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 23,843 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

The objectives of this survey were to establish the prevalence, onset, severity and impact of incontinence and attitudes towards the availability of advice and treatment in female adults with cystic fibrosis (CF) in Northern Ireland. All female patients (n=59) at the Northern Ireland Regional Adult CF Centre were posted a questionnaire on incontinence. Leakage of urine occurred in 14/46 respondents. Leakage of urine occurred when chest was bad in 8/14 patients and when chest was good or bad in 3/14 patients. Patients reported that their bladder problem affected their ability to perform airway clearance or cough (13/14), and exercise (4/14). The main reason given for the patients who did not seek help for their incontinence (10/14) was that they were too embarrassed. This study highlights that patients with CF are reluctant to seek treatment for incontinence despite the impact this condition can have.
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PMID:Incontinence in adult females with cystic fibrosis: a Northern Ireland survey. 1272 20

Since urinary incontinence is one of the most frequent female health problems and may severely affect a woman's life quality, knowledge about its pathophysiology, evaluation and therapy is very important. Even basic diagnostic tests can determine the type of incontinence (stress or urge urinary incontinence) thus permitting appropriate therapy to be initiated. The patients history, micturition diary, clinical evaluation, perineal ultrasound and urinalysis are important parts of these basic diagnostic tests. The positive stress cough test and the typical symptoms such as urine loss during physical activity point to the diagnosis of stress urinary incontinence. Frequency, nocturia and urgency with or without urine loss as well as more objective criteria such as micturition diaries and urinalysis indicate urge incontinence. Questions to help determine how quality of life is affected by the incontinence symptoms aid in deciding how urgent the treatment is. An urodynamic evaluation together with perineal ultrasound and cystoscopy is performed in patients with complex or recurrent urinary incontinence after surgery or with micturition disorders.
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PMID:[Urinary incontinence in the woman--pathophysiology and diagnosis]. 1280 94

Urinary incontinence and urogenital disorders are increasing. This is bothersome and impinges on the patient's quality of life. Early recognition, allowing early diagnosis, effective therapy as well as long-term prophylaxis are important. For diagnosis that quickly leads to a therapeutic decision, the anamnesis should specifically cover this area. Additionally, clinical examination, urinalysis including residual urine determination and cystoscopy for evaluating the bladder wall and a coughing test with a full bladder should be performed-all investigations easily done in the gynecologists's office. After diagnosis, treatment planning takes place. Urinary incontinence and urogenital complaints often have several pathologic causes. To improve success, various treatment possibilities should be optimally combined. Conservative therapy basics include: drinking and miction training, pelvic floor training including training aids and electrostimulation, pessaries, pharmaceutical therapies, estrogen as well as a through prophylaxis and treatment of infection. The primary treatment must be followed up with long-term prophylaxis. The most important requirements for a successful conservative therapy include knowing the various treatment basics, their uses, understanding and having the patience to follow through with an involved and time-intensive treatment plan. This work provides an overview of the various conservative treatments and their successful combinations.
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PMID:[Conservative therapy of urinary incontinence and bladder complaints in the woman]. 1280 97

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.
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PMID:Duloxetine: a serotonin-noradrenaline re-uptake inhibitor for the treatment of stress urinary incontinence. 1294 99

The purpose of this study was to evaluate the feasibility, safety and efficacy of performing the Burch urethropexy (BU) and the abdominal paravaginal repair (APR) through a 1.5-2.5 in suprapubic incision. A prospective clinical study was undertaken by four urogynecologists. Seventy-three patients, each with a urodynamic and clinical diagnosis of genuine stress incontinence, underwent a BU procedure, with 33 of the 73 having concomitant APR through the same incision. The duration of surgery and any complications were recorded. Postoperative outcome tests included subjective incontinence questionnaire, cough stress testing, pad testing, measurement of residual volumes, and analgesia requirements. The BU procedure was accomplished in 72 of 73 patients, with 1 requiring conversion to a 5 in incision. The mean operative time was 64.6 +/-21.9 (SD) min. Intraoperatively, 1 patient was noted to have a suture in the bladder. All patient having only a BU (40) went home on the day of surgery or the first postoperative day, and all patients with BU and APR went home within 2 days. All but 1 patient met the criteria for catheter removal within 7 days, with 1 patient suffering obstructive voiding. At a mean follow-up of 9 months, cough stress test and questionnaire demonstrated complete cure in 70 of 72 patients tested. Pad testing confirmed cure in all of the 46 patients who consented to the test. We conclude that the standard Burch procedure and paravaginal repair can be accomplished safely and with excellent short-term efficacy through a 1.5-2.5 in incision.
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PMID:Mini-incisional Burch urethropexy: a less invasive method to accomplish a time-tested procedure for treatment of genuine stress incontinence. 1475 94

To date several randomized controlled trials (RCT) have shown that pelvic floor muscle (PFM) training is effective in the treatment of female stress (SUI) and mixed urinary incontinence and, therefore, it is recommended as a first-line therapy. While the effectiveness of treatment is established, there are different theoretical rationales for why PFM training is effective. The aims of this article are to discuss the theories behind why PFM training is effective in treating SUI and to discuss each theory in the framework of new knowledge of functional anatomy and examples of results from RCTs. There are three proposed theories to explain the effectiveness of PFM training for SUI: 1) women learn to consciously pre-contract the PFMs before and during increases in abdominal pressure (such as coughing, physical activity) to prevent leakage; 2) strength training builds up long-lasting muscle volume and thus provides structural support; and 3) abdominal muscle training indirectly strengthens the PFM. The first can be placed in a behavioral construct, while the two latter both have the aim of changing neuromuscular function and morphology, thus making the PFM contraction automatic. To date there are RCTs and basic anatomy studies to support the first two concepts only.
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PMID:Pelvic floor muscle training is effective in treatment of female stress urinary incontinence, but how does it work? 1501 33

Development of an animal model of stress urinary incontinence is dependent on a measure of urethral resistance, such as leak point pressure (LPP). However, animals will not cough or perform Valsalva maneuvers upon request. The aim of this study was to use urodynamics to compare bladder pressures during spontaneous voids (SV), anesthetized LPP measurement, and induced sneezing in female rats. A suprapubic catheter was implanted in the bladder dome of 10 female rats. Two days later, the rats were tested urodynamically under urethane anesthesia. The bladder was emptied and filled with saline. The abdomen was then depressed manually to increase abdominal pressure while bladder pressure was measured. The bladder pressure when leakage occurred was taken as LPP. In addition, the rats were stimulated to sneeze by cutting off a whisker and using it to tickle the nostril. Both peak pressure and increase in pressure during LPP (43.4 +/- 3.6 and 33.1 +/- 3.8 cm H2O, respectively) were significantly higher than pressures during both SV (30.4 +/- 3.8 and 19.3 +/- 3.4 cm H2O, respectively) and sneeze (9.5 +/- 0.7 and 2.6 +/- 0.5 cm H2O, respectively). The time course of a sneeze (0.6 +/- 0.2 sec) was significantly shorter than the time course of both LPP (4.4 +/- 0.5 sec) and SV (6.9 +/- 1.3 sec). No rat leaked from a sneeze unless the sneeze triggered an SV. LPP triggered a SV in 5 rats and sneeze triggered a SV in 6 rats. With urodynamic measurement, it is possible to easily distinguish between LPPs, SVs, and sneezes. LPP can provide a quantifiable measure of decreased urethral resistance, whereas induced sneezes can provide a diagnostic test for severe incontinence.
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PMID:Methods of testing urethral resistance in the female rat. 1517 26

Abdominal hysterectomy has been shown to affect anorectal function. These studies are either population-based or have been performed retrospectively. It is not clear from the literature whether those subjects awaiting hysterectomy already have an element of pelvic floor failure and which may be related to obstetric risk factors. A complete anorectal assessment was performed in a group of women awaiting hysterectomy who did not volunteer any bowel symptoms. The patients studied were part of an ongoing study of the functional effects of abdominal hysterectomy. All had their anorectal function assessed before their respective surgery by a questionnaire (functional bowel score), Cleveland continence score, endoanal ultrasound (U/S), anal manometry, defaecatory proctogram and colonic transit. A detailed obstetric history, which included risk factors such as parity, type of delivery, duration of labour and elevated birth weight, were also recorded. Patients with previous bowel disease, bowel surgery and anal sphincter repair were excluded. There were 39 subjects with a median age of 43 years (range 31-65), respectively. Thirty-three rectocoeles and 22 intussusceptions were demonstrated. Two had poor puborectalis function, while five had cough incontinence. Two women had abnormal colonic transit. Thirteen had abnormal anal manometry. Endoanal ultrasound was normal in all patients. None of the obstetric risk factors were associated with rectocoele, intussusception or abnormal anal manometry. Low squeeze pressure was associated significantly with more bowel symptoms (P=0.03). However, rectocoele, intussusception, abnormal colonic transit, abnormal resting anal pressure and maximal tolerated volume were not statistically significantly associated with bowel symptoms. The majority of female subjects who were awaiting hysterectomy had physiological and proctographic abnormalities consistent with pelvic floor failure. Obstetric risk factors were not associated with rectocoele, intussusception, abnormal colonic transit and anal manometry in this cohort of patients. Similarly, the majority of proctographic abnormalities were not associated with bowel symptoms. However, a trend was noted associating bowel symptoms with manometric abnormalities.
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PMID:Are obstetric risk factors and bowel symptoms associated with defaecographic and manometric abnormalities in women awaiting hysterectomy? 1520 25

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. Worldwide, SUI is a highly prevalent condition, both in young and elderly women, and is a condition fraught with social isolation, loss of self-esteem and significant financial burden. Most women with SUI assume that it is an inevitable part of aging and "suffer in silence", relying on absorbent pads or lifestyle changes to cope with their condition.Unfortunately, for those who do seek medical treatment, the absence of effective and well tolerated pharmacological treatments for SUI limits the clinician's choices to behavioural modification, biofeedback and surgery. Many of the nonsurgical approaches have low success rates, particularly in the elderly and more severely afflicted. Although most continence surgeries have been reported to produce very high cure rates, many women are willing to live with their condition rather than undergo such invasive options. In an attempt to help these patients, some physicians prescribe off-label agents, including tricyclic antidepressants such as imipramine, alpha- and beta-adrenoceptor agonists, and estrogen replacement therapy. The use of these therapies has been limited by unpredictable results and adverse reactions. In addition, acetylcholine receptor antagonists are often prescribed for SUI, despite the fact that these medications have never been shown to be effective in this condition. This lack of a reliable pharmaceutical agent led to the development of duloxetine, a balanced dual reuptake inhibitor of serotonin and norepinephrine that is also being studied for the treatment of major depressive disorder. Based on in vivo data in animals, duloxetine is believed to increase the strength of urethral sphincter contractions and, thereby, prevent accidental urine leakage by increasing urethral closure forces. In clinical trials in women with SUI, duloxetine has demonstrated efficacy in reducing incontinence episodes and increasing the quality of life with no serious adverse effects. Nausea was the most common adverse event; however, in most patients it was reported early in treatment, mild-to-moderate in severity and transient. A medication such as duloxetine, if approved, would go a long way towards expanding the available treatment options for patients with SUI.
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PMID:Pharmacotherapy for stress urinary incontinence : present and future options. 1571 22

This review discusses the prevalence, risk factors, the impact on the quality of life and healthcare-seeking behavior of women suffering from urinary incontinence (UI) and stress urinary incontinence (SUI) in particular. UI is a common problem, affecting women in all age groups, and has devastating effects on their social, professional and family life. UI may be manifest as stress urinary continence (SUI), i.e. 'the complaint of involuntary leakage on effort or exertion, or on sneezing or coughing'. SUI is the most common form of UI, reported by approximately 50% of the incontinent women. Alternatively, patients may suffer from urge urinary incontinence (UUI), characterized by the 'complaint of involuntary leakage accompanied or immediately preceded by urgency'. This is reported by 10-20% of incontinent women. Patients having symptoms of both disorders may be afflicted by mixed urine incontinence (MUI), being reported by 30-40% of incontinent women. This complaint was recently included in the definitions as: 'Involuntary leakage associated with urgency and also with exertion, effort, sneezing or coughing'. Urodynamic studies show that the prevalence of SUI is underestimated when based on symptoms alone, as many patients with mixed symptoms have pure SUI during urodynamics. Although the etiology of SUI is still poorly understood, among the main risk factors are age, pregnancy, childbirth and obesity. Unfortunately, the majority of the patients suffering UI postpones looking for medical help for years, or may even never consult a physician regarding their problem, despite the considerable negative impact on their quality of life. Feelings of shame and embarrassment play an important role in this, in combination with the common belief that UI is a normal and inevitable consequence of the aging process. Clearly, there is still a long way to go in making patients and society aware of the fact that UI is a disorder, which can and should be treated. Consequently, patients must be encouraged to report their problem, while health care providers should raise the issue on routine exams in risk groups.
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PMID:Stress urinary incontinence in the gynecological practice. 1530 63


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