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Biomedical subjects

C A Brink

Publications and source records attributed to C A Brink.

17 recordsLinked to original sources
PubMed1996

Psychological factors associated with urinary incontinence.

This nursing study about women with urinary incontinence was designed to explore (1) the incidence of depression in women with urinary incontinence, (2) the correlation between mastery and depression and/or self-esteem and depression in women with urinary incontinence, and (3) depression as a mediating factor in the quality of life (QOL) in these women. This study found a higher incidence of depression in women with urinary incontinence compared with the general population. Correlational and multiple regression analyses both revealed strong and significant relationships between the independent variables of mastery and self-esteem and the dependent variable of depression. Depression did not emerge as a mediator in QOL. When mastery, depression, and self-esteem were considered together, mastery was the only predictor with a direct effect on QOL in women with urinary incontinence. Nursing interventions aimed at increasing women's sense of mastery may be effective in decreasing depression and improving the QOL.

Adult↗
PubMed1994

Correlations between dynamic urethral profilometry and perivaginal pelvic muscle activity.

Of 208 ambulatory female subjects evaluated for complaints of urinary incontinence, complete history, physical findings, and urodynamic data were available on 163 patients allowing correlation of measures of perivaginal muscle activity to urethral profilometry measurement of sphincter strength. Perivaginal measures include pelvic digital exam score as well as vaginal electromyography with a modified perinometer. Urethral profilometry was performed at rest and during pelvic muscle contractions in both supine and standing positions. There was a moderate and significant correlation (r = 0.19 to 0.32) between profilometry measures of voluntary sphincter contractions and perivaginal EMG parameters of endurance peak and area, as well as to the digital test parameters of pressure and displacement. The correlation values between the vaginal EMG and the Digital Test scale of perivaginal strength were higher (r = 0.28 to 0.74). When the patients with pure stress incontinence were stratified by degrees of incontinence (mild, moderate, severe), urethral prolfilometry measures were a more accurate indicator of severity of incontinence than measures of perivaginal strength or the degree of bladder neck mobility as measured by the Q-tip test.

Adult↗
PubMed1991

Pelvic muscle exercise for stress urinary incontinence in elderly women.

PURPOSE: To compare pelvic muscle exercise to pharmacologic treatment of stress urinary incontinence, the most common cause of urine leakage reported by community-living elderly women. SUBJECTS: Convenience sample of 157 community-living women, aged 55 to 90 years, after completion of a comprehensive diagnostic evaluation. METHODS: Eighty-two subjects were randomly assigned to the exercise protocol (with a 34% attrition rate). Pelvic muscle exercises were taught and monitored for 6 months. Phenylpropanolamine hydrochloride was given to the other group in a dose of 50 mg a day, increasing to 50 mg twice a day. MAIN RESULTS: Treatment outcomes (subjective improvement, self recorded frequency of wetting) were equally satisfactory in both groups. The response to exercises was as good in 5 months as in 6. It was also as good when the minimum recommended number of exercises per day was 80 as when it was 125. CONCLUSIONS: Among those completing the protocol, pelvic exercises were beneficial in reducing stress incontinence, and the benefit was comparable to that produced by phenylpropanolamine.

Aged↗
PubMed1988

Relationship between drug use and urinary incontinence in elderly women.

Two hundred older women with urinary incontinence were studied to observe the influence of their prescription and nonprescription drug use on symptoms of incontinence. Ninety percent of women reported using medication, with an average use of four drugs. Medications statistically associated with urinary incontinence symptomatology were prostaglandin inhibitors, diuretics, and estrogen therapy. Further studies are needed to clarify the relationship between medication usage and the presence and severity of urinary incontinence.

Aged↗
PubMed1988

Nursing assessments in the inpatient geriatric population.

Thorough assessment is essential in caring for the institutionalized elderly who have difficulty with urine control. The assessment should include a physical examination, a functional assessment, and an evaluation of the environment. The physical examination should be completed in a timely fashion after incontinence develops in order to rule out treatable causes of urine loss. The examination includes a health history and physical examination, with special attention being given to the genitourinary system. A urine specimen should be obtained during the examination to rule out bladder infection. The functional assessment of the patient is one of the most important aspects of the patient assessment. This is particularly true for elderly inpatients because much of the incontinence found in nursing homes is attributable to functional deficits. The functional assessment should address the history of the patient's incontinence, the patient's cognitive abilities and potential for participating in continence care, the patient's mobility, and the patient's abilities related to activities of daily living. Deficits in any of these areas may contribute to or cause urinary incontinence. In addition to the physical examination and functional assessment of the patient, the environment should be evaluated. The visibility, location, and structure of the toileting facilities can serve to either promote or impair urine control. In addition to the physical facilities provided, the overall nursing care approach may foster or hinder the patient's ability to maintain urinary continence. Nursing assessment that addresses these three areas will provide information that is needed to develop a nursing care plan that will maximize the patient's potential for urine control.

Aged↗
PubMed1987

Comparison of self-reported voided volume with cystometric bladder capacity.

We determined the validity of cystometric bladder capacity compared to self-reported voided urine volumes measured by the patient at home. The subjects included 200 ambulatory incontinent women 55 or more years old who were evaluated with a prospective protocol of home diaries, history, physical examination and urodynamic studies. The mean smallest and largest daily voided volumes, and the daily mean of all voided volumes were determined from the diary. Comparison of the cystometric bladder capacity with the daily voided volumes showed a significant positive correlation between cystometric bladder capacity and the largest voided volume (r equals 0.4938, p less than 0.01). Comparison of the mean daily and mean largest daily void, and the cystometric capacity with the different urodynamic diagnoses using analysis of variance revealed a statistical significance among the groups (p less than 0.01). We established the validity of cystometric bladder capacity in the measurement of functional bladder volume and that a home diary may be useful in clinical practice.

Aged↗
PubMed1987

Urinary incontinence in elderly women: clinical findings.

Two-hundred women self-described as having urinary incontinence, aged 55 to 90 years and living in the community completed a comprehensive history and physical examination. Initial presentation of urine loss was most commonly stress incontinence symptoms (35%). Scoring of peak response to volume lost and frequency revealed urine loss necessitating a clothing change for 78% and daily loss experienced by 73%. Over half had experienced a urine loss problem for more than five years. Most (65%) had sought treatment, but a minority reported current (11%) or previous (36%) treatment. Thirty-six percent were found to have severe atrophic vaginitis with severe urethocele (10%), cystocele (13%), rectocele (12%) less common. Pelvic floor strength by clinical scoring was weak (mean, 1.05 on a 5-point scale). The vaginal electromyograph first contraction peak mean was 5.94 microvolts sustained at 50% or better for 3.92 seconds. Clinical criteria established that 66% had stress, 27% a mixture of stress and urge, only 4% pure urge incontinence, and 4% other.

Aged↗
PubMed1987

Urinary incontinence in elderly women: urodynamic evaluation.

The objective of this study is to characterize urinary incontinence observed in elderly women and to assess the importance of various parameters used to evaluate urinary incontinence. Two hundred consecutive, ambulatory, outpatient, incontinent women 55 years of age and over who were seen at the Continence Program Clinic and completed a medical and urodynamic protocol are included in this paper. After a thorough medical history and a complete physical examination, urodynamic tests were performed. The urodynamic results showed that 77% of incontinent women had an incompetent urethra. Twenty-five percent had a hyperactive bladder, 8% had "other" types, and 7% had a normal study. Comparison of the clinical diagnosis with the actual urodynamic diagnosis for stress incontinence revealed a 78% accuracy and only a 6% false negative. In contrast, a similar comparison for urge incontinence found only 44% accurate and 45% false negative. Analysis of the urodynamic tests revealed that the simple provocative full-bladder stress test was as effective as the radiographic or electronic pressure measurement in detecting incompetent urethra producing stress urinary incontinence. Provocative upright cystometry was helpful in uncovering 33% of hyperactive bladders not provoked in the supine position. Complex urodynamic tests should be reserved for unexplained incontinence or when symptomatology is complex.

Aged↗
PubMedDate not supplied

Pelvic muscle relaxation. Assessment and management.

Strong pelvic musculature is important to the health of women because of the role it plays in maintaining urinary continence and in providing support to the pelvic organs. Therefore, assessment for pelvic muscle relaxation and strategies for preventive and therapeutic management are necessary elements of care. This paper discusses several assessment techniques that were tested in research settings but that are readily transferable to clinical care. Research-based recommendations for nurse-midwifery management, with emphasis on effective teaching of pelvic muscle exercise, are made. Pelvic muscle exercise is a noninvasive technique that should be used as the initial treatment of urinary incontinence, before a surgical alternative is tried. Moreover, women with weaker pelvic musculature, who are identified early, can begin a program of preventive exercise that may help to avoid incontinence in later life.

Exercise↗
PubMedDate not supplied

Digital measurement of pelvic muscle strength in childbearing women.

Fourteen primigravidas were evaluated at 32 and 36 weeks antepartum (AP) and 6 weeks postpartum (PP) to test the reliability and validity of a digital measure of pelvic muscle strength using urine control as the criterion. Interrater reliabilities ranged from .67 to .77. Convergent validity was shown by negative correlations between clinical muscle scores and time required to interrupt urine flow at 32 weeks AP (r = -.41), 36 weeks AP (r = -.64) and 6 weeks PP (r = -.71). Validity was also demonstrated in a pattern of lower scores in women who had urine loss during coughing or reported incontinence as compared with those who did not. Women who had cesarean births had higher postpartum pelvic muscle scores with progressively lower scores demonstrated by those who gave birth vaginally without laceration, with episiotomy, and with laceration, F(3, 10) = 5.40, p = .02.

Adult↗
PubMedDate not supplied

A digital test for pelvic muscle strength in older women with urinary incontinence.

A digital test of pelvic muscle strength for evaluation of a pelvic muscle exercise (PME) program was developed with a sample of 338 incontinent women living at home. Factors of perceived pressure, alteration of the vertical plane, and time were combined to form a 7-point scale ranging from 0 to 4. Test-retest for the anteroposterior score was r = .65, p less than .01 with interrater reliability, r = .91, p less than .01. Relationship to other variables and further development of the measure are discussed.

Age Factors↗
PubMedDate not supplied

A digital test for pelvic muscle strength in women with urinary incontinence.

This article reports further experience with a Version 2 digital test performed on 208 community-residing women, 25 to 87 years old. Test-retest (n = 208) and interrater reliability (n = 36) scores for pressure, displacement, and duration were r = .54, .51, and .53 and r = .67, .73, and .55, respectively. Interrater reliability percentage agreement figures were exact for 94% of the women on pressure and 67% on displacement. With duration permitted to vary by 1 second, agreement was 75%. Validity was tested using vaginal electromyography scores with correlation coefficients ranging from .37 to .63. A weak but significant correlation was found between the digital score and the stand-up test pad gain (r = -.12). No significant relationship was found between the digital test and a history of being able to stop the urine stream or other leakage measures. To address limitations in Version 2, a third version of the digital scale is proposed.

Adult↗