Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: UMLS:C0042024 (incontinence)
 13,409 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Data obtained through five hospital-wide pressure ulcer audits were pooled for exploratory analysis. The purpose of this secondary data analysis was (1) to delineate the association of various risk factors and the presence of pressure ulcers and (2) to generate specific, testable hypotheses. Risk factors studied included fecal incontinence, urinary incontinence, malnutrition, impaired mobility, decreased mental status, diabetes mellitus, peripheral vascular disease, spinal cord injury, multiple sclerosis, and metastatic carcinoma. Stepwise logistic regression resulted in a best-fitting model that included fecal incontinence, impaired mobility, malnutrition, decreased mental status, and an interaction effect between fecal incontinence and impaired mobility. This model suggested that the odds of having a pressure ulcer were 22 times greater for hospitalized adult patients with fecal incontinence compared to hospitalized adult patients without fecal incontinence.
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PMID:Risk factors associated with having a pressure ulcer: a secondary data analysis. 779 63

Vesicosphincteric disorders are frequent in multiple sclerosis and lead to the diagnosis of this disease in 2 to 5% of cases. The clinical signs are dominated by urgency (60 to 80%), frequency (40 to 60%) and incontinence due to vesical disinhibition. Dysuria (15 to 30%) occurs in an areflexive or hyperactive bladder, associated with vesicosphincteric dyssnergia. These signs are frequently associated (50 to 80%). Cystomanometry shows detrusor hyperactivity in 50 to 78% of cases and hypoactivity in 20 to 40% of cases and dyssnergia is frequent (50 to 80%). There is no correlation between the clinical and urodynamic signs. Consequently, urodynamic studies are useful for establishing a precise urological diagnosis and to prescribe adapted and early treatment due to the long-term risk of upper tract damage.
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PMID:[Vesico-sphinteral disorders in multiple sclerosis: value of urodynamic tests]. 785 42

Fifteen women and five men with bladder dysfunction due to multiple sclerosis were randomized to plus/minus biofeedback using bladder pressure and simultaneous EMG registration via surface electrodes. All the patients had behavioural modification, pharmacological adjustment and pelvis floor training. The number of incontinence episodes decreased and maximal cystometric capacity increased, while first sensation and pad test were unchanged. Subjective treatment results assessed by visual analogue scales for incontinence and obstrusive voiding symptoms were highly significant. However no biofeedback parameter was improved and no difference could be demonstrated between the two treatment groups. In conclusion the used biofeedback technique is insufficient and the 60 min. standardized pad weighing test is inadequate in this type of patients.
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PMID:Biofeedback treatment of bladder dysfunction in multiple sclerosis. A randomized trial. 793 55

The aim of this study was to define pelvic floor function in patients with multiple sclerosis and bowel dysfunction, either incontinence (MSI) or defecation difficulties without incontinence (MSC). Normal controls and patients with idiopathic neurogenic faecal incontinence without multiple sclerosis (FI, disease controls) were also studied. Thirty eight multiple sclerosis patients (20 incontinent, 18 incontinent) 73 normal controls, and 91 FI patients were studied. The FI group showed the characteristic combined sensorimotor deficit previously described in these patients of low resting and voluntary contraction and pressures, increased sensory threshold to mucosal stimulation, and increased pudendal nerve terminal motor latencies and fibre densities. MSI patients had significantly lower anal resting pressures (80 (30-140) cm H2O, median (range) v 98 (30-200), normal controls, p = 0.002) and both MSC and MSI patients had significantly lower anal maximum voluntary contraction pressures (65 (0-260) cm H2O, MSC and 25 (0-100), MSI v 120 (30-300), normal controls, p = < 0.0004) and higher external anal sphincter fibre densities (1.7 (1.1-2.6), MSC and 1.7 (1.1-2.4), MSI v 1.5 (1.1-1.75), normal controls, p < 0.006) compared with normal controls but pudendal nerve terminal motor latencies were similar and no sensory deficit was found. This contrasted with the idiopathic faecal incontinent patients who, in addition to significantly higher fibre densities (1.8 (1.1-3), p = 0.001) had increased pudendal latencies (2.5 (1.1-5.5) mS v 2.08 (1.4-2.6), p = 0.001) compared with normal controls. The idiopathic faecal incontinent group had significantly lower resting anal pressures (50 (10-160) cm H2O, p=0.02) than the MSI group. Comparison with the incontinent and continent multiple sclerosis groups showed that incontinence was associated with lower voluntary anal contraction pressures (25 (0-100) v 65 (0-260), p=0.03) but that there were no other differences between these two groups. Pelvic floor function is considerably disturbed in multiple sclerosis, showing muscular weakness with preservation of peripheral motor nerve conduction, providing indirect evidence that this is mainly a result of lesions within the central nervous system.
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PMID:Pelvic floor function in multiple sclerosis. 815 Mar 53

Twenty-four patients, with various combinations of non-healing decubitus ulcers, urethral fistulae, incontinence, and penile skin breakdown were candidates for proximal urinary diversion, having failed intermittent, external, and indwelling catheterization combined with pharmacologic therapy. Seventeen patients underwent bladder neck closure, including seven with multiple sclerosis and ten with spinal cord injury, and because they were unable or unwilling to do catheterization, had their urine diverted by suprapubic catheter. Seven patients, including four with spinal cord injury, underwent bladder neck closure and continent augmentation with formation of a catheterizable cutaneous stoma on the anterior abdominal wall, using right colon and right colon/ileum configurations. When ureteral reflux and obstruction are absent, the patient's bladder was used which spared the added risk of ureteral implantation and possible ureteral stricture while increasing total bladder capacity. In a select group of patients with intractable incontinence, perineal and penile skin breakdown, or urethral fistulae, bladder neck closure and urinary diversion by suprapubic catheter or continent augmentation has proven to be a reliable and effective alternative to an ileal conduit.
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PMID:Bladder neck closure with continent augmentation or suprapubic catheter in patients with neurogenic bladders. 842 80

Intermittent self-catheterization was taught to 70 patients with multiple sclerosis (MS) between 1.9.1989 and 31.1.1992 in Masku Neurological Rehabilitation Centre. All of them were interviewed in April 1992. Altogether 62 (89%) returned the questionnaires. The aims of the study were 1) to define the compliance of the patients to the treatment, and 2) to assess the effect of the catheterization on the quality of life of the patients. The conceptual framework used for the study was self care concept. Bladder symptoms had been present for seven years (mean) and the average time after the diagnosis of MS was ten years. Twenty eight (28) patients discontinued the treatment after having catheterized for 11 months in average. The main reason (50%) for discontinuation was normalization of the bladder function. The patients reported reduction in urgency symptoms, incontinence of urine and difficulties in emptying the bladder. All these changes were statistically significant. The number of urinary infections was slightly increased (not reaching statistical significance). However, the infections caused less subjective discomfort during the treatment than before it. The urinary symptoms interfered with the personal activities of the patients in a variety of ways. As many as 79% of the respondents reported that their quality of life was improved by the intermittent self-catheterization. The treatment allowed the patients to resume their personal, social -- and in some cases occupational--activities of daily living. Significant improvement was reported in f.e. family life, marital relationships, sexual life and the quality of night sleep.
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PMID:[Intermittent self-catheterization in multiple sclerosis]. 842 49

Autonomic dysfunction is responsible for much of the morbidity associated with frequently encountered neurological disorders, such as Parkinson's disease, multiple sclerosis, cerebrovascular disease, and peripheral neuropathies, as well as with the rarer primary autonomic nervous system degenerations. We review the treatment of those aspects of autonomic dysfunction that often present to the neurologist, including orthostatic hypotension, urinary incontinence and retention, and bowel dysmotility syndromes. Pathophysiology is discussed in each instance as it relates to a rational approach to therapy. For management of orthostatic hypotension, we review the use of mineralocorticoids, direct and indirect sympathomimetic agents, other pressors, dopamine-blocking agents, vasopressin receptor agonists, and others. Treatment of urinary incontinence and retention is addressed, with attention to drugs that modulate bladder contractility and bladder outlet resistance. Therapies for bowel dysmotility syndromes (such as gastroparesis, diarrhea, and fecal incontinence) are described, including bulk agents, laxatives, prokinetic agents, and antidiarrheal drugs.
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PMID:The treatment of autonomic dysfunction. 845 96

A 13-year-old girl presented with hyersomnia and incontinence of urine. The clinical course was complicated by strabism, muscle weakness and coordination and balance disturbances. VEP recording were pathologic. Myelin basic protein in the cerebrospinal fluid was elevated. Nuclear resonance imaging of the brain revealed multiple areas of demyelination. These findings supported the diagnosis of multiple sclerosis. There was a marked disturbance of the sleep-waking-pattern during the acute phase of the illness. The hypnogram resembled the pattern of polysymptomatic narcolepsy. Regression of symptoms was noted with dexamethasone therapy.
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PMID:[Hypersomnia in multiple sclerosis]. 867 95

Maximal electrical stimulation by intravaginal or intra-anal electrodes was used for treatment of 75 patients with complaints of urgency and/or urge incontinence. The patient group consisted of 51 women and 24 men. A neurogenic background was present in 30 of the women who had a diagnosis of multiple sclerosis, in the other 45 patients the pathology was idiopathic in nature. After 3 weeks of maximal electrical stimulation treatment, composed of 15 sessions of 20 minutes duration, 59% of the patients had urodynamic and subjective improvement and an additional 40% only subjective improvement. One patient found no benefit after this treatment. The effect lasted for at least 2 years in 64% of the idiopathic group. In the multiple sclerosis group relapse occurred within about 2 months. Re-treatment of the failures was successful again immediately; the multiple sclerosis patients do need daily home stimulation treatments.
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PMID:Maximal external electrical stimulation for treatment of neurogenic or non-neurogenic urgency and/or urge incontinence. 873 85

Two hundred and twenty-five patients with multiple sclerosis and bladder dysfunction were evaluated. 72% had urinary incontinence, 46% dysuria and 24% urinary retention. Detrusor hyperreflexia was the most common finding on cystometry (70%) and 9% of patients had areflexia. Coaxial needle electromyography was performed on all patients and 82% had detrusor-sphincter dyssynergia. Cortical evoked potentials following stimulation of the pudendal nerve were delayed in 72% and sacral evoked latency in 16% especially in patients with incontinence secondary to overactive bladder (25%), suggesting a conus medullaris lesion in these cases. Urologic complications were noted in 40%, with benign lesions in 24% (diverticula, urinary infections) and serious lesions in 16% (hydronephrosis, pyelonephritis, renal reflux). The most common treatment was anticholinergic drugs (efficacy in 92%), alphablockers agents (efficacy in 60%) and autocatheterism in 28%.
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PMID:[Bladder and sphincter disorders in multiple sclerosis. Clinical, urodynamic and neurophysiological study of 225 cases]. 878 3


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