Garg incontinence scores: New scoring system on the horizon to evaluate fecal incontinence. Will it make a difference?

The main aim of this opinion review is to comment on the recent article published by Garg et al in the World Journal of Gastroenterology 2023; 29: 4593-4603. The authors in the published article developed a new scoring system, Garg incontinence scores (GIS), for fecal incontinence (FI). FI is a chronic debilitating disease that has a severe negative impact on the quality of life of the patients. Rome IV criteria define FI as multiple episodes of solid or liquid stool passed into the clothes at least twice a month. The associated social stigmatization often leads to significant under-reporting of the condition, which further impairs management. An important point is that the complexity and vagueness of the disease make it difficult for the patients to properly define and report the magnitude of the problem to their physicians. Due to this, the management becomes even more difficult. This issue is resolved up to a considerable extent by a scoring questionnaire. There were several scoring systems in use for the last three decades. The prominent of them were the Cleveland Clinic scoring system or the Wexner scoring system, St. Marks Hospital or Vaizey's scores, and the FI severity index. However, there were several shortcomings in these scoring systems. In the opinion review, we tried to analyze the strength of GIS and compare it to the existing scoring systems. The main pitfalls in the existing scoring systems were that most of them gave equal weightage to different types of FI (solid, liquid, flatus, etc.), were not comprehensive, and took only the surgeon's perception of FI into view. In GIS, almost all shortcomings of previous scoring systems had been addressed: different weights were assigned to different types of FI by a robust statistical methodology; the scoring system was made comprehensive by including all types of FI that were previously omitted (urge, stress and mucus FI) and gave priority to patients' rather than the physicians' perceptions while developing the scoring system. Due to this, GIS indeed looked like a paradigm shift in the evaluation of FI. However, it is too early to conclude this, as GIS needs to be validated for accuracy and simplicity in future studies.

New objective scoring system to clinically assess fecal incontinence

BACKGROUND

Several scoring systems are used to assess fecal incontinence (FI), among which, the most commonly used are Wexner and Vaizey's scoring systems. However, there are significant lacunae in these scoring systems, due to which they are neither accurate nor comprehensive.

AIM

To develop a new scoring system for FI that is accurate, comprehensive, and easy to use.

METHODS

A pro forma was made in which six types of FI were included: solid, liquid, flatus, mucous, stress, and urge. The weight for each FI was determined by asking a group of patients and laypersons to give a disability score to each type of FI from 0 to 100 (0- least, 100- maximum disability). The disability was assessed on a modified EQ-5D+ (EuroQol) description system, 4D3L (4 dimensions and 3 levels) for each FI. The average score of each FI was calculated, divided by 10, and rounded off to determine the weight of each FI type. The scores for the three levels of frequency of each FI were assigned as never = 0 (No episode of FI ever), occasional = 1 (≤ 1 episode of FI/ wk), and common = 2 (> 1 episode of FI/ wk), and was termed as frequency score. The score for each FI would be derived by multiplying the frequency score and the weight for that FI type. In the second phase of the study, a group of colorectal surgeons was asked to rank the six FI types in order of severity, and their ranking was compared with the patient and laypersons' rankings.

RESULTS

Fifty patients and 50 laypersons participated in the study. The weight was assigned to each FI (solid-8, liquid-8, urge-7, flatus-6, mucus-6, and stress-5), and an new scoring system was formulated. The maximum possible score was 80 (total incontinence), and the least 0 (no incontinence). The surgeons' ranking of FI severity did not correlate well with patients' and laypersons' rankings of FI, highlighting that surgeons and patients may perceive the severity of FI differently.

CONCLUSION

A new scoring system for FI was formulated, which was simple, logical, comprehensive, and easy to use, and eliminated previous shortcomings. Patients' and surgeons' perceptions of FI severity of FI did not correlate well.

Trauma cue-elicited emotional response profiles influence acute experiences of alcohol urge

BACKGROUND AND OBJECTIVES

Affective responses to trauma cues in individuals with posttraumatic stress (PTS) can evoke a desire to drink and may shed light on novel mechanisms of PTS-drinking. The present study aimed to (1) identify and characterize patterns of acute emotional responses (ER) to trauma cues and (2) examine how these patterns influence drinking urge.

METHODS

University students (N = 304; M_age = 19; 52.3% female) completed a structured clinical interview to confirm trauma history and PTS. At an experimental session one week later, participants completed a series of three trauma cue exposures. Affect and drinking urge were measured at baseline, after each cue exposure, and at experiment's end.

RESULTS

Latent profile analysis of ER yielded a five-profile solution: (1) Nonresponders (2) Low Responders (3) Moderate Responders (4) Resilient Responders and (5) High Responders. Profiles differed by trait neuroticism, PTS, and emotion dysregulation, with High Responders as the most severe group. In latent growth curve models, profiles significantly predicted alcohol urge trajectories in a graded pattern. High Responders, with the greatest affective intensity, showed the strongest urge. Duration of affect was also implicated with Resilient Responders, who had similar intensity but faster overall affective recovery time compared to High Responders, demonstrating lower mean levels of urge.

LIMITATIONS

External validity is limited.

CONCLUSIONS

Individual differences in ER to trauma cues are important for understanding alcohol urge. Findings can inform integrative treatments for PTS-drinking by targeting ER to shorten affective recovery to trauma reminders and reduce the need for alcohol use as a regulation strategy.

Efficacy of Kegel exercises in preventing incontinence after partial division of internal anal sphincter during anal fistula surgery

BACKGROUND

The transanal opening of intersphincteric space (TROPIS) procedure, performed to treat complex anal fistulas, preserves the external anal sphincter (EAS) but involves partial incision of the internal anal sphincter (IAS).

AIM

To ascertain the incidence of incontinence after the division of the IAS as is done in TROPIS and to evaluate whether regular Kegel exercises (KE) in the postoperative period can prevent incontinence due to IAS division.

METHODS

Patients operated on for high complex fistulas and having no preoperative continence problem (score = 0) were included in the study. All patients were operated on by the TROPIS procedure and were recommended KE (pelvic contraction exercises) 50 times/day. KE were commenced on the 10^th postoperative day and continued for 1 year. Incontinence was evaluated objectively (by modified Vaizey’s scores) in the immediate postoperative period (Pre-KE group) and on long-term follow-up (Post-KE group). The incontinence scores in both groups were compared to evaluate the efficacy of KE.

RESULTS

Of 102 anal fistula patients operated on between July 2018 and July 2020 were included in this study. There were 90 males, the mean age was 42.3 ± 12.8, and the median follow-up was 30 mo (18-42 mo). Three patients were lost to follow-up. There were 65 recurrent fistulas, 92 had multiple tracts, 42 had associated abscess, 46 had horseshoe fistula and 34 were supralevator fistulas. All were magnetic resonance imaging-documented high fistulas (> 1/3 EAS involved). Overall incontinence occurred in 31% patients (Pre-KE group) with urge and gas incontinence accounting for the majority of cases (28.3%). The mean incontinence scores in the Pre-KE group were 1.19 ± 1.96 (in 31 patients, solid = 0, liquid = 7, gas = 8, urge = 24) and in the Post-KE group were 0.26 ± 0.77 (in 13 patients, solid = 0, liquid = 2, gas = 3, urge = 10) (P = 0.00001, t-test).

CONCLUSION

Division of the IAS led to incontinence, mainly urge incontinence, and also to a mild degree of gas and liquid incontinence. However, regular KE led to a significant reduction in incontinence (both in the number of affected patients and the severity of scores in these patients).

The emperor has no clothes: OAB can be cured surgically

The paper by Karjalainen et al., who reviewed 2,933 pelvic organ prolapse surgeries, showed 75% cure for “bothersome” urge urinary incontinence (UUI), is more than an “Aha” moment; it is an “Emperor has no clothes” moment. Since 1976, a convention of “no surgery” for women with UUI (now overactive bladder, OAB) has become almost an article of faith. Yet, surgical cure of OAB has been known since 1997, when this journal published the first urodynamically controlled study with 20-month data: 86% cure for UUI, 85% for frequency, 80% for nocturia following pubourethral ligament (PUL) and uterosacral ligament (USL) sling repair in 85 women. This study was followed by many other publications over the years recording OAB cure. It is not that even a small fraction of the 600 million women on the planet will now undergo surgery, or that damaged ligaments are the only cause of OAB. However, knowing OAB can be cured opens the door for young creative minds to bring hope and relief to these women non-surgically, as well as surgically.

Update on sacral neuromodulation and overactive bladder in pediatrics: A systematic review

OBJECTIVES

Sacral electrical stimulation has been used for more than a century as an alternative therapy for adult urinary syndromes. In the literature, several studies have validated the efficacy of this technique based on clinical and urodynamic criteria. Nevertheless, few studies have shown beneficial results in children with overactive bladder.

MATERIAL AND METHODS

We performed a systematic review of studies assessing the impact of sacral electroestimulation treatment on overactive bladder in children. The search identified 389 potentially eligible items. Of them, 14 studies published between 2001and 2019 met the study criteria and were selected for systematic review. RESULTS: All of papers included in this review individually demonstrated a high efficiency rate with good shortterm results, as well as safety in its use due to its minimalrate of adverse effects. However, the comparison of the results obtained in all of them was not possible because the high variety and heterogeneity in the different studies. The main limitation is that there is still no standard protocol for the application of this therapy in the pediatric population.

CONCLUSION

This review revealed the promising benefits of sacral electroneuromodulation in pediatric patients with overactive bladder. However, more studies with strictly meet pediatric overactive bladder diagnosis and management criteria should be done to protocolize and clarify the effectiveness of this therapeutic approach.

Inter-individual differences in urge-tic associations in Tourette syndrome

Premonitory urges are a cardinal feature in Tourette syndrome (GTS) and are commonly viewed as a driving force of tics. However, inter-individual differences in experimentally measured urges, tics and urge-tic associations, as well as possible relations to clinical characteristics and abnormal perception-action processing recently demonstrated in these patients have not been investigated in detail. Here, we analyze the temporal associations between urges and tics in 21 adult patients with GTS including inter-individual differences and the relation of such associations with clinical measures and experimentally tested perception-action coupling. At the group level, our results confirm known positive associations between subjective urges and tics, with increased tic frequency and tic intensity during periods of elevated urge. Inter-individual differences in the associations between urges and tics were, however, substantial. While most participants (57-66 % depending on the specific measure) showed positive associations as expected, several participants did not, and two even had negative associations with tic occurrence and intensity being reduced at times of increased urges. Subjective urge levels and tic occurrence correlated with corresponding clinical scores, providing converging evidence. Measures of the strength of urge-tic associations did not correlate with clinical measures nor the strength of perception-action coupling. Taken together, urge-tic associations in GTS are complex and heterogenous, casting doubt on the notion that tics are primarily driven by urges.

Urinary incontinence in older adults: what you need to know

Incontinence is a problem that can affect individuals of all ages. However, it is more frequently seen in older adults. It is a common geriatric syndrome, and its investigation should form part of a comprehensive geriatric assessment. Continence problems are usually ignored by patients and not reported to a medical professional, but with simple assessment and even simpler interventions, a significant improvement can be made for those living with incontinence. Most cases need a simple clinical assessment consisting of a good history and basic examination covering the abdomen, external genitalia and rectum. If no reversible causes are found, further investigations can be considered. The treatment for incontinence can be split into non-surgical and surgical management. Simple conservative measures, such as education around fluid intake, weight loss, managing constipation and pelvic floor exercises, can make a huge and positive impact on managing incontinence. If these are not effective, pharmaceutical therapies and surgical management can be considered, but there needs to be a careful consideration of the risk vs benefit in frail older adults.

Embedded Gambling Promotion in Football: An Explorative Study of Cue-Exposure and Urge to Gamble

Limited research has evaluated the psychological effect of sports-betting advertising (such as embedded promotion) upon consumers considered 'higher-risk'. Students are often considered a higher-risk group given the numerous gambling-related risk factors associated with their lifestyle. Furthermore, students studying sports-related subjects may possess a bespoke vulnerability to sports-betting risk, due to contextual factors such as (mis)perceptions regarding advantages of sports-related knowledge. The pilot study investigated whether exposure to embedded gambling promotions during televised football, elicits urges to gamble amongst students, and whether the severity of reported gambling varies between those who study sports-related and non-sports subjects. An experimental methodology was employed. Sixty students from the University of South Wales were shown one of three videos: (a) televised football match highlights containing a high density of embedded promotion; (b) amateur football match highlights containing no gambling-related cues or embedded promotion; (c) a neutral control video containing footage of a live concert. Urge to gamble and risk of gambling problems were measured following video exposure. Sports-students reported significantly higher risk of gambling problem scores than non-sports students. Correspondingly, sport-students who were exposed to embedded gambling promotion reported significantly higher urges to gamble compared to all other conditions. This effect was also observed amongst sports-students who were exposed to an amateur match containing no gambling-related material. These findings provide evidence for the cue-induced urge effect of sports-embedded gambling promotion, amongst vulnerable audiences. Public health interventions and harm reduction strategies should look to counteract these pervasive forms of gambling advertising.

Desire thinking promotes decisions to game: The mediating role between gaming urges and everyday decision-making in recreational gamers

INTRODUCTION

Desire thinking is a voluntary cognitive process that involves the imaginal forecast of a desired activity and the verbal perseveration with plans and good reasons for engaging in it. Considering theoretical models arguing that specific decision-making processes may be involved in the development of gaming disorder, we hypothesized that an initial urge to game might be accelerated by desire thinking, leading to the decision to game in an everyday setting although the gaming behavior may conflict with another activity or certain other goals.

METHODS

A pre-study helped developing a catalogue of situations that provides forced-choice scenarios warranting a decision for or against gaming. To explore the postulated sequence of cognitive and affective events, a serial mediation model with urge to game as predictor, decision to game as dependent variable, and imaginal prefiguration and verbal perseveration as mediators was tested in a sample of 118 recreational gamers with varying degrees of gaming intensity.

RESULTS

The pre-study revealed a catalogue of 18 conflicting situations that likely happen in the daily life of gamers, containing conflicting activities such as job/educational performance and meeting friends/family/acquaintances. In the sequential mediation model, the desire thinking facets imaginal prefiguration and verbal perseveration fully mediated the relation between an initial urge and the decision to game.

CONCLUSIONS

The mediation model emphasizes the serial ordinance of desire thinking facets and their role in motivating decisions to game after an initial urge has been experienced. Results may indicate that desire thinking plays a considerable role in problematic gaming tendencies.

Electroacupuncture versus solifenacin for women with urgency-predominant mixed urinary incontinence: a protocol for a three-armed non-inferiority randomized controlled trial

Background

Among women suffering from urinary incontinence (UI), about one-third are diagnosed with mixed urinary incontinence (MUI), among which urgency-predominant MUI causes more shame and inconvenience to patients. The treatments for urgency-predominant MUI have limited guidelines and previous studies have indicated that electroacupuncture (EA) might be a safe and effective option. The present study aims to evaluate the effect of EA on women with urgency-predominant MUI.

Methods

The study is a multicentered, three-armed, non-inferiority randomized clinical trial. A total of 282 female patients with urgency-predominant MUI will be randomly divided into three groups, namely the EA group, sham electroacupuncture (SA) group, and solifenacin treatment group at a ratio of 1:1:1. Thirty-six sessions of acupuncture treatment over 12 weeks and solifenacin treatment over 36 weeks will be provided. The primary outcome will be the decrease of urgency urinary incontinence (UUI) episodes after 12-week treatment. Secondary outcomes will include changes in incontinence episodes, urinary frequency, urgency, severity of symptoms, and influence on quality of life, assessed using the International Consultation on Incontinence Questionnaire Short Form (ICIQ SF) and Overactive Bladder Questionnaire Short Form (OAB-q SF). All patients will be continuously followed up until week 36 and their allocations will be statistically analyzed.

Discussion

Though placebo of solifenacin is rather difficult to access and all patients in the trial cannot be fully blinded, the present study will serve as an introduction of three-armed, randomized, non-inferiority, and sham acupuncture-controlled clinical trials to the acupuncture field, in an attempt to compare the effects of EA and solifenacin for treating women with urgency-predominant MUI.

Trial registration

ClinicalTrials.gov: NCT03787654. Registered on 25 December, 2018.

Cue salience of the use of an electronic nicotine delivery system (ENDS) device marketed to women

INTRODUCTION

Passive exposure to the use of electronic nicotine delivery systems (ENDS or e-cigarettes) has been shown to generalize as a smoking cue. As young adult women in particular are increasingly targeted by ENDS distributors, the present study examined whether passive exposure to the use of a female-marketed ENDS product selectively enhanced smoking urge, cigarette and e-cigarette desire, and smoking behavior among women (vs men) smokers.

METHODS

Using a mixed design, young adult smokers (n = 64; mean age 28.2 yrs.; ≥5 cigarettes/day) observed a study confederate drink bottled water (control cue) and then vape a female-marketed tank-based ENDS (active cue). Main measures were the Brief Questionnaire of Smoking Urges (BQSU) and visual analog scales (VAS) for cigarette and e-cigarette desire pre- and post-cue exposure, followed by a smoking latency task.

RESULTS

Compared to the control cue, the female-marketed ENDS cue increased smoking urge and desire for cigarettes and e-cigarettes to a similar extent in women and men. It also affected subsequent smoking behavior similarly between the sexes, with 68% of men and 58% of women opting to smoke (vs. obtaining monetary reinforcers).

CONCLUSIONS

Both women and men were sensitive to the use of the female-marketed ENDS as a smoking cue. Consistent with prior work by our group, findings demonstrate the cue salience of ENDS, which may be attributable to the aspects of vaping that resemble traditional smoking (e.g. hand-to-mouth and inhalation and exhalation behaviors).

The urge to blink in Tourette syndrome

Functional neuroimaging studies have attempted to explore brain activity that occurs with tic occurrence in subjects with Tourette syndrome (TS). However, they are limited by the difficulty of disambiguating brain activity required to perform a tic, or activity caused by the tic, from brain activity that generates a tic. Inhibiting ticcing following the urge to tic is important to patients' experience of tics and we hypothesize that inhibition of a compelling motor response to a natural urge will differ in TS subjects compared to controls. This study examines the urge to blink, which shares many similarities to premonitory urges to tic. Previous neuroimaging studies with the same hypothesis have used a one-size-fits-all approach to extract brain signal putatively linked to the urge to blink. We aimed to create a subject-specific and blink-timing-specific pathophysiological model, derived from out-of-scanner blink suppression trials, to eventually better interpret blink suppression fMRI data. Eye closure and continuously self-reported discomfort were reported during five blink suppression trials in 30 adult volunteers, 15 with a chronic tic disorder. For each subject, data from four of the trials were used with an empirical mathematical model to predict discomfort from eye closure observed during the remaining trial. The blink timing model of discomfort during blink suppression predicted observed discomfort much better than previously applied models. Combining this approach with observed eye closure during fMRI blink suppression trials should therefore extract brain signal more tightly linked to the urge to blink. The simple mean of time-discomfort curves from each subject's other trials also outperformed older models. The TS group blinked more than twice as often during the blink suppression block, and reported higher baseline discomfort, smaller excursion from baseline to peak discomfort during the blink suppression block, and slower return of discomfort to baseline during the recovery block.

The gambling craving experience questionnaire: Psychometric properties of a new scale based on the elaborated intrusion theory of desire

Both research and clinical practice acknowledge the importance of craving as a maintenance and relapse factor in gambling disorder. The elaborated intrusion theory (EIT; Kavanagh et al., 2005) of desire has been extensively investigated in relation to psychoactive substance or food cravings but, to date, has scarcely been studied in relation to gambling. In such a context, developing an assessment tool of gambling craving based on the EIT is warranted. To fill this gap in the literature, we aimed to develop and test the psychometric properties of a gambling-adapted version of the Craving Experience Questionnaire (CEQ; May et al., 2014), which is the best established measure of craving theoretically anchored in the EIT. An online survey that included the gambling CEQ (g-CEQ) and a craving induction procedure was administered to 274 community participants involved in gambling at least a few times a year. Concurrent and convergent validity were explored through correlations with a scale that measured gambling urge and with a series of questionnaires that measured disordered gambling symptoms, gambling cognitions, and gambling motives. The confirmatory factor analyses supported the validity of the expected three-factor model of the "strength" and "frequency" forms of the g-CEQ and showed better model fit than a one-factor solution, corroborating the initial structure of the CEQ. Furthermore, the scale has good internal consistency and its validity is supported by correlations with gambling-related constructs. The g-CEQ is thus a theoretically and psychometrically sound instrument to measure gambling craving based on the EIT.

The role of E-liquid vegetable glycerin and exhaled aerosol on cue reactivity to tank-based electronic nicotine delivery systems (ENDS)

RATIONALE

Electronic nicotine delivery systems (ENDS or e-cigarettes) share salient features of combustible smoking, such as inhalation and exhalation behaviors, and evidence indicates that first- and second-generation ENDS generalize as smoking cues. The present study examined whether newer, tank-based third-generation ENDS ("mods") also evoke smoking urges, and whether enhancing the visibility of exhaled aerosol clouds-by increasing the e-liquid vegetable glycerin (VG) content-strengthens the cue salience of ENDS.

OBJECTIVES

The objective was to assess the role of exhaled aerosol clouds on ENDS cue potency using a standardized laboratory paradigm designed to mimic real-world exposures.

METHODS

Using a mixed design, young adult smokers (n = 50; mean age 26.5 years; ≥ 5 cigarettes/day) observed a study confederate drinking bottled water (control cue) and vaping an ENDS mod containing e-liquid with either high (73%) or low (0%) VG. Participants completed the Brief Questionnaire on Smoking Urges (BQSU) and visual analog scales (VAS) assessing cigarette and e-cigarette desire pre- and post-cue exposure.

RESULTS

Increasing the e-liquid content of VG enhanced the size and visibility of the exhaled aerosol clouds and evoked a greater increase in smoking desire and a more sustained increase in e-cigarette desire relative to the low VG cue. Both cues elicited increases in smoking urges. These results remained after controlling for sex, prior ENDS experience, recent smoking behavior, and menthol preference.

CONCLUSIONS

Observation of tank-based ENDS use generalizes as a smoking cue and its cue salience is strengthened by increasing the e-liquid content of VG to enhance the visibility of the exhaled aerosol cloud.

Cue-Reactive Imagery Mediates the Relationships of Reward Responsiveness with Both Cue-Reactive Urge to Gamble and Positive Affect in Poker-Machine Gamblers

Previous research has demonstrated that gambling cues (e.g., flashing lights on poker-machines) can trigger an urge to gamble in poker-machine gamblers. However, the psychological mechanisms that promote the urge to gamble remain poorly understood. The present study explored whether reward responsiveness predicted urge to gamble and positive affect, and whether cue-reactive rationality, volitional control and imagery mediated these relationships. Ninety-three (45% male and 55% female) Australian regular poker-machine gamblers aged between 18 and 77 participated in an online cue-reactivity experiment. Participants initially completed the Problem Gambling Severity Index and Reward Responsiveness scale. Subsequently, at three time points (i.e., baseline, directly after a neutral cue and directly after a gambling cue) participants completed the rationality, volitional control and imagery subscales of the Phenomenology of Consciousness Inventory and two visual analogue scales that measured urge to gamble and positive affect. Analyses indicated that gambling cues triggered statistically significant increases in both urge to gamble and positive affect and these variables were statistically significantly positively correlated with reward responsiveness. Furthermore, only cue-reactive imagery mediated the relationships between reward responsiveness and the two outcome variables (i.e., cue-reactive urge to gamble and positive affect). These findings highlight the potential importance of targeting reward responsiveness and cue-reactive mental imagery in the context of exposure therapies for poker-machine problem gamblers.

Impulsivity and Response Latency in Non-Suicidal Self-Injury: The Role of Negative Urgency in Emotion Regulation

Impulsivity is thought to be a contributing factor in non-suicidal self-injury (NSSI), yet the research is limited and inconsistent. In particular, little is known about how impulsivity is associated with response latency between initial urge and later self-injury, emotion regulation processes, or severity of NSSI. In this study, we tested group differences between participants with and without a history of NSSI on a questionnaire measure of impulsivity. In addition, we tested hypothesized correlations between impulsivity and relevant variables within the NSSI sample using questionnaires and self-reported response latency between urge and injury. Participants included 159 undergraduate students, 84 with an NSSI history and 75 without an NSSI history. Results indicated greater impulsivity on facets of Urgency and (lack of) Perseverance for the NSSI group. Within the NSSI sample, facets of impulsivity were associated with difficulties in emotion regulation and NSSI severity, but not response latency. In addition, response latency, a possible behavioral marker of impulsivity, was not associated with emotion regulation processes or NSSI frequency. These results suggest that higher scores on self-report measures of impulsivity, but not behavioral response latency measures, are associated with emotion regulation processes in individuals who self-injure.

Long-term urinary symptoms in adolescent and adult women with congenital adrenal hyperplasia

BACKGROUND

Congenital adrenal hyperplasia (CAH) is an autosomal recessive condition resulting in excess androgen production. Females are typically born with ambiguous genitalia and often undergo feminising genitoplasty in infancy or childhood. Recently, there has been considerable international debate as to whether distressing urinary symptoms in CAH patients are truly present and, if so, whether these urinary problems are a consequence of the feminising genitoplasty.

OBJECTIVE

To identify and assess any urinary symptoms in an Australian cohort of adolescent and adult women with CAH who have undergone feminising genitoplasty in infancy, childhood or adolescence as a part of their management.

STUDY DESIGN

Females with CAH aged 12-40 years, who had undergone feminising genitoplasty, and were identified from a hospital database (n = 72). Those aged 12-15 years were assessed using the Paediatric Incontinence Symptom Index questionnaire in conjunction with sections of the Bristol Female Lower Urinary Tract Symptoms Scored Form questionnaire. Those aged 16-40 years were assessed using the Bristol Female Lower Urinary Tract Symptoms Scored Form questionnaire. Uroflowmetry studies and post-void residual volume ultrasounds were also conducted. Previously published normative data were used for the control population.

RESULTS

Responses to the questionnaire indicated that CAH patients had a higher incidence of urgency, frequency, urge incontinence, unexplained incontinence and nocturnal incontinence, when compared to previously published control data. Average and maximum urine flow rates measured by uroflowmetry were within normal range; however, the 16-40-year-old age group had significantly increased mean post-void residual volumes (P < 0.001) (Summary table).

DISCUSSION

The presence of lower urinary tract symptoms in these patients has previously been interpreted as a direct outcome of feminising genitoplasty; however, these results could also be accounted for by the virilisation of pelvic floor musculature. Androgens have been shown to increase skeletal muscle mass, but their exact impact on the pelvic floor musculature requires further research. Three previous studies have measured post-void residual volumes in patients with CAH, all of which found it them be raised.

CONCLUSIONS

Patients with CAH appeared to have overall normal urinary flow but increased post-void residual volumes. The data suggested that this population of patients has an increased probability of incontinence, urgency, and frequency when compared to a control population. These results confirmed findings of other small studies; however, it remains unclear if these changes reflected the underlying diagnosis or were a consequence of management.

Efficacy of pelvic floor muscle training in women with overactive bladder syndrome: a systematic review

INTRODUCTION AND HYPOTHESIS

Our objective was to evaluate the effectiveness of pelvic floor muscle training (PFMT) in reducing overactive bladder (OAB) symptoms in women.

METHODS

Searches were performed at MEDLINE, PubMed, Physiotherapy Evidence Database (PEDro), Scielo, and Central Cochrane Library PubMed until January 2017. Controlled trials were researched by two independent reviewers. Eligible studies were restricted to random and controlled clinical trials that investigated the effectiveness of PFMT in decreasing OAB symptoms. Qualitative methodology was evaluated using the PEDro scale. Data was analyzed and interpreted qualitatively.

RESULTS

The final search retrieved eight studies (n = 1161 women with urgency symptoms), which were published between 2002 and 2016. The methodological scores varied between 4 and 7 in the PEDro scale. PFMT, with the objective of controlling urgent micturition, demonstrated improvements in quality of life in women with OAB. Most data in this revision came from small- to moderate-sized trials, with different and inconsistent outcome measures, which could have impacted the end results.

CONCLUSIONS

The literature regarding the effectiveness of PFMT in OAB remains heterogeneous and inconclusive.

Gender differences in temporal relationships between gambling urge and cognitions in treatment-seeking adults

Many gambling-specific CBT programs seek to target either gambling-related urge or cognitions or both. However, little is known of the influence of one symptom type on another across time and whether these differ for men and women help-seeking problem gamblers. The aim of this study was threefold: to determine presence of measurement invariance for urge and cognition measures over time; to investigate the effect of baseline urge on end-of-treatment gambling-related cognitions - and the reciprocal relationship; and, identify whether these pathways differ across gender. Self-reported gambling urge (GUS), and gambling-related cognitions (GRCS) data from treatment-seeking problem gamblers prior to and post treatment (N = 223; 62% men) were analyzed with cross-lagged panel models, moderated by gender. Conceptualization of urge and cognitions were found to be temporally stable. There was no significant association between baseline GUS scores and post-treatment GRCS scores, nor the reverse relationship. Putatively, this infers that coexisting urge and gambling-related cognition components of problem gambling operate independently over time. Analyses revealed gambling urge had a significantly stronger tracking correlation across time for men than women when adjusting for cognition paths. This investigation provides early evidence for tailoring CBT in response to sub-population gambling-related characteristics, demonstrated across men and women.

Unconscious priming dissociates 'free choice' from 'spontaneous urge' responses

Advances in neuroscience offer the exciting prospect of understanding 'free' choices - the subject of the free will debate in philosophy. However, while physiological techniques and analysis have progressed rapidly to meet this challenge, task design has not. The challenge is now to develop laboratory tasks that adequately capture 'free' picking or choosing. To isolate 'internally' generated intentions from those impelled by external stimulus, observers are asked to 'choose freely' or to wait for a felt 'urge'. However, no previous work has explicitly distinguished between instructions that refer to 'urges' versus to 'choosing'. The philosopher Alfred Mele (e.g., 2009; 2014) has argued that the distinction is of crucial conceptual importance, but the two have not yet been empirically distinguished. Here, we show that conscious and unconscious, task-irrelevant primes, bias observers' binary choices when they are instructed to 'choose freely', not when they 'wait for an urge', underscoring the practical importance of Mele's conceptual distinction. Neuroscience must incorporate this distinction if we are to understand processes underpinning free choice.

Gestational Urinary Incontinence in Nulliparous Pregnancy- A Pilot Study

INTRODUCTION

Urinary Incontinence (UI) in pregnancy is more than a disease; it is a social problem that necessitates special care and management. The exact rationales and biological facts behind urinary incontinence during pregnancy are unclear and multivariate.

AIM

This pilot study was designed to examine the direct effect of gestational factors (e.g., physical and metabolic/hormonal) on the presence of Gestational Urinary Incontinence (GUI), in nulliparous pregnant women.

MATERIALS AND METHODS

This was a questionnaire-based study comprising of 61 nulliparous pregnant woman who had not experienced any Urinary Incontinence (UI) before their pregnancies. Patients were examined during their pregnancies within the framework of the antenatal care program continued at the Division of Perinatology, Hacettepe University, Ankara, Turkey, between January 2015 and December 2016. A 'urinary incontinence questionnaire' was used three times during different periods of gestation (11-14, ~24 and ~37 gestational weeks) for each patient. Statistical analysis was performed using the SPSS software version 20.0. The Chi-Square test or Fisher's-exact test was used to compare proportions in groups.

RESULTS

The prevalence of total urinary incontinence (stress urinary incontinence, urge urinary incontinence and mixed urinary incontinence) in nulliparous pregnant women was 4.9% (n=3), 9.8% (n=6) and 26.2% (n=16) at 11-14, ~24 and ~37 gestational weeks, respectively. Stress urinary incontinence was found to be 3.3% (n=2), 6.6% (n=4) and 16.4% (n=10) at 11-14, ~24 and ~37 gestational weeks, respectively. Urge urinary incontinence frequency was found to be 1.6% (n=1), 3.3% (n=2), 6.6% (n=4), and mixed urinary incontinence frequency was 0% (n=0), 0% (n=0), 3.3% (n=2) at 11-14, ~24 and ~37 gestational weeks, respectively. Maternal age, birth weight of the neonate and gestational age at birth had no statistically significant effect on GUI.

CONCLUSION

Urinary incontinence is an important issue during pregnancy and related symptoms are more common in third trimester.

The Mini Alcohol Craving Experience Questionnaire: Development and Clinical Application

BACKGROUND

Standardized alcohol craving scales are rarely used outside of research environments despite recognized clinical utility. Scale length is a key barrier to more widespread application. A brief measure of alcohol craving is needed to improve research and treatment of alcohol use disorders (AUDs). Grounded in the Elaborated Intrusion Theory of Desire, the Alcohol Craving Experience (ACE) Questionnaire comprises two 11-item self-report scales that assess past-week frequency and maximum strength of alcohol craving. This study aimed to create a brief version of the ACE while maintaining psychometric integrity and clinical utility.

METHODS

Patients attending a university hospital alcohol and drug outpatient service for the treatment of AUD completed the ACE as part of a questionnaire battery. Three patient samples were utilized: 519 patients with pretreatment and outcome data, 228 patients with pretreatment data, and 66 patients who completed the ACE at treatment sessions 1 and 2.

RESULTS

The Frequency scale of the ACE possessed greater clinical utility and predictive validity than the Strength scale. Revision of the Frequency measure produced a 5-item "Mini Alcohol Craving Experience" (MACE) Questionnaire. Satisfactory validity (construct, predictive, concurrent, convergent, and incremental) and reliability (internal and test-retest) were maintained. A 1 standard deviation increase in pretreatment MACE score was associated with a 54 percentage increase in the odds of patient lapse or dropout.

CONCLUSIONS

The MACE provides a brief, theoretically, and psychometrically robust measure of alcohol craving suitable for use with AUD populations in time-limited clinical and research settings.

Cue-Reactive Rationality, Visual Imagery and Volitional Control Predict Cue-Reactive Urge to Gamble in Poker-Machine Gamblers

Poker-machine gamblers have been demonstrated to report increases in the urge to gamble following exposure to salient gambling cues. However, the processes which contribute to this urge to gamble remain to be understood. The present study aimed to investigate whether changes in the conscious experience of visual imagery, rationality and volitional control (over one's thoughts, images and attention) predicted changes in the urge to gamble following exposure to a gambling cue. Thirty-one regular poker-machine gamblers who reported at least low levels of problem gambling on the Problem Gambling Severity Index (PGSI), were recruited to complete an online cue-reactivity experiment. Participants completed the PGSI, the visual imagery, rationality and volitional control subscales of the Phenomenology of Consciousness Inventory (PCI), and a visual analogue scale (VAS) assessing urge to gamble. Participants completed the PCI subscales and VAS at baseline, following a neutral video cue and following a gambling video cue. Urge to gamble was found to significantly increase from neutral cue to gambling cue (while controlling for baseline urge) and this increase was predicted by PGSI score. After accounting for the effects of problem-gambling severity, cue-reactive visual imagery, rationality and volitional control significantly improved the prediction of cue-reactive urge to gamble. The small sample size and limited participant characteristic data restricts the generalizability of the findings. Nevertheless, this is the first study to demonstrate that changes in the subjective experience of visual imagery, volitional control and rationality predict changes in the urge to gamble from neutral to gambling cue. The results suggest that visual imagery, rationality and volitional control may play an important role in the experience of the urge to gamble in poker-machine gamblers.

Trait Mindfulness, Problem-Gambling Severity, Altered State of Awareness and Urge to Gamble in Poker-Machine Gamblers

In Australia, poker-machine gamblers represent a disproportionate number of problem gamblers. To cultivate a greater understanding of the psychological mechanisms involved in poker-machine gambling, a repeated measures cue-reactivity protocol was administered. A community sample of 38 poker-machine gamblers was assessed for problem-gambling severity and trait mindfulness. Participants were also assessed regarding altered state of awareness (ASA) and urge to gamble at baseline, following a neutral cue, and following a gambling cue. Results indicated that: (a) urge to gamble significantly increased from neutral cue to gambling cue, while controlling for baseline urge; (b) cue-reactive ASA did not significantly mediate the relationship between problem-gambling severity and cue-reactive urge (from neutral cue to gambling cue); (c) trait mindfulness was significantly negatively associated with both problem-gambling severity and cue-reactive urge (i.e., from neutral cue to gambling cue, while controlling for baseline urge); and (d) trait mindfulness did not significantly moderate the effect of problem-gambling severity on cue-reactive urge (from neutral cue to gambling cue). This is the first study to demonstrate a negative association between trait mindfulness and cue-reactive urge to gamble in a population of poker-machine gamblers. Thus, this association merits further evaluation both in relation to poker-machine gambling and other gambling modalities.

Patterned changes in urge ratings with tic suppression in youth with chronic tic disorders

BACKGROUND

Premonitory urges are central to emerging behavioral models of chronic tic disorders (CTD). Urge reduction has been proposed as a behavioral explanation for tic maintenance and exacerbation as well as the efficacy of behavioral treatments. Prior investigations have produced inconsistent findings despite common methodologies. The current study evaluated the possibility that data aggregation obscures distinct and meaningful patterns of change in urge ratings when tics are freely expressed versus suppressed.

METHOD

Participants (n = 12) included children with moderate-to-marked tic severity and noticeable premonitory urges. Tic frequencies and urge ratings were obtained at 15 s and 10-s intervals, respectively, across an alternating sequence of 10-min tic freely and 40-min tic suppression conditions. Patterns were established using a two step approach.

RESULTS

Five distinct patterns of urge rating change emerged, suggesting data aggregation may obscure meaningful patterns in the urge-tic relationship when tics are completed versus suppressed.

LIMITATIONS

Eligibility criteria may have unintentionally excluded younger affected children and included older participants with more severe tic disorders than commonly seen. Additional research with less stringent eligibility criteria and a larger sample size will help validate the results.

CONCLUSIONS

The relationship between urges and tics is much more complex than previously theorized. Investigations that rely on global assessments of urge and tic severity and/or assume uniformity when aggregating participant data may obscure meaningful differences in the urge-tic relationship. Future investigations should examine the possibility that individual differences and/or developmental considerations modulate the functional urge-tic relationship.

The Yale Craving Scale: Development and psychometric properties

INTRODUCTION

The current study presents a psychometric evaluation of the Yale Craving Scale (YCS), a novel measure of craving for cigarettes and alcohol, respectively. The YCS is the first craving measure to use a generalized Labeled Magnitude Scale (gLMS) as the scoring format, which facilitates between-group comparisons of subjective craving and eliminates ceiling effects by assessing the full range of imaginable sensation intensities.

METHODS

Psychometric evaluations of the YCS for use with cigarettes (YCS Smoking) and alcohol (YCS Drinking) included assessments of latent factor structure, internal consistency, ceiling effects, and test-criterion relationships. Study samples included 493 treatment-seeking smokers and 213 heavy drinkers.

RESULTS

Factor analyses of the 5-item YCS Smoking and Drinking scores confirmed a 1-factor scale. The YCS Smoking and Drinking scores evidenced: (1) good internal consistency, (2) scalar measurement invariance within several subgroups (e.g., smoking/drinking status; nicotine/alcohol dependence), (3) convergent relationships with extant craving measures, and (4) concurrent relationships with smoking/drinking outcomes.

CONCLUSIONS

These results suggest that the YCS represents a psychometrically sound scale for assessing smoking and drinking urges in dependent populations.

Tourette Syndrome: Update

Tourette Syndrome is a disorder characterized by tics. It typically begins in childhood and often improves in adult life. Tics are best described as voluntary movements made automatically so that volition is not ordinarily appreciated. There is frequently an urge, sometimes in the form of a specific sensory feeling (sensory tic), that precedes the tic. Patients say that they make the tic in order to reduce the urge, although shortly after the tic, the urge recurs. The sensory feeling may arise due to defective sensory habituation. Since tics relieve the urge, this can be considered rewarding, and repetition of this behavior may perpetuate the tic as a habit. Tourette Syndrome affects boys more than girls and is associated with attention deficit hyperactivity disorder and obsessive compulsive disorder. Although Tourette Syndrome often appears to be autosomal recessive in inheritance, it has been difficult to find any abnormal genes. There is a loss of inhibition in these patients and recent studies show abnormalities in brain GABA. Certainly there is also an abnormality in dopamine function and dopamine blocking agents are effective therapy. In severe drug-refractory patients, deep brain stimulation can be effective.

Perceived smoking availability differentially affects mood and reaction time

INTRODUCTION

This between subjects study explored the relationship between smoking availability and smoking motivation and is the first study to include three smoking availability time points. This allowed for an examination of an extended period of smoking unavailability, and a test of the linearity of the relationships between smoking availability and smoking motivation measures.

METHODS

Ninety 3-hour abstinent smokers (mean ~15 cigarettes per day) were randomly assigned to one of three availability manipulations while being exposed to smoking stimuli (i.e., pack of cigarettes): smoke in 20 min, smoke in 3 h, or smoke in 24 h. Participants completed pre- and post-manipulation measures of urge, positive affect and negative affect, and simple reaction time.

RESULTS

The belief that smoking would next be available in 24 h resulted in a significant decrease in positive affect and increase in negative affect relative to the 3 h and 20 min conditions. A Lack of Fit test suggested a linear relationship between smoking availability and affect. A quadratic model appeared to be a better fit for the relationship between smoking availability and simple reaction time with participants in the 24 h and 20 min conditions showing a greater slowing of reaction time relative to the 3 h condition. There were no effects of the manipulations on self-reported urge, but baseline ceiling effects were noted.

CONCLUSIONS

Future investigations that manipulate three or more periods of time before smoking is available will help to better elucidate the nature of the relationship between smoking availability and smoking motivation.

Central inhibition of refractory overactive bladder complaints, results of an inpatient training program

SHORT INTRODUCTION

Overactive bladder (OAB) in children has an overall reported incidence of 16.6-17.8%, with its prevalence of 0.2-9% varying largely between age and gender. OAB is the most important burden in pediatric urology because of the limited effect of treatment. OAB with imperative urge and/or urge incontinence can often be successfully treated with urotherapy and pharmacological treatment. Nevertheless, approximately 20% of patients are considered to be therapy resistant for common treatment options. For the latter group, an inpatient cognitive and biofeedback training program for children has been developed.

OBJECTIVE

Our objective is to evaluate the effect of an inpatient cognitive and biofeedback training program for children with urge complaints and urge incontinence based on overactive bladder (OAB) after failed earlier treatment by anticholinergic medication and by outpatient urotherapy. A search for predictors for success of treatment outcome is included in the study.

STUDY DESIGN

Seventy children with therapy refractory incontinence based on OAB went through a 10-day in-hospital training program between 2007 and 2010. The children were aged between 7 and 13 years (mean 9.29 years) and 48 (68.6%) were male. An essential part of this program is teaching the children central inhibition of their bladder to suppress bladder overactivity. Before attending this training program patients had on average 41.1 months of fruitless treatment by urotherapy and medication, and if needed preceding surgery for meatus correction or deobstruction. The training result was evaluated 6 months after completion of the inpatient training program. A questionnaire was subsequently conducted 2 years after the training to evaluate the long-term efficacy of this program.

RESULTS

Six months after training, evaluation showed that 30 of the 70 patients (42.9%) were free of complaints, 22 (31.4%) had a significant reduction in complaints and 18 (25.7%) had no improvement. Logistic regression analysis was used to look at several variables predicting training outcome. A higher age during clinical training was found to be a predictor for a good training outcome. After 2 years, 44 (62.9%) patients were reached for long-term follow-up. Of these patients, 28 (63.6%) reported a good effect of the training and 11 (25%) experienced no improvement in symptoms compared with before clinical training. Objectively, 26 (59.1%) were dry and 18 (40.9%) were incontinent to some extent. A total of 30 (68.2%) patients had not relapsed into urge complaints (McNemar's test P-value <0.05).

DISCUSSION

Age was found to be a predictor of a good training result, which is in line with the findings of other publications where children above the age of 8 demonstrate better and faster training results. The absolute number of participants to perform statistical analysis on was low, even though it was the number maximally achievable in this cohort, possibly explaining how other variables could not be found to predict training outcome. No differences in outpatient therapy results were observed between patients having received earlier outpatient urotherapy in our hospital when compared with being trained elsewhere. This is coherent with previous research indicating that for outpatient training, the attention offered to the child is of paramount importance. Regarding long-term follow-up, keeping in mind long-term follow-up patient numbers were incomplete, a good effect of the training was seen with a clear reduction in incontinence complaints. Far fewer children are suffering from urge complaints, although some patients had relapsed into urge complaints.

CONCLUSION

The inpatient cognitive and biofeedback training program for refractory OAB complaints has been demonstrated to cure or improve 74.3% of patients, and conveyed favorable long-term results in approximately 75.0% of patients. A higher age during clinical training was found to be a predictor for good training outcome.

The effect of repeated exposure to virtual gambling cues on the urge to gamble

INTRODUCTION

This study aimed to investigate the effectiveness of using a virtual reality (VR) casino environment in cue exposure therapy (CET) for gambling. The main objective of this study was to assess the ability of five VR casino cues to elicit subjective reactions and physiological responses that can be used within the CET paradigm. A second objective was to analyze changes in participants' urge to gamble after repeated exposure to a VR casino program and relaxation training.

METHODS

Twelve recreational gamblers were exposed to five virtual environments with casino-related cues that reproduced typical gambling situations. Self-reported subjective urges and psychophysiological responses were recorded during exposure.

RESULTS

All virtual environments with casino-related cues generated craving in recreational gamblers, whereas no increase in the psychophysiological variables was observed. In addition, urges to gamble elicited by VR casino environment reduced through repeated exposure and relaxation training.

CONCLUSION

These findings provide evidence of the effectiveness of VR for simulating casino environments in the treatment of gambling.

The relationship between smoking motives and smoking urges experienced in response to a negative affect induction

INTRODUCTION

The present study attempted to further elucidate the relationship between self-reported smoking motives and affect in college students.

METHOD

Smoking motives were measured via self-report, and following a laboratory negative affect (NA) mood induction, urge to smoke was assessed via three questions. Participants were college students (N=84) who reported smoking an average of 8.74 (SD=5.36) cigarettes per day.

RESULTS

Results indicated that smoking motives for Positive Reinforcement and Automaticity significantly predicted participants' responses on two measures of urge to smoke immediately following the NA induction. Positive Reinforcement motives were predictive of urge to smoke, and Automaticity motives were predictive of the number of cigarettes participants stated that they would smoke if cigarettes were provided for free.

CONCLUSIONS

These findings indicate that (1) the association between NA and smoking is perhaps more complex than previously thought; and (2) merely two (Positive Reinforcement, Automaticity) of possibly thirteen smoking motives were identified as predictive of smoking urges. It is particularly surprising that other smoking motives (e.g., Negative Reinforcement) were not significant predictors of urge following the NA induction. Implications for relapse risk and treatment considerations among smokers experiencing elevated NA are considered.

Length of smoking deprivation moderates the effects of alcohol administration on urge to smoke

Although smoking deprivation is often used in laboratory studies to induce urges to smoke cigarettes, the optimal length of deprivation has not been established. Previous research showed that overnight abstinence from cigarettes led to high baseline urge to smoke that potentially masked alcohol's acute effects on urge to smoke (Kahler et al., 2012). The current study examined whether alcohol's effects on smoking urge were more pronounced when a shorter length of smoking deprivation was used (i.e., 3h instead of overnight abstinence). Using a balanced placebo design for alcohol administration, we found that participants experienced a significant increase in self-reported urge to smoke when administered alcohol after a 3-h smoking deprivation (n=32), whereas this effect was smaller and nonsignificant when smokers were required to be abstinent overnight (n=96). Research on factors that heighten smoking urges may find stronger effects if a 3-h deprivation is used compared to using overnight abstinence.

Executive function and appetitive processes in the self-control of alcohol use: the moderational role of drinking restraint

BACKGROUND

Dual process models characterize hazardous drinking as a function of appetitive processes and executive processes that enable self-control. Although central to a number of models (e.g., Hofmann et al., 2009a,b), little empirical research has examined how drinking restraint may influence the effects of these processes on alcohol use. The current study examined whether drinking restraint influenced the predictive value of appetitive responses to alcohol cues and executive functioning on typical drinking behavior. It was hypothesized that the interaction between appetitive responses and executive functioning would only be observed among those who had stronger drinking restraint goals.

METHODS

Sixty-nine hazardous drinking young adults (ages 21-30) completed the Trail Making Test and then were exposed to the sight and smell of an alcoholic beverage that they anticipated they would consume. Urge and anticipated stimulant effects of alcohol (A-BAES) were measured following the exposure.

RESULTS

The interaction between Trails B and each of the appetitive response ratings (i.e., urge rating and A-BAES) was predictive of drinking behavior (TLFB) only among those high in drinking restraint.

CONCLUSIONS

These findings highlight the importance of incorporating the role of motivational constructs such as restraint goals in current dual process models of alcohol-related self-control.

[Micturition and cognition]

PURPOSE

The physiopathology of the voiding and urinary continence was one of the hot topic of research these last few years. Unfortunately, anyone have already found a unique cause which could explain urinary incontinence (urge or stress). The concept of cognitive function highlights new ways of research to show the fundamental role of the cortex and the sub-cortex in these diseases.

METHODS

A comprehensive literature review using Pubmed, Medline, Embase and Cochrane: "cognition, urinary tract, urinary continence, neuroimaging, IRMf, micturition, urge, brain factor and cognitive therapy". In all the articles, 72 really dealt with micturition and cognition.

RESULTS

New imaging techniques allowed to show the relationship between the different brain area involved in the bladder control such as the periaqueductal gray, the hypothalamus, the insula, the anterior cingulated cortex and the prefrontal cortex. These cortical area are equally involved in cognition. An alteration of urinary continence implies a modification of activation of these cortical areas.

CONCLUSION

A better knowledge of the cognitive side of micturition and urinary continence will allow to improve the treatment of their associated diseases.

The influence of an overactive bladder on falling: a study of females aged 40 and older in the community

PURPOSE

An overactive bladder (OAB) affects a person's quality of life. Patients who suffer from OAB run to the toilet frequently to prevent incontinence, and this behavior increases their risk of falling and fear of falling. This study evaluated the influence of OAB on falls and concern about falling in females aged 40 and over living in urban and rural communities.

METHODS

We conducted a population-based cohort study using King's Health Questionnaire (KHQ), the Korean version of Falls Efficacy Scale-International (KFES-I) and a questionnaire regarding falls, in females aged 40 and over in Guri city and Yangpyeong county. The data from 514 responders were analyzed. The definition of OAB was 'moderately' or 'a lot' of urgency, or urge incontinence in KHQ. Falls was defined as experience of falls in the last year. High fear of falling was defined as a score of 24 or over in KFES-I. The factors were analyzed by the exact chi-square test and Student's t-test. The multivariate logistic regression model was adopted in order to examine the effects of OAB on falls and concern about falling.

RESULTS

Of the 514 responders, 98 fitted the criterion of OAB. Eighty-nine (17.3%) of the responders had experienced falls in the last year: twenty-seven (27.5%) in the group with OAB and 62 (14.9%) in the group without OAB. There was a significant association between falls and OAB (odds ratio [OR], 1.76; 95% confidence interval [CI], 1.00 to 3.08; P=0.0485), and between high fear of falling and OAB (OR, 2.72; 95% CI, 1.42 to 5.20; P=0.0024).

CONCLUSIONS

Urgency and symptoms of urge incontinence increase the risk of falls in women aged 40 or older in the community. Early diagnosis and proper treatment may prevent falls and improve quality of life in OAB patients.