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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. -
Kegels: Female Pelvic Floor Exercises What Are Kegel Exercises? Kegel Exercises Strengthen the Pelvic Floor Muscles
Kegels: Female Pelvic Floor Exercises What are Kegel exercises? Kegel exercises strengthen the pelvic floor muscles. These muscles support the bladder and bowel openings. Strengthening the muscles of the pelvic floor can aid in preventing leakage of urine or feces when you cough, sneeze, lift, or do other stressful movements. Other benefits of Kegels include: Enhanced sexual function Conditioned muscles to make childbirth easier Decreased or prevention of prolapsed pelvic organs Improved ability to pass stool © NIDDK Who should do Kegel exercises? Women with urinary and /or bowel incontinence Women who have demonstrated weakening of the pelvic floor Pregnant women or women who have previously had children Middle aged and older women Physical Medicine and Rehabilitation - 1 - What do I need to know about Kegels? Your success while doing Kegel exercises depends on you practicing them correctly and regularly. When doing the exercises, it is important to identify the correct muscles of the pelvic floor. At first, most people contract the abdominal or thigh muscles while forgetting the pelvic floor muscles. This could make pelvic floor tone and incontinence worse. If you are not sure that you are doing the Kegel exercise correctly, ask your doctor to refer you to a Pelvic Floor Physical Therapist (PT). The PT will evaluate you and provide specific instructions on how to do the exercises. “Kegel exercises diagram" by Gend27 - Own work. Licensed under CC BY-SA 3.0 via Commons You may do Kegels as part of biofeedback. Biofeedback consists of placing a sensor on the abdomen and around the anal area, which measures the tightening of the pelvic floor muscles. -
Original Article Effects of Kegel Exercises Applied to Urinary Incontinence on Sexual Satisfaction
Int J Clin Exp Med 2016;9(6):12365-12374 www.ijcem.com /ISSN:1940-5901/IJCEM0021587 Original Article Effects of kegel exercises applied to urinary ıncontinence on sexual satisfaction Şenay Topuz1*, Emine Ü Seviğ2* 1Department of Midwifery, Health Science Faculty, Ankara University, Ankara, Turkey; 2Department of Public Health Nursing, Health Science Faculty, Erciyes University, Kayseri, Turkey. *Equal contributors. Received December 10, 2015; Accepted March 19, 2016; Epub June 15, 2016; Published June 30, 2016 Abstract: This study is a semi-experimental study in order to explore the effect of Kegel exercises upon sexual sat- isfaction among the women who suffered from urinary incontinence. The sample of the study is consisted of 30 women who are diagnosed with urinary incontinence. Illustrative data form, GRISS were initially applied to women, kegel exercises were taught to women by the researcher and after 3 months of application were filled with scales. All of the women who were studied are at least primary school graduate and are married. Before the application it was seen that the women had problems in GRISS satisfaction, touch, vaginismus and anorgasmia sub groups. Yet, after the application its seen that the sexual satisfaction raised in these sub groups except vaginismus. A very important positive change was experienced in satisfaction and anorgasmia. A rise in sexual satisfaction was also detected after the application on thickness and avoidance sub groups and on total points. As a result of the study, it was detected that kegel exercises had positive effect on womens sexual satisfaction. However, performing of long term and broader sample studies shouldbe offered. -
Preoperative Exercise Interventions to Optimize Continence Outcomes Following Radical Prostatectomy
REVIEWS Preoperative exercise interventions to optimize continence outcomes following radical prostatectomy Sean F. Mungovan 1,2,3 ✉ , Sigrid V. Carlsson4,5,6, Gregory C. Gass2,7, Petra L. Graham 8, Jaspreet S. Sandhu4, Oguz Akin 9, Peter T. Scardino4, James A. Eastham4 and Manish I. Patel 10,11 Abstract | Urinary incontinence is a common and predictable consequence among men with localized prostate cancer who have undergone radical prostatectomy. Despite advances in the surgical technique, urinary continence recovery time remains variable. A range of surgical and patient- related risk factors contributing to urinary incontinence after radical prostatectomy have been described, including age, BMI, membranous urethral length and urethral sphincter insufficiency. Physical activity interventions incorporating aerobic exercise, resistance training and pelvic floor muscle training programmes can positively influence the return to continence in men after radical prostatectomy. Traditional approaches to improving urinary continence after radical prostatectomy have typically focused on interventions delivered during the postoperative period (rehabilitation). However, the limited efficacy of these postoperative approaches has led to a shift from the traditional reactive model of care to more comprehensive interventions incorporating exercise- based programmes that begin in the preoperative period (prehabilitation) and continue after surgery. Comprehensive prehabilitation interventions include appropriately prescribed aerobic exercise, resistance -
Interstitial Cystitis/Painful Bladder Syndrome
What I need to know about Interstitial Cystitis/Painful Bladder Syndrome U.S. Department of Health and Human Services National Kidney and Urologic Diseases NATIONAL INSTITUTES OF HEALTH Information Clearinghouse What I need to know about Interstitial Cystitis/Painful Bladder Syndrome U.S. Department of Health and Human Services National Kidney and Urologic Diseases NATIONAL INSTITUTES OF HEALTH Information Clearinghouse Contents What is interstitial cystitis/painful bladder syndrome (IC/PBS)? ............................................... 1 What are the signs of a bladder problem? ............ 2 What causes bladder problems? ............................ 3 Who gets IC/PBS? ................................................... 4 What tests will my doctor use for diagnosis of IC/PBS? ............................................................... 5 What treatments can help IC/PBS? ....................... 7 Points to Remember ............................................. 14 Hope through Research........................................ 15 Pronunciation Guide ............................................. 16 For More Information .......................................... 17 Acknowledgments ................................................. 18 What is interstitial cystitis/painful bladder syndrome (IC/PBS)? Interstitial cystitis*/painful bladder syndrome (IC/PBS) is one of several conditions that causes bladder pain and a need to urinate frequently and urgently. Some doctors have started using the term bladder pain syndrome (BPS) to describe this condition. Your bladder is a balloon-shaped organ where your body holds urine. When you have a bladder problem, you may notice certain signs or symptoms. *See page 16 for tips on how to say the words in bold type. 1 What are the signs of a bladder problem? Signs of bladder problems include ● Urgency. The feeling that you need to go right now! Urgency is normal if you haven’t been near a bathroom for a few hours or if you have been drinking a lot of fluids. -
Overactive Bladder: What You Need to Know Whiteboard Animation Transcript with Shawna Johnston, MD and Emily Stern, MD
Obstetrics and Gynecology – Overactive Bladder: What You Need to Know Whiteboard Animation Transcript with Shawna Johnston, MD and Emily Stern, MD Overactive bladder (OAB) is a symptom-based disease state, which includes urinary frequency, nocturia, and urgency, with or without urgency incontinence. Symptoms of a urinary tract infection (UTI) are similar but additionally include dysuria (painful voiding) and hematuria. OAB tends to be a chronic progressive condition, while UTI symptoms are acute and may be associated with fever and malaise. In patients whose symptoms are unclear, urinalysis and urine culture may help rule out infection. If symptoms point to OAB, you should rule out: 1. Neurological disorders, such as multiple sclerosis, dementia, parkinson’s disease, and stroke. 2. Medical disorders such as diabetes, and 3. Prolapse, as women with obstructed voiding, usually from advanced prolapse, can have symptoms that mimic those of OAB. It is important to delineate how OAB symptoms affect a patient’s quality of life. Women with OAB are often socially isolated and sleep poorly. On history, pay attention to lifestyle factors such as caffeine and fluid intake, environmental triggers, and medications that may worsen symptoms like diuretics. Cognitive impairment and diabetes can influence OAB symptoms. Estrogen deficiency worsens OAB symptoms, so menopausal status and hormone use are important to note. Physical exam includes a screening sacral neurologic exam, an assessment for pelvic organ prolapse and a cough stress test to rule out stress urinary incontinence. On pelvic exam, look for signs of estrogen deficiency. Investigations include urinalysis, urine culture, and a post-void residual volume measurement. -
Kegel Exercises2
KEGEL EXERCISES A Kegel exercise, named after Dr. Arnold Kegel, consists of contracting and relaxing the muscles that form part of thepelvic floor (which some people now colloquially call the "Kegel muscles"). The aim of Kegel exercises is to improve muscle tone by strengthening the pubococcygeus muscles of the pelvic floor. Advantages of Kegel eercises are : Kegel is a popular prescribed exercise for pregnant women to prepare the pelvic floor for physiological stresses of the later stages of pregnancy and vaginal childbirth. Kegel exercises are said to be good for treating vaginal prolapse and preventing uterine prolapse in women . In men they say these are useful for treating prostate pain and swelling resulting from benign prostatic hyperplasia(BPH) and prostatitis in men. Kegel exercises may be beneficial in treating urinary incontinence in both men and women. Kegel exercises may also increase sexual gratification. Sexual function Kegel workouts can provide men with stronger erections. Research published in 2005 issue of BJU International, have shown that pelvic floor exercises could help restore erectile function in men with erectile disfunction. There are said to be significant benefits for the problem of premature ejaculation from having more muscular control of the pelvis.It is also possible that strengthening the pelvic floor may allow some men to achieve a form of orgasmwithout allowing ejaculation, and thereby perhaps reach multiple "climaxes" during sexual activity. In men, this exercise lifts up the testicles, also strengthening the cremaster muscle, as well as the anal sphincter, as the anus is the main area contracted when a Kegel is done. -
Frequently Asked Questions About Overactive Bladder
ABOUT OAB Frequently Asked Questions about Overactive Bladder What is Overactive Bladder (OAB)? If you live with OAB, you may also: Overactive Bladder (OAB) isn’t a disease. It’s the u Leak urine (incontinence): Sometimes people name of a group of urinary symptoms. The most with OAB also have “urgency incontinence.” common symptom of OAB is a sudden urge to This means that urine leaks when you feel urinate that you can’t control. Some people will the sudden urge to go. This isn’t the same as leak urine when they feel this urge. Having to “stress urinary incontinence” or “SUI.” People urinate many times during the day and night is with SUI leak urine while sneezing, laughing or another symptom of OAB. doing other physical activities. (You can learn more about SUI at UrologyHealth.org/SUI.) How common is OAB? u Urinate frequently: You may also need to go OAB is common. It affects millions of Americans. to the bathroom many times during the day. As many as 30 percent of men and 40 percent The number of times someone urinates varies of women in the United States live with OAB from person to person. But many experts symptoms. agree that going to the bathroom more than eight times in 24 hours is “frequent urination.” Who is at risk for OAB? u Wake up at night to urinate: Waking from As you grow older, you’re at higher risk for sleep to go to the bathroom more than once a OAB. But no matter what your age, there are night is another symptom of OAB. -
The Effect of Pelvic Floor (Kegel) Exercises on Sexual Satisfaction of 20-40-Year-Old Women Referring to Women′S Counseling Center in 2015: Rafsanjan Health Center No
Focus on Sciences Original Article Feb 2018, Volume 4, Issue 1 The Effect of Pelvic Floor (Kegel) Exercises on Sexual Satisfaction of 20-40-Year-old Women Referring to Women′s Counseling Center in 2015: Rafsanjan Health Center No. 1 Mohammadreza Mirzabeigi 1, Batoul Shafiei Marji 2,*, Mohammadreza Mokhtaree 3 1 Assistant Professor, Psychiatry Department, Rafsanjan University of Medical Sciences, Rafsanjan, Iran 2 MSc, Department of General Psychology, Rafsanjan University of Medical Sciences, Rafsanjan, Iran 3 MSc, Department of Educational Psychology, Social Determinants of Health Research Center, Rafsanjan University of Medical Sciences, Rafsanjan, Iran * Corresponding author: Batoul Shafiei Marji, MSc, Department of General Psychol- ogy, Rafsanjan University of Medical Sciences, Rafsanjan, Iran. E-mail: bty.shafie@ yahoo.com Submitted: 12.13.2017 Abstract Accepted: 04.04.2018 Introduction: Sexual disorders are common among women. This study aimed to investigate the effect of pelvic exercises on women›s sexual satisfaction. Keywords: Methods: Fifty subjects among 20-40-year-old women referring to the counseling center Orgasm No. 1 of Rafsanjan Health Department were selected using convenient sampling and Pelvic Floor Exercises randomly divided into two experimental and control groups. The participants completed Kegel Linda Berg›s Sexual Satisfaction Scale in pretest and posttests. Five training sessions were © 2018. Focus on Sciences held on pelvic muscle (Kegel) exercises for the experimental group. The control group received no training.The collected data were analyzed using independent t-test, chi-square test and covariance analysis. Results: Sexual satisfaction did not differ between the two groups in pretest (P = 0.614). No high rate of sexual satisfaction was observed for both groups in the pre-test; however, the difference was significant between the pre- and post-test sexual satisfaction scores for the experimental group (P = 0.02). -
The Effect of Pelvic Floor Muscle Training on Incontinence
JMHXXX10.1177/1557988318757242American Journal of Men’s HealthAydın Sayılan and Özbaş 757242research-article2018 Original Article American Journal of Men’s Health 2018, Vol. 12(4) 1007 –1015 The Effect of Pelvic Floor Muscle © The Author(s) 2018 Reprints and permissions: sagepub.com/journalsPermissions.nav Training On Incontinence Problems DOI:https://doi.org/10.1177/1557988318757242 10.1177/1557988318757242 After Radical Prostatectomy journals.sagepub.com/home/jmh Aylin Aydın Sayılan1 and Ayfer Özbaş2 Abstract The aim of the current study was to determine the effect of pelvic floor muscle exercises (PFME/Kegel) training administered to patients scheduled for robot-assisted radical prostatectomy on postprocedural incontinence problems. This study was a randomized controlled trial. Pelvic floor muscle exercises were applied to the procedure group three times a day for 6 months. No exercises were applied to the control group. Incontinence and quality-of-life assessments of the 60 patients in the experimental and control groups were performed on months 0 (10 days after removal of the urinary catheter), 1, 3, and 6 through face-to-face and telephone interviews. Total Incontinence Consultation on Incontinence-Short Form scores, which provide an objective criterion for the evaluation of individuals with incontinence problems, decreased over time. This decrease was statistically highly significant in the third and sixth months. Pelvic muscle floor exercises are suitable for patients experiencing incontinence after radical prostatectomy. Keywords urinary incontinence, prostatectomy, muscle stretching exercises. Received October 8, 2017; revised December 19, 2017; accepted January 3, 2018 Prostate cancer is one of the most common cancer types therefore involves noninvasive behavioral therapeutic in men, and the prevalence increases with age (Vidmar methods consisting of diet modification, bladder train- et al., 2017). -
Paediatric Urinary Incontinence
VOLUME 37 : NUMBER 6 : DECEMBER 2014 ARTICLE Paediatric urinary incontinence Gail Nankivell Senior physiotherapist1 SUMMARY Patrina HY Caldwell Staff specialist Urinary incontinence, both in the day and at night, is common in school-aged children and can be paediatrician1,2 very distressing for children and their families. 1 The Children’s Hospital An accurate history together with a thorough physical examination is essential for assessing and Westmead diagnosing urinary incontinence. 2 Discipline of Paediatrics Conservative treatment should be offered to all children. If that fails, treatment with anticholinergic and Child Health University of Sydney drugs could be tried in those with daytime urinary incontinence and overactive bladder. After addressing any daytime bladder symptoms, treatment with alarm therapy is recommended Key words for children with nocturnal enuresis. Desmopressin is another option. bedwetting, nocturnal enuresis Introduction During the day, voiding occurs when children synchronously contract their detrusor muscle and relax Aust Prescr 2014;37:192–5 Urinary incontinence in the day and at night is their urinary sphincters and pelvic floor muscles (usually common in school-aged children. Its causes can be in response to the sensation of bladder fullness). multifactorial. Daytime urinary incontinence occurs This allows the free flow of urine until the bladder is in about 17–20% of children1-3 with a further 6.6% empty. At night, with adequate bladder storage and of those having problems at night as well.2 The urine concentration, children usually sleep through the prevalence of nocturnal enuresis is 8–20% at five night without needing to urinate, but have the ability years of age, with a spontaneous remission rate of to wake up to void when they sense bladder fullness. -
Pelvic Floor Muscle Exercise with Biofeedback Helps Regain Urinary
Original article eISSN 2384-0293 Yeungnam Univ J Med 2021;38(1):39-46 https://doi.org/10.12701/yujm.2020.00276 Pelvic floor muscle exercise with biofeedback helps regain urinary continence after robot-assisted radical prostatectomy Yeong Uk Kim1, Dong Gyu Lee2, Young Hwii Ko3 1Department of Urology, Yeungnam Hospital, of Medicine, Daegu, Korea 2Department of Physical Medicine and Rehabilitation, Yeungnam University College of Medicine, Daegu, Korea 3Department of Urology, Yeungnam University College of Medicine, Daegu, Korea Received: April 12, 2020 Revised: May 5, 2020 Background: To determine the benefit of pelvic floor muscle exercise (PFME) with visual biofeed- Accepted: May 7, 2020 back on promoting patient recovery from incontinence, we investigated variables associated with the early restoration of continence for patients who underwent robot-assisted radical prostatec- Corresponding author: tomy (RARP). Young Hwii Ko Methods: Of the 83 patients enrolled, 41 consecutive patients completed PFME (the exercise Department of Urology, Yeungnam group), and the other 42 consecutive patients just before the PFME program commenced (the University College of Medicine, 170 control group). The primary outcome was whether PFME engagement was associated with zero Hyeonchung-ro, Namgu, Daegu pad continence restoration within 3 months of surgery. 42415, Korea Results: Continence restoration percentages (defined as zero pads used per day) at 1, 3, and 6 Tel: +82-53-620-3694 Fax: +82-53-627-5535 months after surgery were 49.4%, 77.1%, and 94.0%, respectively. The exercise group achieved E-mail: [email protected] significantly higher recovery rates at 1 month (p=0.037), 3 months (p<0.001), and 6 months (p=023).