Screening for Urinary Incontinence
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Urinary Incontinence: Impact on Long Term Care
Urinary Incontinence: Impact on Long Term Care Muhammad S. Choudhury, MD, FACS Professor and Chairman Department of Urology New York Medical College Director of Urology Westchester Medical Center 1 Urinary Incontinence: Overview • Definition • Scope • Anatomy and Physiology of Micturition • Types • Diagnosis • Management • Impact on Long Term Care 2 Urinary Incontinence: Definition • Involuntary leakage of urine which is personally and socially unacceptable to an individual. • It is a multifactorial syndrome caused by a combination of: • Genito urinary pathology. • Age related changes. • Comorbid conditions that impair normal micturition. • Loss of functional ability to toilet oneself. 3 Urinary Incontinence: Scope • Prevalence of Urinary incontinence increase with age. • Affects more women than men (2:1) up to age 80. • After age 80, both women and men are equally affected. • Urinary Incontinence affect 15% to 30% of the general population > 65 years. • > 50% of 1.5 million Long Term Care residents may be incontinent. • The cost to care for this group is >5 billion per year. • The total cost of care for Urinary Incontinence in the U.S. is estimated to be over $36 billion. Ehtman et al., 2012. 4 Urinary Incontinence: Impact on Quality of Life • Loss of self esteem. • Avoidance of social activity and interaction. • Decreased ability to maintain independent life style. • Increased dependence on care givers. • One of the most common reason for long term care placement. Grindley et al. Age Aging. 1998; 22: 82-89/Harris T. Aging in the eighties. NCHS # 121 1985. Noelker L. Gerontologist 1987; 27: 194-200. 5 Health related consequences of Urinary Incontinence • Increased propensity for fall/fracture. -
Urinary Incontinence
GLICKMAN UROLOGICAL & KIDNEY INSTITUTE Urinary Incontinence What is it? can lead to incontinence, as can prostate cancer surgery or Urinary incontinence is the inability to control when you radiation treatments. Sometimes the cause of incontinence pass urine. It’s a common medical problem. As many as isn’t clear. 20 million Americans suffer from loss of bladder control. The condition is more common as men get older, but it’s Where can I get help? not an inevitable part of aging. Often, embarrassment stops Talking to your doctor is the first step. You shouldn’t feel men from seeking help, even when the problem is severe ashamed; physicians regularly help patients with this prob- and affects their ability to leave the house, spend time with lem and are comfortable talking about it. Many patients family and friends or take part in everyday activities. It’s can be evaluated and treated after a simple office visit. possible to cure or significantly improve urinary inconti- Some patients may require additional diagnostic tests, nence, once its underlying cause has been identified. But which can be done in an outpatient setting and aren’t pain- it’s important to remember that incontinence is a symp- ful. Once these tests have determined the cause of your tom, not a disease. Its cause can be complex and involve incontinence, your doctor can recommend specific treat- many factors. Your doctor should do an in-depth evaluation ments, many of which do not require surgery. No matter before starting treatment. how serious the problem seems, urinary incontinence is a condition that can be significantly relieved and, in many What might be causing my incontinence? cases, cured. -
STRESS INCONTINENCE by JOHN BEATTIE, M.D., F.R.C.S., F.R.C.O.G
Postgrad Med J: first published as 10.1136/pgmj.32.373.527 on 1 November 1956. Downloaded from s27 STRESS INCONTINENCE By JOHN BEATTIE, M.D., F.R.C.S., F.R.C.O.G. Gynaecological Surgeon, St. Bartholomew's Hospital So far the mist has cleared very little from around obtain such a history, otherwise a patient may be this difficult subject despite the original work operated upon for urethrocele when the symptoms which has been carried out during the last io are due to something else or if true stress incon- years. Operations for the cure of stress incon- tinence develops after child bearing in such a tinence have been described from time to time patient the results of operation may be dis- during the last 50 years, but until recently most appointing. gynaecologists considered that a modified anterior Other abnormalities of bladder function which colporrhaphy was all that was necessary to achieve must be differentiated from a case of true stress a lasting cure. incontinence are as follows: One of the most important things in dealing with this subject is first to differentiate true stress The Neurogenic Bladder incontinence from inability to control the passage The bladder is often a most sensitive indicator Protected by copyright. of urine from the bladder when the urge to mic- of neurological disease and, of course, there may turate becomes great. There is also the leak which be, and often is, vaginal prolapse present at the occurs in retention with overflow to consider and onset of such a condition. The most often quoted other conditions which cause weakness of the instance of the neurogenic bladder is disseminated bladder sphincterwithout a true stress incontinence sclerosis, and, indeed, it is the commonest neuro- being present. -
Diagnosis and Management of Urinary Incontinence in Childhood
Committee 9 Diagnosis and Management of Urinary Incontinence in Childhood Chairman S. TEKGUL (Turkey) Members R. JM NIJMAN (The Netherlands), P. H OEBEKE (Belgium), D. CANNING (USA), W.BOWER (Hong-Kong), A. VON GONTARD (Germany) 701 CONTENTS E. NEUROGENIC DETRUSOR A. INTRODUCTION SPHINCTER DYSFUNCTION B. EVALUATION IN CHILDREN F. SURGICAL MANAGEMENT WHO WET C. NOCTURNAL ENURESIS G. PSYCHOLOGICAL ASPECTS OF URINARY INCONTINENCE AND ENURESIS IN CHILDREN D. DAY AND NIGHTTIME INCONTINENCE 702 Diagnosis and Management of Urinary Incontinence in Childhood S. TEKGUL, R. JM NIJMAN, P. HOEBEKE, D. CANNING, W.BOWER, A. VON GONTARD In newborns the bladder has been traditionally described as “uninhibited”, and it has been assumed A. INTRODUCTION that micturition occurs automatically by a simple spinal cord reflex, with little or no mediation by the higher neural centres. However, studies have indicated that In this chapter the diagnostic and treatment modalities even in full-term foetuses and newborns, micturition of urinary incontinence in childhood will be discussed. is modulated by higher centres and the previous notion In order to understand the pathophysiology of the that voiding is spontaneous and mediated by a simple most frequently encountered problems in children the spinal reflex is an oversimplification [3]. Foetal normal development of bladder and sphincter control micturition seems to be a behavioural state-dependent will be discussed. event: intrauterine micturition is not randomly distributed between sleep and arousal, but occurs The underlying pathophysiology will be outlined and almost exclusively while the foetus is awake [3]. the specific investigations for children will be discussed. For general information on epidemiology and During the last trimester the intra-uterine urine urodynamic investigations the respective chapters production is much higher than in the postnatal period are to be consulted. -
STRESS INCONTINENCE of URINE in the FEMALE by TERENCE MILLIN, M.CH., F.R.C.S., and CHARLES D
Postgrad Med J: first published as 10.1136/pgmj.24.267.3 on 1 January 1948. Downloaded from 3 STRESS INCONTINENCE OF URINE IN THE FEMALE By TERENCE MILLIN, M.CH., F.R.C.S., and CHARLES D. READ, M.B. F.R.C.S.(E), F.R.A.C.S., F.R.C.O.G. London PART I The distressing condition for which Sir Eardley genital prolapse, but the condition is encountered Holland coined the term stress incontinence is not infrequently in nulliparae about the meno- variously known as orthostatic, exertional or pausal age. It has long been recognized that little diurnal incontinence. relationship exists between the degree of genital The diagnosis presents little difficulty as a rule. prolapse and the severity of the urinary incon- The history varies according to the severity of the tinence. In fact, many women with an extreme condition. In its mildest form the patient is degree of descensus.have no stress incontinence, conscious of an escape of a small quantity of urine and conversely, patients exhibiting marked urinary in any movement which entails a rise of intra- loss may reveal little or no evidence of urethrocoele abdominal pressure when in the upright position or cystocoele. On several occasions we have -sneezing, coughing, walking up or down stairs. encountered stress incontinence which has by copyright. In its most severe form it may be evidenced by developed after the successful repair of a prolapse almost complete incontinence while in the up- in patients who previously had been completely right position. Almost invariably there is adequate continent of urine. -
An Operation for Stress Incontinence Urethral Bulking
Saint Mary’s Hospital/Trafford General Hospital Uro-gynaecology Service Information for Patients An operation for stress incontinence Urethral Bulking Stress Urinary Incontinence (SUI) Stress urinary incontinence is a leakage of urine occurring on physical exertion. It may occur when coughing or sneezing, walking or exercising. It is caused by a weak sphincter (a muscle at the bladder outlet), or by poor support to the bladder outlet from the pelvic floor muscles and ligaments. Why am I being offered urethral bulking? Most often exercise for the pelvic floor muscles are used as the first form of treatment for stress incontinence; you may already have tried this. If the leakage continues and remains a problem despite exercises, then surgery may be required. You may also be offered surgery at the same time for other conditions such as prolapse. The doctor will discuss this with you. What is urethral bulking? Urethral bulking is a surgical procedure for stress urinary incontinence. A bulking material (man-made) can be injected underneath the lining of the urethra (urine pipe), in to the muscle at the bladder outlet, helping it to stay closed when you are physically active, coughing or sneezing. What are the benefits and how long will it work for? Urethral bulking may not completely cure SUI but may improve it. About half of the women who have this treatment feel that they are cured of stress incontinence. Some patients find that one treatment is not enough to stop the leakage. If this is the case, we would bring you back for a second treatment after 4-6 weeks. -
What I Need to Know About Bladder Control for Women
What I need to know about BladderBladder ControlControl forfor WomenWomen U.S. Department NATIONAL INSTITUTES OF HEALTH of Health and National Kidney and Urologic Diseases Information Clearinghouse Human Services What I need to know about Bladder Control for Women NATIONAL INSTITUTES OF HEALTH National Diabetes Information Clearinghouse Contents Urine Leakage: A Common Health Problem for Women of All Ages ................................................................ 1 How does the bladder work?................................................. 2 What are the different types of bladder control problems? ................................................................................ 5 What causes bladder control problems? .............................. 7 How do I tell my health care team about my urine leakage?................................................................................... 9 How is loss of bladder control treated?.............................. 11 Hope Through Research...................................................... 17 For More Information.......................................................... 18 Acknowledgments................................................................. 19 *Inserts in back pocket A. What Your Doctor Needs to Know B. Your Daily Bladder Diary C. Kegel Exercise Tips D. Medicines for Bladder Control Urine Leakage: A Common Health Problem for Women of All Ages You may think bladder control problems are something that happen when you get older. The truth is that women of all ages have urine -
Stress Urinary Incontinence Is the Most Common Type of Urinary Incontinence in Women
Stress incontinence Definition Stress incontinence is an involuntary loss of urine that occurs during physical activity, such as coughing, sneezing, laughing, or exercise. Alternative Names Incontinence - stress Causes The ability to hold urine and maintain continence depends on the normal function of the lower urinary tract, the kidneys, and the nervous system. Additionally, the person must have the ability to recognize and appropriately respond to the urge to urinate. Stress incontinence is a bladder storage problem in which the strength of the muscles (urethral sphincter) that help control urination is reduced. The sphincter is not able to prevent urine flow when there is increased pressure from the abdomen. Stress incontinence may occur as a result of weakened pelvic muscles that support the bladder and urethra or because of malfunction of the urethral sphincter. The weakness may be caused by prior injury to the urethral area, neurological injury, some medications, or after surgery of the prostate or pelvic area. Stress urinary incontinence is the most common type of urinary incontinence in women. Studies have shown about 50% of all women have occasional urinary incontinence, and as many as 10% have frequent incontinence. Nearly 20% of women over age 75 experience daily urinary incontinence. Stress incontinence is often seen in women who have had multiple pregnancies and vaginal childbirths, whose bladder, urethra, or rectal wall stick out into the vaginal space (pelvic prolapse). Risk factors for stress incontinence include: z Being female z Getting older z Childbirth z Smoking z Obesity z Chronic coughing (such as chronic bronchitis and asthma) Symptoms Involuntary loss of urine is the main symptom. -
Initial Assessment of Incontinence
CHAPTER 9 Committee 5 Initial Assessment of Incontinence Chairman D STASKIN (USA) Co-chairman PHILTON (UK) Members A. EMMANUEL (UK), P. G OODE (USA), I. MILLS (UK), B. SHULL (USA), M. YOSHIDA (JAPAN), R. ZUBIETA (CHILE) 485 CONTENTS 3. SYMPTOM ASSESSMENT INTRODUCTION 4. PHYSICAL EXAMINATION I. LOWER URINARY TRACT 5. URINALYSIS AND URINE CYTOLOGY SYMPTOMS 6. MEASUREMENT OF THE SERUM PROSTATE- 1. STORAGE SYMPTOMS SPECIFIC ANTIGEN (PSA) 2. VOIDING SYMPTOMS 7. MEASUREMENT OF PVR 3. POST-MICTURITION SYMPTOMS IV. THE GERIATRIC PATIENT 4. MEASURING THE FREQUENCY AND SEVERI- TY OF LOWER URINARY TRACT SYMPTOMS 1. HISTORY 5. POST VOID RESIDUAL URINE VOLUME 2. PHYSICAL EXAMINATION 6. URINALYSIS IN THE EVALUATION OF THE PATIENT WITH LUTS V. THE PAEDIATRIC PATIENT II. THE FEMALE PATIENT PHYSICAL EXAMINATION VI. THE NEUROLOGICAL PATIENT 1. GENERAL MEDICAL HISTORY 2. URINARY SYMPTOMS PHYSICAL EXAMINATION 3. OTHER SYMPTOMS OF PELVIC FLOOR DYS- VII. FAECAL INCONTINENCE FUNCTION ASSESSMENT 4. PHYSICAL EXAMINATION 1. HISTORY 5. PELVIC ORGAN PROLAPSE 2. EXAMINATION 6. RECTAL EXAMINATION 3. FUTURE RESEARCH 7. ADDITIONAL BASIC EVALUATION VIII. OVERALL III. THE MALE PATIENT RECOMMENDATIONS URINARY INCONTINENCE 1. CHARACTERISTICS OF MALE INCONTINENCE REFERENCES 2. GENERAL MEDICAL HISTORY 486 Initial Assessment of Incontinence D STASKIN, P HILTON A. EMMANUEL, P. GOODE, I. MILLS, B. SHULL, M. YOSHIDA, R. ZUBIETA 3. institute empiric or disease specific therapy based INTRODUCTION on the risk and benefit of the untreated condition, the nature of the intervention and the alternative Urinary (UI) and faecal incontinence (FI) are a therapies concern for individuals of all ages and both sexes. 4. prompt the recommendation of additional more This committee report primarily addresses the role of complex testing or specialist referral. -
Urinary Incontinence in Middle Aged Women: Childhood Enuresis and Other Lifetime Risk Factors in a British Prospective Cohort
J Epidemiol Community Health: first published as 10.1136/jech.53.8.453 on 1 August 1999. Downloaded from J Epidemiol Community Health 1999;53:453–458 453 Urinary incontinence in middle aged women: childhood enuresis and other lifetime risk factors in a British prospective cohort Diana Kuh, Linda Cardozo, Rebecca Hardy Abstract and, in adulthood, on childbearing, a history of Study objective—To investigate the preva- kidney and bladder problems, body weight, hys- lence and lifetime risk factors for urinary terectomy and menopausal status, which previ- incontinence in middle aged women. ous general population studies have suggested Design—Nationally representative birth are related to incontinence in midlife.138912–16 cohort study with prospective data on childhood enuresis, measured adult height and weight, childbearing histories Methods and measures of socioeconomic status The Medical Research Council National Sur- updated at regular contacts, and measures vey of Health and Development is a socially of menopausal status, symptomatology stratified cohort of 2548 women and 2814 men and health care in midlife. followed up 19 times between their birth in March 1946 and the age of 43 years.17–19 When Setting—England, Scotland and Wales. —General population sample they were 47 years old a postal questionnaire Participants was sent to 1778 women study members with of 1333 women aged 48 years. whom the team was still in regular contact to —Fifty per cent reported Main results obtain information about the timing of the symptoms of stress incontinence and 22% menopause, health changes, and use of hor- reported symptoms of urge incontinence in mone replacement therapy.20 Of the original the previous year. -
Guidelines on Urinary Incontinence M.G
Guidelines on Urinary Incontinence M.G. Lucas (Chair), D. Bedretdinova (Guidelines Associate), L.C. Berghmans, J.L.H.R. Bosch, F.C. Burkhard, F. Cruz, A.K. Nambiar, C.G. Nilsson, A. Tubaro, R.S. Pickard © European Association of Urology 2015 TABLE OF CONTENTS PAGE 1. INTRODUCTION 6 1.1 Aim 6 1.1.1 Use in different healthcare settings and by healthcare professionals 6 1.2 Publication history 6 1.3 Panel composition 7 2. METHODS 7 2.1 PICO questions 7 2.2 Search strategies 7 2.3 Terminology 8 3. DIAGNOSTIC EVALUATION 9 3.1 History and physical examination 9 3.2 Patient questionnaires 9 3.2.1 Questions 9 3.2.2 Evidence 9 3.3 Voiding diaries 12 3.3.1 Questions 12 3.3.2 Evidence 12 3.4 Urinalysis and urinary tract infection 12 3.4.1 Questions 12 3.4.2 Evidence 13 3.5 Post-voiding residual volume 13 3.5.1 Question 13 3.5.2 Evidence 13 3.6 Urodynamics 13 3.6.1 Question 14 3.6.2 Evidence 14 3.6.2.1 Variability 14 3.6.2.2 Diagnostic accuracy 14 3.6.2.3 Does urodynamics influence the outcome of conservative therapy 14 3.6.2.4. Does urodynamics influence the outcome of surgery for stress urinary incontinence? 14 3.6.2.5 Does urodynamics help to predict complications of surgery? 14 3.6.2.6 Does urodynamics influence the outcome of surgery for detrusor- overactivity? 15 3.6.2.7 Does urodynamics influence the outcome of treatment for post- prostatectomy urinary incontinence in men? 15 3.7 Pad testing 15 3.7.1 Question 16 3.7.2 Evidence 16 3.8 Imaging 16 3.8.1 Questions 16 3.8.2 Evidence 16 4. -
Female Voiding Dysfunction and Urinary Incontinence
Female Voiding Dysfunction and Urinary Incontinence Amanda Vo, MD, Stephanie J. Kielb, MD* KEYWORDS Overactive bladder (OAB) Urge urinary incontinence (UUI) Stress urinary incontinence (SUI) Vesicovaginal fistula (VVF) Ureterovaginal fistula (UVF) KEY POINTS Urinary continence relies on coordination of the autonomic and somatic nervous systems, in addition to normal lower urinary tract support and sphincter function. Overactive bladder may be treated in a stepwise fashion with behavioral therapies, phar- macologic management, and procedural options. Stress urinary incontinence is most effectively treated with minimally invasive surgical techniques that reinforce urethral support. Urogenital fistulas, although more common in developing countries than in the United States, are extremely distressful to patients and repair often requires larger reconstructive surgery. NORMAL URINARY CONTINENCE AND VOIDING The lower urinary tract (LUT) has 2 main functions, low-pressure storage of urine, then consciously controlled, coordinated emptying. This involves coordination of the auto- nomic and somatic nervous systems. Coordination occurs at the pontine micturition center and the cerebral cortex provides inhibition. Disease states affecting the cortex such as stroke or Parkinson’s disease can, therefore, cause of loss of inhibition, with urinary urgency, frequency, and at times urge incontinence. Neurologic disease below the pontine micturition center can cause a variety of LUT complications, including co- ordination issues which may put upper tract (renal) function at risk; the details of such conditions are complex and are not discussed further in this review. Disclosures: The authors have no disclosures to report. Department of Urology, Northwestern University Feinberg School of Medicine, 303 East Chi- cago Avenue, Tarry 16-703, Chicago, IL 60611, USA * Corresponding author.