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Results for “Urinary Incontinence”

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PubMed1995

[Drug therapy of female urinary incontinence].

Urinary incontinence is a frequently encountered and highly disabilitating disorder in women, especially after menopause. Several causes, sometimes associated, have been identified. After menopause, lower oestrogen levels lead to general cellular, biochemical, bacteriological and anatomic modifications in the urinary tract resulting in vaginal atrophy, diminished sphincter tone and increased bladder sensitivity. Treatment should always be based on results of urodynamic studies and adapted to the aetiologic diagnosis and patient demands. Medical treatment is usually associated with behavioural and physical therapy techniques. Drugs with an effect on bladder instability include: parasympathicolytic or anticholinergic agents which lower bladder pressure by inhibiting bladder receptors; tricyclic antidepressant for their central and peripheral anticholinergic effects; non-steroid anti-inflammatory agents which decrease urethral tone; antispasmodics; and oestrogens in menopaused women. Beta-mimetics, calcium inhibitors, opioids and myorelaxants are also used but in a limited number of cases due to side effects. Urethral instability may respond to tetracycline in case of infection or non-steroid antiinflammatory drugs. Oestrogens play an important role in improving urethral trophicity and sensitive response to alpha-stimulants. Surgery may be indicated in a limited number of specific cases.

Female↗

PubMed2001

The use of neuromodulation for treatment of urinary incontinence.

Urinary incontinence (UI) affects many people in the United States. Although the prevalence of UI increases with age, it should not be considered part of the normal aging process. Medication to relax the bladder and behavioral therapy have been used to treat patients suffering from UI, but they often are unsuccessful or poorly tolerated. Neuromodulation through sacral nerve stimulation is a minimally invasive surgical procedure for treatment of urge incontinence. Neuromodulation is becoming the next logical step at many centers for treating urge incontinence after the failure of more conservative measures.

Electric Stimulation Therapy↗

PubMed2005

New developments in the management of urinary incontinence.

Urinary incontinence is a common and distressing condition known to adversely affect quality of life. In this article the authors aim to highlight developments in the methods of classification, investigation and the treatment of incontinence. It gives a detailed description of the newer drugs and their mode of action, that have recently come on to the market. These include duloxetine for the treatment of stress incontinence and the newer M3 selective antagonists. It also describes the latest surgical procedures, for example the newer slings and injectables used to treat stress incontinence. They are compared with the standard forms of treatment used and the evidence in favour and against these have been given.

Female↗

PubMed1994

Clozapine and urinary incontinence.

Urinary incontinence may occur in patients with severe mental illness. Psychosis and neuroleptic medication have both been implicated, but there has been a lack of systematic evaluation of the precise relationship between these phenomena. Incontinence has been recognized as a complication of clozapine treatment and we examined this in 16 consecutively treated patients. Thirteen were established on therapeutic doses, one of whom was excluded from further study due to pre-existing incontinence. Retrospective assessment revealed that nocturnal incontinence was experienced by five of the remaining 12 patients, occurring in the first 3 months of treatment and resolving spontaneously in all cases. Incontinence was documented in the case notes in only one of the five cases and there was a tendency for affected patients to be embarrassed and reluctant to report it to staff. Specific enquiry may be necessary to elicit this phenomenon and incontinence should be considered as a possible factor in poor compliance with clozapine.

Adult↗

PubMed1996

Assessing and treating urinary incontinence.

Urinary incontinence is a problem many home care patients experience regardless of their diagnosis. Assessment and intervention strategies are presented to help the nurse creatively identify and treat this problem.

Community Health Nursing↗

PubMed1995

Closing the loop in an audit of urinary incontinence.

Urinary incontinence (UI) fulfils the criteria for an indicator condition of quality of care. A records review audit in 1992 indicated that the minimum standards for history taking, physical examination and investigation of UI were not being met, so this was repeated in 1993 after full discussion with staff. 40% of the 368 patients studied met the definition of UI. In Assessment and Rehabilitation wards 57% met the standard for history (60% in the previous audit), 24% for examination (50% previously), and 86% for investigation (100% previously). As previously results were worse on Continuing Care wards, where minimum standards were being met in only 17% for history, 14% for examination and 47% for investigation. However, management planning had improved with care plans for 71% of incontinent patients in Assessment and Rehabilitation wards and 97% in Continuing Care wards. Our repeat audit has highlighted the difficulties inherent in encouraging health professionals to alter practice to correct apparent deficiencies.

Aged↗

PubMed1997

Evaluation and medical management of female urinary incontinence.

Urinary incontinence should not be accepted as inevitable, and is not solely the province of urologic specialists. A through history and physical examination, performed by the primary care physician, is the cornerstone of evaluation Most cases respond to behavioral and medical therapy.

Female↗

PubMed1995

Quality of life and urinary incontinence.

Urinary incontinence affects some aspect of the lives of between 15 and 30% of women. The impact of incontinence, however, varies owing to many factors such as age and cultural beliefs. Quality of life assessments now offer both general and specific questionnaires that measure the impact of this debilitating condition. Although currently an important research tool, these assessments may ultimately become routine in clinical practice.

Female↗

PubMed1997

The role of estrogen replacement therapy in the management of urinary incontinence and urinary tract infection in postmenopausal women.

The hormonal changes associated with normal aging and menopause may contribute to the development of urinary disorders including both urinary incontinence and urinary tract infections. Estrogen replacement therapy has been used successfully in the treatment of both of these disorders in postmenopausal women. Although the selection of specific treatment modalities should be tailored to the individual patient, hormonal replacement should be considered a viable conservative treatment option for many older women with urinary complaints. Future research will help to delineate the most effective route of administration and type of estrogen used in treating these complaints.

Drug Administration Routes↗

PubMed2006

Urinary incontinence.

Urinary incontinence is a common primary care problem. With the proper understanding of normal and abnormal bladder function, pediatricians can create a protocol that will benefit most children seen with this condition. Emphasis should be placed on primary therapy: establishing healthy dietary habits, treating constipation, maintaining appropriate hygiene, and developing a regular voiding pattern. When the initial evaluation identifies an anatomic abnormality or when primary therapy fails, referral to a pediatric urologist is warranted.

Child↗

PubMed1995

Evaluation and conservative management of women with stress urinary incontinence.

Urinary incontinence can be a social and practical problem. A complete evaluation correlating the history, physical examination, and screening studies confirms the syndrome and its significance, leading to the therapeutic management most appropriate for the individual patient. Although long-term cure can be effected by surgery, conservative measures are available and effective depending on the degree of dysfunction and the motivation of the individual patient.

Adolescent↗

PubMedDate not supplied

A team approach to managing urinary incontinence.

Urinary incontinence (UI) affects at least 50% of long-term care residents. With most care being delivered by nursing assistants, a need exists to educate and include these team members when implementing a UI management program. This article describes a pilot program instituted at Tacoma Lutheran Home using a team approach. In addition to the benefits the residents received, 27% of the staff thought incontinence was easier to manage after the program was implemented, and 50% said someone in administration listened to their suggestions and took action. The coordinator thought the program's weaknesses were that the staff required consistent supervision to accomplish tasks in a timely manner and it was extremely time-consuming in addition to the other duties of employee health and staff development.

Aged↗

PubMed2003

Assessment of urinary incontinence.

Urinary incontinence is a highly prevalent condition in women in their post-reproductive years. It is becoming an increasingly common presenting complaint as population demographics continue to change and further emphasis is placed on improving quality of life in this group of women. A wide variety of tools are available to assess the extent of the clinical problem and the impact that this has on psychosocial function. Many different health specialities are involved in caring for this group of patients, including general practitioners, gynaecologists, urologists, physiotherapists, and continence nurses. It is important to individualise each patient's assessment starting with a medical history and examination and leading on to appropriate specialist investigations.

Female↗

PubMed2005

Self-monitoring and pelvic floor muscle exercises to treat urinary incontinence.

Urinary incontinence (UI) is a common chronic condition among women. Treatment of UI can involve behavioral techniques, pharmacological strategies, or surgical intervention. Clinically, treatment strategies should start with the simplest and least invasive measures. To overcome the deficiencies in previous research and provide definitive information for clinical practice, a randomized clinical trial is currently underway. This clinical trial uses a pretest-posttest design to first determine the effectiveness of self-monitoring techniques before subjects are randomized into one of two treatment groups or an attentional control group with a 1-year followup. The study design, sampling plan, and interventions used in an ongoing clinical trial to assess the effectiveness of self-monitoring and efficacy of biofeedback to treat UI in women are described. Innovative techniques to assess adherence to the pelvic muscle exercise protocol are addressed.

Adult↗

PubMed1992

A cost-effectiveness study of the management of intractable urinary incontinence by urinary catheterisation or incontinence pads.

STUDY OBJECTIVE: The aim was to compare the costs and effects of management of intractable urinary incontinence by urinary catheterisation or incontinence pads. DESIGN: This was a prospective, randomised study comparing catheterisation with pads, supplemented by additional data collected from patients with chronic indwelling catheters. Main outcome measures were costs of equipment, nursing time, patient preference, nursing preference, and clinical and bacteriological assessment of urinary infection. SUBJECTS: 78 intractably incontinent elderly female patients were randomly allocated to management by urinary catheter or pads and toileting. Supplementary data on equipment costs and nursing time were collected from 27 patients, of whom 22 were already catheterised at the time of the randomisation and five were catheterised by the nursing staff after the last date for entry into the randomisation. MAIN RESULTS: Of the 38 patients randomised to catheterisation, 14 refused consent so only 24 were catheterised on day 1 of the study. There was a rapid removal of catheters, especially in the first six weeks of the study and only four of the randomised catheter patients completed the full 26 weeks of the study. However, eight of the pads patients were catheterised between the 7th and 22nd week because of deteriorating general condition and all retained their catheters for the remainder of the study period. Of 35 patients who had experienced catheters and pads, 12 expressed a clear preference for catheters, 12 for pads, and 11 were undecided. Nurses were in favour of the use of pads, mainly because of concerns about urinary infection with catheters. Comparing costs for patients managed with catheters (532 patient weeks) or pads (903 patient weeks), catheter patients required less nursing time (15.4 v 29.0 h per patient per week) but equipment costs were higher (19.20-24.65 pounds v 8.79-11.35 pounds per patient per week), mainly because of the cost of catheter care (12.75 pounds per patient per week). Asymptomatic bacteriuria was prevalent in both groups but 73% of catheterised patients received treatment for clinical signs of infection compared with 40% of pads patients. Only 30% of patients who were treated had any generalised symptoms of infection. CONCLUSIONS: Use of catheters reduces nursing time but may increase weekly equipment costs depending on the cost of laundry. Despite the high dropout rate among patients randomised to catheters a minority of patients (12/35) expressed a clear preference for catheters and we believe that more patients with intractable incontinence should be given a trial of catheterisation to assess acceptability. Bacteriuria was prevalent in pads or catheter patients but no major episodes of invasive infection were noted in either group.

Aged↗

PubMed1998

Drug treatment of urinary incontinence.

Urinary incontinence is usually classified into four types: stress, urge, reflex and overflow incontinence. The first three types of incontinence are due to urine storage dysfunction and the latter is due to urine emptying dysfunction. To improve urine storage dysfunction treatment should be aimed at decreasing detrusor overactivity, increasing bladder capacity and/or increasing outlet resistance, whereas to improve emptying dysfunction, increasing detrusor contractility and/or decreasing outlet resistance are required. This review summarizes the various drugs currently in clinical use and new drugs under investigation.

Journal Article↗

PubMed2001

The prevalence of urinary incontinence.

Urinary incontinence is a significant health problem with considerable social and economic impact. It is important to distinguish between prevalence and incidence with regard to incontinence, and prevalence-the probability of having incontinence within a defined population at a defined point in time-is the more important when considering its impact and the utilization of healthcare resources. There are large variations in the severity and impact of incontinence, and its severity, frequency, and predictability all need to be considered when evaluating its effects on patients, The degree of bother is particularly significant when determining who will need treatment. Incontinence may be a result of bladder dysfunction, sphincter dysfunction, or a combination of both, but large-scale studies are not designed to determine the etiology. In young women, the prevalence of incontinence is usually low, but prevalence peaks around menopause, with a steady rise there-after into later life. Although the prevalence of stress and mixed (stress and urge) incontinence is higher than urge incontinence, the latter is more likely to require treatment. In women, moderate and severe bother have a prevalence ranging from about 3% to 17%. Severe incontinence has a low prevalence in young women, but rapidly increases at ages 70 through 80. In men, the prevalence of incontinence is much lower than in women, about 3% to 11% overall, with urge incontinence accounting for 40% to 80% of all male patients. Stress incontinence accounts for less than 10% of cases and is attributable to prostate surgery, trauma, or neurological injury. Incontinence in men also increases with age, but severe incontinence in 70- to 80-year-old men is about half of that in women. The most effective therapy for incontinence will rely on targeting the correct populations to be treated, which depends on how data is collected on prevalence and severity.

Journal Article↗

PubMed1985

Marshall-Marchetti-Krantz procedure and Burch colposuspension in the surgical treatment of female urinary incontinence.

Urinary stress incontinence was treated by the Marshall-Marchetti-Kranz (MMK) procedure in 42 and by Burch coloposuspension in 44 women. All were assessed preoperatively and for greater than 1 year postoperatively, both clinically and by urodynamic tests. Cure of incontinence was achieved to a similar extent by both procedures, in 71% after the MMK and 79% after the Burch operation. Results were better than average if there was no prolapse and if the bladder was stable preoperatively.

Adult↗