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

The cause of detrusor instability and mixed incontinence remains elusive. Although DI is most prevalent at the extremes of age, GSI becomes more common with aging and child bearing, and therefore mixed incontinence is common, especially after menopause. Cystometry is used to diagnosis detrusor instability, but urethral closure pressure profilometry is required for assessment of mixed incontinence. DI is managed initially by behavioral therapy, and if this is not satisfactory then FES should be used depending upon availability. Drug therapy should start with oxybutynin at 2.5 to 5 mg twice-daily and increased as necessary to control symptoms. If the effects of therapy are minimal or side effects are too great, other medications or medication combinations should be tried. When the patient does not respond to this level of therapy, transvesical phenol injections should be considered, or, alternatively, a sacral selective neurolysis or neurectomy should be considered. Finally, invasive procedures will have to be considered starting with bladder transection, especially for the patient showing response to medication but intolerant of side effects. Mixed incontinence should be approached with conservative measures for each component. FES or imipramine therapy may help both conditions. If conservative therapy is not beneficial, surgical correction for GSI should be undertaken, with the knowledge that 35 to 50 per cent of patients will also have cure of DI, while the remainder can be treated medically for the DI.
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PMID:Etiology and management of detrusor instability and mixed incontinence. 269 19

Diagnostic questions about stress and urge incontinence were validated against a final diagnosis made by a gynecologist after urodynamic evaluation. Thereafter, an epidemiological survey was performed, using similar questions, and correcting the answers for lack of validity. Included were 250 incontinent women at the out-patient clinic and 535 women who reported incontinence in the epidemiological survey. The sensitivity for stress incontinence was 0.66 (95% confidence interval +/- 0.08), specificity 0.88 (+/- 0.06). The corresponding values for urge incontinence were 0.56 (+/- 0.15) and 0.96 (+/- 0.03), and for mixed incontinence 0.84 (+/- 0.10) and 0.66 (+/- 0.07). Using these indices of validity as corrective measures for the diagnostic distribution reported in the epidemiological survey, the percentage of stress incontinence increased from 51 to 77%, while mixed incontinence was reduced from 39 to 11%. Pure urge incontinence increased from 10 to 12%. Mixed incontinence will be overreported in epidemiological surveys. Correction for validity indicates that a larger majority than hitherto reported may have pure stress incontinence.
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PMID:Diagnostic classification of female urinary incontinence: an epidemiological survey corrected for validity. 789 55

Consistent efforts to identify and clinically validate new nursing diagnosis within recognized categories are essential to taxonomy development. Mixed incontinence is a clinical condition resulting in leakage of urine associated with increased intra-abdominal pressure (stress) and inability to delay voiding (urge). The presence of mixed incontinence was clinically validated in two populations (n = 9, n = 40) of community-dwelling women and initial defining characteristics were identified. Research findings from both studies support the addition of a proposed sixth nursing diagnosis, mixed incontinence, to the diagnostic category, alteration in urinary elimination.
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PMID:Mixed incontinence: a new nursing diagnosis? 857 31

The value of ambulatory urethral pressure recording (AUPR) was evaluated by reviewing both data from 116 patients investigated and Ambulatory Urodynamic Monitoring (AUM) tracings. Typical tracings are shown from conditions where we find that AUPR is of value. (i) Stress incontinence where a patient who complains of stress incontinence does not leak during the stress test, but leaks while jumping on a trampoline. (ii) Mixed incontinence--in only 43% of patients complaining of both urge ands stress incontinence mixed incontinence was documented by AUM. Thirty-six per cent of patients complaining of both urge and stress incontinence were found to be stress incontinent and 21% were leaking due to an unstable detrusor. (iii) Urethral closure pressure of 20 cmH2O or less (low urethral closure pressure; LUCP). LUCP was found in 13% of the patients. Patients with LUCP may leak due to stress, unstable detrusor or unstable urethra. We conclude that ambulatory recording of both urethral and bladder pressures in addition to leakage may contribute to a more complete diagnosis and treatment in these conditions.
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PMID:The clinical value of ambulatory urethral pressure recording in women. 1140 16

The requirements for reliable urodynamics are standardized techniques, including uniform pressure sensors, filling rates, position and posture during the investigation, and uniform diuresis. Physiological variations in flow and urethral pressure profile (UPP) (menstrual cycle, intensity of coughing, circadian variations) must be considered. Parameters of the UPP (maximum (closure) urethral pressure, pressure-transmission ratio and leak-point pressure) are useful if interpreted with caution. Uninhibited detrusor contractions are more frequently recorded in ambulatory urodynamics, and range from 'subthreshold' to very strong. No quantification formulae correlate with subjective symptoms or degree of urge (incontinence). Mixed incontinence can make the results of surgery worse, but do not so necessarily. Postoperative dysuria cannot be predicted from urodynamics, as surgical factors are more important. Electromyography is not useful in non-neurogenic female incontinence. For routine nonneurogenic incontinence extensive urodynamic testing can be reduced to one pressure measurement; more complicated cases must be tested by a physician with large practical experience and a theoretical background.
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PMID:A critical view on the value of urodynamics in non-neurogenic incontinence in women. 1148 47

Urinary incontinence is a prevalent condition that impacts many women's lives. Stress urinary incontinence (SUI), urine loss associated with exertion, typically has its onset during the reproductive years, whereas urge incontinence, urine loss associated with urgency, more frequently affects postmenopausal women. Mixed incontinence, a combination of stress and urge incontinence, affects up to 30% of incontinent women. Simple modifications such as dietary and fluid management, timed voiding, and adjustment of medications can lessen symptom severity and should be attempted prior to instituting other treatments. Physiotherapy, including pelvic floor exercises, biofeedback, and functional electrical stimulation, center on improving pelvic floor neuromuscular function, thus improving bladder and urethral function. Current pharmacologic treatments focus primarily on urge incontinence, anticholinergics being the mainstays of therapy. Local estrogen therapy may improve urethral and bladder function if a woman's incontinence is associated with urogenital atrophy. Surgery is primarily reserved for management of severe SUI. Minimally invasive sling procedures have replaced the Burch colposuspension as the most common surgeries performed for SUI, and appear to have similar success rates. Surgical therapies for refractory urge incontinence have been attempted with limited success. Many new, potentially more effective, treatments are being developed.
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PMID:Current treatment options for female urinary incontinence--a review. 1530 11

A follow-up was done 7 and 38 months after tension-free vaginal tape (TVT) operation in 1,113 women with mixed urinary incontinence. Mixed incontinence and predominant bother were subjectively defined. The results were analyzed according to the women's predominant bother: stress incontinence, urge incontinence, or stress and urge incontinence equally. Across the groups, stress incontinence was cured in 87 and 83% of the women at 7 and 38 months, respectively, with no difference between the three groups. Women with predominant stress incontinence had significantly better results at both 7 and 38 months than those in the other groups, especially those predominantly bothered by urge incontinence. Women with mixed incontinence were significantly more often cured both objectively and subjectively at 7 than 38 months. Only 11% of the women experienced an increase in urge incontinence 38 months after TVT. Before a TVT operation, women with mixed urinary incontinence should be informed that their prognosis depends on their predominant bother. TVT is an appropriate treatment in mixed urinary incontinence, but women with predominant urge incontinence have poorer results than those with predominant stress incontinence.
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PMID:Follow-up of TVT operations in 1,113 women with mixed urinary incontinence at 7 and 38 months. 1789 26

The objective of this study was to evaluate comorbidity and risk factors associated with female urinary incontinence and to assess quality of life for women with different types of urinary incontinence. Subjects included 551 consecutive females who attended the outpatient clinic from 9 March to 8 July 2006 and did not have a chief complaint of incontinence. A four-item incontinence questionnaire and a Chinese version of the Incontinence-Quality of Life (I-QOL) questionnaire were completed in the waiting room. Patient characteristics and medical conditions were summarized from outpatient electronic databases. A total of 371 females were included for statistical analysis. Among them, 114 patients (30.7%) did not indicate any urinary incontinence, while 257 (69.3%) patients indicated symptoms of urge incontinence, stress incontinence, or mixed incontinence. Comorbidities significantly associated with incontinence included osteoarthritis (P = 0.001), peptic ulcer disease (P = 0.031), obesity (P < 0.001), and cardiac disease (P < 0.001). After multiple logistic regression analysis, obesity (OR 3.38, 95% CI 1.94-6.98) and postmenstrual status (OR 2.17, 95% CI 1.35-3.50) were found to be risk factors of incontinence (P < 0.001). Mixed incontinence patients exhibited the least satisfaction in quality of life, while no significant differences were observed between patients with urge incontinence and stress incontinence. In conclusion, the incidence of urinary incontinence may be greater in the outpatient population than previously thought. Osteoarthritis, peptic ulcer disease, and cardiac disease are more common in women with urinary incontinence, obesity and postmenopausal status appear predictive of incontinence, and women with mixed incontinence exhibit the least satisfying quality of life.
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PMID:Urinary incontinence among Taiwanese women: an outpatient study of prevalence, comorbidity, risk factors, and quality of life. 1919 71