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PubMedDate not supplied

New approaches for managing stress incontinence in women.

Stress urinary incontinence is a problem for one in four women seen in the primary care setting. The incontinence usually is not identified as women do not view it as a problem, do not seek treatment, and turn to self-care practices. Technology in product development is evolving that can assist women in managing their incontinence. This article reviews new innovations in treatment that can be recommended by primary care providers.

Exercise Therapy↗
PubMed1995

Costs and management of urinary incontinence in long-term care.

The three aims of the study were (1) to assess the impact and cost of urinary incontinence in long-term care, (2) to determine whether 24-hour incontinence monitoring provides information that improves management, and (3) to ascertain whether costs (nursing time and laundry) could be reduced. The setting was two 24-bed long-term care units in an urban hospital. The research was conducted in three stages. During the initial stage, the impact of incontinence was measured on each unit. Impact was defined as total number of incontinent episodes, nursing time spent changing these patients, and laundry costs, measured during a 7-day period on each unit. After this phase of the investigation, individualized 24-hour incontinence monitoring, followed by recommendations and implementation of care plan, was carried out on one unit. No monitoring or recommendations for care were completed on the other unit, which served as a control. During the third phase of the study, the number of incontinent episodes, nursing time, and laundry costs were again measured on both units. Initially (58%) of residents (24/48) were incontinent, representing 859 episodes of urinary leakage each week that required 45 hours of nursing time to change clothing, containment devices, and bed linens. The direct costs of the nursing time and laundry, expressed in Canadian dollars were $8.60/day per incontinent resident. After 24-hour monitoring of 10 residents one on unit, suggestions were made for various incontinence management programs. An unexpected but simple recommendation was a change to a better containment system for urinary leakage. When impact was measured, a 13% reduction in the number of incontinent episodes was found.(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗
PubMedDate not supplied

Choosing and using disposable body-worn continence pads.

Disposable, body-worn pads are the product most commonly chosen to contain and absorb urine and faeces (Pomfret, 2000). The cost to the NHS of supplying continence pads has been estimated at 80 million pounds per annum (Euromonitor, 1999) and is a huge financial burden on local services.

Clinical Competence↗
PubMed2003

[Incontinence aids].

Incontinence aids are mechanical devices that help reduce, capture, absorb or channel urinary and stool loss. They can exert a significant positive impact on the quality of life and the social integration of those affected, as well as provide relief to their care-givers. Incontinence aids are used as a bridge until conservative and operative treatments bring continence, as a complement to other therapies or as a long-term course of treatment. The selection of appropriate incontinence aids, such as vaginal pessaries, penis clamps, and tampons, urinals, urine and faecal collectors, absorbing aids, urethral and suprapubic catheter channelling systems--requires a great deal of experience and an extensive assortment of various products in different sizes. In order to provide the patient with optimal treatment and advice where not only the products available are changing rapidly, but the conditions and environment as well (e.g., insurance reimbursement), close-knit teamwork is required among the physician, incontinence nurse, and the care-providers. Likewise to be considered is the fact that incontinence aids and care requirements vary significantly among the specialties of urogynaecology, urology, paraplegic centres, paediatrics and nursing homes; specific competence centres are therefore required for these areas.

Fecal Incontinence↗
PubMed2005

Pelvic floor dysfunction after Burch colposuspension--a comprehensive study. Part I.

OBJECTIVE: To evaluate the occurrence of voiding dysfunction and symptoms of genital prolapse at long-term follow-up after Burch colposuspension (Bc) in relation to the occurrence of the symptoms in an age-matched normal population. MATERIALS AND METHODS: A follow-up study of the 190 patients who underwent Bc in 1980-88 and 305 age-matched control women randomly selected from the general population. The participants answered a questionnaire in 1998 with detailed questions about the pelvic floor function. Univariate and multivariate analyses were performed. RESULTS: The prevalence and frequency of urinary incontinence were significantly higher in the patient group compared with those in the control group as were urge incontinence, difficulty to start voiding, time needed at the toilet for voiding, the need to return to the toilet for emptying the bladder, feeling of incomplete emptying of the bladder, and limitation of social life because of the leakage. The symptoms of genital prolapse were significantly more common in the patient group in spite of a significantly larger proportion of genital prolapse surgery in this group. Parity, high body mass index, heavy lifting work, chronic pulmonary diseases, hiatus hernias, and hysterectomy were significantly more common in the patient group than among the controls. CONCLUSIONS: At long-term follow-up, patients exhibit substantial symptoms of pelvic floor dysfunction (PFD) concerning voiding dysfunction and symptoms of genital prolapse compared with a normal population. This highlights the importance and need of treating pelvic floor disorders in a comprehensive way. Scientific works with comprehensive studies of PFD are needed.

Activities of Daily Living↗
PubMed1998

[FPSUND: a pan-Canadian evaluation of a clinical classification of urinary incontinence].

Historically, urinary incontinence is divided into 3 subtypes: stress, urge and mixed. This latter group, which according to many studies can account for up to 50% of the patients, is very heterogenous. For this same reason, the reports of treatments of urinary incontinence are very difficult to analyse using this simple classification. In a attempt to clarify this situation and to help the acquisition of useful clinical information relating to urinary incontinence, were have developed a clinical classification of urinary incontinence (FPSUND) in which 6 symptoms are graded in severity from 0 to 3. In this acronym, the F stands for frequency, the P for the use of protection, the S for stress-related complaints, the U for urge-related complaints, the N for nocturia and the D for the number of daily micturitions. Urologists across Canada were sent the French or English version of the classification and used it to evaluate 148 female patients aged from 18 to 70, suffering from urinary incontinence. A second, independent evaluation, was also performed on the same patients by registered nurses or urodynamic technicians. Reproducibility between observers, as assessed by the weighted Kappa score ranged from 0.47 and 0.74 (p < 0.05), was very good. Generally, the users of the classification found it very easy to use. In summary, we propose the FPSUND clinical classification of urinary incontinence as a useful and accurate tool to classify urinary incontinence and as a means to assess treatment outcome.

Adolescent↗
PubMed2006

Does condition-specific quality of life correlate with generic health-related quality of life and objective incontinence severity in women with stress urinary incontinence?

AIMS: We examined the impact of stress urinary incontinence (SUI) on health-related quality of life (QOL) and evaluated the relationships between incontinence-specific QOL and objective disease severity. METHODS: A total of 158 women (mean age 49.9) suffering from SUI were included in the study. The Medical Outcomes Study Short Form-36 (SF-36) and the King's Health Questionnaire (KHQ) were used to assess QOL in the patient and control groups. RESULTS: The SF-36 scores did not show any significant differences between the two groups except for one domain (physical functioning, P = 0.005). The patient KHQ scores were significantly lower than those of the controls (P < 0.001 for all domains). The scores of the KHQ domains correlated with those of the SF-36 domains, but the relationship was low to moderate, ranging from -0.033 to -0.686. However, they did not correlate with Valsalva leak point pressure (VLPP). When patients were divided into the low VLPP group (n = 60) and the higher VLPP group (n = 98), statistically significant differences were found between the groups for general health domains of the SF-36 (P = 0.010) and of the KHQ (P = 0.027). No statistically significant differences were found in other domains of both questionnaires. CONCLUSIONS: The generic QOL instrument is not a sensitive tool for measuring QOL in women with SUI. In addition, our findings suggest that objective disease severity is not associated with generic or incontinence-specific QOL.

Adult↗
PubMedDate not supplied

Choosing continence products for children.

A wide variety of continence products are available, and the range is changing constantly. Selecting products for children with continence difficulties requires sound knowledge, thorough assessment, regular review, and involvement of the child and family. This article provides some guidance on the products available and how to make an informed choice.

Acute Disease↗
PubMed1999

Patient selection and education for use of the CapSure (Re/Stor) continence shield.

Stress urinary incontinence affects millions of women. Many treatment options are available, ranging from behavioral or nonsurgical therapies to surgical intervention. The clinical findings of a multicenter trial using the CapSure (Re/Stor) continence shield to evaluate the safety and efficacy of this device for treating women with stress urinary incontinence are reported here. Additionally, the role of patient education and selection is discussed.

Adult↗
PubMed2005

Continence pads: have we got it right?

Women listed in the Croydon Community Continence database were contacted with a self-assessment questionnaire regarding continence pad usage and quality of life. Completed questionnaires were received from 763 of 1509 (51%) participants. Pads were used for bladder dysfunction (88.1%) and bowel dysfunction (44%). The majority (82.5%) had concurrent medical disorders and problems with mobility with 77.5% being on one or more types of medication. Nearly 39% of women claimed that they would be happy to continue pad use indefinitely and only 28% expressed interest in seeking further help. Compared to bowel dysfunction, bladder dysfunction appeared to have a greater impact on women's quality of life (P < 0.001). Containment products make a substantial contribution in improving the quality of lives of women with bowel and bladder dysfunction. The financial burden of containment products has a major impact on the health budget and therefore, comprehensive clinical evaluation should be mandatory before relegating women to pads as a final resort.

Activities of Daily Living↗
PubMed1986

Perineal pad weighing versus videographic analysis in genuine stress incontinence.

A comparison was made of the sensitivity of perineal pad testing and the videographic diagnosis of genuine stress incontinence (GSI) in postmenopausal women. The 99% upper confidence limit for pad weight gains in 90 normal women was 1.4 g. Ninety-nine women with urodynamically proven GSI were studied and 14 had false negative pad tests. There was no significant correlation between the videographic assessment and the gain in pad weight. We recommend the use of the pad test to confirm incontinence only in the absence of imaging facilities as the latter is more sensitive.

Adult↗
PubMed2004

Comorbidities affect the impact of urinary incontinence as measured by disease-specific quality of life instruments.

The aim of this study was to determine if the impact of urinary incontinence on activities of daily living, as measured by a disease-specific quality of life instrument, is dependent on comorbid conditions. Incontinent kidney transplant recipients participated in a survey to determine the impact of urinary incontinence on activities of daily living using the Incontinence Impact Questionnaire (IIQ-7). Similar information was collected from the charts of nontransplant incontinent women. Participants were matched for age, incontinence severity, pads per day, and leaks per day noted in a 3-day 24-h bladder diary. IIQ-7 scores from participants were compared using Mann-Whitney U tests. Nontransplant incontinent women reported a 200% greater affect of incontinence on activities of daily living than incontinent renal transplant recipients (35.5+/-26.5 vs 12.9+/-15.4, p<0.0001) despite similarities in incontinence severity measures. Urinary incontinence has less of an impact on activities of daily living for renal transplant recipients than nontransplant incontinent women with similar incontinence severity measures because the disease-specific quality of life instrument used in this study was sensitive to their comorbid condition (transplant status).

Activities of Daily Living↗
PubMed1995

Sustained improvement of subjective quality of life in older community-dwelling people after treatment of urinary incontinence.

We aimed to study the impact of conservative non-pharmacological, non-surgical management on quality of life in elderly incontinent patients. Community-dwelling patients age 60 years or older were randomized to receive immediate or delayed conservative management. A number of questions relating to quality of life were administered at admission and then at 2, 4, 8 and 12 months. By 4 months, incontinence was cured in 25% and improved in 63% of patients. The frequency and severity of incontinence was reduced (p < 0.001), and deferment time was improved (p < 0.01). There were statistically significant improvements in subjective quality of life measures at 4 and 12 months involving depression (p < 0.001), isolation (p < 0.03), embarrassment (p < 0.001), laundry (p < 0.001) and smell (p < 0.02) when comparing these variables with initial assessment. This effect did not appear to be a placebo effect as evidenced by comparison with the delayed intervention group, and was sustained over 12 months. There are significant short- and long-term benefits to the quality of life of older patients with incontinence when treated by conservative measures. Intervention studies should measure and report quality of life as an outcome variable.

Activities of Daily Living↗