents a complex problem which commonly affects women and influences their physical, mental, and social wellbeing. The objective of this study was to explore the experiences of a group of women with urinary incontinence. Methods: A qualitative exploratory study. Purposeful sampling was used. Recruited patients were females aged >18 years old with positive symptoms, signs of urinary incontinence, and attending a specialized urinary incontinence center for the first time. We collected data using interviews and participants’ personal letters. A thematic analysis was performed. Results: 18 women participated with a mean age of 47.32 years. Four themes emerged: (a) Experiencing uncontrolled urinary leakage, (b) Information based on beliefs and myths regarding UI, (c) Adapting to change and developing strategies, (d) The role of education. Women’s experiences were accompanied by feelings of stress and shame. A lack of information regarding UI was found, together with numerous misconceptions. Urinary incontinence triggers many changes in women. Some women may develop feelings of rejection towards their own body. Family involvement during these times is essential for education and promoting healthy sexual practices. Conclusions: This study highlights the importance of developing educational programs that focus on women’s information and education regarding triggering factors and coping strategies.
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Nguyen A, Cheung A, Berg W, Lee W, Weissbart S, Kim J. What's in a name? Choosing a title for a female pelvic medicine and reconstructive surgery clinic: A prospective questionnaire. Neurourol Urodyn 2019; 39:197-202. [PMID: 31578790 DOI: 10.1002/nau.24168] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2019] [Accepted: 09/04/2019] [Indexed: 11/09/2022]
Abstract
AIMS A new multidisciplinary clinic specializing in female pelvic medicine and reconstructive surgery (FPMRS) opened at our institution. We sought to assess patient preference in naming this new center, and how readability and word choice informs these preferences. METHODS We prospectively surveyed patient preference in naming this new center, as well as patient knowledge and societal perception of pelvic floor disorders. This survey was distributed to female patients presenting to general urology and gynecology clinics. RESULTS There were 300 respondents out of 1000 distributed surveys. Patients preferred titles with accessible readability scores and societally neutral vocabulary. Preferred titles for the clinic were at a 6th-grade readability level. Patients preferred neutral titles that included the word "health" and disliked titles that contained the words "pelvic floor" and "dysfunction." In general, survey participants believed that "incontinence" was associated with negative connotations. CONCLUSION Readable and neutral vocabulary in the title of the clinic are key components of patient-preferred titles for an FPMRS clinic and affect patient comfort levels in scheduling an appointment.
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Affiliation(s)
- Anh Nguyen
- Department of Urology, Stony Brook University School of Medicine, Stony Brook, New York
| | - Alice Cheung
- Department of Urology, Stony Brook University School of Medicine, Stony Brook, New York
| | - William Berg
- Department of Urology, Stony Brook University Hospital, Stony Brook, New York
| | - Wai Lee
- Department of Urology, Stony Brook University Hospital, Stony Brook, New York
| | - Steven Weissbart
- Department of Urology, Stony Brook University Hospital, Stony Brook, New York
| | - Jason Kim
- Department of Urology, Stony Brook University Hospital, Stony Brook, New York
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Smiles FB, Mazzei LG, Lopes LC, Barberato-Filho S, Castro J, Castro A, Marengo LL, Bergamaschi CC. Critical appraisal of clinical practice guidelines for treatment of urinary incontinence: Protocol for a systematic review. Medicine (Baltimore) 2019; 98:e16698. [PMID: 31415362 PMCID: PMC6831340 DOI: 10.1097/md.0000000000016698] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Urinary incontinence is a common complaint in all parts of the world, cause of distress, as well as significant costs for both individuals and society. The aim of this study will be to evaluate the rigor of the development of clinical practice guidelines and to identify the recommendations of interventions for urinary incontinence in adult women. METHODS In this systematic review, clinical practice guidelines will be identified using a prospective protocol through a systematic search of: MEDLINE (via Ovid); EMBASE (Excerpt Medical Database, via Ovid); Web of Science and Virtual Health Library. Specific databases of guidelines for clinical practice will also be searched (National Institute for Health and Care Excellence, American Urological Association, and others). Reviewers, independently and in duplicate, will assess the quality of the guidelines using the Appraisal of Guidelines Research and Evaluation (AGREE II). The results will be checked for discrepancies. Differences between the scores equal to or greater than 2 will be considered as discrepant and the final result will be decided by consensus. A comparison of the recommendations of interventions and information about the level of evidence, the degree of recommendation, the level of agreement and the level of acceptance will be described. This step will also be done independently and in duplicate, and the result will be decided by consensus. The results will be presented in tables and the descriptive statistics will be calculated for all domains of the AGREE II instrument as mean (standard deviation) and median (interquartile range). RESULTS The results derived from this study will increase the knowledge about the development of recommendations guidelines for urinary incontinence of high methodological rigor. This study may also identify key areas for future research. CONCLUSION This study may guide health professionals, policy makers, and health policy managers in choosing the guidelines for recommendation in clinical practice. PROTOCOL REGISTRATION PROSPERO - CRD42018116517.
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Low LK, Williams BR, Camenga DR, Hebert-Beirne J, Brady SS, Newman DK, James AS, Hardacker CT, Nodora J, Linke SE, Burgio KL. Prevention of Lower Urinary Tract Symptoms Research Consortium Focus Group Study of Habits, Attitudes, Realities, and Experiences of Bladder Health. J Adv Nurs 2019; 75:10.1111/jan.14148. [PMID: 31287183 PMCID: PMC8088730 DOI: 10.1111/jan.14148] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2019] [Accepted: 06/25/2019] [Indexed: 01/01/2023]
Abstract
AIM The study purpose is to explore adolescent and adult women's experiences, perceptions, beliefs, knowledge and behaviors related to bladder health across the life course using a socioecological perspective. Lower urinary tract symptoms affect between 20-40% of young adult to middle-aged women, with symptoms increasing in incidence and severity with aging. There is limited evidence to address bladder health promotion and prevention of dysfunction. This first study of the Prevention of Lower Urinary Tract Symptoms (PLUS) Research Consortium is designed to address gaps in existing qualitative research in this area. DESIGN This focus group study will be implemented across seven geographically diverse United States research centers using a semi-structured focus group guide informed by a conceptual framework based on the socioecological model. METHODS The study was approved in July 2017. A total of 44 focus groups composed of 6-8 participants representing six different age categories (ranging from 11 to over 65 years) will be completed. We aim to recruit participants with diverse demographic and personal characteristics including race, ethnicity, education, socioeconomic status, urban/rural residence, physical/health conditions and urinary symptom experience. Up to 10 of these focus groups will be conducted in Spanish. Focus group transcripts will undergo content analysis and data interpretation to identify and classify themes and articulate emerging themes. DISCUSSION This foundational qualitative study seeks to develop an evidence base to inform future research on bladder health promotion in adolescent and adult women. IMPACT This study has the potential to provide new insights and understanding into adolescent and adult women's lived experience of bladder health, the experience of lower urinary symptoms and knowledge and beliefs across the life course. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Lisa Kane Low
- Women's Studies and Department of Obstetrics and Gynecology, University of Michigan
| | - Beverly Rosa Williams
- Department of Medicine, Division of Gerontology, Geriatrics and Palliative Care, University of Alabama at Birmingham (UAB)
| | - Deepa R Camenga
- Department of Emergency Medicine, Section of Research, Yale School of Medicine
| | - Jeni Hebert-Beirne
- Community Health Sciences, School of Public Health, University of Illinois at Chicago
| | - Sonya S Brady
- Division of Epidemiology & Community Health, University of Minnesota School of Public Health
| | - Diane K Newman
- Department of Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Aimee S James
- Division of Public Health Sciences, Department of Surgery, Washington University School of Medicine, Saint Louis, MO
| | | | - Jesse Nodora
- Department of Family Medicine and Public Health, UC San Diego Moores Cancer Center
| | - Sarah E Linke
- Department of Family Medicine & Public Health, UC San Diego
| | - Kathryn L Burgio
- Department of Medicine, Division of Gerontology, Geriatrics and Palliative Care, University of Alabama at Birmingham (UAB) and Birmingham/Atlanta Geriatric Research, Education and Clinical Center, Department of Veterans Affairs, Birmingham, Alabama
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