Questions to ask a patient with nocturia.

BACKGROUND: Patients may not raise nocturia as a concern as they mistakenly consider the symptom to be a normal part of ageing. Nocturia is associated with significant morbidity and is likely to be a marker of poor health. OBJECTIVE: This paper provides questions to guide diagnosis, evaluation and individualised treatment of nocturia. DISCUSSION: Nocturia results from the interplay between nocturnal polyuria, reduced bladder storage and sleep disruption. Changes in the function of the urinary bladder, kidneys, brain and cardiovascular system, and hormone status underlie the development and progression of nocturia. Medications commonly prescribed to older people can affect development or resolution of nocturia. The bother caused to a patient by waking to void relates to disturbance of slow-wave sleep, the physical act of getting out of bed and resulting chronic fatigue. An assessment process that identifies relevant and co-existing causes of an individual's nocturia will facilitate a targeted approach to treatment.

Guillain-Barré syndrome: prevalence and long-term factors impacting bladder function in an Australian community cohort.

BACKGROUND AND PURPOSE: Urinary dysfunction is associated with significant morbidity in persons with Guillain-Barré Syndrome (GBS). The aim of this study was to describe prevalence and long-term impact of bladder dysfunction on daily activities and quality of life (QoL) in persons in chronic phase of GBS and to examine the relationships between commonly used continence measures in this cohort. METHODS: Prospective cohort (n=66) following GBS treatment (1996-2009) was recruited from a tertiary hospital and assessed using standardised measures for bladder dysfunction: American Urological Association (AUA) Symptom Index, Incontinence Impact Questionnaire, Urogenital Distress Inventory. RESULTS: Sixty-six participants (64% male, mean age 56 years, median disease duration of 6.1 years) completed the study. Of these more than half reported nocturia and one-third reported urinary urgency and frequency. Urinary problems impacted on participants' daily activities: physical recreation (21%), emotional health and mood (17%), entertainment (14%), participation and mobility (>30 min) (12%), and performance of household chores (8%). Since GBS, 49% reported interference of urinary symptoms with daily life to some extent; and adverse impact on QoL (10.6%). Significant relationship between bladder symptoms; and the level of urogenital distress (p<0.001) and the impact of urinary problems (p<0.001), was noted. Higher scores on the bladder scales showed significant correlations with psychological, functional and participation scales. The single QoL item (AUA scale) correlated significantly with all other bladder scales (rho=0.63-0.86). This can be a potential 'screening tool' to identify patients for further assessment. CONCLUSIONS: Bladder dysfunction in chronic phase of GBS is not well studied. More research in longer-term screening and outcomes for bladder intervention are needed for integrated care and to guide treating clinicians.

Multiple sclerosis: prevalence and factors impacting bladder and bowel function in an Australian community cohort.

PURPOSE: To describe the prevalence and impact of bladder and bowel dysfunction on quality of life (QoL) in persons with multiple sclerosis (pwMS) in an Australian community cohort and to explore the relationships between commonly used continence measures. METHODS: Patients (N = 73) recruited from a tertiary hospital database, interviewed using standardised measures, based on the framework of International Classification of Functioning, Disability and Health. RESULTS: Of 73 participants (mean age 50 yrs, 73% female, 56% progressive MS), two thirds were bothered by urinary frequency whereas half reported urinary incontinence, and 14% bowel incontinence. Urinary problems impacted emotional health (31%), ability to perform household chores (22%) and physical recreation (28%), with detrimental impact on QoL. There was a significant relationship between symptoms, level of urogenital distress (rho = 0.74, p < 0.001) and impact of incontinence (rho = 0.68, p < 0.001). The single item of Urological Association Symptom Index assessing impact of bladder symptoms on QoL correlated significantly with all other bladder scales (rho = 0.60-0.74), making it a potential 'screening tool' to identify patients for further assessment. CONCLUSION: Continence issues cause significant disability in pwMS. Improved awareness of currently available treatment options and clinically robust trials are needed to assess outcomes of continence intervention.