[Stress urinary incontinence in the woman. I. Mechanisms of urinary continence and physiopathology of stress urinary incontinence].
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Female↗
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Urodynamically age-specific prevalence of urinary incontinence in women with urinary symptoms.
AIMS: To determine the age-specific prevalence rates of different types of urinary incontinence in women with urinary symptoms using urodynamic studies (UDS). METHODS: One thousand five hundred women with urinary symptoms who underwent UDS in our department from January 1997 through December 1999 were enrolled. A detailed history, physical examination, and data of multi-channel UDS including uroflowmetry, filling and voiding cystometry, stress urethral pressure profile, and 20-minute pad test were obtained for each patient. The urodynamic findings of each patient were analyzed and correlated with age in decades. RESULTS: Of 1,500 women, 329 were excluded from analysis because they had undergone anti-incontinence surgery (n=27), had undergone treatment for cervical cancer (n=147), or were being followed-up after medication (n=155). Of the remaining 1,171 patients, 656 (56%) had genuine stress incontinence (GSI), 68 (5.8%) had detrusor instability (DI), 187 (16%) had mixed GSI/DI, 245 (20.9%) had either voiding or storing dysfunction without concomitant incontinence, and 15 (1.3%) had normal urodynamic findings. The 41-50- and 51-60-year age groups had the highest prevalence rates of urinary incontinence, accounting for 31% and 28% of GSI cases, 35% and 25% of DI cases, and 40% and 27% of mixed GSI/DI cases, respectively. The prevalence of GSI and mixed GSI/DI increased consistently with age, but the prevalence of DI decreased after age 66. Thus, the prevalence rates of GSI, DI, and mixed GSI/DI were 56%, 5.8%, and 16%, respectively, in women with urinary symptoms. CONCLUSIONS: Female urinary incontinence had a biogenic peak prevalence in the 41-50-year and 51-60-year age groups.
Adult↗
[Urinary incontinence--difficult to learn to live with urinary incontinence].
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Adaptation, Psychological↗
Urinary incontinence in women.
Urinary incontinence is common in women, but is under-reported and under-treated. Urine storage and emptying is a complex coordination between the bladder and urethra, and disturbances in the system due to childbirth, aging, or other medical conditions can lead to urinary incontinence. The two main types of incontinence in women, stress urinary incontinence and urge urinary incontinence, can be evaluated by history and simple clinical assessment available to most primary care physicians. There is a wide range of therapeutic options, but the recent proliferation of new drug treatments and surgical devices for urinary incontinence have had mixed results; direct-to-consumer advertising has increased public awareness of the problem of urinary incontinence, but many new products are being introduced without long-term assessment of their safety and efficacy.
Aged↗
Development and testing of the Urinary Incontinence Scales.
The Urinary Incontinence Scales were developed to measure RNs' attitude, belief, practice, and knowledge about urinary incontinence in adults. The purpose of this article is to introduce the scales and discuss their development and testing. These scales include the Urinary Incontinence Attitude Scale, the Urinary Incontinence Belief Scale, the Urinary Incontinence Practice Scale, and the Urinary Incontinence Knowledge Scale. Evaluation using confirmatory factor analysis showed the attitude, belief, and practice scales to be reliable and valid. Reliability of the knowledge scale was slightly lower than desired using both Cronbach's alpha coefficient and squared multiple correlation. While the hypothesized measurement model demonstrated acceptable goodness-of-fit, further testing is needed for generalizability of findings.
Adult↗
[Urinary incontinence and senile dementia. The relationship between the severity of dementia and the potential for treatment of the urinary incontinence].
The occurrence of urinary incontinence was traced of 1077 patients, admitted to the geriatric department from 1978 through 1986 and was observed in 444 patients (41.3%), in women a little more frequent than in men (respectively 43.5% and 35.2%). In cases of people being psychiatrically ill incontinence was more frequent than in somatic cases. The percentages are respectively 45.1% and 38.0%. Among patients with dementia those SDAT did not show a higher prevalence of urinary incontinence than those with other types of dementia. Treatment (bladder-training, in 50% of the patients combined with medication) proved to be successful in 54.4% of all patients, for the group of somatically ill patients not significantly better than for the psychiatric patients (respectively 58% and 50.1%). Patients with SDAT showed better results (50% versus 32.1%) than cases of other types of dementia. The results of treatment in patients in the amnestic stage were 2.5 times better (65.9%) than in patients with more advanced stages of senile dementia (25.9%).
Activities of Daily Living↗
Current treatments for patients with stress urinary incontinence.
Stress urinary incontinence (SUI) has been defined as the complaint of involuntary leakage of urine on effort, exertion, sneezing or coughing (Abrams et al, 2002). It becomes known as urodynamically proven stress incontinence (USI) when filling cystometry (a test of bladder function) shows a rise in intra-abdominal pressure, without a detrusor muscle (bladder muscle) contraction, causing urine loss via the urethra.
Causality↗
The functional and psychosocial impact of fecal incontinence on women with urinary incontinence.
OBJECTIVES: The study was undertaken to determine the impact of fecal incontinence (FI) on functional status and quality of life in women with urinary incontinence (UI). STUDY DESIGN: In 24 months 732 women completed a standardized assessment and questionnaire, including the Short Form (SF)-12 and Incontinence Quality of Life (I-QOL) scores. Analysis of variance was used to compare SF-12 scores between groups defined as having UI, FI, or both UI and FI. I-QOL scores in patients with UI or UI and FI were compared by using the Student t test. RESULTS: Of the 732 patients enrolled, 425 patients had either UI (n = 342, 80%), FI (n = 18, 4%), or both (n = 65, 15%). Greater impairment in physical functioning was seen in the group with UI and FI (38.6; P =.027) compared with the group with UI (42.4). Significant decreases in I-QOL scores were seen for the group with UI and FI compared with those with UI (P <.005). CONCLUSION: Fecal incontinence further reduces the functional status and quality of life of women with urinary incontinence.
Adult↗
Conservative management of post prostatectomy incontinence.
BACKGROUND: Urinary incontinence after prostatectomy is a common problem. Conservative management of this condition includes pelvic floor muscle training, biofeedback, electrical stimulation using a rectal electrode, transcutaneous electrical nerve stimulation, or a combination of methods. OBJECTIVES: To assess the effects of conservative management for urinary incontinence after transurethral, suprapubic, radical retropubic or perineal prostatectomy. SEARCH STRATEGY: The Cochrane Incontinence Group's trials register, Medline, Cinahl, Embase, PsycLit and ERIC all up to January 1999, and reference lists of relevant articles. We contacted investigators to locate studies and we handsearched the following conference proceedings: American Urological Association (1989-1999); Society of Urologic Nurses and Associates (1991-1998); Wound Ostomy and Continence Nurses (1996-1999); and International Continence Society (1980-1998). Date of most recent searches: January 1999. SELECTION CRITERIA: Randomised or quasi-randomised trials which evaluated conservative management aimed at improving urinary continence after prostatectomy. DATA COLLECTION AND ANALYSIS: Two reviewers independently assessed the methodological quality of studies and abstracted data from included trials onto a standard form. MAIN RESULTS: Only five randomised trials were identified which included 365 men, each evaluating different treatments, and all studying men after radical prostatectomy. The trials were of moderate quality and data were not available for many of the pre-stated outcomes. Confidence intervals for both dichotomous and continuous data were wide; it was not possible to reliably identify or rule out a useful effect. Men's symptoms tended to improve over time, irrespective of management. REVIEWER'S CONCLUSIONS: The value of the various approaches to conservative management of post prostatectomy incontinence remains uncertain. Further well designed trials are needed.
Biofeedback, Psychology↗
Exercise and urinary incontinence in women.
Urinary incontinence is a common problem in women and may significantly impair their quality of life. Although women often report stress urinary incontinence during exercise, current data indicates that most types of exercise are not a risk factor for the development of urinary incontinence. However, certain extreme high-impact sports such as parachute jumping may cause pelvic organ support defects that result in stress urinary incontinence. Eating disorders also increase the risk of urinary incontinence in athletes. Overall, women should be encouraged to pursue physical activity that will benefit their general health without the risk of development of urinary incontinence later in life. Women athletes should be counseled about the increased risk of urinary incontinence with ultra high-impact sports and eating disorders.
Exercise↗
Communication between older adults and their physicians about urinary incontinence.
BACKGROUND: Urinary incontinence (UI) is a common but undertreated condition in older adults. The study objective was to determine older patients' characteristics related to communication patterns with their physicians about UI. METHODS: Telephone surveys of a sample of patients age 60 and older who visited a primary care provider (PCP) for any reason within the past 2 months were conducted. Participating physicians included general internists and family physicians from 41 primary care practices located in the 17 counties of northwest North Carolina whose 435 incontinent and 711 continent patients completed the surveys. The main outcome measures were patients' frequency and amount of urinary leakage, being asked about incontinence, and initiating a discussion of incontinence if not asked by their PCP. RESULTS: Age and gender were significant independent predictors of incontinence. PCPs were significantly more likely to assess incontinent women than incontinent men (21% vs 10%, p = .053). The older cohorts of older adults were significantly more likely to be symptomatic for UI than their younger counterparts. However, the younger cohorts were more likely to be screened for incontinence by their physicians. CONCLUSIONS: Despite the publication of guidelines on improving the screening and management of UI, the problem remains common and underdetected in older adults. Physicians don't ask and patients don't tell. Interventions are needed to remind physicians to screen high risk patients and to encourage patients with UI to communicate with their physicians.
Age Factors↗
Targeting serotonin and norepinephrine receptors in stress urinary incontinence.
Stress urinary incontinence (SUI) in women is prevalent, and there are no globally developed or widely approved drugs for the disease. One strategy for improving urinary continence is to augment the function of the urethral rhabdosphincter through neuropharmacology. The present review describes the innervation of the urethra, and the role of the central nervous system in controlling nerve activity. Targeting serotonin and norepinephrine (or noradrenaline) receptors in Onuf's nucleus is shown to augment the function of the urethral rhabdosphincter by increasing pudendal nerve efferent activity. It is proposed that the ability of serotonin and norepinephrine to enhance the effects of glutamate (the primary excitatory neurotransmitter for pudendal sphincter motor neurons) while having no direct effects of their own, allow facilitation of rhabdosphincter activity during urine storage while allowing complete relaxation during micturition. Duloxetine, a potent and balanced dual serotonin (5-HT)-norepinephrine reuptake inhibitor (SNRI), potentiates these physiological effects of endogenous serotonin and norepinephrine (by inhibiting the reuptake of these neurotransmitters in the pre-synaptic element) and thereby enhances the central nervous system's natural continence control mechanisms.
Adrenergic Uptake Inhibitors↗
Serotonin and norepinephrine involvement in efferent pathways to the urethral rhabdosphincter: implications for treating stress urinary incontinence.
Stress urinary incontinence (SUI), the most common form of incontinence, continues to be a largely underdiagnosed problem that imposes large financial and quality-of-life burdens on many women but has few treatment options. Ongoing animal and early human studies have shown that monoamine neurotransmitters play key roles in controlling urethral storage and micturition reflexes. Motor neurons found in the Onuf nucleus of the sacral spinal cord control urethral function, and have several unique properties that distinguish them from other motor neurons. First, the neurons are uniformly smaller than other surrounding motor neurons and have bundled dendrites, allowing strong synchronous activation or inhibition. Second, the neurons demonstrate unique neurochemical profiles. Unlike neurons in surrounding areas, the motor neurons of the Onuf nucleus have dense populations of noradrenergic and serotonergic terminals. Animal studies have shown that alpha1-adrenoceptors and serotonin (5-hydroxytryptamine [5-HT]) receptors in the Onuf nucleus facilitate sphincter contraction. Agonists that stimulate these receptors facilitate the guarding or incontinence reflex, whereas antagonists that block the receptors inhibit this reflex. Therefore, boosting the effects of 5-HT and norepinephrine (NE) to enhance sphincter activity could be clinically promising for improving the symptoms of SUI. Importantly, the activity of the sphincter neurons can be increased pharmacologically during urine storage without interfering with bladder-sphincter synergy. Administering the 5-HT/NE uptake inhibitor duloxetine facilitates sphincter contraction during bladder filling but not during bladder contraction in micturition. This unique effect of duloxetine may be maintained by the selective neuromodulatory effects of 5-HT and NE on activation of sphincter motor neurons by the neurotransmitter glutamate. Prolonging the effect of naturally released NE and 5-HT with duloxetine could augment the body's normal processes for controlling urine storage and micturition. Early trials have demonstrated that duloxetine significantly reduces incontinence episodes and is well tolerated in the clinical setting.
Adrenergic Uptake Inhibitors↗
Duloxetine: a serotonin-noradrenaline re-uptake inhibitor for the treatment of stress urinary incontinence.
Stress urinary incontinence (SUI) is the accidental leakage of urine associated with physical activities such as running, jumping or lifting or with sneezing and coughing. For many patients it can be a very bothersome symptom, causing social isolation, loss of self-esteem and increased financial outlays. Although there is currently no medication approved worldwide for the treatment of SUI, a variety of off-label agents are sometimes prescribed. Duloxetine (LY-248686; Eli Lilly), a new centrally acting compound with dual activity as a serotonin and noradrenaline re-uptake inhibitor, offers a promising new approach for treatment. Due to its inhibition of presynaptic neuron re-uptake of serotonin and noradrenaline in the sacral spinal cord, duloxetine is believed to increase the strength of urethral sphincter contractions and thereby prevent accidental urine leakage by increasing urethral closure pressure. In three published trials in women with the predominant symptom of SUI, duloxetine significantly reduced the number of incontinence episodes compared to placebo. Adverse events were usually observed early in treatment, were mild-to-moderate in severity and were transient. Nausea was the most common reason for discontinuation.
Adrenergic Uptake Inhibitors↗
Practical approach to stress urinary incontinence.
Stress urinary incontinence (SUI) in women is more frequent in the multiparous patient, especially in those postmenopausal after withdrawal of hormonal stimulation of the pelvic supportive tissues. With loss of support of the vesical neck and urethra, sphincter incompetence may result. A patient whose symptoms are purely irritative (urinary frequency, nocturia, urgency, or urge incontinence), without a significant degree of stress incontinence, should not benefit from any operation.
Aged↗
Surgery for stress urinary incontinence.
Stress urinary incontinence is a common problem, with various degrees of disability. Its etiology may be defective external or internal urethral sphincter mechanisms. Evaluation of the patient with symptoms of stress incontinence requires objective testing for diagnostic accuracy. Patient management may be individualized to conservative measures or to one of the various surgical approaches, which produce success rates between 80% and 95%. Retropubic suspension or long needle procedures should be considered for patients with stress incontinence and evidence of bladder neck detachment. Sling procedures, artificial sphincters, and periurethral injections should be considered for patients with minimal bladder neck mobility or low urethral pressures and for those with a high risk of failing other procedures.
Adult↗
Key trends in the management and treatment of stress urinary incontinence.
Stress urinary incontinence is a problem affecting about 42% of women in the UK. Nurses are working to overcome the perception that it is a natural outcome of childbirth or the ageing process. This paper provides an overview of current treatment options, including lifestyle management, pelvic floor exercises and surgical options.
Estrogens↗
Treatments for stress urinary incontinence.
Stress urinary incontinence (SUI) is a common problem among women, particularly after childbearing. While it is not in itself life-threatening, it inevitably impairs quality of life, causing embarrassment and even social isolation--this is often both the reason that people with SUI seek medical help and the method of measuring the success of treatment. A range of treatment and management options is available for dealing with this distressing condition.
Humans↗