Percutaneous Tibial Nerve Stimulation for Voiding Dysfunction
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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. -
CMS Manual System Human Services (DHHS) Pub
Department of Health & CMS Manual System Human Services (DHHS) Pub. 100-07 State Operations Centers for Medicare & Provider Certification Medicaid Services (CMS) Transmittal 8 Date: JUNE 28, 2005 NOTE: Transmittal 7, of the State Operations Manual, Pub. 100-07 dated June 27, 2005, has been rescinded and replaced with Transmittal 8, dated June 28, 2005. The word “wound” was misspelled in the Interpretive Guidance section. All other material in this instruction remains the same. SUBJECT: Revision of Appendix PP – Section 483.25(d) – Urinary Incontinence, Tags F315 and F316 I. SUMMARY OF CHANGES: Current Guidance to Surveyors is entirely replaced by the attached revision. The two tags are being combined as one, which will become F315. Tag F316 will be deleted. The regulatory text for both tags will be combined, followed by this revised guidance. NEW/REVISED MATERIAL - EFFECTIVE DATE*: June 28, 2005 IMPLEMENTATION DATE: June 28, 2005 Disclaimer for manual changes only: The revision date and transmittal number apply to the red italicized material only. Any other material was previously published and remains unchanged. However, if this revision contains a table of contents, you will receive the new/revised information only, and not the entire table of contents. II. CHANGES IN MANUAL INSTRUCTIONS: (N/A if manual not updated.) (R = REVISED, N = NEW, D = DELETED) – (Only One Per Row.) R/N/D CHAPTER/SECTION/SUBSECTION/TITLE R Appendix PP/Tag F315/Guidance to Surveyors – Urinary Incontinence D Appendix PP/Tag F316/Urinary Incontinence III. FUNDING: Medicare contractors shall implement these instructions within their current operating budgets. IV. ATTACHMENTS: Business Requirements x Manual Instruction Confidential Requirements One-Time Notification Recurring Update Notification *Unless otherwise specified, the effective date is the date of service. -
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. -
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. -
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. -
Diagnosis and Treatment of Overactive Bladder (Non-Neurogenic) in Adults: AUA/SUFU Guideline
Diagnosis and Treatment of Overactive Bladder (Non-Neurogenic) in Adults: AUA/SUFU Guideline E. Ann Gormley, Deborah J. Lightner, Kathryn L. Burgio, Toby C. Chai, J. Quentin Clemens, Daniel J. Culkin, Anurag Kumar Das, Harris Emilio Foster, Jr., Harriette Miles Scarpero, Christopher D. Tessier, Sandip Prasan Vasavada From the American Urological Association Education and Research, Inc., Linthicum, Maryland, and the Society of Urodynamics, Female Pelvic Medicine and Urogenital Reconstruction Purpose: The purpose of this guideline is to provide a clinical framework for the Abbreviations diagnosis and treatment of non-neurogenic overactive bladder (OAB). and Acronyms Materials and Methods: The primary source of evidence for this guideline is the AE ϭ adverse event systematic review and data extraction conducted as part of the Agency for ER ϭ extended release Healthcare Research and Quality (AHRQ) Evidence Report/Technology Assess- ϭ ment Number 187 titled Treatment of Overactive Bladder in Women (2009). That FDA Food and Drug report searched PubMed, MEDLINE®, EMBASE and CINAHL for English- Administration language studies published from January 1966 to October 2008. The AUA IR ϭ immediate release conducted additional literature searches to capture treatments not covered in OAB ϭ overactive bladder detail by the AHRQ report and relevant articles published between October PTNS ϭ peripheral tibial nerve 2008 and December 2011. The review yielded an evidence base of 151 treat- stimulation ment articles after application of inclusion/exclusion criteria. When sufficient PVR ϭ post-void residual evidence existed, the body of evidence for a particular treatment was assigned QoL ϭ quality of life a strength rating of A (high), B (moderate) or C (low). -
Overactive Bladder
Urological Health Overactive bladder An overactive bladder is a common condition of frequent and urgent urination in men, women he bladder normally stores urine without discomfort In most cases, the cause of overactive bladder Tor pressure until emptying is appropriate. This is symptoms is unknown. In some patients this problem controlled by nerves with input from the brain and can be associated with certain conditions including spinal cord. Most adults void 6-10 times a day and urinary tract infections, prostate enlargement and often up to twice a night. Toilet trained children void others. Diseases of the brain and spinal cord can 4-8 times a day. This will depend on the amount you cause overactive bladder symptoms. Your urologist drink. will clarify your symptoms by asking questions and performing some investigations. Different bladder problems require different treatments. Normal bladder anatomy s ossi r Investigation of overactive bladder D oula R The investigation of overactive bladder symptoms begins with a thorough questioning regarding your voiding pattern, including the timing, frequency and discomfort associated with your voiding or urinary leakage. A voiding diary, recording times and amounts, may be helpful. bladder uterus A urine sample may be obtained to exclude a urinary tract infection and other bladder diseases. Other prostate bladder urethra more sophisticated tests may be required and will be urethra described by your doctor. This may include a visual inspection of the bladder (cystoscopy). Urodynamic Male side view Female side view assessment, where pressures in the bladder are measured during filling and emptying, may be Normal bladder anatomy recommended to better understand your bladder function. -
Neurogenic Detrusor Overactivity: an Update on Management Options
CONTRIBUTIONS Neurogenic Detrusor Overactivity: An Update on Management Options EUGENE CONE; PAMELA ELLSWORTH, MD ABSTRACT neuromodulation (electrical stimulation) has been used in Neurogenic detrusor overactivity (NDO) affects a variety patients who have failed anticholinergics. Intra-detrusor in- of patients with storage and voiding dysfunction includ- jection of onabotulinum toxin-A is approved by the FDA for ing those with multiple sclerosis, spinal cord injuries, the management of NDO in patients refractory or intolerant Parkinson’s disease, cerebral palsy, and myelomeningo- of anticholinergics. In select individuals, a chronic indwell- cele, and includes symptoms of urinary frequency, ur- ing catheter may be indicated. Surgical intervention may be gency, and incontinence. Primary treatment goals are 1) indicated for protection of the upper urinary tract in high- preventing renal injury, and 2) improving quality of life. risk patients or to achieve continence. First-line therapies include behavioral and anticholiner- gic agents, with onabotulinum toxin-A as the only FDA- Anticholinergic Therapy approved second-line therapy, and non-FDA approved Anticholinergic agents inhibit the binding of acetylcholine second-line therapies including neuromodulation, and in- to muscarinic receptors in the bladder detrusor muscle, travesical vanilloids. Surgical intervention is reserved for decreasing involuntary detrusor contractions, increasing those at risk for upper-tract deterioration and with per- bladder capacity, and improving bladder compliance -
Urinary Retention in Women Workshop Chair: David Castro-Diaz, Spain 07 October 2015 08:30 - 11:30
W16: Urinary Retention in Women Workshop Chair: David Castro-Diaz, Spain 07 October 2015 08:30 - 11:30 Start End Topic Speakers 08:30 08:45 Urinary retention in women: concepts and pathophysiology David Castro-Diaz 08:45 08:50 Discussion All 08:50 09:05 Evaluation Tufan Tarcan 09:05 09:10 Discussion All 09:10 09:30 Conservative management Cristina Naranjo-Ortiz 09:30 09:35 Discussion All 09:35 09:55 Medical and surgical management Christopher Chapple 09:55 10:00 Discussion All 10:00 10:30 Break None 10:30 11:20 Typical clinical cases discussion All 11:20 11:30 Take home messages David Castro-Diaz Aims of course/workshop Urinary retention in women is rare and diverse. Diagnostic criteria are not agreed and epidemiology is not well known. Forms of urinary retention in women include: complete retention, incomplete or insufficient emptying and elevated post-void residual. It may be acute or chronic, symptomatic or asymptomatic. Etiology is multifactorial including anatomic or functional bladder outlet obstruction and bladder dysfunction related to neurological diseases, diabetes mellitus, aging, pharmacotherapy, pain and infective/inflammatory disease and idiopathic or unknown aetiology. This workshop will analyse and discuss physiopathology, evaluation and management of urinary retention in women from an integral, practical and evidence based approach. Learning Objectives 1. Identify urinary retention in women, its etiology and risk factors. 2. Carry out proper diagnosis of urinary retention in women as well as its relationship with risk and influent factors. 3. Properly manage female acute and chronic acute and chronic urinary retention with the different approaches including conservative, medical and surgical therapies. -
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 -
Nerve Disease and Bladder Control
Nerve Disease and Bladder Control National Kidney and Urologic Diseases Information Clearinghouse For the urinary system to do its job, muscles and nerves must work together to hold Brain urine in the bladder and then release it at the right time. Nerves carry messages from NATIONAL the bladder to the brain to let it know when INSTITUTES the bladder is full. They also carry messages OF HEALTH Central nervous from the brain to the bladder, telling muscles system (brain either to tighten or release. A nerve prob and spinal cord) lem might affect your bladder control if the nerves that are supposed to carry messages Spinal cord between the brain and the bladder do not work properly. Nerve signals U.S. Department to bladder of Health and Bladder and sphincter Human Services What bladder control muscles problems does nerve damage cause? Nerves that work poorly can lead to three Urethra different kinds of bladder control problems. Overactive bladder. Damaged nerves may Sphincter muscles send signals to the bladder at the wrong time, causing its muscles to squeeze with Nerves carry signals from the brain to the bladder out warning. The symptoms of overactive and sphincter. bladder include • urinary frequency—defined as urination eight or more times a day or two or nerves to the sphincter muscles are dam more times at night aged, the muscles may become loose and allow leakage or stay tight when you are • urinary urgency—the sudden, strong trying to release urine. need to urinate immediately Urine retention. For some people, nerve • urge incontinence—leakage of urine damage means their bladder muscles do that follows a sudden, strong urge to not get the message that it is time to release urinate urine or are too weak to completely empty Poor control of sphincter muscles.