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

Urinary incontinence, difficulty voiding and recurrent urinary tract infections are common in general practice. In patients with multiple sclerosis, spina bifida, intervertebral disc lesions, spinal injuries or tumours, the symptoms may be associated with a high residual volume of urine owing to a neuropathic bladder. Similar complaints may occur in elderly people or in women with gynaecological problems owing to atonic urinary retention. Provided that a significant residual volume of urine is found on abdominal examination, ultrasound, x-ray or catheterization, both groups of patients may be helped by intermittent self catheterization. Intermittent self catheterization is a safe and simple technique. By catheterizing themselves between four and six times daily patients can gain control over their bladders. Abandoning indwelling catheters or bulky external appliances does much for a patient's morale and self esteem. In addition, since the bladder is being drained effectively, urinary tract infections cease to be a problem and the kidneys are safeguarded. Severe disability is not a contraindication since patients in wheelchairs have mastered the technique despite paraplegia, an anaesthetic perineum, spinal deformity, intention tremor, mental handicap, old age or blindness. Patients should be referred to urologists for a trial of intermittent self catheterization. If unsuccessful or unacceptable it can be abandoned with no long term consequences. If it is effective the benefits may be considerable.
Br J Gen Pract 1992 Jun
PMID:Intermittent self catheterization for patients with urinary incontinence or difficulty emptying the bladder. 141 49

The aim of this study was to assess the usefulness of pelvic floor exercises in the treatment of urinary incontinence in women and to analyse the factors which determine a successful outcome. The study involved 66 women who had reported 'genuine stress incontinence' to their general practitioner. They were assigned at random to the treatment or control group. The treatment group received instructions in pelvic floor exercises from a general practitioner. The control group received no therapy. At the start of the trial the severity of the patients' incontinence was assessed objectively. This assessment was repeated after three months and patients were also asked for their own perception of whether their incontinence had improved. After the three months' evaluation the patients in the control group were also given instructions in pelvic floor exercises. After another three months they were assessed in the same way. About 60% of the patients in the treatment group were dry or mildly incontinent after three months compared with only one patient in the control group; the mean weekly frequency of incontinence episodes fell from 17 to five in the treatment group but remained virtually unchanged in the control group; and about 85% of the women in the treatment group felt that their incontinence had improved or was cured compared with no one in the control group. These results were later corroborated by those for the control group. The most important factor in the success of the treatment was the patients' motivation, as demonstrated by their adherence to the daily exercises.(ABSTRACT TRUNCATED AT 250 WORDS)
Br J Gen Pract 1991 Nov
PMID:Controlled trial of pelvic floor exercises in the treatment of urinary stress incontinence in general practice. 180 3

A random sample of 239 patients aged 75 years and over registered with general practitioners in north and north west London was selected for home assessment to determine the functional abilities and medical problems of this group of patients. Nearly one in five of the patients were incontinent of urine (18.4%), although this was on a daily basis for only 4.1%. Around one in 20 patients were incontinent of faeces (5.9%), yet only one patient had laundry service support. Unassisted mobility outdoors was reported as possible by 81.2% of the patients. Fourteen different types of aids were present in the participants' homes, the commonest being walking sticks, bath aids and stair rails. Only a small proportion of aids seemed to be currently unused. The major functional problems were bathing, housework, shopping, washing and ironing, and cooking main meals, but the level of demand for extra help was low. One in five patients had a hearing aid (19.8%) but for only 30% of these patients was it in continuous use. Polypharmacy was common, with 29.7% of patients taking three or more prescribed medicines. The workload implications of this approach to anticipatory care of elderly people are considerable. In an average practice of 2000 patients with 130 patients aged 75 years and over the primary care team would need over 150 hours of face-to-face contact per year with these patients to fulfil the new contractual obligation and the yield of new information leading to effective medical or social intervention is limited.(ABSTRACT TRUNCATED AT 250 WORDS)
Br J Gen Pract 1991 Jan
PMID:Assessment of elderly people in general practice. 2. Functional abilities and medical problems. 200 50

In the context of a large scale survey of health problems in women aged 50 to 65 years, a study was undertaken on the effects of incontinence on daily life. For this purpose 1442 women randomly selected from the practice files of 75 general practitioners in the eastern part of the Netherlands were interviewed at home (response rate 60%). In cases of moderate or severe incontinence the general practitioner of the woman concerned was asked whether this problem had been diagnosed in general practice. Incontinence was reported in 22.5% of the women. Overall, 77.8% of the women did not feel worried about it and 75.4% did not feel restricted in their activities; even for women with severe incontinence (daily frequency and needing protective pads) only 15.6% experienced much worry and 15.7% much restriction. About a third of the women with incontinence (32.0%) had been identified by their general practitioner. The greater the worries and restrictions owing to incontinence, the greater the chance that the incontinence was known to the general practitioner concerned. Only a small minority of the women who felt severely restricted were not identified by their general practitioner. There was a positive relation between recognized incontinence and a history of hysterectomy. This study contradicts the image of the incontinent woman as isolated and helpless; most women in this study seemed able to cope.
Br J Gen Pract 1990 Aug
PMID:Women with urinary incontinence: self-perceived worries and general practitioners' knowledge of problem. 212 Nov 79

In response to an invitation sent to women who had complained previously of regular incontinence, 65 women with regular incontinence were seen by their general practitioner. A diagnosis was made using a personally administered questionnaire and appropriate examination. Patients were placed in one of three diagnostic/management categories--stress, urge or stress/urge incontinence--and were given an appropriate treatment programme. Fifty six women were recruited as matched controls from non-responders while attending the surgery for other reasons. They underwent identical entry procedures but were not offered a treatment programme. All the patients were reassessed after 12 weeks at which time significant improvement in incontinence was reported by the treated women in the stress and urge categories compared with the controls. There was no significant difference in reported efficacy of treatment between age groups and treatment was shown to be effective irrespective of the duration of incontinence. This study shows that for the majority of women reporting incontinence the condition can be diagnosed by a general practitioner and significantly improved by appropriate intervention.
J R Coll Gen Pract 1989 Jul
PMID:Diagnosis and management of female urinary incontinence in general practice. 255 41

A 32-year-old female with a seven year history of multiple sclerosis was hospitalized due to an exacerbation of symptoms, and complained of a high frequency of urination and occasional urinary incontinence. A urologic consult was obtained and the patient was diagnosed as having neurogenic (spastic) bladder, resulting in a reflexive voiding whenever the accumulation of urine in the bladder reacher 100 mls. A behavioral management program using feedback and goal-setting was implemented. Whenever she voided, the patient recorded the time of day, and measured the amount by using a graduated urinal. Following a 5-day baseline the patient and experimenter, on a daily basis, established a goal specifying a minimum waiting period between voidings, even when waiting might result in incontinence. Feedback on average duration between voidings was given daily. After 13 days of treatment, the duration between voidings had increased from a baseline of 58 min to 130 min and the average amount of urine had increased from 95 ml to 160 ml. At three and six month follow-ups, the patient reported that she was able to maintain treatment gains without difficulty; however, she had been unable to increase the time between voidings beyond approximately two hours.
Gen Hosp Psychiatry 1982 Apr
PMID:Behavior therapy for urinary frequency in a patient with neurogenic bladder: a case report. 707 50

We investigated the management of urinary incontinence in 50 patients with multiple sclerosis (MS) in two London boroughs. Only seven appeared to be satisfied with the management of their bladder problems. A total of 51 suggestions was made for improving management in 33 of the patients. Most of these suggestions involved services which were available though not being used. The management of urinary incontinence in patients with MS should be tailored to the requirements of the individual. Alternative forms of management may often not be reaching patients who might benefit from them.
J R Coll Gen Pract 1981 May
PMID:Management of urinary incontinence in patients with multiple sclerosis. 731 Jul 60

Strategies to evaluate patients with continence disorders continue to evolve at a rapid pace. These novel methods quantify physiologic events that, in turn, facilitate increasingly accurate discrimination among the causes of incontinence and constipation. This review discusses recent advances in the causes, diagnostic approaches, and management options available for patients with continence disorders.
Curr Opin Gen Surg 1993
PMID:Continence disorders. 758 52

Control of micturition is a complex physiological and anatomical process which often fails in women. The sequelae of urinary incontinence in women range from inconvenience to social and psychological stigmatization. Surprisingly, many women are tolerant of often quite severe sequelae, despite a range of management techniques that exist to alleviate or cure incontinence. Some of the more successful techniques are well suited to general practice management and can be carried out by the patient under the supervision of her doctor, district nurse, practice nurse or midwife. This paper reviews the physiology of micturition, stress urinary incontinence and incontinence caused by detrusor instability, and the management techniques available to alleviate or cure the problem.
Br J Gen Pract 1993 Oct
PMID:Management of urinary incontinence in women. 826 Feb 22

Bacteremia has a high mortality rate in all elderly populations, but especially nursing home residents and the hospitalized elderly. Elderly patients with bacteremia may present in a nonspecific fashion with incontinence, with falls, or afebrile. Mortality is greater in patients whose bacteremia originates outside the genitourinary tract or who are bacteremic with gram-positive organisms. Early appropriate treatment has been found to reduce mortality in some studies, especially in patients over 85 years old or with gram-positive bacteremias. Gram-negative bacteremias are more common than those caused by gram-positive organisms in most studies. E. coli is the most common gram-negative isolate, followed in most studies by either Proteus or Klebsiella. Staphylococcus aureus is the most common gram-positive isolate; enterococcus and pneumococcus are also frequently isolated. Bacteremia in the elderly may present in a subtle fashion. Appropriate antibiotic therapy may reduce mortality and should include antibiotic coverage for S. aureus and gram-negative bacilli, as well as for anaerobes if pressure ulcers are suspected as the source. Clinicians who care for the elderly should be aware of the possible presentations of bacteremia and the appropriate treatment in all clinical settings.
J Gen Intern Med 1993 Feb
PMID:Bacteremia in the elderly. 844 Oct 82


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