Improving pelvic floor health: advice for nurses and their patients.

Jane Simpson, Independent Continence Nurse Specialist, The London Clinic, explains why pelvic floor health is important for everyone and provides information that nurses can pass on to patients.

Do urodynamic findings influence the approach to mid-urethral sling surgery for stress urinary incontinence?

Recent press coverage on vaginal mesh surgery has resulted in a change in how patients are counselled, managed and treated in the UK. For stress urinary incontinence surgical procedures such as insertion of tension-free vaginal tape are commonplace and generally performed as a day-case procedure. Effective and successful management of female urinary incontinence is difficult, even when using diagnostic testing where all conservative managements have failed, and this indicates a need to investigate further. Specialist texts in the fields of urology and urogynaecology argue that urodynamics can help inform the success of surgical intervention for stress urinary incontinence. The aim of this review was to look for evidence of practice where urodynamic findings are used to determine the successful outcome of mid-urethral sling surgery in females. A literature search to identify research on this topic was performed with appraisal of qualifying literature. The qualifying research included attitudes towards urodynamic studies among urogynaecologists and urologists, demonstration that urodynamics has been proven to influence changes in diagnosis and surgical approaches, and the capacity for urodynamics to predict successful outcomes in mid-urethral sling surgery. Analysis of the literature found no evidence to suggest that urodynamic findings can be used to determine successful outcomes following mid-urethral sling surgery.

Male urinary incontinence management: penile sheaths.

Urinary incontinence is a hidden problem that affects 14 million adults in the UK. It affects around 30% of men aged 65 and over and can have a huge effect on quality of life. Often this distressing symptom can be treated effectively. It is important to manage incontinence while the man is undergoing investigations and treatment or when treatment is not possible. This article examines the role of urinary sheaths in the management of incontinence and provides links to further information.

Disease stigma and its mediating effect on the relationship between symptom severity and quality of life among community-dwelling women with stress urinary incontinence: a study from a Chinese city.

AIMS AND OBJECTIVES: To examine the association between disease stigma and quality of life and whether disease stigma mediates the relationship between symptom severity and quality of life among community-dwelling women with stress urinary incontinence in China. BACKGROUND: Urinary incontinent patients perceived great stigma, which inhibited from seeking medical help. There is evidence that stigma associated with some other diseases had a complex relationship with illness severity and quality of life. However, little empirical research has examined the role that stigma plays among urinary incontinent population. DESIGN: A cross-sectional, descriptive design was used. METHODS: A purposive sample of 333 women with stress urinary incontinence from a Chinese city was enrolled. Data were collected on symptom severity, disease stigma and quality of life using the International Consultation on Incontinence Questionnaire-Urinary Incontinence Short Form, Social Impact Scale and Incontinence Quality-of-Life Measure, respectively. The mediate effect of disease stigma was analysed using a series of hierarchical regression models. RESULTS: Disease stigma negatively correlated with quality of life among stress urinary incontinent women. Social isolation and internalised shame, but not social rejection, the domains of disease stigma, partially mediated the effect of symptom severity on quality of life, attenuating the effect by 34·3% together. CONCLUSIONS: Disease stigma impairs quality of life of women with stress urinary incontinence and mediates the association between symptom severity and quality of life. Health workers may improve their quality of life by addressing perceived stigma. RELEVANCE TO CLINICAL PRACTICE: Our findings suggest that in clinical practice, stigma reduction may have the potential to not only improve quality of life, but also mitigate the impact of the severity on quality of life among urinary incontinent women. Social isolation and internalised shame should be more concerned in targeted interventions.

Urinary incontinence among adult women with diabetes in Jordan: epidemiology, correlates and perceived impact on emotional and social well-being.

AIMS AND OBJECTIVES: To assess the epidemiology and correlates of urinary incontinence and its perceived impact on the emotional and social well-being of Jordanian women. BACKGROUND: Diabetes is a chronic disease with rising prevalence in women worldwide. Although urinary incontinence is a complication of diabetes, it is not commonly assessed with limited nurses' knowledge available on its prevalence, correlates and its perceived impact on lives of women. DESIGN: A cross-sectional survey design using probability sampling approach was used to collect information on incontinence. METHODS: A total of 1011 adult women, 20-65 years old, attending primary healthcare centres in Jordan were interviewed using a standardised incontinence questionnaire. Questionnaire included items to assess the perceived impact of incontinence on social and emotional well-being of women. The study outcome included weekly or more any, stress and urge incontinence. RESULTS: Of 435 (43%) diabetic and 576 (57%) nondiabetic women, a total of 676 (66·8%) women reported incontinence. The prevalence of weekly or more any, urge and stress incontinence was significantly higher in diabetic than in nondiabetic women, 31·5, 13·8 and 20% versus 18·2, 5·9 and 14·2%, respectively. After adjusting for age, body mass index, parity and history of urinary tract infections, in multiple logistic regression analyses, diabetes was significantly associated with any (OR: 1·99; 95% CI: 1·44-2·74) urge (OR: 2·23; 95% CI: 1·38-3·61) and stress incontinence (OR: 1·54; CI: 1·07-2·22). Obesity and age were found to be significant correlates for urge incontinence in diabetics. Women with incontinence perceived incontinence as bothersome condition with negative impact on social well-being. CONCLUSIONS: Incontinence is a common and distressing problem in diabetic women, especially for those who are older and obese. Prospective cohort studies are needed to assess how nurse-led interventions may impact the negative consequences of incontinence on women well-being. RELEVANCE TO CLINICAL PRACTICE: Nurses are in the right position to assess urinary incontinence in diabetic women. Proper communications, culturally sensitive screening and tailored interventions may assist nurses in providing care and support to alleviate the impact of incontinence on women well-being.

The effectiveness of massage in stress urinary incontinence-case study.

PURPOSE: The aim of the case study was to determine the effectiveness of massage in the management of stress urinary incontinence. DESIGN: A 50-year-old woman with many years' history of stress incontinence was treated with massage. METHODS: The methodology involved positioning of the patient and massage according to an original method including the initial, main, and final parts. FINDINGS: The applied therapy contributed to a decreased amount of urine leakage (immediately following the therapy-by 21%, a month later-by 100%) and improved the quality of patient's life. CONCLUSIONS: A decrease in the amount of urinary leakage was observed immediately after therapy. One month after termination of massage therapy, a complete remission of symptoms was observed. CLINICAL RELEVANCE: The presented massage procedure had a positive effect on the amount of urinary leakage on effort immediately after therapy and on few-month follow-up produced complete relief from the distress.

Male sling procedures for stress urinary incontinence.

Radical prostatectomy is the most common cause of urinary incontinence in males. Urinary slings are a relatively new treatment option for men. This article describes two urinary sling procedures as possible surgical approaches for incontinence in men.

Stress incontinence and pelvic floor exercises in pregnancy.

This literature review is a critique of the research looking at the impact of pelvic floor exercises during pregnancy on urinary stress incontinence in postnatal women. Seven studies were selected for review following a database search on the Cumulative Index to Nursing and Allied Health Literature (CINAHL), Embase, Medline and the British Nursing Index (BNI). The research produced mixed findings. Four of the seven studies demonstrated a significant improvement in urinary stress incontinence in postnatal women following pelvic floor muscle exercise during pregnancy. However, the studies that spanned a longer time period found no long-term effectiveness. More research is needed for a more conclusive picture as to whether antenatal pelvic floor exercises can improve stress incontinence in the postpartum period.

Managing stress incontinence in postnatal women.

Urinary incontinence can have a significant impact on quality of life. This article explores the causes of stress urinary incontinence, and the impact of childbirth in particular, and discusses the importance of thorough assessment and treatment options.

Traces: making sense of urodynamics testing--part 7: Evaluation of bladder filling/storage: Evaluation of urethral sphincter incompetence and stress urinary incontinence.

The "Traces" series discusses how the urodynamic clinician generates usable data from a filling cystometrogram. Part 7 focuses on the question, "Is the urethral sphincter mechanism competent?" From a practical viewpoint, this question can be divided into two queries: 1) does this patient have observable urodynamic stress urinary incontinence (SUI), and 2) does this patient have intrinsic urethral sphincter incompetence, also referred to as intrinsic sphincter deficiency or a low pressure urethra? Signs of SUI include clinician observation of urine loss with coughing or during Valsalva's maneuver. Urodynamic SUI is the observation of urine loss with increased abdominal and intravesical pressures in the absence of a detrusor contraction. The most commonly used techniques for assessment of urethral sphincter function and SUI are the urethral pressure profile and the abdominal leak point pressure. Both are useful for answering these queries, but both tests are vulnerable to physiologic and technical artifacts that must be minimized to produce technically accurate and clinically meaningful results.

Understanding stress urinary incontinence.

Underreported and undertreated, stress urinary incontinence leads to decreased quality of life in sufferers and financial burdens for both the patient and the healthcare industry. Nurse practitioners should understand their role in identifying, diagnosing, and treating the condition.

Eficacia de un programa de tratamiento conservador de la incontinencia urinaria de esfuerzo. Cumplimiento y modificación de los parámetros evaluados a corto y medio plazo / No disponible

Objetivo Evaluar el resultado de un programa de reeducación de la musculatura del suelo pélvico (MSP) en una población de mujeres con incontinencia urinaria de esfuerzo (IUE) diagnosticada mediante estudio urodinámico. Método Estudio prospectivo de 144 mujeres diagnosticadas urodinámicamente de IUE, con indicación de tratamiento conservador mediante ejercicios de contracción de la MSP, biofeedback y electroterapia, asociado a un programa de educación terapéutica (ET). Se incluyeron mujeres tratadas en un periodo de tres años, con un seguimiento mínimo de un año. Los parámetros evaluados fueron: capacidad contráctil de la MSP, cuantificación de la pérdida de orina (test de la compresa), el número de absorbentes de protección, el cuestionario de calidad de vida International Consultation Incontinence Questionnaire (ICIQ-IU-SF) y una escala de percepción subjetiva de mejoría-curación. Se valoró también el cumplimiento en la realización del programa pautado de ejercicios al finalizar el tratamiento y en los controles evolutivos. Resultados De las 144 pacientes que realizaron el tratamiento, 96 completaron el seguimiento mínimo de 12 meses. Al finalizar el tratamiento se observó un cambio en los síntomas y en la afectación de la vida diaria, que se objetivó en el valor del ICIQ-IU-SF que indicaba una mejoría (puntuación menor que al inicio) en el 73% de las pacientes. Un 19% manifestaba no tener IUE y sólo un 8% seguía igual. En el seguimiento, a partir de los 12 meses, se observó que el porcentaje de pacientes con mejoría del ICIQ-IU-SF era menor que al inicio (53%), un 16%seguía sin síntomas de IU y el 31% manifestaba que sus síntomas permanecían igual que antes del tratamiento. En cuanto a la percepción subjetiva de las pacientes, a los 12 meses, el 80% presentó mejoría, el (..) (AU)

SUMMARY Aim To assess the outcome of a pelvic floor muscles (PFM) rehabilitation program in a women population with stress urinary incontinence (UI) diagnosed by urodynamic study. Method Prospective study of 144 women diagnosed urodynamically for stress UI, with conservative treatment indication through MSP contraction exercises, biofeedback and electrotherapy, associated to a therapeutic education program (ET). We included women treated during a three years period, with a minimum one-year follow-up. The evaluated parameters were: the MSP contractile ability, loss of urine quantification (pad test), number of absorbent needed, the International Consultation Incontinence Questionnaire (ICIQ-IU-SF) quality of life questionnaire and a self-perception scale improvement-healing. It was also assessed the performance in carrying out the program of exercises scheduled at the end of treatment and evolutive controls. Results From 144 patients who carried out the treatment, 96 completed the minimum 12 months follow-up period. At the end of the treatment it was observed a change in symptoms and in the disruption of daily life, showed by the value of the IU-SF-ICIQ, which indicated an improvement(score lower than at the beginning) in 73% of the patients, 19% expressed no UI and only 8% remained unchanged. The followup, from 12 months, showed that the percentage of patients with improvement of ICIQ-IU-SF was lower than at the beginning (53%),followed by 16% without symptoms of UI and 31% reported that their symptoms remained the same as before treatment. As for the subjective perception of patients at 12 months, 80% referred improvement, 18% related no (..) (AU)

Stress urinary incontinence: a review of treatment options.

Stress urinary incontinence occurs when the support structures of the pelvic floor and the urinary system are stretched, damaged, or defective. This condition is common in women of all ages, and billions of dollars are spent each year to correct the condition and improve quality of life. This article reviews three current treatments for stress urinary incontinence: the Burch colposuspension procedure, urethral slings, and radiofrequency treatments. In one study, researchers reported that patient satisfaction rates were higher for the Burch procedure than for urethral sling procedures. Other researchers found that urethral sling procedures had high rates of success but that adverse events were more common. Adverse events for both types of procedures include voiding difficulties, postoperative urge incontinence, and urinary tract infections. Radiofrequency interventions can improve the quality of life for many patients and can provide a short-term intervention for many patients who later may require a more-invasive surgical procedure.

Incontinencia Urinaria de esfuerzo en la gestante. Una revisión bibliográfica / Female stress urinary incontinence during pregnancy. A bibliographical review

Se presenta una breve revisión bibliográfica sobre la Incontinencia Urinaria de Esfuerzo (IUE) asociada a la mujer gestante. La alta prevalencia de este trastorno y la introducción de novedosas técnicas sanitarias exige una profunda revisión que ayude a los profesionales de enfermería a tomar conciencia de la magnitud del problema, así como a diagnosticarlo y tratarlo eficazmente. La IUE es la pérdida involuntaria de orina asociada a un esfuerzo físico que provoca un aumento de la presión abdominal. La revisión de la literatura no deja lugar a dudas de que, entre los factores de riesgo que predisponen a una mujer a padecerla, el traumatismo obstétrico consecuencia del embarazo y parto es uno de los principales. Se presentan sendas herramientas diagnósticas (cuestionario ICIQ-SF) y terapéuticas (Entrena-miento Muscular del Suelo Pélvico) cuya efectividad ha sido demostrada suficientemente y que pueden resultar de gran utilidad clínica para su aplicación en la consulta de enfermería(AU)

The authors have prepared a brief bibliographical review on female stress urinary incontinence during pregnancy. The high degree of incidence this disorder has and the introduction of the latest sanitary techniques combine to make necessary a profound review which aids medical professionals to realize the magnitude of this problem, as well as to diagnose and treat it effectively. Female stress urinary incontinence during pregnancy is an involuntary urine loss associated to the physical effort which an increase in abdominal pressure provokes. A literary review of articles related to this disorder leaves no doubt that among the risk factors which make a woman be predisposed to suffer female stress urinary incontinence, obstetric trauma as a consequence of pregnancy and birth is a main risk factor. The authors describe a couple of diagnostic tools, a ICIQ-SF questionnaire, and therapeutic tools, the pelvic floor muscle exercise program, whose effectiveness has been sufficiently demonstrated and may prove to have very beneficial clinical uses which can be applied in a nurse’s office(AU)

Why women leave therapy for stress incontinence.

Stress urinary incontinence (SUI) is the involuntary leakage of urine associated with effort, exertion, sneezing or coughing (Abrams et al, 2002) and is the most common type of incontinence in women (Hampel et al, 2004). In 2005, NHS Greater Glasgow introduced a primary care management of SUI pathway. However, a high percentage of patients failed to complete their therapy.The aim of this study was to explore why some women with SUI dropped out of the pathway.