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Query: UMLS:C0042024 (incontinence)
 13,409 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Fifty five patients between 65 and 89 years old who had their urinary problems assessed by urodynamics study were reviewed. The most common urinary symptom among males was urge incontinence, while retention and urge incontinence occurred with equal frequency among females. The commonest cause of retention in males was bladder outlet obstruction, while atonic neurogenic bladder was the most common cause in females. Urge incontinence was strongly associated with an unstable bladder, small bladder volume and Parkinson's disease. Retention of urine, and an atonic neurogenic bladder strongly correlated with diabetes mellitus. Three patients (out of 31) with unstable bladders also had detrusor external sphincter dyssynergia. Of these, two had Parkinson's disease. Although three patients were thought to have stress incontinence after history and physical examination, only two had stress incontinence with detrusor instability on urodynamic studies. The last patient had atonic bladder with overflow.
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PMID:Urinary symptoms and urodynamic diagnosis of patients in one geriatric department. 129 23

Treatment of acute urinary incontinence should be directed toward the underlying cause, such as infection, medication side effect, atrophic vaginitis, anxiety, depression and restricted mobility. Pharmacologic treatment depends on identification of one of the four subtypes of chronic urinary incontinence: stress, urge, overflow or mixed. Stress incontinence responds to alpha-adrenergic agents, which increase sphincter tone. Urge incontinence is the most common type of incontinence in the elderly; it can be treated with anticholinergic agents, smooth muscle relaxants, estrogen replacement therapy in women and, possibly, calcium antagonists. Overflow incontinence is caused by neurologic deficits, such as diabetes, or outflow obstruction, such as from prostatic enlargement, urethral stricture and tumors. Anticholinergic agents and alpha-adrenergic agents should be considered only after existing outflow obstruction is surgically corrected or intermittent catheterization is unsuccessful.
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PMID:Urinary incontinence in the elderly: pharmacologic therapies. 821 3

The diagnosis and treatment of urinary incontinence in the elderly out-clinic patients were reviewed. Sixty-three patients (24 males and 39 females) over 60 years old, who consulted our clinic complaining urinary incontinence, were subjected to the present study. The patients' ages ranged from 60 to 91, with the mean age of 72.9 years old. The types of the incontinence were urge in 44 cases (69.8%), stress in 10 (15.9%), outflow in 5 (7.9%) and mixture of urge and stress in 4 (6.4%). Urge incontinence resulted from unstable bladder in 63.6% and from neurogenic bladder (overactive detrusor) in 36.4%. Cerebrovascular diseases were the most common cause of the neurogenic bladder. Fifty-four patients (85.7%) were out-patients and 9 (14.3%) were hospitalized for other diseases. Thirteen patients (20.6%) with dementia were included. Diagnosis was made on the basis of a detailed questionnaire, physical examination and voiding chart, and confirmed by urodynamic study. Treatment was positively made by means of drug therapy, operation, clean intermittent catheterization and/or behavior training. As results, incontinence disappeared in 52.4% (frequency of incontinence/day: 5.0 +/- 2.6 times/day to 0), was fairly improved in 30.2% (5.1 +/- 2.3 to 1.2 +/- 0.8), was slightly improved in 7.9% (3.4 +/- 1.4 to 2.4 +/- 1.4) and unchanged in 9.5% (8.2 +/- 2.3 to 8.3 +/- 2.2). Severe neurogenic bladder (overactive), dementia and physical disability were proposed to be important factors responsible for treatment failure. Aggressive therapy should be tried to treat the urinary incontinence in the elderly, since favourable results can be expected in most of the cases.
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PMID:[Results in treatment of urinary incontinence in the elderly]. 149 5

In order to understand the pathology of incontinence, it is important to investigate urinary symptoms, urological and neurological examinations and urodynamics. There are two kinds of incontinence. One is true incontinence in which urine passes through urethra, and the other is false incontinence due to the ectopic opening of the ureter, for example to the vagina. The former includes stress incontinence, urge incontinence, reflex incontinence, overflow incontinence and total incontinence. Stress incontinence occurs with the sudden increase of abdominal pressure such as cough, running and exertion. The cause of stress incontinence is thought to be weakening of pelvic floor muscles after delivery or aging. In these patients, the bladder base and urethra move downwards and backwards, which make the posterior vesico-urethral angle more than 120 degrees. Treatment of stress incontinence includes pelvic floor exercise, administration of alpha-stimulants which increase the tonus of the internal sphincter and surgery to elevate the urethra. Urge incontinence is observed when detrusor instability occurs. It is also seen in patients with neurological diseases such as multiple cerebral infarction or with benign prostatic hypertrophy (BPH). Treatment of urge incontinence includes administration of anticholinergics to decrease bladder hyperreflexia. Reflex incontinence is seen in patients with spinal cord disorders. It occurs due to reflex contraction of detrusor and the treatment involves administration of anti-cholinergics. Overflow incontinence is seen in patients with voiding difficulties due to BPH. It occurs when residual urine increases and when the intravesical pressure exceeds urethral pressure on body movement. Treatment for this is intended to improve voiding difficulties. Total incontinence occurs when total sphincter function is damaged.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:[The pathology and treatment of incontinence]. 159 84

Urinary incontinence among institutionalized elderly were analyzed from clinical and social viewpoints. The patient group included 25 males and 107 females with an average age of 78 years (ranged from 66 to 92). They had neither highly impaired performance status nor severe dementia. Forty-nine of them (37%) underwent urological examination. Urge incontinence was common among male patients, while urge, stress or mixed incontinence were prevalent in female patients. Thirty-six per cent of the patients had to use pads, diapers and others for their incontinence, while other needed no special protection for their incontinence. Incontinence caused limitation of social activity in 30% of the patients. Many causal factors were assumed for incontinence in elderly; weakness of the pelvic muscles, urinary tract infection, cerebrovascular disorders, neurological disorders and prior pelvic surgery. Prostatic carcinoma or urethral stricture caused overflow incontinence in a few patients. Diuretics or tranquilizers appeared to lead incontinence in some patients. Nine of 18 patients undergoing cystometry had overactive detrusor. Majority of the incontinent elderly showed no intention to visit clinics. Therefore, it recommended to keep staffs in elderly institutions as well as elderly themselves informed that incontinence in the elderly should be treated, which in turn improves the quality of life.
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PMID:[Clinical analysis of urinary incontinence in the institutionalized elderly]. 192 Oct 22

In a sample of 919 respondents aged 65 years and older, resident in a public housing estate in Singapore, the prevalence of regular urinary incontinence was 4.6%. Thirty-five of the 42 incontinent subjects consented to a detailed interview. The majority of these 35 cases leaked urine daily, leaked amounts over one tablespoon, or were suffering some psychological [corrected] or social effect of the incontinence. Urge incontinence was the commonest type in women and outlet obstruction in men. Almost all incontinent subjects were agreeable to having medical attention for the condition although over a third had not previously consulted medical personnel about the problem. There may be scope for the provision of primary health care continence services.
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PMID:Urinary incontinence among the elderly people of Singapore. 192 32

We report a 10-year-old boy with and unstable bladder, bilateral epididymitis, urge incontinence, bed wetting, and unilateral reflux. Previously, he complained of urinary incontinence and was operated on elsewhere with Y-V plasty in the bladder neck and pulling out a balloon catheter through the urethra. Following the surgery the urinary force was weakened, incontinence got worse and bilateral epididymitis broke out frequently. Since the patient was refractory to anti-cholinergic medicine, sacral nerve block, antireflux operation and narrowing the bladder neck were attempted. The surgery was successful in eradicating reflux and urinary tract infection, but failed to normalize the extremely widened bladder neck. Urge incontinence and bed wetting recurred 11 months after the sacral block, which was effective in a selected patient. We believe that Y-V plasty at the bladder neck should not be indicated for a patient with bladder dysfunction closely related to an unstable bladder.
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PMID:[Case report: an unstable bladder with bilateral epididymitis, urge incontinence and unilateral reflux]. 280 84

The different types of urinary incontinence are defined and the possible educational treatment modalities are described. Stress incontinence may be treated by pelvic floor exercise and bio-feed-back. The object is training in muscle awareness with the purpose of teaching the patients to squeeze without activating the abdominal muscles. Significant improvement can be obtained in 22-63% of the patients. Urge incontinence can be treated by bladder drill and bio-feed-back. Voluntary control over the detrusor reflex is re-educated and the patients are instructed to adhere to a fixed voiding schedule every three hours. In women, 80% may be improved. In reflex incontinence, prophylactic bladder emptying may be initiated by stimulation of specific trigger points. Overflow incontinence may be reduced by optimal voiding technique and clean intermittent self-catheterization. Postmicturition dribble can be relieved by manual emptying of the urethra. No treatment is known for giggle incontinence. In nocturnal enuresis, conditioning treatment is recommended. Immediate waking is essential. Environmental incontinence is treated by securing easy access to voiding facilities and by training in toileting skills. Half of the patients are curable.
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PMID:[Training of patients with urinary incontinence]. 291 43

Urge incontinence caused by hyperactive urethral closing mechanism can be influenced by relaxation training of the striated sphincter muscle. This is done through a biofeedback mechanism with pelvic floor EMG control. The indications are for urge incontinence with urethral hyperactivity and pelvic floor hyper-reactivity diagnosed through urodynamic examination. Twenty-two female patients with urge incontinence were treated for four weeks by biofeedback training with a portable pelvic floor EMG apparatus. The urge incontinence were improved subjectively and objectively in 73%. The therapy focused on the striated muscle seemed to have better results than therapy of the detrusor.
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PMID:[Modification of urge incontinence by biofeedback mechanisms]. 378 88

Urge incontinence places a considerable burden on incontinence treatment. The autonomous nerve supply of the bladder is effected via two anatomically clearly separate ways. On the one hand, we have the accessory innervation via the fascia endopelvina, whereas on the other hand fibres from the plexus pelvicus as the classical site of innervation penetrate into the bladder. Transection of the fascia endopelvina followed by detachment of the plexus pelvicus from the lateral bladder wall in the course of separation of the bladder and levator enables corporofundal partial peripheral bladder denervation. By this procedure both afferent and efferent nerve fibres are transected. As a result, excess autonomous impulses are reduced, thus effecting favourable reduction of the urge incontinence pattern. This method is quite fascinating not only because it is easily translated into practice, offers ideal vaginal access, and is reproducible at all times, but also because it can be utilised as a therapeutic tool in the treatment of urge incontinence, and because it can be integrated in an optimal manner into the standard incontinence and descensus programme. A failure rate of 3% is hardly ever exceeded. Compared with the other methods described so far, which are mostly very severe in their effect and highly specialised, the advantages of corporofundal partial peripheral bladder denervation point towards considerable chances to translate the method into practical reality.
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PMID:[Corporofundal partial peripheral bladder denervation as surgical therapy of urge incontinence]. 401 16


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