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

Urinary incontinence (UI) is any involuntary leakage of urine and can be further defined according to the patient's symptoms or complaints. Stress urinary incontinence (SUI) is the complaint of involuntary leakage on effort or exertion, or on sneezing or coughing. Urge urinary incontinence (UUI) is characterized by the complaint of involuntary leakage accompanied by or immediately preceded by urgency. Mixed urinary incontinence (MUI) is the presence of both SUI and UUI symptoms. In order to effectively treat UI, an accurate diagnosis is necessary since treatment of SUI or UUI is very different. Assessment obtaining a detailed medical history includes making general assessments taking into account quality of life (QoL), performing an appropriate physical examination with cough stress test; and simple investigations namely a urinary diary, urine analysis and post-void residual assessment and, occasionally, simple urodynamics. These assessments should suffice to commence conservative treatment. Multichannel urodynamics are required in patients presenting with more complicated UI and prior to surgery.
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PMID:Differentiating stress urinary incontinence from urge urinary incontinence. 1530 64

Overactive bladder (OAB) is a common, disabling condition associated with considerable negative impact on quality of life, quality of sleep, and mental health. The age-specific prevalence of OAB is similar among men and women. Urge incontinence affects only a portion of the OAB population: 33% of patients have OAB with urge incontinence ("OAB wet"), while 66% have OAB without urge incontinence ("OAB dry"). The symptoms of OAB can affect social, psychological, occupational, domestic, physical, and sexual aspects of life. OAB can also lead to depression and low self-esteem. The shift away from urodynamic observation (essential in the identification of OAB) reflects increased emphasis on the symptom-specific nature of this common disorder. The overall costs of OAB to society are in the billions. Yet the condition often goes unrecognized, largely because of the reluctance of those with OAB to seek medical attention.
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PMID:Defining overactive bladder: epidemiology and burden of disease. 1562 Dec 20

The aim of this study was to evaluate the effect of intravaginal electrical stimulation (IES) on pelvic floor muscle (PFM) strength in patients with mixed urinary incontinence (MUI). Between January 2001 and February 2002, 40 MUI women (mean age: 48 years) were studied. Urge incontinence was the predominant symptom; 92.5% also presented mild stress urinary incontinence (SUI). Selection criteria were clinical history and urodynamics. Pre-treatment urodynamic study showed no statistical differences between the groups. Ten percent of the women in each group had involuntary detrusor contractions. Patients were randomly distributed, in a double-blind study, into two groups. Group G1 (n=20), effective IES, and group G2 (n=20), sham IES, with follow-up at 1 month. The following parameters were studied: (1) clinical questionnaire, (2) examiner's evaluation of perineal muscle strength, (3) objective evaluation of perineal muscle by perineometry, (4) vaginal weight test, and (5) urodynamic study. The IES protocol consisted of three 20-min sessions per week over a 7-week period using a Dualpex Uro 996 at 4 Hz. There was no statistically significant difference in the demographic data of both groups. The number of micturitions per 24 h after treatment was reduced significantly in both groups. Urge incontinence, present in all patients before treatment, was reduced to 15% in G1 and 31.5% in G2 post-treatment. The subjective evaluation of PFM strength demonstrated a significant improvement in G1. Objective evaluation of PFM force by perineometer showed a significant improvement in maximum peak contraction post-treatment in both groups. In the vaginal weight test, there was a significant increase in average number of cone retentions post-treatment in both groups. With regard to satisfaction level, after treatment, 80% of the patients in G1 and 65% of the patients in G2 were satisfied. There was no statistically significant difference between the groups. There was a significant improvement in PFM strength from both effective and sham electrostimulation, questioning the effectiveness of electrostimulation as a monotherapy in treating MUI.
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PMID:Effect of intravaginal electrical stimulation on pelvic floor muscle strength. 1564 85

Urinary incontinence affects millions of people worldwide and also represents a social problem. Costs of urinary incontinence and overactive bladder are very high. Urge incontinence is the involuntary loss of urine associated with a strong desire or urge to urinate. There are two types of urge incontinence: One is associated with involuntary detrusor contractions leading to a loss of urine, the other is characterized by a hypersensitive bladder in which micturition reflexes are induced due to an increased afferent activity. It is important to distinguish between an idiopathic type of urge incontinence and a symptomatic type possibly caused by infections, tumours, bladder stones or foreign bodies. Diagnostics is based on a careful medical history, clinical examination and urodynamic evaluation. The use of a voiding diary is necessary. Current agents for drug therapy rely upon their anticholinergic properties. Their use is limited by side effects such as blurred vision, dizziness, constipation and dryness of the mouth. Additionally, patients refractory to anticholinergic medication can be treated by endoscopic direct injection of botulinum toxin into the detrusor muscle. These patients can also be treated by intravesical application of vanilloid derivatives in the bladder leading to a desensitization of bladder sensory fibers. In some cases of refractory urge incontinence, electrical neuromodulation is effective. Other pharmacological approaches could be selective b-adrenoceptor agonists, calcium antagonists and potassium channel openers, but these substances are not yet available for clinical use.
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PMID:[Current diagnostics and therapy of the overactive bladder and urge incontinence]. 1594 40

Two cases of intractable overactive bladder which were treated by intradetrusor botulinum-A toxin (BTX-A) are presented. Case 1: A 53-year-old woman suffered from adhesive arachinoiditis. She had severe detrusor hyperreflexia and urge urinary incontinence despite a high dose of anticholinergic medication. Under cystoscopic control, a total of 300 units of BTX-A were injected into the detrusor muscle at 30 sites (10 units per ml per site), sparing the trigone area using a 27G flexible injection needle. This procedure was done under both caudal anesthesia with 10 ml 1% lidocaine and bladder mucosa anesthesia by instilling 40 ml 2% lidocaine. At a 12-week followup she was completely continent. Case 2: A 63-year-old man with intractable detrusor overactivity of idiopathic origin was treated using the above technique. Urge urinary incontinence decreased 4 weeks after the BTX-A injections. However, postvoid residual urine volume was increased, and intermittent self-catheterization was needed. Intradetrusor BTX-A dramatically increases the bladder capacity and decreases the frequency of urge urinary incontinence. However, this treatment caused urinary retention in Case 2. We believe that the dosage amount of BTX-A should be changed case by case.
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PMID:[The effect of botulinum toxin injection into the bladder for overactive bladder: two case]. 1594 13

The International Continence Society (ICS) recently derived a consensus symptomatic definition of overactive bladder (OAB) as urinary urgency, with or without urge incontinence, usually with frequency and nocturia. These symptom combinations are suggestive of urodynamically demonstrable detrusor overactivity. The etiology of OAB falls into two broad categories: neurogenic and nonneurogenic. It is not easy to confirm the etiology of OAB in patients with bladder outlet obstruction and neurological disease. This debate has attempted to examine the pathophysiology of OAB and to determine the optimal treatment strategy in a patient with two diseases possibly causing OAB. A 75-year-old man visited our hospital due to symptoms of OAB (urgency, nocturia, and urge incontinence) occurring after cerebrovascular accidents. Urge incontinence worsened concomitantly with the appearance of turbid urine. Urinary tract infection was accompanied by 84 ml of post-void residual. The prostate volume and PSA value were 28 ml and 1.2 ng/ml, respectively. The total International Prostate Symptom Score (IPSS) and Quality of Life (QOL) Index were 23 and 5, respectively. IPSS for storage symptoms was higher than that for obstructive symptoms. The maximum flow rate, measured after treatment for UTI, was 9.4 ml/s. Two debaters discuss the treament modality, TURP, or pharmacotherapy.
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PMID:["Pathophysiology and treatment of the overactive bladder"]. 1622 72

Urinary incontinence affects millions of people worldwide and also represents a social problem. People of all ages suffer from urinary incontinence. The disease is found in about 30% of women aged 30 to 60 years. There are different types of incontinence. Urge incontinence is the most often pharmacologically treated type. The mainly used substances belong to the class of antimuscarinic drugs. Their use is limited by several side effects. Furthermore, in some patients anticholinergic medication is ineffective and antimuscarinics used as single medication do not lead to a sufficient therapeutic effect. Other possible pharmacological substances for treatment of overactive bladder (detrusor instability) associated with urge and urge incontinence are the selective beta-adrenoceptor-agonists which are mainly responsible for the adrenergic mediated relaxation. It depends on the species, which beta-adrenoceptor-subtype (the beta2- and/or beta3-adrenoceptor) mainly mediates the relaxation. Non selective beta-adrenoceptor-agonists exhibit serious cardiovascular side effects like tachycardia or decrease of blood pressure by stimulating beta1- and beta2-adrenoceptors. These side effects should be decreased when using selective agonists. Additionally, substances whose targets are membrane channels of muscle cells could be interesting for treatment of overactive bladder. This group includes L-type calcium antagonists and potassium channel openers of ATP-sensitive potassium channels or BK channels. Especially the local use of the pharmacologically very potent calcium antagonists could be an interesting therapeutic approach, since systemic cardiovascular side effects were avoided. After chronic oral treatment with different calcium antagonists effects on the detrusor muscle were reduced or could not be detected, possibly due to an upregulation of 1,4-dihydropyridine-sensitive potassium channels. A very interesting approach is the use of potassium channel openers said to be selective for the urinary bladder. If there is a selectivity for the detrusor muscle, cardiovascular side effects were reduced. Possibly, the local use is a useful application form. Selective beta-adrenoceptor agonists, calcium antagonists and potassium channel openers are pharmacological approaches, which are not yet available for clinical use.
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PMID:Selective beta-adrenoceptor agonists, calcium antagonists and potassium channel openers as a possible medical treatment of the overactive bladder and urge incontinence. 1659 54

A prospective cohort study was undertaken to evaluate the effect of pregnancy and childbirth in nulliparous pregnant women. The focus of this paper is on the difference in the prevalences and risk factors for lower urinary tract symptoms (LUTS) between woman who delivered vaginally or by cesarean and secondly the effect of LUTS on the quality of life between these two groups was analyzed. Included were 344 nulliparous pregnant women who completed four questionnaires with the Urogenital Distress Inventory and the Incontinence Impact Questionnaire (IIQ). Two groups were formed: vaginal delivery group (VD), which included spontaneous vaginal delivery and an instrumental vaginal delivery and cesarean delivery group (CD). No statistical significant differences were found in the prevalences of LUTS during pregnancy between the two groups. Three months after childbirth, urgency and urge urinary incontinence (UUI) are less prevalent in the CD group, but no statistical difference was found 1 year postpartum. Stress incontinence was significantly more prevalent in the VD group at 3 and 12 months postpartum. The presence of stress urinary incontinence (SUI) in early pregnancy is predictive for SUI both in the VD as in CD group. A woman who underwent a CD and had SUI in early pregnancy had an 18 times higher risk of having SUI in year postpartum. Women were more embarrassed by urinary frequency after a VD. After a CD, 9% experienced urge urinary incontinence. Urge incontinence affected the emotional functioning more after a cesarean, but the domain scores on the IIQ were low, indicating a minor restriction in lifestyle. In conclusion, after childbirth, SUI was significantly more prevalent in the group who delivered vaginally. Besides a vaginal delivery, we found both in the VD and in the CD group that the presence of SUI in early pregnancy increased the risk for SUI 1 year after childbirth. Further research is necessary to evaluate the effect of SUI in early pregnancy on SUI later in life. Women were more embarrassed by urinary frequency after a vaginal delivery. UUI after a CD compared to a vaginal birth limited the women more emotionally; no difference was found for the effect of SUI on the quality of life between the two groups.
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PMID:The effect of vaginal and cesarean delivery on lower urinary tract symptoms: what makes the difference? 1741 4

The aim of the study is to investigate the changes in continence status in a population of women hysterectomized in 1998-2000. Four hundred fifteen hysterectomized women who participated in a questionnaire study on continence status in September 2001 were retested with the same questionnaire on actual continence status in January 2005. As controls we used 97 women who had a laparoscopic cholecystectomy in 1999-2000 and were tested and retested similarly. Urinary incontinence was defined as involuntary urinary leakage at least once a week. Stress incontinence was defined as leakage when coughing, laughing, or lifting heavy weights. Urge incontinence was defined as an uncontrollable desire to void with leakage before reaching the toilet. Stress incontinence was reported by 30% of the hysterectomized women in 2005 vs 28% in 2001. The similar prevalences of urge incontinence were 15 and 13%, respectively. Women who had a subtotal hysterectomy significantly more often had stress incontinence compared to controls in 2005 and 2001. No other significant differences were found. However, the similar prevalences of incontinence reflected that 16% of the hysterectomized women changed from continent in 2001 to stress incontinent in 2005, while 32% changed from stress incontinent to continent. For urge incontinence the similar changes were 8 and 35%, respectively. A large proportion of women change from continent to incontinent or from incontinent to continent during the 3 years of investigation, which should be born in mind when prevalence studies on urinary incontinence are evaluated. Previous hysterectomy does not seem to be of great importance for the development of de novo incontinence or remission.
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PMID:Incidence and remission of urinary incontinence after hysterectomy--a 3-year follow-up study. 1689 26

This paper reports the efficacy and complications of the trans-obturator foramen procedure (TOT). The effect of TOT on co-existing urgency and urge incontinence and voiding difficulty were also noted. It reports on patients (31) undergoing TOT (Obtape) from April 2005 to April 2006, who were sent a questionnaire. The mean age was 53 years, mean parity 2.3, mean duration of incontinence 6.2 years and the mean duration of follow-up was 9 months. All patients had significant stress incontinence. Co-existing urge incontinence was present in 70%; no intraoperative complications. One patient had a urinary tract infection (UTI) and one, catheterisation for 5 days. A total of 16.6% of patients developed sling erosion. There was a 93% response rate to the postal survey, indicating a 31% complete cure of urinary incontinence; 65% a significant improvement and 3.5% failure. Urge incontinence disappeared in 66%, no de-novo urgency and 8% reported slower voiding. Satisfaction was 8.9 on a 1 - 10 Scale. The success rate of the TOT procedure was high, helping both stress and concomitant urge incontinence, but due to an unacceptably high erosion rate, Obtape was discontinued.
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PMID:Short-term complications of the trans-obturator foramen procedure for urinary stress incontinence. 1770


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