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Sample records for incontinence inpatient procedures

  1. Urinary incontinence - vaginal sling procedures

    MedlinePlus

    ... types of surgeries that help control stress urinary incontinence . This is urine leakage that happens when you ... sling procedures are done to treat stress urinary incontinence. Before discussing surgery, your doctor will have you ...

  2. Urinary incontinence - vaginal sling procedures

    MedlinePlus

    ... this page: //medlineplus.gov/ency/article/007376.htm Urinary incontinence - vaginal sling procedures To use the sharing features ... are types of surgeries that help control stress urinary incontinence . This is urine leakage that happens when you ...

  3. Voiding trial outcome following pelvic floor repair without incontinence procedures

    PubMed Central

    Wang, Rui; Won, Sara; Haviland, Miriam J.; Bargen, Emily Von; Hacker, Michele R.; Li, Janet

    2016-01-01

    Introduction and hypothesis Our aim was to identify predictors of postoperative voiding trial failure among patients who had a pelvic floor repair without a concurrent incontinence procedure in order to identify low-risk patients in whom postoperative voiding trials may be modified. Methods We conducted a retrospective cohort study of women who underwent pelvic floor repair without concurrent incontinence procedures at two institutions from 1 November 2011 through 13 October 2013 after abstracting demographic and clinical data from medical records. The primary outcome was postoperative retrograde voiding trial failure. We used modified Poisson regression to calculate the risk ratio (RR) and 95 % confidence interval (CI). Results Of the 371 women who met eligibility criteria, 294 (79.2 %) had complete data on the variables of interest. Forty nine (16.7%) failed the trial, and those women were less likely to be white (p = 0.04), more likely to have had an anterior colporrhaphy (p = 0.001), and more likely to have had a preoperative postvoid residual (PVR) ≥150 ml (p = 0.001). After adjusting for race, women were more likely to fail their voiding trial if they had a preoperative PVR of ≥150 ml (RR: 1.9; 95 % CI: 1.1–3.2); institution also was associated with voiding trial failure (RR: 3.0; 95 % CI: 1.6–5.4). Conclusions Among our cohort, postoperative voiding trial failure was associated with a PVR of ≥150 ml and institution at which the surgery was performed. PMID:26886553

  4. [Urinary incontinence, should fertile women undergo surgical procedure?].

    PubMed

    Panel, L; Mares, P; de Tayrac, R

    2009-02-01

    The goal of this study was to make a Medline research about pregnancies which occur after surgical procedures for stress urinary incontinence (SUI). Therefore, we do not know the recurrence rate of SUI after pregnancy and the influence of the way of delivery on the risk of recurrence. We do not know either if we should apply a surgical procedure on women who have not achieved their pregnancies. In 1998, a questionnaire based survey conducted in the USA showed a lower risk of recurrence after a caesarean section than after a vaginal delivery (p=0,03) when women had previously colposuspension or sling procedures. We found ten case reports and a French national survey (2006) about pregnancies after TOT or TVT procedure. No complication related to the tape was described during pregnancy. The recurrence rate along the pregnancy is about 15%, and the global recurrence rate (during pregnancy and after the childbirth) is about 20%. As a conclusion, pregnancy itself has an influence, and vaginal delivery seams to increase the risk of recurrence after the birth compare to the c-section. However this recurrence rate and these data do not appear enough to us to refuse a surgical treatment for women who have not completed their pregnancies and who suffer from UI without efficacy of physiotherapy. We do not have objective data to assess the best way of delivery. Further and large studies are needed although they are difficult to be carried through. PMID:19117785

  5. [Ambulatory procedures to replace inpatient care. Background and applications].

    PubMed

    Hensen, P; Bunzemeier, H; Fürstenberg, T; Luger, T A; Rochell, B; Roeder, N

    2004-07-01

    Since January 2004, German hospitals and specialists in private practice have equal rights to provide and to charge for ambulatory surgeries according to paragraph 115b, 5th Code of Social Law. The current agreement between the German self-governing bodies replaces the existing contracts from 1993. In contrast to the previous version, the revised catalogue contains additional non-operative procedures. Some procedures may be provided either in an ambulatory or inpatient setting. However, for the hospitals it is of particular importance that some specified procedures should be performed on an ambulatory basis. If these particular services are delivered in an inpatient setting at least one stipulated criteria of exception has to be fulfilled. From the perspective of dermatology, not only opportunities but also obligations for ambulatory care arise from the new conditions. The critical facts and aspects with special relevance to dermatology are reviewed in detail. PMID:15168028

  6. 42 CFR 416.75 - Performance of listed surgical procedures on an inpatient hospital basis.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... inpatient hospital basis. 416.75 Section 416.75 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES... on an inpatient hospital basis. The inclusion of any procedure as a covered surgical procedure under § 416.65 does not preclude its coverage in an inpatient hospital setting under Medicare....

  7. [Anal incontinence].

    PubMed

    Signorelli, I; Andreoni, G M; Capelli, G; Gozzini, P A

    1983-06-01

    The Authors describe the clinical rectal incontinence according to etiology, physiology and pathologic anatomy. They report a case of such rectal incontinence followed to hemorroidectom and treated by transplantation of gracilis muscle according to Pikrell technique, comparing this approach with other current surgical procedures. PMID:6680848

  8. Current interventional management of male stress urinary incontinence following urological procedures

    PubMed Central

    Ostrowski, Ireneusz; Śledź, Emil; Ciechan, Janusz; Bukowczan, Jakub; Przydacz, Mikolaj; Wiatr, Tomasz; Stangel-Wojcikiewicz, Klaudia; Chłosta, Piotr L.

    2015-01-01

    Introduction Despite improvements in surgical techniques and implementation of minimally invasive procedures, male stress urinary incontinence affects a substantial number of patients after prostatic surgery. In response to increasing demand of optimal treatment modality, new alternatives to artificial urinary sphincter have recently been introduced. This review summarises the therapeutic surgical options with their outcomes in management of postprostatectomy stress incontinence. Material and methods We performed a literature review by searching the PubMed, Web of Science and Embase databases for articles published from January 2000 until April 2015 based on clinical relevance. Results Artificial urinary sphincter is currently considered the “gold standard” treatment of male stress urinary incontinence. Although the new devices in this group have recently been investigated, the AMS 800 remains the only widely used implant. Male slings and adjustable continence devices, achieve the social continence rates up to 60%. Periurethral injections of bulking agents, have limited efficacy of male stress incontinence. Argus sling and ProACT are both associated with substantial explantation rates. Stem cell therapy is a promising option but still requires additional testing. Conclusions The development of new alternatives to artificial urinary sphincter is constantly progressing. Although recently introduced minimally invasive treatment options have not yet surpassed the outcomes of the artificial urinary sphincter they should continue to be evaluated and compared against the gold standard. PMID:26568879

  9. [Postoperative evaluation of different surgical procedures in genuine stress urinary incontinence: a retrospective study].

    PubMed

    Rodríguez-Colorado, S; Pérez-Soriano, P; Alvarez-Mercado, R L; Herbert, A; Kunhardt-Rasch, J

    1996-06-01

    An evaluation of the surgical treatment for stress and mixed urinary incontinence and pelvic relaxation. One-year follow-up, was done. A retrospective study with 144 files from the surgeries performed between February 1993 and June 1994, at the Clínica de Urología Ginecológica del Instituto Nacional de Perinatología. We excluded 37 files because of incomplete information. The age, parity, hormonal stage, preoperative diagnosis by urodynamic studies, surgical treatments and one-year follow-up were analyzed. The mean age was 45.5 years. Pereyra procedure was performed in 53, Burch procedure in 47, anterior colporrhaphy in 5, and sling procedure in 2 patients. The incidence of complications was similar between the different groups. Resumption of spontaneous postsurgical voiding was delayed in the Pereyra group. The Burch urethropexy and Pereyra procedures were equally effective, with no statistical differences observed. Burch vaginal suspension was not more effective for the correction of urinary stress incontinence than Pereyra procedure. PMID:8754724

  10. Urinary incontinence - retropubic suspension

    MedlinePlus

    Retropubic suspension is surgery to help control stress incontinence . This is urine leakage that happens when you ... This procedure is done to treat stress incontinence . Before discussing ... medicines, or other options. If you tried these and are ...

  11. Urinary Incontinence

    MedlinePlus

    ... of this page please turn Javascript on. Urinary Incontinence What Is Urinary Incontinence? Urinary incontinence means a person leaks urine by ... about what you can do. Types of Urinary Incontinence There are different types of urinary incontinence. Stress ...

  12. Different sling procedures for stress urinary incontinence: a lesson from 453 patients.

    PubMed

    Luo, De-Yi; Wang, Kun-Jie; Zhang, Han-Chao; Dai, Yi; Yang, Tong-Xing; Shen, Hong

    2014-03-01

    Several midurethral sling (MUS) procedures, such as tension-free vaginal tape (TVT), TVT obturator (TVT-O), tension-free vaginal tape SECUR (TVT-S), and pubovaginal sling (PVS), have been used for the treatment of female stress urinary incontinence (SUI); however, which method is best for a particular patient group is not known. This study aimed to identify the best rationale for choosing the optimal MUS procedure for each patient. In total, 453 consecutive female patients with SUI who were treated with MUSs in West China Hospital of Sichuan University from September 2003 to September 2011 were enrolled in this study. All the patients underwent comprehensive pre-, intra-, and postoperative evaluations, including collection of demographic information, pelvic examination, and urodynamic testing, and operation-related complications were recorded. The Incontinence Quality of Life questionnaire was also completed. Under local or general anesthesia, 105 cases were treated with TVT, 243 with TVT-O, 90 with TVT-S, and 15 with PVS. Patients with different profiles in terms of age, symptom duration, concomitant procedures, urodynamic parameters, and pelvic organ prolapse (POP) quantification score were treated successfully; the body mass index did not differ significantly among the various treatment options. The cure and improvement rates were similar among the treatment groups: 97.14% (102/105) in TVT, 100% (243/243) in TVT-O, 98.89% (89/90) in TVT-S, and 100% (15/15) in PVS. Only minor complications were experienced by the patients. In conclusion, each MUS procedure was observed to be safe and effective in different subpopulations of patients, and the results suggest that appropriate patient selection is crucial for the success of each MUS procedure. PMID:24581214

  13. Analysis of risk factors associated with vaginal erosion after synthetic sling procedures for stress urinary incontinence.

    PubMed

    Chen, Huey-Yi; Ho, Ming; Hung, Yao-Ching; Huang, Li-Chia

    2008-01-01

    The goal of this study was to analyze the risk factors associated with vaginal erosion after synthetic sling procedure for stress urinary incontinence. Follow-up evaluations were at 1 week, 1 to 3 months, 6 months, and annually after the operation. The evaluations included detailed history taking, vaginal examinations, and perineal ultrasonographic urethrocystography. The vaginal erosion rate (6/239) after the synthetic sling procedure was 2.5%. We assessed the relationship between clinical features and vaginal erosion. Of these, only diabetes mellitus (DM) was a significant risk factor for vaginal erosion. Women with DM were 8.3 times more at risk than women without DM for developing vaginal erosion after synthetic sling procedure (p < 0.05). The vaginal erosion-free rate during the 24-month follow-up decreased significantly in women with DM. The rate of vaginal erosion associated with type III multifilamentous polypropylene sling (intravaginal slingplasty) is 10.7% more than that with type I monofilament polypropylene sling (such as tension-free vaginal tape and inside out transobturator vaginal tape) (p = 0.054). Women with DM should be informed that vaginal erosion is a possible complication after synthetic sling procedure. PMID:17594046

  14. 42 CFR 405.1206 - Expedited determination procedures for inpatient hospital care.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... hospital care. 405.1206 Section 405.1206 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT... Hospital Discharges § 405.1206 Expedited determination procedures for inpatient hospital care. (a... expedited determination by the QIO when a hospital (acting directly or through its utilization...

  15. Incontinence - resources

    MedlinePlus

    Resources - incontinence ... The following organizations are good resources for information on incontinence. Fecal incontinence : The American Congress of Obstetricians and Gynecologists -- www.acog.org/~/media/for%20patients/faq139.ashx ...

  16. Electrostimulated gracilis neosphincter for faecal incontinence and in total anorectal reconstruction: still an experimental procedure?

    PubMed

    Altomare, D F; Rinaldi, M; Pannarale, O C; Memeo, V

    1997-01-01

    The possibility of converting an easily fatiguable muscle like the gracilis muscle into a fatigue-resistant one using chronic electrostimulation has renewed interest in Pickrell's procedure. Between July 1991 and June 1996, 9 patients (2 M; 7 F) mean age = 45 y (range 14-72) underwent dynamic graciloplasty using Medtronic electrostimulators. Five patients had faecal incontinence (2 congenitally anomaly, 1 neurological, 2 post-operative) and 4 had a perineal colostomy performed either simultaneously (two cases) or at 3 to 4 years after abdominoperineal excision of the rectum. Early post-operative complications included distal tendon necrosis [1], perineal colostomy breakdown [1], detachment of the gracilis tendon [2] and seroma in the thigh [1]. Long-term complications included rectocele with faecal impaction in one patient with imperforate anus, anal stricture in one patient who had refashioning of a perineal colostomy, and displacement of the lead from the main nerve in 3 with external expulsion in 2. The patient with anal stricture was successfully treated with anoplasty but subsequently returned to an abdominal colostomy due to stricture recurrence 2 years later. The rectocele was successfully treated using a transvaginal approach. Electrical conversion of the muscle was completed in all patients but long term functional results are available for only 5 cases. Manometry revealed a significant improvement in anal pressure under electro-stimulation and the continence grading scale score significantly improved in 4 patients. The technique is applicable to a very selected group of patients with no other options but is still in the experimental phase and should not be performed outside controlled trials. Repeated hospitalisation and reoperations are often required although the complication rate may diminish and improve with experience. PMID:9401848

  17. The artificial urinary sphincter and male sling for postprostatectomy incontinence: Which patient should get which procedure?

    PubMed Central

    Dobberfuhl, Amy D.

    2016-01-01

    Surgery is the most efficacious treatment for postprostatectomy incontinence. The ideal surgical approach depends on a variety of patient factors including history of prior incontinence surgery or radiation treatment, bladder contractility, severity of leakage, and patient expectations. Most patients choose to avoid a mechanical device, opting for the male sling over the artificial urinary sphincter. The modern male sling has continued to evolve with respect to device design and surgical technique. Various types of slings address sphincteric incompetence via different mechanisms of action. The recommended surgery, however, must be individualized to the patient based on degree of incontinence, detrusor contractility, and urethral compliance. A thorough urodynamic evaluation is indicated for the majority of patients, and the recommendation for an artificial urinary sphincter, a transobturator sling, or a quadratic sling will depend on urodynamic findings and the patient's particular preference. As advancements in this field evolve, and our understanding of the pathophysiology of incontinence and mechanisms of various devices improves, we expect to see continued evolution in device design. PMID:26966721

  18. Stress urinary incontinence.

    PubMed

    Nygaard, Ingrid E; Heit, Michael

    2004-09-01

    Stress urinary incontinence, the complaint of involuntary leakage during effort or exertion, occurs at least weekly in one third of adult women. The basic evaluation of women with stress urinary incontinence includes a history, physical examination, cough stress test, voiding diary, postvoid residual urine volume, and urinalysis. Formal urodynamics testing may help guide clinical care, but whether urodynamics improves or predicts the outcome of incontinence treatment is not yet clear. The distinction between urodynamic stress incontinence associated with hypermobility and urodynamic stress incontinence associated with intrinsic sphincter deficiency should be viewed as a continuum, rather than a dichotomy, of urethral function. Initial treatment should include behavioral changes and pelvic floor muscle training. Estrogen is not indicated to treat stress urinary incontinence. Bladder training, vaginal devices, and urethral inserts also may reduce stress incontinence. Bulking agents reduce leakage, but effectiveness generally decreases after 1-2 years. Surgical procedures are more likely to cure stress urinary incontinence than nonsurgical procedures but are associated with more adverse events. Based on available evidence at this time, colposuspension (such as Burch) and pubovaginal sling (including the newer midurethral synthetic slings) are the most effective surgical treatments. PMID:15339776

  19. Comparison Between the Transobturator Tape Procedure and Anterior Colporrhaphy With the Kelly’s Plication in the Treatment of Stress Urinary Incontinence: a Randomized Clinical Trial

    PubMed Central

    Sohbati, Samira; Salari, Zohreh; Eftekhari, Nahid

    2015-01-01

    Background Stress urinary incontinence in women is a common problem that impairs the quality of life in patients. The extraordinary number of procedures to treat stress urinary incontinence reflects a lack of consensus on an appropriate intervention for this problem. Objectives The current study aimed to compare the results of transobturator tape (TOT) procedure and anterior colporrhaphy with the Kelly’s Plication to treat women with stress urinary incontinence. Patients and Methods This randomized clinical trial was conducted on 60 patients with stress urinary incontinence referred to Afzalipour Hospital in Kerman, Iran. The patients were randomly divided into two surgery groups and were subsequently assessed regarding the outcomes of the procedures, incontinence symptoms and complications during the follow-up period. Results The cure rates at follow-up period of one month, six months and one year after surgery were 86.7%, 80% and 80% in the TOT group versus 80%, 70% and 66.7% in the anterior colporrhaphy with the Kelly’s Plication group, respectively. There were no significant differences between the two groups in the aforementioned follow-up periods (P = 0.68, P = 0.54 and P = 0.22, respectively). Conclusions The current results showed no significant differences between the outcomes of the two procedures at short-term follow-up. However, the results might have changed in the long term. PMID:26543834

  20. Urinary incontinence - injectable implant

    MedlinePlus

    Injectable implants are injections of material into the urethra to help control urine leakage ( urinary incontinence ) caused by a ... into the tissue next to the sphincter. The implant procedure is usually done in the hospital. Or ...

  1. Bowel incontinence

    MedlinePlus

    Uncontrollable passage of feces; Loss of bowel control; Fecal incontinence; Incontinence - bowel ... and weaken, leading to diarrhea and stool leakage. Fecal impaction . It is usually caused by chronic constipation. ...

  2. Fecal Incontinence

    MedlinePlus

    ... control than formed stool, it is an added stress that can lead to fecal incontinence. Diagnosis & Tests How will my doctor diagnose the cause of fecal incontinence? Along with a physical exam, your doctor may want to do other tests ...

  3. Urinary incontinence

    MedlinePlus

    Loss of bladder control; Uncontrollable urination; Urination - uncontrollable; Incontinence - urinary ... Causes of urinary incontinence include: Blockage in the urinary system Brain or nerve problems Dementia or other mental health problems that make ...

  4. [Conservative treatment in male urinary incontinence].

    PubMed

    Kirschner-Hermanns, R; Anding, R

    2014-03-01

    Prevalence, pathophysiology, diagnostic and therapeutic approaches of urinary incontinence are well studied in women; however, studies on male urinary incontinence focus on incontinence following surgery of the bladder or prostate, predominantly incontinence after radical prostatectomy. Aging men suffer from incontinence, most frequently urge incontinence (overactive bladder, OAB), nearly as often as women do.The domain of conservative therapy of urinary stress incontinence in men is pelvic floor training. It remains unclear whether biofeedback procedures, electrostimulation therapy, or magnetic stimulation therapy can enhance pelvic floor training. There are data suggesting that an off-label therapy with Duloxetin®, a selective serotonin-noradrenaline reuptake inhibitor (SSNRI), improves urinary incontinence following radical prostatectomy. Antimuscarinic agents in combination with bladder training have been proven as safe and effective treatment in men with OAB. Data, however, suggest that men with OAB are far less frequently treated than women. PMID:24585116

  5. Opioid Use Is Not Associated with Incomplete Wireless Capsule Endoscopy for Inpatient or Outpatient Procedures

    PubMed Central

    Kleinman, Bryan; Stanich, Peter P.; Betkerur, Kavita; Porter, Kyle; Meyer, Marty M.

    2014-01-01

    Objective. Wireless capsule endoscopy (WCE) is commonly used to directly visualize the small bowel. Opioids have variably been linked with incomplete studies and prolonged transit times in heterogeneous cohorts. We aimed to investigate the effect of opioid use on WCE for inpatient and outpatient cohorts. Methods. We performed a retrospective review of patients receiving WCE at our institution from April 2010 to March 2013. Demographic data, medical history, and WCE details were collected. Transit times were compared by log-rank analysis. Multivariable logistic regression and Cox proportional hazard models were utilized. Results. We performed 314 outpatient and 280 inpatient WCE that met study criteria. In the outpatient cohort, gastric transit time (GTT) was not significantly different between opioid and nonopioid users. Completion rates were similar as well (88% and 87%, P = 0.91). In the inpatient cohort, GTT was significantly longer in patients receiving opioids than in patients not receiving opioids (44 versus 23 min, P = 0.04), but completion rates were similar (71% versus 75%, P = 0.31). Conclusion. Opioid use within 24 hours of WCE did not significantly affect completion rates for inpatients or outpatients. GTT was prolonged in inpatients receiving opioids but not in outpatients. PMID:25214757

  6. Incontinence Treatment: Surgical Treatments

    MedlinePlus

    ... Incontinence Managing Incontinence: A Survey The Patient's Perspective Barriers on Diagnosis and Treatment Personal Stories Contact Us ... Incontinence Managing Incontinence: A Survey The Patient's Perspective Barriers on Diagnosis and Treatment Personal Stories Contact Us ...

  7. Symptoms of Incontinence

    MedlinePlus

    ... Incontinence Managing Incontinence: A Survey The Patient's Perspective Barriers on Diagnosis and Treatment Personal Stories Contact Us ... Incontinence Managing Incontinence: A Survey The Patient's Perspective Barriers on Diagnosis and Treatment Personal Stories Contact Us ...

  8. Incontinence Treatment: Medication

    MedlinePlus

    ... Incontinence Managing Incontinence: A Survey The Patient's Perspective Barriers on Diagnosis and Treatment Personal Stories Contact Us ... Incontinence Managing Incontinence: A Survey The Patient's Perspective Barriers on Diagnosis and Treatment Personal Stories Contact Us ...

  9. Incontinence Treatment: Biofeedback

    MedlinePlus

    Donate Find a Doctor Join eNewsletter Sidebar × MOBILE MENU About Us What is Incontinence? Prevalence Causes of Incontinence Fecal Incontinence in Children Reporter's Guide to Bowel Incontinence Signs & Symptoms Symptoms of ...

  10. Fecal Incontinence in Children

    MedlinePlus

    Donate Find a Doctor Join eNewsletter Sidebar × MOBILE MENU About Us What is Incontinence? Prevalence Causes of Incontinence Fecal Incontinence in Children Reporter's Guide to Bowel Incontinence Signs & Symptoms Symptoms of ...

  11. Urinary Incontinence

    MedlinePlus

    Urinary incontinence (UI) is loss of bladder control. Symptoms can range from mild leaking to uncontrollable wetting. It can happen to anyone, but it becomes more common with age. Women experience ...

  12. Urinary Incontinence

    MedlinePlus

    ... injury, birth defects, stroke, diabetes, multiple sclerosis, and physical changes associated with aging. Pregnancy — Unborn babies push down ... incontinence in women. It is often caused by physical changes from pregnancy, childbirth, and menopause. It can be ...

  13. Urinary Incontinence

    MedlinePlus

    ... you risk getting rashes, sores, skin infections and urinary tract infections. Also, you may find yourself avoiding friends and ... elderly and may be a sign of a urinary tract infection or an overactive bladder. Overflow incontinence This type ...

  14. Surgical Management for Fecal Incontinence

    PubMed Central

    Anandam, Joselin L.

    2014-01-01

    Fecal incontinence is a socially debilitating condition that can lead to social isolation, loss of self-esteem and self-confidence, and depression in an otherwise healthy person. After the appropriate clinical evaluation and diagnostic testing, medical management is initially instituted to treat fecal incontinence. Once medical management fails, there are a few surgical procedures that can be considered. This article is devoted to the various surgical options for fecal incontinence including the history, technical details, and studies demonstrating the complication and success rate. PMID:25320569

  15. Incontinence and incontinence-associated dermatitis.

    PubMed

    Langemo, Diane; Hanson, Darlene; Hunter, Susan; Thompson, Patricia; Oh, In Eui

    2011-03-01

    Incontinence is a prevalent problem and can lead to many complications. Both urinary and fecal incontinence can result in tissue breakdown, now commonly referred to as incontinence-associated dermatitis. This article addresses the types of incontinence, its etiology and pathophysiology, assessment, prevention and treatment, and the latest research. PMID:21326024

  16. Urinary Incontinence

    MedlinePlus

    ... Adults Making Your Wishes Known Home & Community Home › Aging & Health A to Z › Urinary Incontinence Font size A A A Print Share Glossary Basic Facts & Information Causes & Symptoms Diagnosis & Tests Care & Treatment Lifestyle & Management Other Resources Caregiving How ...

  17. Fecal Incontinence

    MedlinePlus

    ... Adults Making Your Wishes Known Home & Community Home › Aging & Health A to Z › Fecal Incontinence Font size A A A Print Share Glossary Basic Facts & Information Causes & Symptoms Diagnosis & Tests Care & Treatment Lifestyle & Management Other Resources Caregiving How ...

  18. MedlinePlus: Urinary Incontinence

    MedlinePlus

    ... Also in Spanish Stress incontinence Also in Spanish Suprapubic catheter care Also in Spanish Urge incontinence Also in ... catheterization - male Skin care and incontinence Stress incontinence Suprapubic catheter care Urge incontinence Urinary catheters Urinary catheters - what ...

  19. Stress urinary incontinence

    MedlinePlus

    Incontinence - stress ... over 2 cups of urine in their bladder. Stress incontinence occurs when the muscles that control your ... area or the prostate (in men) Unknown causes Stress incontinence is the most common type in women. ...

  20. Urinary incontinence - injectable implant

    MedlinePlus

    ... repair; ISD repair; Injectable bulking agents for stress urinary incontinence ... Blaivas JM, Gormley EA, et al. Female Stress Urinary Incontinence Update Panel of the American Urological Association Education ...

  1. Current Management of Fecal Incontinence

    PubMed Central

    Wang, Jennifer Y; Abbas, Maher A

    2013-01-01

    Objective: To review the management of fecal incontinence, which affects more than 1 in 10 people and can have a substantial negative impact on quality of life. Methods: The medical literature between 1980 and April 2012 was reviewed for the evaluation and management of fecal incontinence. Results: A comprehensive history and physical examination are required to help understand the severity and type of symptoms and the cause of incontinence. Treatment options range from medical therapy and minimally invasive interventions to more invasive procedures with varying degrees of morbidity. The treatment approach must be tailored to each patient. Many patients can have substantial improvement in symptoms with dietary management and biofeedback therapy. For younger patients with large sphincter defects, sphincter repair can be helpful. For patients in whom biofeedback has failed, other options include injectable medications, radiofrequency ablation, or sacral nerve stimulation. Patients with postdefecation fecal incontinence and a rectocele can benefit from rectocele repair. An artificial bowel sphincter is reserved for patients with more severe fecal incontinence. Conclusion: The treatment algorithm for fecal incontinence will continue to evolve as additional data become available on newer technologies. PMID:24355892

  2. Incontinence Treatment: Newer Treatment Options

    MedlinePlus

    ... Incontinence Managing Incontinence: A Survey The Patient's Perspective Barriers on Diagnosis and Treatment Personal Stories Contact Us ... Incontinence Managing Incontinence: A Survey The Patient's Perspective Barriers on Diagnosis and Treatment Personal Stories Contact Us ...

  3. Urinary Incontinence Could Be Controlled by an Inflatable Penile Prosthesis

    PubMed Central

    Choi, Hyung Ki; Lee, Hye-Yeon

    2016-01-01

    Purpose Due to the increasing numbers of radical prostatectomies (RP) performed for prostate cancer, a substantial and increasing number of patients suffer from postoperative urinary incontinence and erectile dysfunction (ED). The objective of our study was to see whether an inflatable penile prosthesis implantation could control urinary incontinence for patients with the dual problems of ED and incontinence. Materials and Methods From March 2010 through May 2015, 25 post-RP patients were referred to our clinic with ED or incontinence. The degree of incontinence was classified according to the International Consultation on Incontinence Questionnaire-Short Form. Inflatable penile prostheses were implanted in all 25 patients. Results For one month after implantation, partial or full inflation was performed progressively to control urine leakage. Of 18 patients, 13 patients were categorized with mild or moderate stress incontinence. All 13 patients obtained control of incontinence with partial inflation (30% to 60%) and all reported satisfactory outcomes. Five out of the 18 patients were categorized with severe total incontinence. Three of the 5 patients could tolerate incontinence with full inflation on and off. Thirteen patients out of the total of 18 (72.2%) had their incontinence controlled by an inflating penile prosthesis. Conclusions An inflatable penile prosthesis is highly recommended as an initial procedure, especially in patients with the dual problems of ED and incontinence. PMID:27169127

  4. Sphincteroplasty for anal incontinence

    PubMed Central

    Pescatori, Lorenzo Carlo; Pescatori, Mario

    2014-01-01

    Sphincteroplasty (SP) is the operation most frequently performed in patients suffering from moderate-to-severe anal incontinence (AI) who do not respond to conservative treatment. Other costly surgeries, such as artificial bowel sphincter (ABS) and electro-stimulated graciloplasty, have been more or less abandoned due to their high morbidity rate. Minimally invasive procedures are widely used, such as sacral neuromodulation and injection of bulking agents, but both are costly and the latter may cure only mild incontinence. The early outcome of SP is usually good if the sphincters are not markedly denervated, but its effect diminishes over time. SP is more often performed for post-traumatic than for idiopathic AI. It may also be associated to the Altemeier procedure, aimed at reducing the recurrence rate of rectal prolapse, and may be useful when AI is due either to injury to the sphincter, or to a narrowed rectum following the procedure for prolapse and haemorrhoids (PPH) and stapled transanal rectal resection (STARR). The outcome of SP is likely to be improved with biological meshes and post-operative pelvic floor rehabilitation. SP is more effective in males than in multiparous women, whose sphincters are often denervated, and its post-operative morbidity is low. In conclusion, SP, being both low-cost and safe, remains a good option in the treatment of selected patients with AI. PMID:24759337

  5. Urinary incontinence in women.

    PubMed

    Wood, Lauren N; Anger, Jennifer T

    2014-01-01

    Urinary incontinence affects women of all ages. History, physical examination, and certain tests can guide specialists in diagnosing stress urinary incontinence, urgency urinary incontinence, and mixed urinary incontinence. First line management includes lifestyle and behavior modification, as well as pelvic floor strength and bladder training. Drug therapy is helpful in the treatment of urgency incontinence that does not respond to conservative measures. In addition, sacral neuromodulation, intravesical onabotulinumtoxinA injections, and posterior tibial nerve stimulation can be used in select patient populations with drug refractory urgency incontinence. Midurethral synthetic slings, including retropubic and transobturator approaches, are safe and efficacious surgical options for stress urinary incontinence and have replaced more invasive bladder neck slings that use autologous or cadaveric fascia. Despite controversy surrounding vaginal mesh for prolapse, synthetic slings for the treatment of stress urinary incontinence are considered safe and minimally invasive. PMID:25225003

  6. External incontinence devices

    MedlinePlus

    ... of products that are available in your area. URINARY INCONTINENCE DEVICES Urine collection devices are mainly used by ... urinary system References Payne CK. Conservative management of urinary incontinence: Behavioral and pelvic floor therapy, urethral and pelvic ...

  7. Urinary incontinence - retropubic suspension

    MedlinePlus

    ... this page: //medlineplus.gov/ency/article/007374.htm Urinary incontinence - retropubic suspension To use the sharing features on ... may be because other problems are causing your urinary incontinence. Over time, some or all of the leakage ...

  8. [Update on fecal incontinence].

    PubMed

    Buhmann, Helena; Nocito, Antonio

    2014-10-29

    Fecal incontinence is defined as an accidental loss of stool or the inability to control defecation. There are three subtypes of fecal incontinence: passive incontinence, urge incontinence and soiling. About 8% of the adult population suffer from fecal incontinence, but only 1/3 consults a doctor. Beside the individual handicap, fecal incontinence has a huge socio-economic impact. Causes of fecal incontinence are changes in the quantity or quality of the stool and structural or functional disorders. Diagnostics encompass the medical history, clinical examination including the digital rectal examination, imaging (particularly endoanal ultrasound) as well as functional diagnostics (anal manometry and defecography). Nowadays, the most promising conservative treatment option consists of loperamide and biofeedback therapy. The most successful invasive method is the sacral neuromodulation. PMID:25351694

  9. Midurethral slings for stress urinary incontinence: a urogynecology perspective.

    PubMed

    Ridgeway, Beri; Barber, Matthew D

    2012-08-01

    Stress urinary incontinence (SUI), the involuntary leakage of urine associated with an increase in intraabdominal pressure (coughing, laughing, and sneezing), affects 12.8% to 46.0% of women. SUI is the most common type of urinary incontinence in women younger than 60 years and accounts for at least half of incontinence in all women. Retropubic and transobturator midurethral sling procedures are safe and effective treatments for stress urinary incontinence but have different complication profiles. History, examination, and additional testing may assist in choosing the correct sling type. Appropriate counseling and managing patient expectation are necessary to optimize patient satisfaction. PMID:22877711

  10. Urinary Incontinence: Bladder Training

    MedlinePlus

    ... following ways: Lengthen the amount of time between bathroom trips. Increase the amount of urine your bladder ... Kegel exercises may also help control urges. Scheduled bathroom trips: Some people control their incontinence by going ...

  11. Skin care and incontinence

    MedlinePlus

    Incontinence - skin care ... in a wheelchair, regular chair, or bed TAKING CARE OF THE SKIN Using diapers and other products ... skin. Over time, the skin breaks down. Special care must be taken to keep the skin clean ...

  12. Prevalence of Bowel Incontinence

    MedlinePlus

    ... and how improve living with these conditions . Publication Library Books of Interest Medical Definitions About IFFGD About us Our Mission Awareness Activities Advocacy Activities Research Leadership IFFGD Symposium Report Industry Council Contact Us Living with Incontinence A Personal ...

  13. [Diagnosis of urinary stress incontinence in men].

    PubMed

    Goepel, M

    2014-03-01

    Male lower urinary tract symptoms (LUTS) occur more frequently with increasing age. LUTS can either be caused by benign prostatic syndrome (BPS) and consecutive subvesical obstruction as well as detrusor hyperactivity. On the other hand, stress urinary incontinence is mostly seen after surgical intervention in the pelvis like radical prostatectomy. Also high volume centers report persisting incontinence rates of 2-4 % after radical prostatectomy.The diagnostic procedure in men with LUTS is divided in two steps: basic diagnostics, followed by a conservative treatment option, and extended diagnostic procedures including measurement of bladder pressure during filling and voiding. In addition, radiologic examinations, including voiding cystouretherogram, retrograde cystogram, CT scan, MRI scan, are added according to the severity of the symptoms and the scheduled surgical procedure. According to the guidelines of the DGU, EAU, AUA, and ICS, this extended examination is also mandatory prior to any surgical procedure like suburethral tapes, artificial sphincters, and sacral foramen neuronal stimulators. PMID:24615463

  14. [Pharmacotherapy of stress incontinence].

    PubMed

    Jost, W H; Marsalek, P; Michel, M C

    2005-10-14

    Female urinary incontinence is a medical and social problem with a large prevalence. Stress urinary incontinence (SUI) is the most common form of urinary incontinence and is responsible for 49 % of all incontinence, if mixed forms are included even for 78 %. As of yet, apart from "off-label" treatment, there is no pharmacological treatment available for stress urinary incontinence. For instance, estrogens are used in menopausal patients but a substantial effect in the treatment of SUI has not been demonstrated. a-Adrenergics, such as phenylpropanolamine and midodrine, and b-adrenergics, such as clenbuterol, are also used in "off-label" therapy. A recently conducted meta-analysis of 15 randomised studies with female patients who received a- und b-adrenergics as part of their therapy, failed to detect efficacy compared to placebo. Tricyclic antidepressives, such as imipramine and doxepine, which are used for the treatment of urge incontinence, are also used "off-label" in the treatment of SUI. However, no placebo-controlled studies have been conducted so far. The serotonin-norepinephrine reuptake inhibitor duloxetine represents a new therapeutic approach in the treatment of SUI. It has shown positive effects on bladder and urethra in animal experiments, most likely through an effect on the Onuf's nucleus in the spinal cord. In randomised, placebo-controlled studies (phase II and III) in women with SUI, a significant and clinically relevant reduction in urinary incontinence episodes as well as an improvement in the quality of life compared to placebo was shown. PMID:16231235

  15. Surgery for Stress Urinary Incontinence

    MedlinePlus

    ... Education FAQs Surgery for Stress Urinary Incontinence Patient Education Pamphlets - Spanish Surgery for Stress Urinary Incontinence FAQ166, July 2014 ... Your Practice Patient Safety & Quality Payment Reform (MACRA) Education & Events Annual ... Pamphlets Teen Health About ACOG About Us Leadership & ...

  16. Urinary incontinence surgery - female - discharge

    MedlinePlus

    ... this page: //medlineplus.gov/ency/patientinstructions/000134.htm Urinary incontinence surgery - female - discharge To use the sharing features ... Blaivas JM, Gormley EA, et al; Female Stress Urinary Incontinence Update Panel of the American Urological Association Education ...

  17. Management of patients with faecal incontinence

    PubMed Central

    Duelund-Jakobsen, Jakob; Worsoe, Jonas; Lundby, Lilli; Christensen, Peter; Krogh, Klaus

    2016-01-01

    Faecal incontinence, defined as the involuntary loss of solid or liquid stool, is a common problem affecting 0.8–8.3% of the adult population. Individuals suffering from faecal incontinence often live a restricted life with reduced quality of life. The present paper is a clinically oriented review of the pathophysiology, evaluation and treatment of faecal incontinence. First-line therapy should be conservative and usually include dietary adjustments, fibre supplement, constipating agents or mini enemas. Biofeedback therapy to improve external anal sphincter function can be offered but the evidence for long-term effect is poor. There is good evidence that colonic irrigation can reduce symptoms and improve quality of life, especially in patients with neurogenic faecal incontinence. Surgical interventions should only be considered if conservative measures fail. Sacral nerve stimulation is a minimally invasive procedure with high rate of success. Advanced surgical procedures should be restricted to highly selected patients and only performed at specialist centres. A stoma should be considered if other treatment modalities fail. PMID:26770270

  18. Management of patients with faecal incontinence.

    PubMed

    Duelund-Jakobsen, Jakob; Worsoe, Jonas; Lundby, Lilli; Christensen, Peter; Krogh, Klaus

    2016-01-01

    Faecal incontinence, defined as the involuntary loss of solid or liquid stool, is a common problem affecting 0.8-8.3% of the adult population. Individuals suffering from faecal incontinence often live a restricted life with reduced quality of life. The present paper is a clinically oriented review of the pathophysiology, evaluation and treatment of faecal incontinence. First-line therapy should be conservative and usually include dietary adjustments, fibre supplement, constipating agents or mini enemas. Biofeedback therapy to improve external anal sphincter function can be offered but the evidence for long-term effect is poor. There is good evidence that colonic irrigation can reduce symptoms and improve quality of life, especially in patients with neurogenic faecal incontinence. Surgical interventions should only be considered if conservative measures fail. Sacral nerve stimulation is a minimally invasive procedure with high rate of success. Advanced surgical procedures should be restricted to highly selected patients and only performed at specialist centres. A stoma should be considered if other treatment modalities fail. PMID:26770270

  19. Incontinence: The Potential Budget Buster

    ERIC Educational Resources Information Center

    Gardner, Sharon

    2009-01-01

    Someone who lives with incontinence, whether bowel, bladder, or both, knows the social stigma and personal toll on his life. Incontinence is the ever-present shadowy silhouette lurking over almost every decision, sometimes requiring complex preplanning. In this article, the author describes the challenges of incontinence and discusses how she…

  20. Female urinary incontinence rehabilitation.

    PubMed

    Di Benedetto, P

    2004-08-01

    Pelvic floor rehabilitation (PFR) is an important and recommended strategy for the treatment of many urogynecological disorders including urinary incontinence (UI). The recognised pioneer of PFR is the American gynecologist Arnold Kegel who, over 50 years ago, proposed pelvic floor muscle exercises (PFME) to prevent and/or treat female UI. Kegel's techniques were successfully used by others too, but as the years passed these techniques sank into unjustified oblivion. In the 1980s in Europe the medical world's interest in PFME techniques gained ground, contemporaneously with functional electrical stimulation (FES) and biofeedback (BFB). As a general rule, the least invasive and least dangerous procedure for the patient should be the first choice, and behavioural and rehabilitative techniques should be considered as the first line of therapy for UI. The behavioural approaches in women with UI and without cognitive deficits are tailored to the patient's underlying problem, such as bladder training or retraining (BR) for urge UI. BR has many variations but generally consists of education, scheduled voiding, and positive reinforcements. The rehabilitative approaches comprise BFB, FES, PFME, and vaginal cones (VC). BFB allows the subject to modify the unconscious physiological events, while FES is aimed at strengthening perineal awareness, increasing the tone and trophism of the pelvic floor, and inhibiting detrusor overactivity. PFME play an extremely important role in the conservative treatment of UI and overactive bladder, and many studies have demonstrated their effectiveness. Many authors have used the different methods for PFR in a heterogeneous manner: the best results were obtained when protocols requiring the contemporary use of 2 or more techniques were followed. PMID:15377984

  1. [Postpartum incontinence. Narrative review].

    PubMed

    Rodríguez, Rodolfo; Alós, Rafael; Carceller, M Soledad; Solana, Amparo; Frangi, Andrés; Ruiz, M Dolores; Lozoya, Roberto

    2015-01-01

    The development of fecal incontinence after childbirth is a common event. This incontinence responds to a multifactorial etiology in which the most common element is external anal sphincter injury. There are several risk factors, and it is very important to know and avoid them. Sphincter injury may result from perineal tear or sometimes by incorrectly performing an episiotomy. It is very important to recognize the injury when it occurs and repair it properly. Pudendal nerve trauma may contribute to the effect of direct sphincter injury. Persistence of incontinence is common, even after sphincter repair. Surgical sphincteroplasty is the standard treatment of obstetric sphincter injuries, however, sacral or tibial electric stimulation therapies are being applied in patients with sphincter injuries not repaired with promising results. PMID:25467972

  2. Faecal incontinence in the elderly : epidemiology and management.

    PubMed

    Wald, Arnold

    2005-01-01

    Faecal incontinence occurs in up to 10% of community dwelling persons > or = 65 years of age and approximately 50% of nursing home residents. It is a vastly under-reported problem that has a devastating effect on those who experience it as well as their spouses and caregivers. There are three broad categories of faecal incontinence among the elderly: (i) overflow incontinence; (ii) reservoir incontinence; and (iii) rectosphincteric incontinence. The first two can be diagnosed based upon the patient's history and physical examination and the response to dietary and pharmacological interventions. The third is assessed by careful physical examination supplemented by diagnostic tests directed towards evaluation of anorectal continence mechanisms. The most important of these is anorectal manometry, which can be supplemented by studies of structure (anal ultrasonography or pelvic floor magnetic resonance imaging) and neuromuscular function (electromyogram). A variety of therapeutic interventions are employed in patients with rectosphincteric incontinence; these include dietary, behavioural, pharmacological and surgical modalities chosen on the basis of the results of diagnostic testing. For isolated internal anal sphincter weakness, a cotton barrier in the anal canal is often effective. Acute sphincter injury is best treated with sphincteroplasty but, otherwise, surgical procedures are of uncertain benefit. Peripheral neurogenic incontinence may be treated with antidiarrhoeal agents, biofeedback techniques and dietary manipulations. Sacral spinal nerve stimulation is a promising new technique for selected patients with neurogenic faecal incontinence and is currently undergoing testing in the US and Europe. Significant improvement in quality of life can be achieved in most elderly persons with faecal incontinence. PMID:15733020

  3. Sacral Nerve Stimulation For Urinary Urge Incontinence, Urgency-Frequency, Urinary Retention, and Fecal Incontinence

    PubMed Central

    2005-01-01

    Executive Summary Objective The aim of this review was to assess the effectiveness, safety, and cost of sacral nerve stimulation (SNS) to treat urinary urge incontinence, urgency-frequency, urinary retention, and fecal incontinence. Background: Condition and Target Population Urinary urge incontinence, urgency-frequency, urinary retention, and fecal incontinence are prevalent, yet rarely discussed, conditions. They are rarely discussed because patients may be uncomfortable disclosing their symptoms to a health professional or may be unaware that there are treatment options for these conditions. Briefly, urge incontinence is an involuntary loss of urine upon a sudden urge. Urgency-frequency is an uncontrollable urge to void, which results in frequent, small-volume voids. People with urgency-frequency may or may not also experience chronic pelvic pain. Urinary retention refers to the inability to void despite having the urge to void. It can be caused by a hypocontractile detrusor (weak or no bladder muscle contraction) or obstruction due to urethral overactivity. Fecal incontinence is a loss of voluntary bowel control. The prevalence of urge incontinence, urgency-frequency, and urinary retention in the general population is 3.3% to 8.2%, and the prevalence of fecal incontinence is 1.4% to 1.9%. About three-quarters of these people will be successfully treated by behaviour and/or drug therapy. For those who do not respond to these therapies, the options for treatment are management with diapers or pads, or surgery. The surgical procedures are generally quite invasive, permanent, and are associated with complications. Pads and/or diapers are used throughout the course of treatment as different therapies are tried. Patients who respond successfully to treatment may still require pads or diapers, but to a lesser extent. The Technology Being Reviewed: Sacral Nerve Stimulation Sacral nerve stimulation is a procedure where a small device attached to an electrode is

  4. Emerging surgical therapies for faecal incontinence.

    PubMed

    Mitchell, Peter J; Sagar, Peter M

    2014-05-01

    Faecal incontinence is a common condition and is associated with considerable morbidity and economic cost. The majority of patients are managed with conservative interventions. However, for those patients with severe or refractory incontinence, surgical treatment might be required. Over the past 20 years, numerous developments have been made in the surgical therapies available to treat such patients. These surgical therapies can be classified as techniques of neuromodulation, neosphincter creation (muscle or artificial) and injection therapy. Techniques of neuromodulation, particularly sacral nerve stimulation, have transformed the management of these patients with a minimally invasive procedure that offers good results and low morbidity. By contrast, neosphincter procedures are characterized by being more invasive and associated with considerable morbidity, although some patients will experience substantial improvements in their continence. Injection of bulking agents into the anal canal can improve symptoms and quality of life in patients with mild-to-moderate incontinence, and the use of autologous myoblasts might be a future therapy. Further research and development is required not only in terms of the devices and procedures, but also to identify which patients are likely to benefit most from such interventions. PMID:24275793

  5. Efficacy of Physiotherapy for Urinary Incontinence following Prostate Cancer Surgery

    PubMed Central

    Bakuła, Stanisław

    2014-01-01

    The study enrolled 81 with urinary incontinence following radical prostate-only prostatectomy for prostatic carcinoma. The patients were divided into two groups. The patients in Group I were additionally subdivided into two subgroups with respect to the physiotherapeutic method used. The patients of subgroup IA received a rehabilitation program consisting of three parts. The patients of subgroup IB rehabilitation program consist of two parts. Group II, a control group, had reported for therapy for persistent urinary incontinence following radical prostatectomy but had not entered therapy for personal reasons. For estimating the level of incontinence, a 1-hour and 24-hour urinary pad tests, the miction diary, and incontinence questionnaire were used, and for recording the measurements of pelvic floor muscles tension, the sEMG (surface electromyography) was applied. The therapy duration depended on the level of incontinence and it continued for not longer than 12 months. Superior continence outcomes were obtained in Group I versus Group II and the difference was statistically significant. The odds ratio for regaining continence was greater in the rehabilitated Group I and smaller in the group II without the rehabilitation. A comparison of continence outcomes revealed a statistically significant difference between Subgroups IA versus IB. The physiotherapeutic procedures applied on patients with urine incontinence after prostatectomy, for most of them, proved to be an effective way of acting, which is supported by the obtained results. PMID:24868546

  6. Slings in iatrogenic male incontinence: Current status

    PubMed Central

    Gallo, Fabrizio; Schenone, M.; Giberti, C.

    2010-01-01

    Objectives: The increasing number of prostatectomies entails an increasing number of patients suffering from iatrogenic incontinence despite improved surgical techniques. The severity of this problem often requires invasive treatments such as periurethral injection of bulking agents, artificial urinary sphincter (AUS) implantation, and sub-urethral sling positioning. The artificial urethral sphincter has represented, until today, the gold standard but, in the recent years, sling systems have been investigated as minimally invasive alternative options. Today, three different sling procedures are commonly performed: bone-anchored, readjustable, and trans-obturator slings systems. The aim of this review is to critically report the current status of sling systems in the treatment of iatrogenic male incontinence. Materials and Methods: MEDLINE and PubMed databases were searched and all articles between 1974 and 2009 were evaluated. Results: With regard to bone-anchored, readjustable, and trans-obturator slings systems, cure rates ranged between 58.0% and 86.0%, 55.5% and 73.0%, and 40.0% and 63.0%, respectively, while major complication rates ranged between 0 and 14.5%, 10.0 and 22.2%, and 0 and 10.0%, respectively. Conclusions: Suburethral slings are the only alternative techniques which can be favorably compared with the AUS, showing more advantages with respect to AUS implantations which are mainly represented by a quick and less invasive approach, low morbidity, and low costs. In spite of the difficulty in identifying the most effective sling procedure, overall, sling systems can be recommended for patients with persistent mild or moderate incontinence. However, the indication can also be extended to patients with severe incontinence, after appropriate counseling, allowing AUS implantation in the event of sling failure. PMID:20877609

  7. Incontinence in Elderly Cared for by Family.

    ERIC Educational Resources Information Center

    Noelker, Linda S.

    1987-01-01

    Analyzed the consequences of incontinence for both the family members caring for the incontinent elderly and for the elderly. Found that incontinence was related to perceived negative affect in family relations and to considering an alternative care arrangement. Suggests that interventions directed to the management of incontinence may help to…

  8. Obstetrics and Fecal Incontinence

    PubMed Central

    Chin, Kathleen

    2014-01-01

    Anal incontinence (AI) can be a debilitating condition for women following vaginal delivery. Operative vaginal delivery and anal sphincter laceration are important risk factors for the development of postpartum AI. Obtaining a comprehensive delivery history, along with a thorough physical examination of the perineum, vagina and rectum may aid the clinician in the diagnosis of an anal sphincter defect. Sonographic imaging can also assist in identifying sphincter defects. The treatment of AI may include a combination of dietary modification, medications that promote constipation, pelvic floor physical therapy, biofeedback, anal sphincteroplasty, and/or sacral neuromodulation. PMID:25320570

  9. Obstetrics and fecal incontinence.

    PubMed

    Chin, Kathleen

    2014-09-01

    Anal incontinence (AI) can be a debilitating condition for women following vaginal delivery. Operative vaginal delivery and anal sphincter laceration are important risk factors for the development of postpartum AI. Obtaining a comprehensive delivery history, along with a thorough physical examination of the perineum, vagina and rectum may aid the clinician in the diagnosis of an anal sphincter defect. Sonographic imaging can also assist in identifying sphincter defects. The treatment of AI may include a combination of dietary modification, medications that promote constipation, pelvic floor physical therapy, biofeedback, anal sphincteroplasty, and/or sacral neuromodulation. PMID:25320570

  10. Urogynecologic conditions: urinary incontinence.

    PubMed

    Kelley, Robert; Garely, Alan D

    2015-03-01

    Urinary incontinence (UI), the leakage of urine, is a condition that frequently goes untreated. There are many different types of UI, including stress and urge UI, and the etiology is multifactorial. Diagnosis can be made with a pertinent history, including use of a questionnaire; a pelvic examination; and direct observation. Additional testing can include physical maneuvers to elicit stress leakage and urodynamic studies. Treatment ranges from pelvic floor exercise to surgical support of the pelvic floor for stress UI and, typically, behavioral therapy and/or pharmacotherapy, starting with antimuscarinic drugs, for urge UI. PMID:25756372

  11. The relationship of urinary incontinence to early spaying in bitches.

    PubMed

    Stöcklin-Gautschi, N M; Hässig, M; Reichler, I M; Hubler, M; Arnold, S

    2001-01-01

    It is still controversial whether a bitch should be spayed before or after the first oestrus. It would be desirable to spay bitches at an age that would minimize the side effects of neutering. With regard to the risk of mammary tumours, early spaying must be recommended because the incidence of tumours is reduced considerably. The aim of the present study was to determine whether early spaying also reduces the risk of urinary incontinence. The owners of 206 bitches that had been spayed before their first oestrus and for at least 3 years were questioned on the occurrence of urinary incontinence as a result of spaying. At the time of the enquiry the average age of the bitches was 6.5 years, and the average age at the time of surgery was 7.1 months. Urinary incontinence after spaying occurred in 9.7% of bitches. This incidence is approximately half that of spaying after the first oestrus. Urinary incontinence affected 12.5% of bitches that were of a large body weight (> 20 kg body weight) and 5.1% of bitches that were of a small body weight (< 20 kg body weight). The surgical procedure (ovariectomy versus ovariohysterectomy) had no influence on the incidence, or on the period between spaying and the occurrence of urinary incontinence. Urinary incontinence occurred on average at 2 years and 10 months after surgery and occurred each day, while the animals were awake or during sleep. However, compared with late spaying the clinical signs of urinary incontinence were more distinct after early spaying. PMID:11787155

  12. HealthLines: Incontinent? You're Not Alone

    MedlinePlus

    ... or are injured. The three main disorders are urinary incontinence, fecal incontinence, and pelvic organ prolapse, which happens ... least one pelvic disorder; nearly 16 percent reported urinary incontinence; 9 percent had fecal incontinence; and nearly 3 ...

  13. [The anal incontinence-- study on 20 operated cases].

    PubMed

    Iusuf, T; Sârbu, V; Grasa, C; Cristache, C; Botea, F

    2001-01-01

    The authors present 20 cases operated for anal incontinence. Two techniques were performed: direct repair (18 cases) and Musset-Cottrell procedure (2 cases). The results were excellent in 12 cases, good in 5 cases and satisfactory in 3 cases. The method of choice seems to be the direct repair of the anal sphincter after a proper local and general preparation. PMID:12731180

  14. Incontinence-associated dermatitis: a cross-sectional prevalence study in the Australian acute care hospital setting.

    PubMed

    Campbell, Jill L; Coyer, Fiona M; Osborne, Sonya R

    2016-06-01

    The purpose of this cross-sectional study was to identify the prevalence of incontinence and incontinence-associated dermatitis (IAD) in Australian acute care patients and to describe the products worn to manage incontinence, and those provided at the bedside for perineal skin care. Data on 376 inpatients were collected over 2 days at a major Australian teaching hospital. The mean age of the sample group was 62 years and 52% of the patients were male. The prevalence rate of incontinence was 24% (91/376). Urinary incontinence was significantly more prevalent in females (10%) than males (6%) (χ(2)  = 4·458, df = 1, P = 0·035). IAD occurred in 10% (38/376) of the sample group, with 42% (38/91) of incontinent patients having IAD. Semi-formed and liquid stool were associated with IAD (χ(2)  = 5·520, df = 1, P = 0·027). Clinical indication of fungal infection was present in 32% (12/38) of patients with IAD. Absorbent disposable briefs were the most common incontinence aids used (80%, 70/91), with soap/water and disposable washcloths being the clean-up products most commonly available (60%, 55/91) at the bedside. Further data are needed to validate this high prevalence. Studies that address prevention of IAD and the effectiveness of management strategies are also needed. PMID:24974872

  15. Anal encirclement with polypropylene mesh for rectal prolapse and incontinence.

    PubMed

    Sainio, A P; Halme, L E; Husa, A I

    1991-10-01

    Seventeen selected patients (mean age, 74 years)--14 with rectal prolapse and 3 with persisting anal incontinence after previous operations--underwent high anal encirclement with polypropylene mesh. There was no operative mortality. Prolapse recurred in 2 (15 percent) of the 13 patients followed up for 6 months or more (mean, 3.5 years). Three (27 percent) of the 11 patients with associated anal incontinence improved functionally, as did the three operated on for persisting incontinence, but only one patient regained normal continence. No breakage, cutting out, or infection related to the mesh was observed. Because of the risk of fecal impaction encountered in three of our patients, the procedure is not advocated for severely constipated patients. Despite the somewhat disappointing results regarding restoration of continence, we find this method useful in patients with rectal prolapse who are unfit for more extensive surgery, in controlling the prolapse to an acceptable degree. PMID:1914725

  16. Managing incontinence: women's normalizing strategies.

    PubMed

    Skoner, M M; Haylor, M J

    1993-01-01

    Women's strategies for managing urinary incontinence were examined in a grounded-theory study. The women's basic social concern was dealing with incontinence in a manner that enabled them to feel normal. Feeling normal meant being able to do what they wanted to do and needed to do to have a normal life-style as they perceived it. This goal was accomplished by normalizing incontinence and its management. Normalization was achieved by directing its course through self-management, accounting for it in terms of personal history and life experiences, and delaying medical counsel. These strategies are described. The findings provide fresh insights about women's response to incontinence and their practice of self-managing its consequences. PMID:8138472

  17. When you have urinary incontinence

    MedlinePlus

    ... rub baking soda into the stain, and then vacuum off the baking powder. You can also use ... management of urinary incontinence: behavioral and pelvic floor therapy, urethral and pelvic devices. In: Wein AJ, ed. ...

  18. Urge incontinence: the patient's perspective.

    PubMed

    Brown, J S; Subak, L L; Gras, J; Brown, B A; Kuppermann, M; Posner, S F

    1998-12-01

    Urge incontinence has a profound effect on the day-to-day lives of women. The purpose of this study was to identify specific aspects of functioning and well-being affected by urge incontinence or mixed incontinence with a primary urge component. We conducted six focus groups of 65 racially and age diverse, community-dwelling women with urge incontinence. Transcripts of the focus groups were quantitatively analyzed for word use frequency with QSR NUD*IST software. Demographics, symptomatology, and the impact of incontinence on daily activities and feelings were assessed by questionnaire. Participants in the focus groups were on average 62 years of age; 52% were nonwhite, and 26% had a high school or less education. In the three identified broad domains, 52% of domain-related words were associated with feelings, 40% with activities, and 8% with relationships. Frequently identified references were bathroom availability (24%), loss of control (14%), anxiety (11%), and sleep disturbance (10%). Women under the age of 70 compared with older women more commonly identified feeling unattractive and low self-esteem (12% versus 2%, p < 0.007) and adverse effects on dating and sexual activity (45% versus 0%, p < 0.02). The effect of incontinence on quality of life correlated with frequency, nocturia, and pad use (Kendall's tau beta 0.02-0.32, p < 0.05). Urge incontinence affects many quality of life issues and contributes to limitation of activities, loss of control, and negative self-perception. Focus groups of diverse women with urge incontinence symptomatology are useful in understanding these effects. PMID:9929859

  19. [Incontinence - Etiology, diagnostics and Therapy].

    PubMed

    Frieling, Thomas

    2016-08-01

    Fecal incontinence is defined by the unintentional loss of solid or liquid stool, and anal incontinence includes leakage of gas and / or fecal incontinence. Anal-fecal incontinence is not a diagnosis but a symptom. Many patients hide the problem from their families, friends, and even their doctors. Epidemiologic studies indicate a prevalence between 7-15 %, up to 30 % in hospitals and up to 70 % in longterm care settings. Anal-fecal incontinence causes a significant socio-economic burden. There is no widely accepted approach for classifying anal-fecal incontinence available. Anal-fecal continence is maintained by anatomical factors, rectoanal sensation, and rectal compliance. The diagnostic approach comprises muscle and nerve injuries by iatrogenic, obstetric or surgical trauma, descending pelvic floor or associated diseases. A basic diagnostic workup is sufficient to characterize the different manifestations of fecal incontinence in most of the cases. This includes patient history with a daily stool protocol and digital rectal investigation. Additional investigations may include anorectal manometry, anal sphincter EMG, conduction velocity of the pudendal nerve, needle EMG, barostat investigation, defecography and the dynamic MRI. Therapeutic interventions are focused on the individual symptoms and should be provided in close cooperation with gastroenterologists, surgeons, gynecologists, urologists, physiotherapeutics and psychologists (nutritional-training, food fibre content, pharmacological treatment of diarrhea/constipation, toilet training, pelvic floor gymnastic, anal sphincter training, biofeedback). Surgical therapy includes the STARR operation for rectoanal prolapse and sacral nerve stimulation for chronic constipation and anal-fecal incontinence. Surgery should not be applied unless the diagnostic work-up is complete and all conservative treatment options failed. PMID:27557074

  20. Intractable incontinence in the elderly.

    PubMed

    Ouslander, J G

    2000-05-01

    The number of people living into extreme old age is rising exponentially in the USA, Europe and other developed countries. Urinary incontinence is prevalent in this population. While many very old (age > 75 years) incontinent individuals are relatively healthy and respond well to various treatments, a substantial proportion has impaired cognitive function and impaired mobility. These impairments make urinary incontinence much more difficult to assess, manage and cure than in younger populations. Irrespective of age and disability, a basic assessment of incontinence should be carried out to identify potentially reversible causes and indications for further evaluation. The outcome of such an assessment may not be cure or improvement of incontinence, but better quality of life and the prevention of morbid and expensive medical conditions that may result from poorly managed incontinence. Incontinence in this population should generally not be considered 'intractable' until a trial of noninvasive therapy (i.e. behavioural and/or pharmacological) has been undertaken. Some very frail elderly respond well to a toileting programme such as prompted voiding, and a small but significant proportion benefit from the careful addition of a bladder relaxant drug to the toileting programme. Others, depending on their ability and willingness to toilet and their preferences for further treatment, may be candidates for surgical intervention. Pads and garments should not be used so that they foster dependency, or as a primary treatment until other specific interventions have been tried. Indwelling catheters should be used only for specific and well-documented indications, because of the risks of urinary tract infection and sepsis associated with their long-term use. The dictionary defines 'intractable' as 'not easily relieved or cured'. In the elderly, cure for incontinence, and most other chronic conditions, is the exception rather than rule. Relief (or amelioration), improvement in

  1. Brief inpatient psychotherapeutic technique.

    PubMed

    Stein, Michelle B; Jacobo, Michelle C

    2013-09-01

    Trainees rotate onto the medical psychiatric inpatient unit at Massachusetts General Hospital every 6 weeks to learn how to conduct brief inpatient psychotherapy from two staff psychologists and one staff psychiatrist. This article focuses on four key therapeutic principles/techniques used when teaching these trainees about brief inpatient psychotherapy. These include support, affective experience and expression, chain analysis, and identification of relational styles/maladaptive relational patterns. We also briefly discuss our approach to training. Theoretical rationale, numerous clinical examples, and empirical support (of inpatient psychotherapy) are provided. PMID:24000872

  2. Incidence and predicting factors of falls of older inpatients

    PubMed Central

    Abreu, Hellen Cristina de Almeida; Reiners, Annelita Almeida Oliveira; Azevedo, Rosemeiry Capriata de Souza; da Silva, Ageo Mário Cândido; Abreu, Débora Regina de Oliveira Moura; de Oliveira, Adriana Delmondes

    2015-01-01

    OBJECTIVE To estimate the incidence and predicting factors associated with falls among older inpatients. METHODS Prospective cohort study conducted in clinical units of three hospitals in Cuiaba, MT, Midwestern Brazil, from March to August 2013. In this study, 221 inpatients aged 60 or over were followed until hospital discharge, death, or fall. The method of incidence density was used to calculate incidence rates. Bivariate analysis was performed by Chi-square test, and multiple analysis was performed by Cox regression. RESULTS The incidence of falls was 12.6 per 1,000 patients/day. Predicting factors for falls during hospitalization were: low educational level (RR = 2.48; 95%CI 1.17;5.25), polypharmacy (RR = 4.42; 95%CI 1.77;11.05), visual impairment (RR = 2.06; 95%CI 1.01;4.23), gait and balance impairment (RR = 2.95; 95%CI 1.22;7.14), urinary incontinence (RR = 5.67; 95%CI 2.58;12.44) and use of laxatives (RR = 4.21; 95%CI 1.15;15.39) and antipsychotics (RR = 4.10; 95%CI 1.38;12.13). CONCLUSIONS The incidence of falls of older inpatients is high. Predicting factors found for falls were low education level, polypharmacy, visual impairment, gait and balance impairment, urinary incontinence and use of laxatives and antipsychotics. Measures to prevent falls in hospitals are needed to reduce the incidence of this event. PMID:26083943

  3. Managing stress incontinence in postnatal women.

    PubMed

    Whitehouse, Tracy

    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. PMID:22708190

  4. Inpatients hypospadias care: Trends and outcomes from the American nationwide inpatient sample

    PubMed Central

    Sukumar, Shyam; Sood, Akshay; Hanske, Julian; Vetterlein, Malte; Elder, Jack S.; Fisch, Margit; Trinh, Quoc-Dien; Friedman, Ariella A.

    2015-01-01

    Purpose Hypospadias is the most common congenital penile anomaly. Information about current utilization patterns of inpatient hypospadias repair as well as complication rates remain poorly evaluated. Materials and Methods The Nationwide Inpatient Sample was used to identify all patients undergoing inpatient hypospadias repair between 1998 and 2010. Patient and hospital characteristics were attained and outcomes of interest included intra- and immediate postoperative complications. Utilization was evaluated temporally and also according to patient and hospital characteristics. Predictors of complications and excess length of stay were evaluated by logistic regression models. Results A weighted 10,201 patients underwent inpatient hypospadias repair between 1998 and 2010. Half were infants (52.2%), and were operated in urban and teaching hospitals. Trend analyses demonstrated a decline in incidence of inpatient hypospadias repair (estimated annual percentage change, -6.80%; range, -0.51% to -12.69%; p=0.037). Postoperative complication rate was 4.9% and most commonly wound-related. Hospital volume was inversely related to complication rates. Specifically, higher hospital volume (>31 cases annually) was the only variable associated with decreased postoperative complications. Conclusions Inpatient hypospadias repair have substantially decreased since the late 1990's. Older age groups and presumably more complex procedures constitute most of the inpatient procedures nowadays. PMID:26279829

  5. Factors associated with urinary incontinence in women.

    PubMed Central

    Yarnell, J W; Voyle, G J; Sweetnam, P M; Milbank, J; Richards, C J; Stephenson, T P

    1982-01-01

    Possible aetiological factors for urinary incontinence were examined in a prevalence study among a random sample of 1000 women aged 18 and over. Infective factors were not markedly associated with incontinence but mechanical factors such as parity and obesity were. No association was found, however, between a history of perineal damage at childbirth and incontinence. Women with incontinence had on average a higher score for a 'neuroticism' trait elicited by questionnaire than women without the disorder. PMID:7069357

  6. Urinary Incontinence: Management and Treatment Options

    ERIC Educational Resources Information Center

    Griebling, Tomas L.

    2009-01-01

    Urinary incontinence, defined as the involuntary leakage of urine, is a common health problem in both women and men. Children may also suffer from this condition. Management and treatment of urinary incontinence depends primarily on the specific type of incontinence and the underlying problem causing the leakage for a given patient. Because…

  7. Urinary incontinence in the bitch: an update.

    PubMed

    Reichler, I M; Hubler, M

    2014-06-01

    Urinary incontinence (UI), defined as the involuntary loss of urine during the filling phase of the bladder (Abrams et al. 2002), is a commonly seen problem in veterinary practice. Urinary sphincter mechanism incompetence (USMI) after spaying is the most common micturition disorder, and its medical treatment is normally successful, even though the underlying pathophysiological mechanism is not fully understood. Hormonal changes inducing structural and functional alterations in the bladder, as well as in the urethra composition, are discussed. To manage incontinent patients successfully, possible underlying abnormalities besides USMI should be ruled out. In the majority of cases, history, physical examination and simple tests including urinalysis and urine bacterial culture lead to a presumed aetiology. If USMI is the most likely cause, then the advantage of further diagnostic tests should be discussed with the owner before starting a trial therapy with alpha-adrenergic drugs. Potential side effects of this therapy have to be mentioned even though they rarely occur. It is important to thoroughly evaluate the success of the initial treatment. Its failure should lead to further diagnostic testing. Specialized clinical assessments may provide an aetiological diagnosis, and this could serve as a basis for discussing further treatment options. Surgical procedures, which may in rare cases cause irreversible side effects, may be instituted. If incontinence reoccurs after initial treatment was successfully performed, the diagnostic work-up including urinalysis should always be repeated. As results of urinalysis did not correlate well with results of bacterial culture, a urine culture is recommended (Comer and Ling 1981). Cystocentesis is the preferred method of urine collection (Bartges 2004). Equivocal results of quantitative cultures of urine samples obtained during midstream voiding or by catheterization require repeat collection by cystocentesis (Comer and Ling 1981

  8. Surgical management of fecal incontinence.

    PubMed

    Bleier, Joshua I S; Kann, Brian R

    2013-12-01

    The surgical approach to treating fecal incontinence is complex. After optimal medical management has failed, surgery remains the best option for restoring function. Patient factors, such as prior surgery, anatomic derangements, and degree of incontinence, help inform the astute surgeon regarding the most appropriate option. Many varied approaches to surgical management are available, ranging from more conservative approaches, such as anal canal bulking agents and neuromodulation, to more aggressive approaches, including sphincter repair, anal cerclage techniques, and muscle transposition. Efficacy and morbidity of these approaches also range widely, and this article presents the data and operative considerations for these approaches. PMID:24280402

  9. [Male Urinary Incontinence--a Taboo Issue].

    PubMed

    Kozomara-Hocke, Marko; Hermanns, Thomas; Poyet, Cédric

    2016-03-01

    Male urinary incontinence is an underestimated and frequently not broached issue. The urinary incontinence is divided into stress-, urge incontinence and hybrid forms as well as overflow incontinence. The fact that there are increasingly more men over 60 means that the prevalence of the urinary incontinence is up to 40%, and urinary incontinence will increasingly gain importance in daily routine practice. Many investigations and therapies can be realized by the general practitioner. Already simple therapy approaches can lead to a considerable clinical improvement of male urinary incontinence. If the initial therapy fails or pathological results (i. e. microhaematuria, recurrent urinary tract infections, raised residual urine and so on) are found, the patient should be referred to a urologist. PMID:26934011

  10. Midurethral Slings for Women with Stress Urinary Incontinence

    PubMed Central

    2006-01-01

    Executive Summary Objective The objective of the current review was to evaluate the safety, efficacy, and cost-effectiveness of midurethral slings compared with traditional surgery. Background This assessment was undertaken in order to update and expand upon the health technology & policy assessment of tension-free vaginal tape (TVT, Gynecare Worldwide, a division of Ethicon Inc, a Johnson & Johnson company, Somerville, New Jersey) sling procedure for stress urinary incontinence published by the Medical Advisory Secretariat in February 2004. Since the publication of the 2004 assessment, a number of TVT-like sling alternatives have become available which employ the same basic principles as TVT slings: minimally invasive, midurethral placement, self-fixing, and tension-free. This update will evaluate the efficacy and safety of midurethral slings. Clinical Need Normal continence is controlled by the nervous system and involves co-ordination between bladder, urethra, urethral sphincter, and pelvic floor. Incontinence occurs when the relationship among the above components is compromised, either due to physical damage or nerve dysfunction. (1) Stress urinary incontinence is the most common form of urinary incontinence in women. It is characterized by the “complaint of involuntary leakage on effort or exertion, or on sneezing or coughing” when there is increased abdominal pressure without detrusor (bladder wall) contraction. (2) There are 2 factors which define stress urinary incontinence: a weakening in the support of the proximal urethra, causing urethral hyper-mobility and deficiency in the sphincter, causing urethral leakage. Both factors are thought to coexist. (1) Accurate tests are not available to distinguish these 2 types of stress urinary incontinence. Urinary incontinence is estimated to affect about 250,000 Canadian women and 8 million American women aged 65 and over. (3;4) The prevalence of stress urinary incontinence is very difficult to measure because

  11. [Urinary incontinence in castrated bitches. 2. Diagnosis and treatment].

    PubMed

    Arnold, S

    1997-01-01

    Urinary incontinence due to spaying is caused by a sphincter incompetence of the urethra. In practice the diagnosis is established by ruling out other causes of incontinence such as neurological disease, bacterial cystitis, urinary tract malformation, iatrogenic ureterovaginal fistula and neoplasia of the urinary tract. An accurate diagnosis of urethral sphincter incompetence is made by urethral pressure profilometry. A urethral closure pressure of 7.4 cm H2O allowed the differentiation of bitches with urinary incontinence, due to spaying, from healthy control dogs with a diagnostic accuracy of 91%. For therapy alpha-adrenergic drugs (Ephedrine or Phenylpropanolamine) are recommended, which result in continence in 74% and improvement in 24% of incontinent patients. In the absence of response estrogens may be used. If the medical therapy fails to achieve urinary continence, the endoscopic injection of collagen into the submucosa of the proximal urethra can be performed. This is a simple and minimally invasive procedure. It rarely leads to complications and may be repeated when necessary. The method is successful in 75% of cases. PMID:9281063

  12. Fecal incontinence: A review of current treatment options.

    PubMed

    Fejka, Michael David

    2016-09-01

    Fecal incontinence affects patients of all sexes, races, and ethnicities; however, those affected often are afraid or too embarrassed to ask for help. Attention to risk factors and directed physical examinations can help healthcare providers diagnose and formulate treatment plans. Numerous diagnostic tests are available. Diligent follow-up is needed to direct patients to second-line therapies such as sacral nerve stimulation or surgical procedures. PMID:27580000

  13. High Costs of Urinary Incontinence Among Women Electing Surgery to Treat Stress Incontinence

    PubMed Central

    Subak, Leslee L.; Brubaker, Linda; Chai, Toby C.; Creasman, Jennifer M.; Diokno, Ananias C.; Goode, Patricia S.; Kraus, Stephen R.; Kusek, John W.; Leng, Wendy W.; Lukacz, Emily S.; Norton, Peggy; Tennstedt, Sharon

    2008-01-01

    OBJECTIVE To estimate costs for incontinence management, health-related quality of life, and willingness to pay for incontinence improvement in women electing surgery for stress urinary incontinence. METHODS A total of 655 incontinent women enrolled in the Stress Incontinence Surgical Treatment Efficacy Trial, a randomized surgical trial. Baseline out-of-pocket costs for incontinence management were calculated by multiplying self-report of resources used (supplies, laundry, dry cleaning) by national resource costs ($2006). Health-related quality of life was estimated with the Health Utilities Index Mark 3. Participants estimated willingness to pay for 100% improvement in incontinence. Potential predictors of these outcomes were examined by using multivariable linear regression. RESULTS Mean age was 52±10 years, and mean number of weekly incontinence episodes was 22±21. Mean and median (25%, 75% interquartile range) estimated personal costs for incontinence management among all women were $14±$24 and $8 (interquartile range $3, $18) per week, and 617 (94%) women reported any cost. Costs increased significantly with incontinence frequency and mixed compared with stress incontinence. The mean and median Health Utilities Index Mark 3 scores were 0.73±0.25 and 0.84 (interquartile range 0.63, 0.92). Women were willing to pay a mean of $118±$132 per month for complete resolution of incontinence, and willingness to pay increased significantly with greater expected incontinence improvement, household income, and incontinent episode frequency. CONCLUSION Urinary incontinence is associated with substantial costs. Women spent nearly $750 per year out of pocket for incontinence management, had a significant decrement in quality of life, and were willing to pay nearly $1,400 per year for cure. PMID:18378749

  14. Fecal Incontinence: Etiology, Evaluation, and Treatment

    PubMed Central

    Hayden, Dana M.; Weiss, Eric G.

    2011-01-01

    Fecal incontinence is a debilitating problem facing ~2.2% of the U.S. general population over 65 years of age. Etiologic factors include traumatic, neurologic, congenital, and iatrogenic. Most commonly, obstetric trauma causes fecal incontinence as well as poorly performed anorectal surgery or pelvic radiation. Several severity scores and quality of life indexes have been developed to quantify incontinent symptoms. There are several nonsurgical and surgical options for the treatment of fecal incontinence. Biofeedback is among the most successful nonoperative strategies. Depending on the cause, anal sphincter repair, artificial bowel sphincter, and sacral nerve stimulation are used to treat fecal incontinence with some success. Unfortunately, fecal incontinence is an extremely difficult problem to manage: there has not been one, single treatment option that has proven to be both safe and effective in long-term studies. PMID:22379407

  15. Female urinary incontinence: effective treatment strategies.

    PubMed

    Castro, R A; Arruda, R M; Bortolini, M A T

    2015-04-01

    Urinary incontinence is a dysfunction that tremendously affects women's quality of life, involving social, emotional and economic aspects. Although various treatments for urinary incontinence have been described, it is important to know which of them are truly effective. This review seeks to determine the current available therapies for women with stress urinary incontinence and overactive bladder syndrome, based on the best scientific evidence. PMID:25307986

  16. Psychosomatic Aspects of Urinary Incontinence in Women

    PubMed Central

    Debus, G.; Kästner, R.

    2015-01-01

    Urinary incontinence in women is a common problem. With increasing age its prevalence and severity of its manifestations increase. Among nursing home residents the frequency is between 43 and 77 %, 6 to 10 % of all admissions to nursing homes are due to urinary incontinence. The risk for urinary incontinence among women with cognitive deficits is 1.5- to 3.4-fold higher than for women without mental disorders. The most common form is stress incontinence (50 %), followed by mixed stress-urge incontinence (40 %) and purely urge incontinence (OAB = overactive bladder, 20 %). With regard to its cause, the latter remains unclarified in about 80 % of the cases. It is often difficult to treat. There are also cases in which urge incontinence is related to traumatic events. In such cases behavioural and psychotherapeutic options may be helpful. Almost inevitably every form of incontinence has psychological consequences: shame and insecurity are often results of uncontrolled loss of urine. Among others, in the long term, they lead to the avoidance of social contacts and possibly to depression and isolation. Consideration of the psychosomatics is important in the therapy for female urinary incontinence from three points of view: 1) the efficacy of treatment is better suited to the patient, 2) the treatment costs are lower, 3) the professional satisfaction of the responsible physician increases. PMID:25797959

  17. Effectiveness of psychiatric inpatient care.

    PubMed

    Sonesson, Ove; Arvidsson, Hans; Tjus, Tomas

    2013-06-01

    There is a growing demand for evaluating the process and outcome of mental health care. Most healthcare providers routinely collect and register data related to the process of treatment, and it is important to acquire more knowledge about how to make use of these databases. The aim of this study was to investigate the outcome of psychiatric inpatient care in relation to different clinical factors, using the Global Assessment of Functioning Scale (GAF) as a measure of outcome. Another objective was to explore the ability of routinely collected and registered data to provide valuable information about patients and their care. The studied psychiatric inpatient sample consisted of 816 care episodes with GAF ratings made both at admission and at discharge for 648 patients. Variables used in the study included GAF score at admission and at discharge, age, gender, diagnosis, length of stay and ward affiliation. The overall mean GAF change was 20.74, and the overall effect size Cohen's d 1.67, which corresponds to a large effect. The mean GAF change for women was 21.6, with an effect size of 1.80, and for men 19.4 with an effect size of 1.52. The effect size spectra including all groups of diagnoses ranged from 1.03 (substance-related disorders) to 2.33 (other mood disorders). Length of stay and ward affiliation also showed significant results concerning GAF change. Some limitations in this study could depend on the absence of randomization procedures and a control group. Another limitation concerns the insufficient control of the inpatient care interventions performed. The results support the capacity of the GAF to function as a measure of outcome in relation to different clinical factors, such as length of stay and diagnosis. Support was also found for the importance and usefulness of routinely collected and registered data. PMID:22775246

  18. Recent concepts in fecal incontinence.

    PubMed

    Douglas, J M; Smith, L E

    2001-08-01

    Fecal incontinence is an inability to defer release of gas or stool from the anus and rectum by mechanisms of voluntary control. It is an important medical disorder affecting the quality of life of more than 2% of the US population. The most common contributing factors include previous vaginal deliveries, pelvic or perineal trauma, previous anorectal surgery, and rectal prolapse. Many physicians lack experience and knowledge related to pelvic floor incontinence disorders, but advancing technology has improved this knowledge. Increased experience with endoanal ultrasound and endoanal magnetic resonance imaging have given us better understanding of the anatomy of the anal canal, and new techniques with muscle translocation and artificial neosphincters and neuromodulation have expanded our armamentarium of options for restoring continence. PMID:12112954

  19. Conservative treatment for anal incontinence

    PubMed Central

    Carter, Dan

    2014-01-01

    Anal incontinence (AI) in adults is a troublesome condition that negatively impacts upon quality of life and results in significant embarrassment and social isolation. The conservative management of AI is the first step and targets symptomatic relief. The reported significant improvement with conservative treatments for AI is close to 25% and involves prescribed changes in lifestyle habits, a reduced intake of foods that may cause or aggravate diarrhea or rectal urgency, and the use of specific anti-diarrheal agents. The use of a mechanical barrier in the form of an anal plug and the outcomes and principles of pelvic kinesitherapies and biofeedback options are outlined. This review discusses a gastroenterologist's approach towards conservative therapy in patients referred with anal incontinence. PMID:24759347

  20. Neuromodulation for fecal incontinence: an effective surgical intervention.

    PubMed

    Chiarioni, Giuseppe; Palsson, Olafur S; Asteria, Corrado R; Whitehead, William E

    2013-11-01

    Fecal incontinence is a disabling symptom with medical and social implications, including fear, embarrassment, isolation and even depression. Most patients live in seclusion and have to plan their life around the symptom, with secondary impairment of their quality of life. Conservative management and biofeedback therapy are reported to benefit a good percentage of those affected. However, surgery must be considered in the non-responder population. Recently, sacral nerve electrostimulation, lately named neuromodulation, has been reported to benefit patients with fecal incontinence in randomized controlled trials more than placebo stimulation and conservative management, by some unknown mechanism. Neuromodulation is a minimally invasive procedure with a low rate of adverse events and apparently favorable cost-efficacy profile. This review is intended to expand knowledge about this effective intervention among the non-surgically skilled community who deals with this disabled group of patients. PMID:24222947

  1. A Prospective, Descriptive, Quality Improvement Study to Decrease Incontinence-Associated Dermatitis and Hospital-Acquired Pressure Ulcers.

    PubMed

    Hall, Kimberly D; Clark, Rebecca C

    2015-07-01

    Incontinence is a common problem among hospitalized patients and has been associated with multiple health complications, including incontinence-associated dermatitis (IAD) and hospital-acquired pressure ulcers (HAPUs). A prospective, descriptive study was conducted in 2 acute care neurology units to 1) assess the prevalence of incontinence and incidence of IAD and HAPUs among incontinent patients, and 2) evaluate the effect of caregiver education and use of a 1-step cleanser, moisturizer, barrier product on the development of IAD and HAPUs among patients with incontinence. During a period of 1 month, the incontinence status of admitted patients was recorded and skin was assessed for the presence/absence of IAD and HAPUs twice per day. After the 1-month data collection, all clinicians on the study units completed a facility-based online education program about IAD, HAPUs, and skin care followed by the implementation of a 1-step cleanser/barrier product for skin care of all patients with incontinence. Data collection procedures remained the same. Data were collected using a paper/pencil instrument and entered into a spreadsheet for analysis. Descriptive statistics were calculated and prevalence and incidence rates were compared between the pre-intervention and post-intervention phase using Fisher's exact analysis. During the first phase of the study, 17 of 40 admitted patients (42.5%) were incontinent. Of those, 5 (29.4%) developed IAD and all of these patients developed HAPUs (5 of 40 admitted, 29.4%) during an average length of stay of 7.3 (range: 2-14) days. In the intervention phase of the study, 25 of 46 (54.3%) patients were incontinent and none developed IAD or a HAPU during an average length of stay of 7.4 (range: 2-14) days. The average Braden scale score was 14.14 in the pre-intervention group of patients with incontinence and 12.74 in the intervention group. The prevalence of incontinence among patients admitted to acute care neurology units and the rate

  2. Preventing Suicide Among Inpatients

    PubMed Central

    Sakinofsky, Isaac

    2014-01-01

    Objective Inpatient suicide comprises a proportionately small but clinically important fraction of suicide. This study is intended as a qualitative analysis of the comprehensive English literature, highlighting what is known and what can be done to prevent inpatient suicide. Method: A systematic search was conducted on the Cochrane Library, PubMed, Embase, Web of Knowledge, and a personal database for articles on cohort series, preferably controlled, of inpatient suicide (not deliberate self-harm or attempted suicide, unless they also dealt specifically with suicide data). Results: A qualitative discussion is presented, based on the findings of the literature searched. Conclusions: The bulk of inpatient suicides actually occur not on the ward but off premises, when the patient was on leave or had absconded. Peaks occur shortly after admission and discharge. It is possible to reduce suicide risk on the ward by having a safe environment, optimizing patient visibility, supervising patients appropriately, careful assessment, awareness of and respect for suicide risk, good teamwork and communication, and adequate clinical treatment. PMID:24881161

  3. Incontinent Children Discover Hope at Camp Oakhurst.

    ERIC Educational Resources Information Center

    Raps, Marvin A.

    1991-01-01

    Describes summer-camp experiences of young people who are incontinent because of spina bifida. Focuses on residential camp program as encouragement for youth to learn independent incontinence management. Describes self-catheterization program and process as minor inconvenience and positive alternative to soiled clothing and accompanying…

  4. Urinary Incontinence: Causes and Methods of Evaluation

    ERIC Educational Resources Information Center

    Griebling, Tomas L.

    2008-01-01

    This article presents the third of a multi-part series offering the most timely educational information, innovative approaches, products and technology solutions as well as coping and stigma-fighting approaches available on the subject of incontinence. Here, the author introduces the types and physiology of urinary incontinence. The author also…

  5. Characterizing hospital inpatients: the importance of demographics and attitudes.

    PubMed

    Danko, W D; Janakiramanan, B; Stanley, T J

    1988-01-01

    To compete effectively, hospital administrators must understand inpatients who are involved in hospital-choice decisions more clearly. To this end, a methodology is presented to measure and assess the importance of inpatients' personal attributes in predicting hospital selection. Empirical results show that demographic characteristics are poor--but attitudes are useful--segmentation variables that delineate differences between two particular hospitals' inpatients. More generally, the survey method and statistical procedures outlined are applicable (with slight modification) to markets with a greater number of competitors. PMID:10288638

  6. Current and Emerging Treatment Options for Fecal Incontinence

    PubMed Central

    2014-01-01

    Fecal incontinence (FI) is a multifactorial disorder that imposes considerable social and economic burdens. The aim of this article is to provide an overview of current and emerging treatment options for FI. A MEDLINE search was conducted for English-language articles related to FI prevalence, etiology, diagnosis, and treatment published from January 1, 1990 through June 1, 2013. The search was extended to unpublished trials on ClinicalTrials.gov and relevant publications cited in included articles. Conservative approaches, including dietary modifications, medications, muscle-strengthening exercises, and biofeedback, have been shown to provide short-term benefits. Transcutaneous electrical stimulation was considered ineffective in a randomized clinical trial. Unlike initial studies, sacral nerve stimulation has shown reasonable short-term effectiveness and some complications. Dynamic graciloplasty and artificial sphincter and bowel devices lack randomized controlled trials and have shown inconsistent results and high rates of explantation. Of injectable bulking agents, dextranomer microspheres in non-animal stabilized hyaluronic acid (NASHA Dx) has shown significant improvement in incontinence scores and frequency of incontinence episodes, with generally mild adverse effects. For the treatment of FI, conservative measures and biofeedback therapy are modestly effective. When conservative therapies are ineffective, invasive procedures, including sacral nerve stimulation, may be considered, but they are associated with complications and lack randomized, controlled trials. Bulking agents may be an appropriate alternative therapy to consider before more aggressive therapies in patients who fail conservative therapies. PMID:25014235

  7. 42 CFR 412.405 - Preadmission services as inpatient operating costs under the inpatient psychiatric facility...

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... under the inpatient psychiatric facility prospective payment system. 412.405 Section 412.405 Public... PROSPECTIVE PAYMENT SYSTEMS FOR INPATIENT HOSPITAL SERVICES Prospective Payment System for Inpatient Hospital... under the inpatient psychiatric facility prospective payment system. The prospective payment...

  8. [Decubitus or incontinence-associated dermatitis?].

    PubMed

    Houwing, Ronald H; Koopman, Eddy S M

    2014-01-01

    A lack of understanding about the distinction between incontinence-associated dermatitis and pressure sores leads to inadequate treatment and therefore a higher incidence of pressure sores. Pressure relief may not be adequately carried out due to concentration exclusively on treatment of incontinence. In this article we will discuss the multifactorial approach, based on 2 patient cases. In order to prevent pressure sores, the cause of incontinence has to be investigated and treated if possible. Appropriate pressure relief must be carried out, in addition to adequate skin care. PMID:25159696

  9. Adynamic and dynamic muscle transposition techniques for anal incontinence

    PubMed Central

    Barišić, Goran; Krivokapić, Zoran

    2014-01-01

    Gracilis muscle transposition is well established in general surgery and has been the main muscle transposition technique for anal incontinence. Dynamization, through a schedule of continuous electrical stimulation, converts the fatigue-prone muscle fibres to a tonic fatigue-resistant morphology with acceptable results in those cases where there is limited sphincter muscle mass. The differences between gluteoplasty and graciloplasty, as well as the techniques and complications of both procedures, are outlined in this review. Overall, these techniques are rarely carried out in specialized units with experience, as there is a high revision and explantation rate. PMID:24759348

  10. Validation of questionnaires to assess quality of life related to fecal incontinence in children with anorectal malformations and Hirschsprung's disease

    PubMed Central

    Mathias, Arthur Loguetti; Tannuri, Ana Cristina Aoun; Ferreira, Mariana Aparecida Elisei; Santos, Maria Mercês; Tannuri, Uenis

    2016-01-01

    Abstract Objective: Surgical treatment of anorectal malformations (ARMs) and Hirschsprung's disease (HD) leads to alterations in bowel habits and fecal incontinence, with consequent quality of life impairment. The objectives were to create and validate a Questionnaire for the Fecal Incontinence Index (FII) based on the Holschneider score, as well as a Questionnaire for the Assessment of Quality of Life Related to Fecal Incontinence in Children and Adolescents (QQVCFCA), based on the Fecal Incontinence Quality of Life. Methods: The questionnaires were applied to 71 children submitted to surgical procedure, in two stages. Validity was tested by comparing the QQVCFCA and a generic quality of life questionnaire (SF-36), and between QQVCFCA and the FII. A group of 59 normal children was used as control. Results: At two stages, 45.0% (32/71) and 42.8% (21/49) of the patients had fecal incontinence. It was observed that the QQVCFCA showed a significant correlation with the SF-36 and FII (Pearson's correlation 0.57), showing that the quality of life is directly proportional to improvement in fecal incontinence. Quality of life in patients with fecal incontinence is still globally impaired, when compared with control subjects (p<0.05, Student's t-test). There were also significant differences between the results of children with ARMs and children with HD. Conclusions: QQVCFCA and FII are useful tools to assess the quality of life and fecal incontinence in these groups of children. Children with ARMs submitted to surgical procedure and HD have similar quality of life impairment. PMID:26522822

  11. Management of urinary incontinence in women.

    PubMed Central

    O'Dowd, T C

    1993-01-01

    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. PMID:8260222

  12. Urinary incontinence - what to ask your doctor

    MedlinePlus

    ... I use to clean a mattress? How much water or liquids should I drink every day? Which foods or liquids can make my urinary incontinence worse? Are there activities I should avoid that may cause problems with ...

  13. General practitioners and women with urinary incontinence.

    PubMed Central

    Grealish, M; O'Dowd, T C

    1998-01-01

    BACKGROUND: Urinary incontinence is a common problem for adult women. It results in a large financial and psychosocial cost. Much urinary incontinence goes unreported. Women with urinary incontinence can be successfully assessed and treated in general practice but studies have shown that many GPs manage the condition inadequately. AIM: This study aims to examine GPs' awareness of urinary incontinence in women and their management of, and attitudes to, female urinary incontinence. METHOD: A qualitative study was conducted with 21 GPs responding to semi-structured interviews. Thematic analysis was carried out on these interviews, with recurrent views and experiences being identified and grouped. RESULTS: The interviews of 11 male and nine female GPs were suitable for analysis. GPs were aware of the prevalence and under-reporting of urinary incontinence in women. Many were unhappy with their own management of the condition and with the management options available to them. Male GPs in particular were reluctant to carry out gynaecological examinations, and few GPs expressed enthusiasm for teaching pelvic floor exercises or bladder drills. Medications were frequently used but generally considered ineffective or intolerable. The services of both public health nurses and practice nurses were under-used, largely because of lack of training in this area. Although incontinence nurses were employed in the area, many GPs did not know of their availability and, of those who did, few referred to them more than infrequently. CONCLUSION: This study demonstrates that many GPs avoid dealing with the problem of urinary incontinence in women and that they find it to be a difficult, chronic problem to treat. Specialist options seem not to be useful in general practice. The findings need to be explored in other GP settings. PMID:9624768

  14. The management of urinary incontinence.

    PubMed

    Barnard, R J

    1982-01-01

    Urinary incontinence is defined as the involuntary loss of urine which is a social or hygienic problem and is objectively demonstrable. It is common in the general population and not all patients will report the presence of the problem because of, among other things, embarrassment. Assessment is important and should be multi-disciplinary. It includes a history, physical examination and some simple tests. A bladder chart kept by the patient aids assessment. Most patients can then be categorized and further testing planned. These tests are usually invasive and include urodynamic tests and electromyographic studies. With their conclusion treatment can be instituted, such as bladder training, drugs and various aids and appliances. PMID:7095985

  15. [Faecal incontinence - serious medical and social issue].

    PubMed

    Ihnát, Peter; Kozáková, Radka; Vávra, Petr; Pelikán, Anton; Zonča, Pavel

    2016-01-01

    Faecal incontinence presents gastrointestinal disorder with high prevalence (more than 2% of population) and serious impact on the quality of life. General practitioners, gastroenterologists and colorectal surgeons play the principal role in screening, diagnostics and providing health care to patients who suffer from faecal incontinence. Insufficient knowledge about faecal incontinence and minimal training aimed at its diagnostics and therapy lead to the low quality of provided health care.Authors offer comprehensive up-to-date review focused on faecal incontinence - its definition, prevalence, seriousness, consequences, pathophysiology, diagnostics and management. Detailed anatomical and physiological assessment of each patient is fundamental in determining correct cause of faecal incontinence and consequent selection of the most appropriate therapeutic modality.Broad spectrum of available therapeutic options comprises conservative management (lifestyle modification, diet, medications, and absorbent tools), biofeedback and surgical interventions (sphincter augmentation, sphincter reconstruction, sacral nerve stimulation, sphincter substitution and stools diversion). Application of the most appropriate treatment can lead in majority of patients to significant improvement in faecal incontinence and quality of life. Early diagnosis prevents possible complications, which would possibly deteriorate patients quality of life. PMID:27256145

  16. Pad testing in incontinent women: a review.

    PubMed

    Ryhammer, A M; Djurhuus, J C; Laurberg, S

    1999-01-01

    This article reviews the literature on pad-weighing tests used for objectifying and quantifying incontinence in urinary incontinent women. The patients wear pads weighed before and after the test period. A weight gain is taken as a measure of the amount of urine loss. The tests are in principle of two different types: short-term office tests and long-term home tests, and measure different aspects of urinary control and dysfunction. Both have an inherent large intra- and interindividual variability. Pad weight gains obtained from patients referred for incontinence and those from self-reported continent controls overlap to a certain degree, and it is not possible to identify distinct numerical cut-off values separating continence from incontinence. This suggests that incontinence is a complex condition in which the amount of leakage, other sources of weight gain, and differences in the individual patients' personal characteristics influence the identification and quantification of the problem. In spite of the shortcomings the pad tests remain a valuable tool for both the clinician and the researcher. The home pad tests are superior to the office tests in terms of authenticity, and should be performed with a concomitant systematic registration of the participant's voidings, fluid intake and episodes of incontinence. PMID:10384973

  17. The use of synthetic materials in the treatment of stress urinary incontinence.

    PubMed

    Stanek, Robert; Kądziołka, Przemysław; Stanek, Anna M; Szymanowski, Krzysztof; Wilczak, Maciej

    2016-06-01

    Stress urinary incontinence is a very serious problem which has been noticed by the WHO. This difficult medical condition poses a serious problem as it affects c.a. 20% of the female population and it increases up to 35% in the group of females over 60 years of age. Since there is no single standard surgical procedure which could solve this problem, numerous synthetic materials are used for the operations. It seems that the materials are effective as they improve the condition of women suffering from stress urinary incontinence. Unfortunately these materials have their shortcomings which might lead to certain post-operative complications. Stress urinary incontinence is a disease which affects the social life of the patients. It has a high percentage of recurrence and causes the patient substantial difficulties with keeping high standards of personal hygiene which is consequence makes it impossible to fulfill their social roles. The etiology of this disease is complex and calls for a cross-disciplinary approach to the problem. As there are no standardized or unanimous treatment methods of stress urinary incontinence, numerous sources based on the clinical experience of many medical centers suggest performing TVT and TOT procedures as the most effective treatment methods. The efficacy of the TOT procedure is about 90.8%. PMID:27582680

  18. The use of synthetic materials in the treatment of stress urinary incontinence

    PubMed Central

    Kądziołka, Przemysław; Stanek, Anna M.; Szymanowski, Krzysztof; Wilczak, Maciej

    2016-01-01

    Stress urinary incontinence is a very serious problem which has been noticed by the WHO. This difficult medical condition poses a serious problem as it affects c.a. 20% of the female population and it increases up to 35% in the group of females over 60 years of age. Since there is no single standard surgical procedure which could solve this problem, numerous synthetic materials are used for the operations. It seems that the materials are effective as they improve the condition of women suffering from stress urinary incontinence. Unfortunately these materials have their shortcomings which might lead to certain post-operative complications. Stress urinary incontinence is a disease which affects the social life of the patients. It has a high percentage of recurrence and causes the patient substantial difficulties with keeping high standards of personal hygiene which is consequence makes it impossible to fulfill their social roles. The etiology of this disease is complex and calls for a cross-disciplinary approach to the problem. As there are no standardized or unanimous treatment methods of stress urinary incontinence, numerous sources based on the clinical experience of many medical centers suggest performing TVT and TOT procedures as the most effective treatment methods. The efficacy of the TOT procedure is about 90.8%. PMID:27582680

  19. Transurethral Radiofrequency Collagen Denaturation for Treatment of Female Stress Urinary Incontinence: A Review of the Literature and Clinical Recommendations

    PubMed Central

    Lukban, James Chivian

    2012-01-01

    Stress urinary incontinence is a prevalent condition in women with a significant negative effect on quality of life. Intervention includes behavioral modification, intravaginal devices, pelvic floor muscle exercises, biofeedback, functional electrical stimulation, and surgical procedures. We will review a new in-office procedure for the treatment of SUI that may serve as a viable nonsurgical option. PMID:22007230

  20. Urinary Incontinence Treatments for Women (Beyond the Basics)

    MedlinePlus

    ... neurogenic urinary incontinence: results of a single treatment, randomized, placebo controlled 6-month study. J Urol 2005; ... treatment of urge incontinence in older women: a randomized controlled trial. JAMA 2002; 288:2293. Herbison P, ...

  1. Socioeconomic Factors Impact Inpatient Mortality in Pediatric Lymphoma Patients

    PubMed Central

    Puckett, Yana

    2016-01-01

    Purpose: Our objective was to determine the risk factors for inpatient mortality of pediatric patients diagnosed with lymphoma through the utilization of a large national pediatric database. Methods: This cross-sectional study uses data from the Healthcare Cost and Utilization Project Kids' Inpatient Database (HCUP KID) for the year of 2012 to estimate the risk factors for inpatient mortality for pediatric patients diagnosed with lymphoma. All patients diagnosed with lymphoma between the ages of one and 18 years were included. Chi-square test was used to analyze categorical variables. Independent t-test was used to analyze continuous variables. Results: A total of 2,908 study subjects with lymphoma were analyzed. Of those, 56.1% were male and the average age was three years old. Total inpatient mortality was 1.2% or 34 patients. We found that patients with four or more chronic conditions were much more likely to die while hospitalized (p < 0.0001). In addition, we also saw that patients with median household incomes below $47,999 dollars (p = 0.05) having a need for a major procedure (p = 0.008) were associated with inpatient mortality. Congestive heart failure, renal failure, coagulopathy, metastatic disease, and electrolyte abnormalities were all found to be associated with inpatient mortality. Conclusions: Pediatric lymphoma mortality in children is not only influenced by their medical condition but also by their socioeconomic condition as well. PMID:27433403

  2. Intersphincteric anal lipofilling with micro-fragmented fat tissue for the treatment of faecal incontinence: preliminary results of three patients

    PubMed Central

    De Rosa, Michele; Massa, Salvatore; Amato, Bruno; Gentile, Maurizio

    2014-01-01

    Faecal incontinence is a very debilitating problem. Many techniques have been proposed to treat this condition, with controversial results. Autologous transplant of fat tissue is an established procedure used for the repair of tissue damage, and recent studies revealed the potentiality of tissue regeneration by human adipose-derived stem cells. We treated this condition with the injection, in the intersphincteric anal groove, of lipoaspirate processed by an innovative technology (Lipogems). The aim of the study was to evaluate the efficacy of Lipogems injection for the treatment of faecal incontinence. In February 2014 we treated 3 patients with faecal incontinence. The surgical procedure required three phases: lipoaspiration, processing of lipoaspirate with the Lipogems system, and injection of the obtained product in the intersphincteric anal groove. An accurate proctological examination followed at 1 week, 1 month and 6 months after treatment. Each patient reported an improved Wexner incontinence score at 1 month after the procedure. We observed an increase of resting pressure (by at least 10 mm Hg) and thickness of the internal anal sphincter respectively at ano-rectal manometry and by ultrasound (US) evaluation at the sixth month of follow-up. Our preliminary results are encouraging, but multicentric studies with longer follow-up are needed to validate this novel technique for treatment of faecal incontinence. PMID:26240640

  3. 21 CFR 876.5920 - Protective garment for incontinence.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... 21 Food and Drugs 8 2011-04-01 2011-04-01 false Protective garment for incontinence. 876.5920... garment for incontinence. (a) Identification. A protective garment for incontinence is a device that... garment from the patient's excreta. This generic type of device does not include diapers for infants....

  4. 21 CFR 876.5920 - Protective garment for incontinence.

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ... 21 Food and Drugs 8 2012-04-01 2012-04-01 false Protective garment for incontinence. 876.5920... garment for incontinence. (a) Identification. A protective garment for incontinence is a device that... garment from the patient's excreta. This generic type of device does not include diapers for infants....

  5. 21 CFR 876.5920 - Protective garment for incontinence.

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ... 21 Food and Drugs 8 2014-04-01 2014-04-01 false Protective garment for incontinence. 876.5920... garment for incontinence. (a) Identification. A protective garment for incontinence is a device that... garment from the patient's excreta. This generic type of device does not include diapers for infants....

  6. 21 CFR 876.5920 - Protective garment for incontinence.

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ... 21 Food and Drugs 8 2013-04-01 2013-04-01 false Protective garment for incontinence. 876.5920... garment for incontinence. (a) Identification. A protective garment for incontinence is a device that... garment from the patient's excreta. This generic type of device does not include diapers for infants....

  7. 21 CFR 876.5920 - Protective garment for incontinence.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Protective garment for incontinence. 876.5920... garment for incontinence. (a) Identification. A protective garment for incontinence is a device that... garment from the patient's excreta. This generic type of device does not include diapers for infants....

  8. Comorbidity of ADHD and incontinence in children.

    PubMed

    von Gontard, Alexander; Equit, Monika

    2015-02-01

    ADHD and incontinence are common childhood disorders which co-occur at much higher rates than expected by chance. The aim of this review was to provide an overview both of the comorbidity of nocturnal enuresis (NE), daytime urinary incontinence (DUI) and faecal incontinence (FI) in children with ADHD; and, vice versa, of the co-occurrence of ADHD in children with NE, DUI and FI. Most clinical studies have focussed on the association of ADHD and NE. Population-based studies have shown that children with DUI have an even greater risk for ADHD than those with NE. While children with FI have the highest overall comorbidity rates of psychological disorders, these are heterogeneous with a wide range of internalising and externalising disorders--not necessarily of ADHD. Genetic studies indicate that ADHD and NE, DUI and FI do not share the same genetic basis. The comorbidity is conferred by non-genetic factors. Possible aetiological and pathogenetic links between ADHD and incontinence are provided by neurophysiological, imaging and pharmacological studies. The co-occurrence has clinical implications: children with ADHD and NE, DUI and FI are more difficult to treat, show lower compliance and have less favourable treatment outcomes for incontinence. Therefore, both groups of disorders have to be assessed and treated specifically. PMID:24980793

  9. Diagnostic Testing for Fecal Incontinence

    PubMed Central

    Olson, Craig H.

    2014-01-01

    Many tests are available to assist in the diagnosis and management of fecal incontinence. Imaging studies such as endoanal ultrasonography and defecography provide an anatomic and functional picture of the anal canal which can be useful, especially in the setting of planned sphincter repair. Physiologic tests including anal manometry and anal acoustic reflexometry provide objective data regarding functional values of the anal canal. The value of this information is of some debate; however, as we learn more about these methods, they may prove useful in the future. Finally, nerve studies, such as pudendal motor nerve terminal latency, evaluate the function of the innervation of the anal canal. This has been shown to have significant prognostic value and can help guide clinical decision making. Significant advances have also happened in the field, with the relatively recent advent of magnetic resonance defecography and high-resolution anal manometry, which provide even greater objective anatomic and physiologic information about the anal canal and its function. PMID:25320566

  10. Prevention and management of incontinence-associated dermatitis.

    PubMed

    Bardsley, Alison

    Maintaining skin integrity in people with incontinence is challenging. Incontinence is common in older people and those compromised by medical or surgical comorbidities. Urinary and faecal incontinence can result in skin breakdown, which is characterised by erosion of the epidermis, creating a moist, macerated appearance to the skin. Incontinence and associated skin breakdown can have a considerable effect on an individual's physical and psychological wellbeing. This article discusses the aetiology of incontinence-associated dermatitis and considers the best options for the prevention, management and treatment of this condition. PMID:23940938

  11. Prevalence and Risk Indicators for Anal Incontinence among Pregnant Women

    PubMed Central

    Skjeldestad, Finn Egil; Sandvik, Leiv

    2013-01-01

    The aim of this study was to assess the prevalence and risk factors of anal incontinence in an unselected pregnant population at second trimester. A survey of pregnant women attending a routine ultrasound examination was conducted in a university hospital in Oslo, Norway. A questionnaire consisting of 105 items concerning anal incontinence (including St. Mark's score), urinary incontinence, medication use, and comorbidity was posted to women when invited to the ultrasound examination. Results. Prevalence of self-reported anal incontinence (St. Mark's score ≥ 3) was the lowest in the group of women with a previous cesarean section only (6.4%) and the highest among women with a previous delivery complicated by obstetric anal sphincter injury (24.4%). Among nulliparous women the prevalence of anal incontinence was 7.7% and was associated to low educational level and comorbidity. Prevalence of anal incontinence increased with increasing parity. Urinary incontinence was associated with anal incontinence in all parity groups. Conclusions. Anal incontinence was most frequent among women with a history of obstetric anal sphincter injury. Other obstetrical events had a minor effect on prevalence of anal incontinence among parous women. Prevention of obstetrical sphincter injury is likely the most important factor for reducing bothersome anal incontinence among fertile women. PMID:23819058

  12. Coping with the Impact of Incontinence

    ERIC Educational Resources Information Center

    Gartley, Cheryle

    2008-01-01

    This article presents Part 2 of a multi-part series offering the most timely educational information, innovative approaches, products and technology solutions as well as coping and stigma-fighting approaches available on the subject of incontinence. In this article, the author contends that it is extremely important to teach children coping skills…

  13. Electrokinetic properties of incontinence nonwoven devices

    Technology Transfer Automated Retrieval System (TEKTRAN)

    An understanding of the water transport properties of nonwoven incontinence devices is a prerequisite to the design of cotton-based nonwovens. A complete understanding of the interfacial moisture movement which occurs between the layers of coverstock, acquisition layer, distribution layer, absorbent...

  14. [Rare differential diagnosis of urinary incontinence].

    PubMed

    Coutty, Nadège; Dubreucq, Sylvie; Delahousse, Guy; Cosson, Michel

    2003-04-01

    The authors report the case of a 55-year-old woman with prolapse presenting a differential diagnosis of urinary incontinence: a peritoneo-vaginal fistula with serous discharge in a patient with ascites and a history of hysterectomy. The only cases of peritoneo-vaginal fistula reported in the literature were discovered during extra-uterine pregnancy after hysterectomy. PMID:12765075

  15. Urinary incontinence quality improvement in nursing homes: where have we been? Where are we going?

    PubMed

    Palmer, Mary H

    2008-12-01

    The Centers for Medicare and Medicaid Services (CMS) has made urinary incontinence (UI) a quality indicator as part of the Nursing Home Quality Initiative (NHQI). In addition, CMS issued revised guidance on UI and catheters (known as tag F315) for nursing homes regarding compliance in the evaluation and management of UI and catheters, and an investigative protocol for state nursing home surveyors to use during regulatory inspections. The prevalence of UI in nursing homes remains high despite many years of research and clinical efforts to cure or improve it. Nurses play a key role in assuring appropriate assessment of nursing home residents to prevent and treat UI. Changes at the organizational level and inpatient care are needed to make dignity of nursing home residents central to UI quality improvement efforts. This article reviews the epidemiology of UI, the evidence for behavioral interventions, and the types of quality improvement strategies used for UI in nursing homes. PMID:19241782

  16. Efficacy of an improved absorbent pad on incontinence-associated dermatitis in older women: cluster randomized controlled trial

    PubMed Central

    2012-01-01

    Background Most older adults with urinary incontinence use absorbent pads. Because of exposure to moisture and chemical irritating substances in urine, the perineal skin region is always at risk for development of incontinence-associated dermatitis (IAD). The aim of this study was to examine the efficacy of an improved absorbent pad against IAD. Methods A cluster randomized controlled design was used to compare the efficacy of two absorbent pads. Female inpatients aged ≥65 years who had IAD and used an absorbent pad or diaper all day were enrolled. Healing rate of IAD and variables of skin barrier function such as skin pH and skin moisture were compared between the usual absorbent pad group (n = 30) and the test absorbent pad group (n = 30). Results Thirteen patients (43.3%) from the test absorbent pad group and 4 patients (13.3%) from the usual absorbent pad group recovered completely from IAD. Moreover, the test absorbent pad group healed significantly faster than the usual absorbent pad group (p = 0.009). On the other hand, there were no significant differences between the two groups in skin barrier function. Conclusion The test absorbent pad for older adults with urinary incontinence might be more efficacious against IAD than usual absorbent pad. Trial registration UMIN-CTR: UMIN000006188 PMID:22642800

  17. 29 CFR 825.114 - Inpatient care.

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ... LEAVE ACT OF 1993 Coverage Under the Family and Medical Leave Act § 825.114 Inpatient care. Inpatient care means an overnight stay in a hospital, hospice, or residential medical care facility, including... 29 Labor 3 2011-07-01 2011-07-01 false Inpatient care. 825.114 Section 825.114 Labor...

  18. 29 CFR 825.114 - Inpatient care.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... LEAVE ACT OF 1993 Coverage Under the Family and Medical Leave Act § 825.114 Inpatient care. Inpatient care means an overnight stay in a hospital, hospice, or residential medical care facility, including... 29 Labor 3 2010-07-01 2010-07-01 false Inpatient care. 825.114 Section 825.114 Labor...

  19. Prosecuting Assaultive Forensic and Psychiatric Inpatients

    ERIC Educational Resources Information Center

    Angus, Kerri C.; Reddon, John R.; Chudleigh, Michele D.

    2008-01-01

    Inpatient assault of forensic and psychiatric staff is a complex and multifaceted issue. Hence, the consequences reported in the literature regarding prosecuting assaultive inpatients are quite variable. In this article, issues pertaining to the prosecution of violent inpatients are reviewed. Illustrative cases, challenges of prosecution,…

  20. An Inpatient Vocational Rehabilitation Unit.

    ERIC Educational Resources Information Center

    Bielefeld, Martin

    This paper describes the Cleveland Veterans Administration inpatient Vocational Rehabilitation Unit (VRU), an intensive vocational assessment and counseling program designed to maximize the self-reliance and productivity of patients. The VRU is presented as a minimal care, 3-month maximum treatment program in which patients work on incentive pay…

  1. Risk Factors for Urinary Incontinence among Middle-aged Women

    PubMed Central

    DANFORTH, Kim N.; TOWNSEND, Mary K.; LIFFORD, Karen; CURHAN, Gary C.; RESNICK, Neil M.; GRODSTEIN, Francine

    2005-01-01

    Objective: Identify risk factors for urinary incontinence in middle-aged women. Study Design: Cross-sectional analysis of 83,355 Nurses' Health Study II participants. Since 1989, women have provided health information on mailed questionnaires; in 2001, at age 37-54 years, information on urinary incontinence was requested. We examined adjusted odds ratios of incontinence using logistic regression. Results: 43% of women reported incontinence. After adjustment, African-American (OR=0.49, 95% CI 0.40-0.60) and Asian-American women (OR=0.57, 95% CI 0.46-0.72) were at reduced odds of severe incontinence compared to Caucasians. Increased age, body mass index, and parity were all positively associated with incontinence, as were current smoking, type 2 diabetes, and hysterectomy. Women aged 50-54 years had 1.81 times the odds of severe incontinence compared to women <40 years (95% CI 1.66-1.97); women with BMI ≥ 30 kg/m2 had 3.10 times the odds of severe incontinence compared to BMI 22-24 kg/m2 (95% CI 2.91-3.30). Conclusions: Urinary incontinence is highly prevalent among these middle-aged women. Potential risk factors include age, race/ethnicity, body mass index, parity, smoking, diabetes, and hysterectomy. PMID:16458626

  2. Male urinary incontinence and the urinary sheath.

    PubMed

    Smart, Clare

    This article addresses the assessment and management of male incontinence with a specific focus on the use of the male external catheter (MEC) or urinary sheath. Education and expertise when dealing with a man with urinary incontinence, as well as a tactful and sensitive attitude towards this embarrassing problem, are essential for a successful outcome. The urinary sheath is often perceived by nurses and patients as a difficult product to master and is prone to failure owing to incorrect fitting and management. With correct usage it can make a great difference to a patient's quality of life and avoid problems often associated with urinary catheters and pads such as urinary infection and skin excoriation. Detailed assessment of the patient as well as his suitability for the MEC is essential for a successful outcome. PMID:24820510

  3. [Treatment of cystoceles with urinary stress incontinence].

    PubMed

    Sarf, I; Aboutaieb, R; Dakir, M; el Moussaoui, A; Rabii, R; Hafiani, M; Bennani, S; el Mrini, M; Meziane, F; Benjelloun, S

    1998-01-01

    Thirteen women were operated for cystocele associated with urinary stress incontinence. Cystoceles were grade I in 6 cases, grade II in 6 cases and grade III in 1 case. Five patients underwent retropubic colposuspension according to Burch (3 cases) and M.M.K. (2 cases). Eight patients were treated by RAZ's technique associated with anterior colporaphy in order to reduce the cystocele. In this latter group, only one recurrence was observed and was treated by repeat colporaphy with good results. Colposuspension associated with anterior colporaphy is a reliable method for the treatment of cystocele with urinary stress incontinence, associated with low morbidity and short hospitalization. Its results are probably comparable to those of retropubic colposuspension, at least for a 6 months follow-up. PMID:9827204

  4. Ischemic fecal incontinence and rectal angina.

    PubMed

    Devroede, G; Vobecky, S; Massé, S; Arhan, P; Léger, C; Duguay, C; Hémond, M

    1982-11-01

    In 36 patients who consulted for fecal incontinence or rectal pain, or both, there was grossly visible scarring of the rectum and biopsy revealed mucosal atrophy and fibrosis. A steal from the hemorrhoidal arteries to the iliac vessels was demonstrated in 3 subjects. Maximum tolerable volumes within a rectal balloon were smaller than in control subjects, both in men (192 vs. 273 ml) and in women (142 vs. 217 ml) (p less than 0.01). The rectoanal inhibitory reflex was abnormal in all but 1 patient. Specific abnormalities were a decreased amplitude or a prolonged duration of the reflex. It was totally absent in 2 patients. This study is compatible with the hypothesis that chronic ischemia of the rectum may cause fecal incontinence or rectal pain. PMID:7117809

  5. A Curious Case of Continuous Incontinence.

    PubMed

    Saltzman, Amanda; Roth, Christopher C

    2016-06-01

    Obstructed hemivagina, ipsilateral renal anomaly (OHVIRA) is a rare Müllerian duct abnormality with renal manifestations. Classical presentation is an adolescent female with abdominal pain following menarche. Because of its rarity, diagnosis is often delayed. There have been <20 reported cases of prepubertal OHVIRA. We present a case of missed OHVIRA diagnosis that presented with continuous incontinence following incision of the obstructed hemivagina and discuss the current medical literature on this subject. PMID:26898899

  6. Fecal Incontinence: Epidemiology, Impact, and Treatment.

    PubMed

    Bochenska, Katarzyna; Boller, Anne-Marie

    2016-09-01

    Fecal incontinence (FI) is a chronic and debilitating condition that carries a significant health, economic, and social burden. FI has a considerable psychosocial and financial impact on patients and their families. A variety of treatment modalities are available for FI including behavioral and dietary modifications, pharmacotherapy, pelvic floor physical therapy, bulking agents, anal sphincteroplasty, sacral nerve stimulation, artificial sphincters, magnetic sphincters, posterior anal sling, and colostomy. PMID:27582653

  7. The treatment of iatrogenic male incontinence: latest results and future perspectives.

    PubMed

    Adamakis, Ioannis; Vasileiou, Ioanna; Constantinides, Constantinos A

    2013-03-01

    Male Stress Urinary Incontinence (SUI) is an increasingly recognized problem particularly after the treatment of prostate cancer. Postprostatectomy incontinence is a major problem that needs to be solved, since it has great impact on quality of life affecting the patient's physical activity and social well-being. The initial treatment for SUI that persists after 12 months consists of conservative measures such as pelvic floor muscle exercises and behavioral therapy. Properly selected and informed patients can also be treated efficiently with minimally invasive procedures such as the implantation of a male suburethral sling, although the experience with such devices is not extensive. However, the implantation of artificial urinary sphincter is the gold standard therapy. PMID:23259418

  8. Mini-invasive tension-free surgery for female urinary incontinence

    PubMed Central

    LEANZA, V.; INTAGLIATA, E.; FERLA, F.; LEANZA, A.; LEANZA, G.; CANNIZZARO, M.A.; VECCHIO, R.

    2014-01-01

    Summary The Authors describe the techniques they perform of prepubic, retropubic and transobturator mini-invasive anti-incontinence surgical procedures and point-out some technical details. The state of art and the results of these three main surgical procedure are compared and discussed. Data from the Literature have been reviewed in order to evaluate the efficacy of the techniques. A Medline search has been performed, and 65 relevant articles from 1996 to 2012 were selected. Literature showed similar cure rates among retropubic (71,4–91%), trans-oburator (77,3–95%) and prepubic (81–87,2%) anti-incontinence procedures. Cystoscopy was considered necessary in the retropubic, optional in transobturator and in the prepubic techniques. Intra-operative cough stress test was believed useful only in the retropubic and prepubic procedures. Obstruction symptoms prevailed in the retropubic, were rare in the transobturator and missing in the prepubic technique. Erosion rate was very low and similar for all the three techniques. Intra-operative vascular and perforating risks prevailed in the retropubic technique, due to the danger present in the retropubic space, whereas late infective complications overcame in the transobturator procedure. Severe complications in the prepubic procedure were not reported, but the procedure is performed only in few centers. PMID:24690339

  9. Addressing Inpatient Glycaemic Control with an Inpatient Glucometry Alert System

    PubMed Central

    Seheult, J. N.; Pazderska, A.; Gaffney, P.; Fogarty, J.; Sherlock, M.; Gibney, J.; Boran, G.

    2015-01-01

    Background. Poor inpatient glycaemic control has a prevalence exceeding 30% and results in increased length of stay and higher rates of hospital complications and inpatient mortality. The aim of this study was to improve inpatient glycaemic control by developing an alert system to process point-of-care blood glucose (POC-BG) results. Methods. Microsoft Excel Macros were developed for the processing of daily glucometry data downloaded from the Cobas IT database. Alerts were generated according to ward location for any value less than 4 mmol/L (hypoglycaemia) or greater than 15 mmol/L (moderate-severe hyperglycaemia). The Diabetes Team provided a weekday consult service for patients flagged on the daily reports. This system was implemented for a 60-day period. Results. There was a statistically significant 20% reduction in the percentage of hyperglycaemic patient-day weighted values >15 mmol/L compared to the preimplementation period without a significant change in the percentage of hypoglycaemic values. The time-to-next-reading after a dysglycaemic POC-BG result was reduced by 14% and the time-to-normalization of a dysglycaemic result was reduced from 10.2 hours to 8.4 hours. Conclusion. The alert system reduced the percentage of hyperglycaemic patient-day weighted glucose values and the time-to-normalization of blood glucose. PMID:26290664

  10. The Management of Urinary Incontinence by Community-Living Elderly.

    ERIC Educational Resources Information Center

    Mitteness, Linda S.

    1987-01-01

    Explored ways elderly people (N=30) manage urinary incontinence. Subjects tended to dismiss their urinary incontinence as a normal part of aging and used various behavioral and psychological strategies to maintain their independence, usually without any assistance from the health professions. Management strategies commonly involved some degree of…

  11. An Overview of Bowel Incontinence: What Can Go Wrong?

    ERIC Educational Resources Information Center

    Norton, William F.

    2008-01-01

    Bowel incontinence, also called fecal incontinence, is the loss of control over liquid or solid stools. It can occur at any age--as a child, teenager, or adult. Severity can range from infrequent leakage of a small amount of stool to total loss of bowel control. Some persons might feel the urge to have a bowel movement but be unable to control it…

  12. School Experiences of an Adolescent with Medical Complexities Involving Incontinence

    ERIC Educational Resources Information Center

    Filce, Hollie Gabler; Bishop, John B.

    2014-01-01

    The educational implications of chronic illnesses which involve incontinence are not well represented in the literature. The experiences of an adolescent with multiple complex illnesses, including incontinence, were explored via an intrinsic case study. Data were gathered from the adolescent, her mother, and teachers through interviews, email…

  13. [Conservative therapy of female urinary incontinence--potential and effect].

    PubMed

    Horcicka, L; Chmel, R; Novácková, M

    2005-01-01

    Non-surgical treatment of female stress urinary incontinence is not as effective as surgical methods but it is very successful in indicated cases. Rehabilitation of the pelvic floor muscles (Kegel exercises, vaginal cones, and electrostimulation of the pelvic floor muscles), drug treatment (alfa-mimetics, tricyclic antidepressives, estrogens, duloxetin), pessarotherapy and uretral obturator devices represent possibilities of conservative therapy of the stress incontinence. Conservative therapy is the method of choice in the treatment of urge incontinence. The most successful are anticholinergic drugs but they have very frequent serious side effects (dryness of the mucous membranes, accommodation disorders, constipation). Spasmolytics, estrogens and tricyclic antidepressives are the other popular used drugs. Life style modification, bladder training and electrostimulation represent very important parts of the conservative treatment. Effectiveness of the non-surgical treatment of both urge and stress urinary incontinence can not reach 100 percent but it helps very much in the quality of life improvement of incontinent women. PMID:15887395

  14. Office management of urinary incontinence among older patients

    PubMed Central

    Frank, Christopher; Szlanta, Agata

    2010-01-01

    OBJECTIVE To provide family physicians with a guide to office management of urinary incontinence (UI) among older patients. SOURCES OF INFORMATION Ovid MEDLINE and the Cochrane database were searched using the terms urinary incontinence, stress incontinence, overactive bladder, urge incontinence, elderly, and geriatrics. MAIN MESSAGE A variety of conditions affecting the nervous system and the lower urinary tract can affect bladder function and UI. Among older patients the effects of decreased cognition and impaired mobility can be substantial, and environmental barriers can play a role. When managing older patients with UI, emphasis on treating concurrent conditions, optimizing medications, and working on lifestyle and behavioural factors is at least as important as pharmacologic treatment. Medications are relevant, but the potential for adverse effects increases among older patients. CONCLUSION Various resources are available to support family physicians in office management of UI, and family physicians can improve symptoms and the quality of patients’ lives by screening for and helping patients to manage incontinence. PMID:21075990

  15. The Differential Impact of Flatal Incontinence in Women With Anal Versus Fecal Incontinence

    PubMed Central

    Meyer, Isuzu; Tang, Ying; Szychowski, Jeff M; Richter, Holly E

    2015-01-01

    Objectives The differential impact on quality of life (QOL) that leakage of both stool and flatus confers on women compared to stool only is unclear. Our aim was to characterize differences in symptom distress, impact on QOL, and anorectal testing among women with leakage of stool and flatus, stool only, and flatus only. Methods A retrospective review was conducted of women undergoing evaluation of at least monthly bowel incontinence symptoms. Subjects were divided into 3 groups: liquid/solid stool and flatus (anal incontinence, AI); liquid/solid stool only (fecal incontinence, FI); and flatal only (FL). Baseline assessment included the Modified Manchester Health Questionnaire (MMHQ) including the Fecal Incontinence Severity Index (FISI), Short Form-12 (SF-12), as well as anorectal manometry and endoanal ultrasound evaluations. Results Of 436 subjects, 381 had AI, 45 FI, and 10 FL. Significant between-group differences were noted in MMHQ (p=0.0002) and FISI total scores (p<0.0001) where women with AI reflected greater negative impact than women with FI. The SF-12 (PCS, MCS) scores were similar in all three groups (p=0.22, 0.08). Resting/squeeze pressures were significantly lower in AI and FI groups compared to FL (p=0.0004), whereas rectal capacity was similar in all three groups. Although exploratory, MMHQ scores were similar between FI and FL groups, although FISI scores were higher in the FI group (p<0.0001). Conclusions Women with AI have higher symptom specific distress and greater negative impact on QOL compared to women with FI. Treatment of all bowel incontinence symptoms is important to improve symptom-specific and general QOL. PMID:26506162

  16. Management of fecal incontinence - focus on a vaginal insert for bowel control.

    PubMed

    Sokol, Eric R

    2016-01-01

    Fecal incontinence, also referred to as accidental bowel leakage, is a debilitating condition that impacts quality of life in a significant number of women. Current treatments for fecal incontinence include behavioral modification, biofeedback, drug therapy, and invasive surgical procedures. However, these treatments have suboptimal efficacy due to patient adherence, variability of presentation across patients, cost, and additional health risks. A vaginal bowel control system (Eclipse™ System) was developed to offer a low-risk, effective, and patient-managed approach to treating accidental bowel leakage. The vaginal bowel control system consists of a vaginal insert and user-controlled, pressure-regulated pump. Once inflated, the balloon of the vaginal insert is directed posteriorly to occlude the rectum, allowing the woman to immediately regain control of bowel function. This article will introduce the design evolution and feasibility studies of the Eclipse System. In addition, this review will discuss the results from a recent clinical trial that demonstrated the safety and efficacy of the vaginal bowel control system in managing fecal incontinence and other symptoms of bowel dysfunction. PMID:27274318

  17. Management of fecal incontinence – focus on a vaginal insert for bowel control

    PubMed Central

    Sokol, Eric R

    2016-01-01

    Fecal incontinence, also referred to as accidental bowel leakage, is a debilitating condition that impacts quality of life in a significant number of women. Current treatments for fecal incontinence include behavioral modification, biofeedback, drug therapy, and invasive surgical procedures. However, these treatments have suboptimal efficacy due to patient adherence, variability of presentation across patients, cost, and additional health risks. A vaginal bowel control system (Eclipse™ System) was developed to offer a low-risk, effective, and patient-managed approach to treating accidental bowel leakage. The vaginal bowel control system consists of a vaginal insert and user-controlled, pressure-regulated pump. Once inflated, the balloon of the vaginal insert is directed posteriorly to occlude the rectum, allowing the woman to immediately regain control of bowel function. This article will introduce the design evolution and feasibility studies of the Eclipse System. In addition, this review will discuss the results from a recent clinical trial that demonstrated the safety and efficacy of the vaginal bowel control system in managing fecal incontinence and other symptoms of bowel dysfunction. PMID:27274318

  18. Inpatient Applications of Cognitive-Behavioral Therapy

    PubMed Central

    STUART, SCOTT; THASE, MICHAEL E.

    1994-01-01

    The authors review empirical research of the past decade on cognitive-behavioral therapy (CBT) in the treatment of depressed inpatients and offer suggestions for future investigations. CBT appears to offer additive benefits in combination with pharmacotherapy, particularly after the transition from inpatient to outpatient treatment. CBT also holds promise as a primary treatment for inpatients but has not been clearly shown to be as effective as antidepressants. There is as yet no evidence that inpatient CBT is superior to other psychotherapies of comparable intensity or that short-term inpatient CBT has enduring value if not followed by outpatient therapy. Further research is needed to clarify the specific effects of CBT for inpatients and to establish its cost-effectiveness. PMID:22700196

  19. [Significance of conservative treatment for faecal incontinence].

    PubMed

    Schwandner, O

    2012-08-01

    Based on a variety of aetiological factors and combined disorders in faecal incontinence, a conservative treatment option as the primary treatment can be recommended. Conservative treatment includes medical therapy influencing stool consistency and stool passage, pelvic floor exercises and biofeedback as well as local treatment options. However, defining the role of conservative treatment concepts related to success or failure remains a challenging task. The lack of evidence derived from studies is related to a variety of reasons including inclusion criteria, patient selection, treatment standardisation, and the principal difficulty to objectively define functional success. PMID:22933004

  20. Stress Urinary Incontinence: Comparative Efficacy Trials.

    PubMed

    Lavelle, Erin Seifert; Zyczynski, Halina M

    2016-03-01

    Women seeking relief from symptoms of stress urinary incontinence (SUI) may choose from a broad array of treatment options. Therapies range from lifestyle/behavioral modification to surgical interventions, and differ in terms of both effectiveness and risk. Individualized treatment plans can be developed to address a patient's expectations and goals for treatment, as well as her tolerance for potential adverse events. This article reviews the highest-quality clinical trials comparing contemporary treatment options for women with SUI. Clinicians and patients can use this compendium to inform their treatment selection. PMID:26880507

  1. [Inpatient-ambulatory network of psychotherapy care].

    PubMed

    Studt, Hans Henning

    2003-01-01

    The development and state of the art is presented for inpatient psychotherapy in neurotic and psychosomatic patients. The question is then posed whether time-tested inpatient psychotherapy can survive the introduction of "diagnosis-related groups" (DRG) with its threat of flat-rate case billing. Thus, the development of an "in- and outpatient network" has been considered as a possible alternative, in which hospitals and private practices combine intervals of inpatient and outpatient psychotherapy. PMID:14733063

  2. Internal Medicine Training in the Inpatient Setting

    PubMed Central

    Lorenzo, Di Francesco; Pistoria, Michael J; Auerbach, Andrew D; Nardino, Robert J; Holmboe, Eric S

    2005-01-01

    PURPOSE Although the inpatient setting has served as the predominant educational site of internal medicine training programs, many changes and factors are currently affecting education in this setting. As a result, many educational organizations are calling for reforms in inpatient training. This report reviews the available literature on specific internal medicine inpatient educational interventions and proposes recommendations for improving internal medicine training in this setting. METHOD We searched Medline for articles published between 1966 and August 2004 which focused on internal medicine training interventions in the inpatient setting; bibliographies of Medline-identified articles, as well as articles suggested by experts in the field provided additional citations. We then reviewed, classified, and abstracted only articles where an assessment of learner outcomes was included. RESULTS Thirteen studies of inpatient internal medicine educational interventions were found that included an outcome assessment. All were single institution studies. The majority of these studies was of poor methodological quality and focused on specific content areas of internal medicine. None assessed the effectiveness or impact of internal medicine core inpatient experiences or curriculum. CONCLUSION This review identifies significant gaps in our understanding of what constitutes effective inpatient education. The paucity of high quality research in the internal medicine inpatient setting highlights the urgent need to formally define and study what constitutes an effective “core” inpatient curriculum. PMID:16423111

  3. Paliperidone Palmitate-induced Urinary Incontinence: A Case Report

    PubMed Central

    Karslıoǧlu, Ersin Hatice; Özalp, Elvan; Çayköylü, Ali

    2016-01-01

    Urinary incontinence, although rarely reported, is one of the most important adverse effects of antipsychotic medication. It can be an embarrassing, distressing, and potentially treatment-limiting. Several antipsychotics, including both typical and atypical varieties, are known to induce urinary incontinence. Many antipsychotic drugs target the neural pathways controlling continence by binding to receptors of some neurotransmitters such as serotonin, dopamine, acetylcholine, and adrenaline. Pharmacological management of incontinence should be considered if there is a risk of cessation of the antipsychotic therapy or any decline in patients’ compliance. Amitriptyline, desmopressin, ephedrine, and anticholinergics such as oxybutynin and trihexyphenidyl are the most frequently used agents to treat incontinence. We think that the frequency of incontinence is higher than reported in the literature, and that follow-up routines should include a form of standardized screening for all possible adverse effects, including incontinence, of any given antipsychotic. In this article, we report a case of urinary incontinence as an adverse effect of paliperidone palmitate use during maintenance therapy in a patient with schizophrenia. PMID:26792046

  4. Paliperidone Palmitate-induced Urinary Incontinence: A Case Report.

    PubMed

    Karslıoǧlu, Ersin Hatice; Özalp, Elvan; Çayköylü, Ali

    2016-02-29

    Urinary incontinence, although rarely reported, is one of the most important adverse effects of antipsychotic medication. It can be an embarrassing, distressing, and potentially treatment-limiting. Several antipsychotics, including both typical and atypical varieties, are known to induce urinary incontinence. Many antipsychotic drugs target the neural pathways controlling continence by binding to receptors of some neurotransmitters such as serotonin, dopamine, acetylcholine, and adrenaline. Pharmacological management of incontinence should be considered if there is a risk of cessation of the antipsychotic therapy or any decline in patients' compliance. Amitriptyline, desmopressin, ephedrine, and anticholinergics such as oxybutynin and trihexyphenidyl are the most frequently used agents to treat incontinence. We think that the frequency of incontinence is higher than reported in the literature, and that follow-up routines should include a form of standardized screening for all possible adverse effects, including incontinence, of any given antipsychotic. In this article, we report a case of urinary incontinence as an adverse effect of paliperidone palmitate use during maintenance therapy in a patient with schizophrenia. PMID:26792046

  5. Screening for incontinence in a secure psychiatric service for women.

    PubMed

    Long, Clive G; West, Rachel; Siddique, Rizwana; Rigg, Samantha; Banyard, Ellen; Stillman, Swee-Kit; Butler, Sarah; Dolley, Olga

    2015-12-01

    Incontinence is associated with mental illness and neuroleptic medications but diagnosis and treatment is often poor or non-existent. Problems of incontinence are compounded in secure psychiatric services for women by poor health, obesity, and a sedentary lifestyle. Addressing the physical health of this group necessitates a more accurate picture of the nature, incidence, and management of incontinence. A point-in-time survey of 108 women who agreed to be interviewed (93%) covered presence, frequency, and nature of incontinence, and information on management case note data was used to gather demographic and previous medical history, comparisons were made between patients with and without problems of incontinence. Findings indicate a problem of incontinence in 48% of women with a dominance of problems of stress and urge enuresis. Of modifiable factors that contribute to enuresis, the current study highlighted the contribution of obesity, smoking and clozapine medication. A further finding was the preference for managing rather than treating problems of incontinence. Actions to improve the detection and treatment of this problem are described. PMID:26146962

  6. Treatment histories of borderline inpatients.

    PubMed

    Zanarini, M C; Frankenburg, F R; Khera, G S; Bleichmar, J

    2001-01-01

    In this study, we describe the types and amounts of psychiatric treatment received by a well-defined sample of borderline personality disorder (BPD) inpatients, and compare these parameters with those of a group of carefully diagnosed personality-disordered controls. Finally, we assess the risk factors associated with a history of intensive, high-cost treatment, which we defined as having had two or more prior psychiatric hospitalizations. The treatment histories of 290 borderline inpatients and 72 axis II controls were assessed using a reliable semistructured interview. All nine forms of treatment studied except electroconvulsive therapy (ECT) were common among borderline patients (36% to 96%). In addition, a significantly higher percentage of borderline patients than axis II controls reported a history of individual and group therapy, day and residential treatment, psychiatric hospitalization, participating in self-help groups, and taking standing medications. They were also significantly younger when they first entered individual therapy and began to take standing medications. In addition, borderline patients spent more time than axis II controls in individual therapy and psychiatric hospitals, and were on standing medications for a significantly longer period of time. They also reported a significantly higher number of psychiatric hospitalizations, lifetime number of standing medications, and number of psychotropic medications taken at the same time. In addition, we found a highly significant multivariate predictive model for multiple prior hospitalizations. The six significant predictors were age 26 or older, a history of quasi psychotic thought, lifetime number of self-mutilative efforts and suicide attempts, a childhood history of reported sexual abuse, and an adult history of being physically and/or sexually assaulted. Taken together, these results confirm clinical impressions concerning the high rates of mental health services used by borderline patients

  7. Utilization of incontinence clinical practice guidelines.

    PubMed

    Roe, B; Moore, K N

    2001-11-01

    Clinical practice guidelines (CPGs) are evidence-based recommendations for best practice and have been developed with the assumption they will be embraced by practitioners; a further assumption is that clinical practice guidelines will improve the delivery of care. In this article, we provide a working definition of evidence-based practice, discuss the strengths and limitations of CPGs, describe the implementation of CPGs in the context of urinary incontinence, and consider the steps that the WOCN has taken to initiate evidence-based practice. Current issues are presented along with initiatives that have resulted in clinical practice guidelines on incontinence from the United States, United Kingdom, and Canada. On the basis of the current literature, it is concluded that clinical practice guidelines can play an important role in WOCN practice and that the implementation of guidelines may improve clinical practice. However, guidelines are only as valid as the evidence on which they are based and may not take into account gender or cultural differences or the effect that comorbid conditions can have on treatment outcomes. Finally, guidelines must follow a comprehensive approach that involves management and staff and includes education, facilitation, evaluation, feedback, and an understanding of change strategies. PMID:11707762

  8. A comprehensive inpatient discharge system.

    PubMed Central

    O'Connell, E. M.; Teich, J. M.; Pedraza, L. A.; Thomas, D.

    1996-01-01

    Our group has developed a computer system that supports all phases of the inpatient discharge process. The system fills in most of the physician's discharge order form and the nurse's discharge abstract, using information available from sign-out, order entry, scheduling, and other databases. It supplies information for referrals to outside institutions, and provides a variety of instruction materials for patients. Discharge forms can be completed in advance, so that the patient is not waiting for final paperwork. Physicians and nurses can work on their components independently, rather than in series. Response to the system has been very favorable. PMID:8947755

  9. Diagnosis, Evaluation, and Treatment of Mixed Urinary Incontinence in Women

    PubMed Central

    Chughtai, Bilal; Laor, Leanna; Dunphy, Claire; Lee, Richard; Te, Alexis; Kaplan, Steven

    2015-01-01

    Mixed urinary incontinence (MUI) is a common clinical problem in the community and hospital setting. The broad definition of the term makes it difficult to diagnose, as well as determine effective treatment strategies. There are no current guidelines recommended for physicians. The estimated prevalence of this condition is approximately 30% in all women with incontinence. It has also been suggested that patients with MUI report more bothersome symptoms than either stress or urge incontinence; approximately 32% of 40- to 64-year-olds with MUI report symptoms of depression. The authors examine the diagnosis, evaluation, and treatment of patients with MUI. PMID:27222643

  10. Steinert's syndrome presenting as anal incontinence: a case report

    PubMed Central

    2011-01-01

    Introduction Myotonic dystrophy (MD) or Steinert's syndrome is a rare cause of chronic diarrhea and anal incontinence. In the presence of chronic diarrhea and fecal incontinence with muscle weakness, neuromuscular disorders such as myotonic dystrophy should be considered in the differential diagnosis. Case Presentation We present the case of a 45-year-old Turkish man with Steinert's syndrome, who was not diagnosed until the age of 45. Conclusions In clinical practice, the persistence of diarrhea and fecal incontinence with muscle weakness should suggest that the physician perform an anal manometric study and electromyography. Neuromuscular disorders such as myotonic dystrophy should be considered in the differential diagnosis. PMID:21838873

  11. Evaluation and management of voiding dysfunction after midurethral sling procedures

    PubMed Central

    Çelik, Hatice; Harmanlı, Özgür

    2012-01-01

    Midurethral slings have become the most popular surgical procedure for the correction of stress urinary incontinence in women. Urinary retention or obstructive voiding symptoms may arise from partial urethral obstruction as a result of oversuspension of the urethra or exaggerated tension. Fortunately, most cases of voiding dysfunction are transient and resolve spontaneously within days. Clean intermittent self-catheterization is the mainstay of conservative treatment. If symptoms persist, tape mobilization, incision or urethrolysis may be performed. Recurrent stress urinary incontinence may occur in a small group of patients, who may benefit from another incontinence treatment. PMID:24592021

  12. A CBT Approach to Inpatient Psychiatric Hospitalization

    ERIC Educational Resources Information Center

    Masters, Kim J.

    2005-01-01

    During a psychiatric hospitalization of 5 to 10 days, cognitive-behavioral therapy (CBT) strategies can be used for the management of inpatients and to support the transition to outpatient treatment. This format was chosen after several years of frustration dealing with crisis inpatient care. The use of CBT is well known, and it seemed that an…

  13. Dietary Issues Inpatients Face With Being Vegetarian

    PubMed Central

    Potter-Dunlop, Julie A.; Tse, Alice M.

    2016-01-01

    This article reviews the literature from 1985 through 2010 on research related to the dietary issues vegetarian inpatients may encounter in the acute care setting. A thematic portrayal of vegetarianism in the context of the inpatient setting is described. Implications for future research and nursing practice are identified. PMID:22157507

  14. Pelvic artery embolization in the management of pelvic arterial bleeding following midurethral sling surgery for stress urinary incontinence

    PubMed Central

    Cho, Eun-Ji; Kim, Jun-Bum; Park, So-Yun; Kim, Sung-Hoon; Kim, Chung-Hoon; Kang, Byung-Moon

    2016-01-01

    The transobturator tape (TOT) method is the recent minimally invasive midurethral sling surgery. The TOT method was invented to reduce complication rate of surgical technique for female stress urinary incontinence. Pelvic bleeding following TOT procedure, although extremely rare, could be occurred. We presented three cases which treat pelvic arterial bleeding after midurethral sling (TOT and tension-free vaginal tape Secur) surgery via pelvic artery embolization. Therefore we report our cases with brief review of the literature. PMID:27004210

  15. Adjustable perineal male sling using tissue expander as an effective treatment of post-prostatectomy urinary incontinence

    PubMed Central

    Balci, Melih; Tuncel, Altug; Bilgin, Ovunc; Aslan, Yilmaz; Atan, Ali

    2015-01-01

    Purpose To report our intermediate experience in treating patients with severe incontinence using an adjustable perineal male sling with a tissue expander. Materials and Methods An adjustable male sling procedure was performed on 21 patients with severe incontinence. The underlying etiology of urinary incontinence was radical prostatectomy in 13 patients, open prostatectomy in 5 patients and transurethral prostate resection in 3 patients. The difference between the classical and the adjustable sling is that in the latter there is a 25 mL tissue expander between the two layers of polypropylene mesh with an injection port. Adjustment of the sling was performed with saline via an inflation port, in case of recurrence or persistence of incontinence. Results The mean age of the patients was 66.2±7.3 (50-79) years and mean pad usage was 6.4±0.6 per day. The mean follow-up time was 40.1±23.2 (6-74) months. The balloon was postoperatively inflated on average with 11.6±5.7 (5-25) mL. After the mean 40.1 months of follow-up, 16 of the 21 patients (76.2%) were dry (11 patients, 0 pads; 5 patients using safety pads), 3 patients (14%) had mild and 2 (9.8%) had moderate degree post-prostatectomy urinary incontinence (PPI). The average maximum urine flow rate of the patients was 15.6±4.7 (10-31) mL/s. No residual urine was found. In 2 patients, all parts of the device were removed due to infection and discomfort, and in 3 patients only the inflation component was removed due to local scrotal infection. Conclusions Our results show that using an adjustable perineal male sling with a tissue expander seems to be an efficient, and safe surgical treatment option in patients with PPI. PMID:26005973

  16. [Urinary incontinence caused by urocolpos. Report of a new case].

    PubMed

    Ortega Mariscal, J; Congregado Ruiz, B; Campoy Martínez, P; Pérez Pérez, M; Rodríguez Pérez, A; Soltero González, A

    2001-06-01

    We present a new case of urocolpos that appeared as urinary incontinence. We discuss the etiology and the available therapeutic choices, emphasizing on the value of the clinical history and physical exploration showed data. PMID:11512514

  17. [Health care of geriatric patients with urinary incontinence].

    PubMed

    Mueller, Edgar A; Kirch, Wilhelm

    2015-04-01

    Urinary incontinence occurs frequently in geriatric patients. In the doctor's practice, the symptoms are often not mentioned by the patients; this may lead to loss of autonomy and social isolation. A screening for urinary incontinence should therefore be part of each geriatric assessment. In the presence of urinary incontinence, several treatment options are available, which need to be tailored according to the individual capabilities (mobility, motivation and cognitive performance) of the patient. Non-pharmacological treatment options, such as behavior modification, toilet training and pelvic floor training, should be exploited before any pharmacotherapy commences. If the pharmacological treatment involves the use of anticholinergic agents, the cognitive performance should be monitored. An interdisciplinary collaboration is a prerequisite for the optimized treatment and adequate health care of geriatric patients with urinary incontinence. PMID:25826038

  18. Anterior vaginal wall repair (surgical treatment of urinary incontinence) - slideshow

    MedlinePlus

    ... page: //medlineplus.gov/ency/presentations/100110.htm Anterior vaginal wall repair (surgical treatment of urinary incontinence) - series ... 4 out of 4 Normal anatomy Overview The vaginal opening lies just below the urethral opening, and ...

  19. Pelvic floor muscle training for urinary incontinence postpartum.

    PubMed

    Hall, Bethany; Woodward, Sue

    The offering of pelvic floor muscle exercises to all women during their first pregnancy is recommended by National Institute for Health and Care Excellence (NICE) guidelines. Pelvic floor muscles suffer significant trauma throughout pregnancy and childbirth, which may sometimes lead to urinary incontinence postpartum. However, it is uncertain how effective pelvic floor muscle exercises are in treating this incontinence. Several trials have been analysed to try to understand this question. Issues such as when the exercises were undertaken, how often they were performed and in what circumstances they were carried out, have all been considered. While it is still uncertain whether they are effective in reducing urinary incontinence postpartum, as they are non-invasive and fairly simple to carry out, they are still the first-line management for urinary incontinence postpartum with other treatments being considered if this is ineffective. PMID:26067791

  20. What's New in the Toolbox for Constipation and Fecal Incontinence?

    PubMed

    Lee, Yeong Yeh

    2014-01-01

    Constipation and fecal incontinence (FI) are common complaints predominantly affecting the elderly and women. They are associated with significant morbidity and high healthcare costs. The causes are often multi-factorial and overlapping. With the advent of new technologies, we have a better understanding of their underlying pathophysiology which may involve disruption at any levels along the gut-brain-microbiota axis. Initial approach to management should always be the exclusion of secondary causes. Mild symptoms can be approached with conservative measures that may include dietary modifications, exercise, and medications. New prokinetics (e.g., prucalopride) and secretagogues (e.g., lubiprostone and linaclotide) are effective and safe in constipation. Biofeedback is the treatment of choice for dyssynergic defecation. Refractory constipation may respond to neuromodulation therapy with colectomy as the last resort especially for slow-transit constipation of neuropathic origin. Likewise, in refractory FI, less invasive approach can be tried first before progressing to more invasive surgical approach. Injectable bulking agents, sacral nerve stimulation, and SECCA procedure have modest efficacy but safe and less invasive. Surgery has equivocal efficacy but there are promising new techniques including dynamic graciloplasty, artificial bowel sphincter, and magnetic anal sphincter. Despite being challenging, there are no short of alternatives in our toolbox for the management of constipation and FI. PMID:25705618

  1. Fecal incontinence in men: Causes and clinical and manometric features

    PubMed Central

    Muñoz-Yagüe, Teresa; Solís-Muñoz, Pablo; Ciriza de los Ríos, Constanza; Muñoz-Garrido, Francisco; Vara, Jesús; Solís-Herruzo, José Antonio

    2014-01-01

    AIM: To determine the causes and characteristics of fecal incontinence in men and to compare these features with those presented by a group of women with the same problem. METHODS: We analyzed the medical history, clinical and manometric data from 119 men with fecal incontinence studied in our unit and compared these data with those obtained from 645 women studied for the same problem. Response to treatment was evaluated after 6 mo of follow-up. RESULTS: Fifteen percent of patients studied in our unit for fecal incontinence were male. Men took longer than women before asking for medical help. Ano-rectal surgery was the most common risk factor for men related to fecal incontinence. Chronic diarrhea was present in more than 40% of patients in both groups. Decreased resting and external anal sphincter pressures were more frequent in women. No significant differences existed between the sexes regarding rectal sensitivity and recto-anal inhibitory reflex. In 17.8% of men, all presenting soiling, manometric findings did not justify fecal incontinence. Response to treatment was good in both groups, as 80.4% of patients improved and fecal incontinence disappeared in 13.2% of them. CONCLUSION: In our series, it was common that men waited longer in seeking medical help for fecal incontinence. Ano-rectal surgery was the major cause of this problem. Chronic diarrhea was a predisposing factor in both sexes. Manometric differences between groups were limited to an increased frequency of hypotony of the external anal sphincter in women. Fecal incontinence was controllable in most patients. PMID:24976729

  2. Office-Based Management of Fecal Incontinence

    PubMed Central

    Costilla, Vanessa C.; Mayer, Anita P.; Crowell, Michael D.

    2013-01-01

    Fecal incontinence (FI) is a devastating disorder that is more prevalent than previously realized. FI is the involuntary loss of stool. Many factors contribute to the pathophysiology of FI, including advanced age, bowel irregularity, parity, and obesity. A detailed history and focused rectal examination are important to making the diagnosis and determining contributing causes. Although multiple diagnostic studies are available to assess the cause of FI, specific guidelines that delineate when testing should be done do not exist. Clinicians must weigh the risk, benefit, and burden of testing against the need for empiric treatment. All types of FI are initially managed in the same way, which includes lifestyle modification to reduce bowel derangements, improved access to toileting, and initiation of a bulking regimen to improve stool consistency. If initial conservative management fails, pharmaco-logic agents, biofeedback, or surgery may be indicated. PMID:23935551

  3. Incontinence-associated dermatitis: a consensus.

    PubMed

    Gray, Mikel; Bliss, Donna Z; Doughty, Dorothy B; Ermer-Seltun, JoAnn; Kennedy-Evans, Karen L; Palmer, Mary H

    2007-01-01

    Incontinence-associated dermatitis (IAD) is an inflammation of the skin that occurs when urine or stool comes into contact with perineal or perigenital skin. Little research has focused on IAD, resulting in significant gaps in our understanding of its epidemiology, natural history, etiology, and pathophysiology. A growing number of studies have examined clinical and economic outcomes associated with prevention strategies, but less research exists concerning the efficacy of various treatments. In the clinical and research settings, IAD is often combined with skin damage caused by pressure and shear or related factors, sometimes leading to confusion among clinicians concerning its etiology and diagnosis. This article reviews existing literature related to IAD, outlines strategies for assessing, preventing, and treating IAD, and provides suggestions for additional research needed to enhance our understanding and management of this common but under-reported and understudied skin disorder. PMID:17228207

  4. Animal Models of Stress Urinary Incontinence

    PubMed Central

    Jiang, Hai-Hong

    2011-01-01

    Stress urinary incontinence (SUI) is a common health problem significantly affecting the quality of life of women worldwide. Animal models that simulate SUI enable the assessment of the mechanism of risk factors for SUI in a controlled fashion, including childbirth injuries, and enable preclinical testing of new treatments and therapies for SUI. Animal models that simulate childbirth are presently being utilized to determine the mechanisms of the maternal injuries of childbirth that lead to SUI with the goal of developing prophylactic treatments. Methods of assessing SUI in animals that mimic diagnostic methods used clinically have been developed to evaluate the animal models. Use of these animal models to test innovative treatment strategies has the potential to improve clinical management of SUI. This chapter provides a review of the available animal models of SUI, as well as a review of the methods of assessing SUI in animal models, and potential treatments that have been tested on these models. PMID:21290221

  5. Female sexual function following mid-urethral slings for the treatment of stress urinary incontinence.

    PubMed

    Alwaal, A; Tian, X; Huang, Y; Zhao, L; Ma, L; Lin, G; Deng, D

    2016-07-01

    The aim of our study was to describe the impact of mid-urethral sling procedure for the treatment of stress urinary incontinence (SUI) on female sexual function. We used PubMed (updated March 2015) to conduct a literature electronic search that included peer-reviewed English language articles. We analyzed the studies about the impact of mid-urethral slings on female sexual function. There are different and contradictory results of the effects of mid-urethral sling on female sexual function. However, more papers show that women undergoing mid-urethral sling procedures report that their sexual function is improved or remains unchanged. The main mechanism of this improved sexuality is the complete relief from coital incontinence, reduction in anxiety and avoidance of sex, whereas the most common symptom related to worsened sexual activity is dyspareunia. Women undergoing sling procedures for SUI should be informed that their sexual activity is likely to remain unchanged or even improve after the operation, but that dyspareunia may occur. PMID:27146350

  6. Incontinence in Intellectual Disability: An Under Recognized Cause.

    PubMed

    Nair, Lal Devayanivasudevan; Sagayaraj, Benjamin; V T T, Rajan; Kumar, Radha

    2015-09-01

    Many children with Down syndrome may develop urinary incontinence during adolescence or nearing adulthood. Most often low mental ability, behavioural issues, urinary tract infection, hypothyroidism, atlanto-axial subluxation or sexual abuse may be suspected to be the reason. We report a case of Down syndrome with tethered cord syndrome (TCS) and Lipoma of Filum terminale with Cauda equina in normal position, as a cause of bowel and bladder incontinence. The need for operating with Cauda Equina in normal position is debated. But a conscious decision was taken to operate and the incontinence improved markedly which was documented by using a standardized questionnaire (King's questionnaire) and thereby making a difference in the child's life. A literature search did not result in any case of Down syndrome with tethered cord syndrome and secondary incontinence as presentation. Considering the possibility of TCS as a cause of incontinence, often neglected even in normal children, careful evaluation and correction of such problems will make a difference in the life of many intellectually disabled children. Incontinence should not be casually attributed to intellectual disability without ruling out other causes. PMID:26500975

  7. [Urinary incontinence in the elderly can be treated].

    PubMed

    van Houten, Paul

    2015-01-01

    A recent survey on the use of drugs for incontinence in the elderly stated that only anticholinergic drugs used for urge incontinence have a slight positive effect on incontinence episodes. However, this does not mean that there are no potential treatments for incontinence in the frail elderly. The Dutch surveillance on problems in the care sector, the 'National prevalence survey of care problems' ('Landelijke prevalentiemeting zorgproblemen'), shows that between 2004 and 2014 the prevalence of urinary incontinence dropped from 76% to 49%. This fall in prevalence is due to the policies developed by institutions, and by training for nurses and physicians. Successful treatment begins with assessment of functionality (mobility and cognition), assessment of relevant multimorbidity and reconsideration of the use of drugs with an impact on continence. As a next step, bladder retraining and pelvic floor exercises may be used if the elderly person is able to perform these exercises independently. An anticholinergic drug can be tried as a last resort if there is urge incontinence and there are no contraindications. PMID:26732219

  8. Development of Computer-Based Training to Enhance Resident Physician Management of Inpatient Diabetes

    PubMed Central

    Cook, Curtiss B.; Wilson, Rebecca D.; Hovan, Michael J.; Hull, Bryan P.; Gray, Richard J.; Apsey, Heidi A.

    2009-01-01

    Background Treating hyperglycemia promotes better outcomes among inpatients. Knowledge deficits about management of inpatient diabetes are prevalent among resident physicians, which may affect the care of a substantial number of these patients. Methods A computer-based training (CBT) curriculum on inpatient diabetes and hyperglycemia was developed and implemented for use by resident physicians and focuses on several aspects of the management of inpatient diabetes and hyperglycemia: (1) review of importance of inpatient glucose control, (2) overview of institution-specific data, (3) triaging and initial admission actions for diabetes or hyperglycemia, (4) overview of pharmacologic management, (5) insulin-dosing calculations and ordering simulations, (6) review of existing policies and procedures, and (7) discharge planning. The curriculum was first provided as a series of lectures, then formatted and placed on the institutional intranet as a CBT program. Results Residents began using the inpatient CBT in September 2008. By August 2009, a total of 29 residents had participated in CBT: 8 in family medicine, 12 in internal medicine, and 9 in general surgery. Most of the 29 residents confirmed that module content met stated objectives, considered the information valuable to their inpatient practices, and believed that the quality of the online modules met expectations. The majority reported that the modules took just the right amount of time to complete (typically 30 min each). Conclusions Improvement in inpatient diabetes care requires continuous educational efforts. The CBT format and curriculum content were well accepted by the resident physicians. Ongoing assessment must determine whether resident practice patterns are influenced by such training. PMID:20144392

  9. The Decline of Inpatient Penile Prosthesis over the 10‐Year Period, 2000–2010

    PubMed Central

    Harris, Catherine R.; Hussein, Ahmed A.; Sanford, Thomas H.; McCulloch, Charles E.; Shindel, Alan W.; Breyer, Benjamin N.

    2015-01-01

    Abstract Introduction Across all specialties, economic pressure is driving increased utilization of outpatient surgery when feasible. Aims Our aims were to analyze national trends of penile prosthesis (PP) surgery and to examine patient and hospital characteristics, and perioperative complications in the inpatient setting. Methods We analyzed data from National Inpatient Sample. Patients in NIS who underwent PP insertion between 2000 and 2010 were included. Main Outcome Measures Our main outcomes were the number of inpatient PP procedures, type of prosthesis, patient demographics, comorbidities, hospital characteristics, and immediate perioperative complications. Results There was a progressive and dramatic decline by nearly half in the number of both inflatable (IPP) and noninflatable (NIPP) inpatient insertions performed from 2000 to 2010 (P = 0.0001). The overall rate of inpatient complications for PP insertion was 13.5%. Patients with three or more comorbidities were found to have a higher risk of complications than patients with no comorbidities (OR = 1.45, 95% CI = 1.18–1.78) (P = 0.0001). Surgeries performed in high‐volume hospitals (10 or more PP cases per year) were associated with reduced risk of complications (OR = 0.6) (P < 0.0001). There was a dramatic decrease in inpatient setting for PP placement in high‐volume hospitals (32% in 2000 compared with 6% in 2010; P < 0.0001), and when compared with lower volume hospitals. NIPP was more likely performed in younger patients and in community hospitals, and less likely in white patients. Medicaid health insurance was associated with much higher rate of NIPP insertion than other types of insurance. Conclusions The number of PP procedures performed in the inpatient setting declined between 2000 and 2010, likely reflecting a shift toward increasing outpatient procedures. Our data also suggest a better outcome for patients having the procedure done at a high‐volume center in

  10. Effective inpatient medication reconciliation: The 10 commandments.

    PubMed

    Siu, Henry K

    2015-01-01

    Medication Reconciliation (MedRec) is the comprehensive process of medication verification, clarification and documentation in an effort to avoid medication errors. There are many reasons that contribute to the inadequacies of current day inpatient MedRec. Among these include the limited medical literacy of patients, communication between providers and teams of providers, and the intrinsic difficulties of medical charting. Although the best approach to inpatient MedRec is not known, the following outlines the 10 most important aspects, or "Commandments", for effective inpatient MedRec. The tenets are not listed in any particular order of importance. PMID:25758318

  11. De Novo Pudendal Neuropathy After TOT-O Surgery for Stress Urinary Incontinence

    PubMed Central

    Baker, James

    2011-01-01

    Background and Objectives: Five cases of pelvic nerve complications after transobturator tape (TOT) inside-out surgical procedures for stress urinary incontinence are presented. Methods: We conducted a chart review of patients with complications referred to our practice. Results: Five patients with nerve complications after TOT inside-out procedures were investigated. Pudendal neuropathy and interstitial cystitis were seen in this series of patients with several patients having myofascial pain in the lower abdominal area. Conclusions: Although not commonly reported, complications from needle placement and from the area of needle exit in a TOT procedure can exist, and the surgeon must be careful when placing the needle through the area of the obturator fossa. PMID:21985718

  12. Tension-Free vaginal tape: analysis of outcomes and complications in 404 stress incontinent women.

    PubMed

    Meschia, M; Pifarotti, P; Bernasconi, F; Guercio, E; Maffiolini, M; Magatti, F; Spreafico, L

    2001-01-01

    The aim of this prospective multicenter study was to evaluate the safety and efficacy of tension-free vaginal tape (TVT) for the surgical treatment of female stress incontinence. Four hundred and four women underwent the TVT procedure. Their mean age was 57 years (range 31-83). The median follow-up time was 21 months (range 12-35). The subjective and objective cure rates were 92% and 90%, respectively. Another 4% of the women were significantly improved by the procedure. Intra- and postoperative complications were few and included uneventful bladder perforations (6%), retropubic bleeding requiring surgery (0.5%), voiding difficulties (4%) in the postoperative course, and one obturator nerve injury. We conclude that the TVT procedure is associated with a high cure rate and a low morbidity. PMID:11450976

  13. Nonsurgical Management of Urinary Incontinence in Women: A Clinical Practice Guideline

    MedlinePlus

    Annals of Internal Medicine Summaries for Patients Nonsurgical Management of Urinary Incontinence in Women: A Clinical Practice ... of Physicians The full report is titled “Nonsurgical Management of Urinary Incontinence in Women: A Clinical Practice ...

  14. Taking Control: Non-Surgical Treatment Options for Urinary Incontinence in Women

    MedlinePlus

    ... UI? Taking Control: Non-surgical Treatment Options for Urinary Incontinence in Women What is UI? “Taking Control” (5- ... own home. Page 0 Page 2 What is urinary incontinence (UI)? Taking Control (5-minute video) Click on ...

  15. New Guidelines Recommend Inpatient Rehab After Stroke

    MedlinePlus

    ... nlm.nih.gov/medlineplus/news/fullstory_158656.html New Guidelines Recommend Inpatient Rehab After Stroke American Heart ... skilled nursing facility or nursing home, according to new guidelines by the American Heart Association/American Stroke ...

  16. Novel bulking agent for faecal incontinence

    PubMed Central

    Ratto, C; Parello, A; Donisi, L; Litta, F; De Simone, V; Spazzafumo, L; Giordano, P

    2011-01-01

    Background Various injectable bulking agents have been used for the treatment of faecal incontinence (FI). However, encouraging early results are not maintained over time. This study aimed to assess short- and medium-term results of a new bulking agent for the treatment of FI. Methods The Gatekeeper™ prosthesis comprises a thin solid polyacrylonitrile cylinder that becomes thicker, shorter and softer within 24 h after implantation. Fourteen patients with FI underwent treatment with Gatekeeper™ under local anaesthesia. Four prostheses were implanted in the intersphincteric space in each patient, under endoanal ultrasound guidance. Number of episodes of major FI, Cleveland Clinic FI score (CCFIS), Vaizey score, anorectal manometry, endoanal ultrasonography (EUS), health status and quality of life (Short Form 36 and Faecal Incontinence Quality of Life questionnaires) were assessed before and after treatment. Results Mean(s.d.) follow-up was 33·5(12·4) months. There were no complications. There was a significant decrease in major FI episodes from 7·1(7·4) per week at baseline to 1·4(4·0), 1·0(3·2) and 0·4(0·6) per week respectively at 1-month, 3-month and last follow-up (P = 0·002). CCFIS improved significantly from 12·7(3·3) to 4·1(3·0), 3·9(2·6) and 5·1(3·0) respectively (P < 0·001), and Vaizey score from 15·4(3·3) to 7·1(3·9), 4·7(3·0) and 6·9(5·0) respectively (P = 0·010). Soiling and ability to postpone defaecation improved significantly, and patients reported significant improvement in health status and quality of life. At follow-up, manometric parameters had not changed and EUS did not demonstrate any prosthesis dislocation. Conclusion The Gatekeeper™ anal implant seemed safe, reliable and effective. Initial clinical improvement was maintained over time, and follow-up data were encouraging. Copyright © 2011 British Journal of Surgery Society Ltd. Published by John Wiley & Sons, Ltd. PMID:21928378

  17. Pelvic Organ Prolapse Repair with and without Concomitant Burch Colposuspension in Incontinent Women: A Randomised Controlled Trial with at Least 5-Year Followup

    PubMed Central

    Costantini, Elisabetta; Lazzeri, Massimo; Bini, Vittorio; Del Zingaro, Michele; Frumenzio, Emanuela; Porena, Massimo

    2012-01-01

    The aim of this study was to reevaluate and update the followup of a previously published randomized controlled trial (RCT) on the impact of Burch Colposuspension (BC), as an anti-incontinence procedure, in patients with UI and POP, who underwent POP repair. Forty-seven women were randomly assigned to abdominal POP repair and concomitant BC (24 patients; group A) or POP repair alone without any anti-incontinence procedure (23 patients; group B). Median followup was 82 months (range 60–107); from over 47 patients, 30 reached 6-year followup. Two patients were lost at followup. In group A, 2 patients showed a stage I rectocele. In group B, 2 patients had a stage I rectocele and 1 a stage II rectocele. In group A, 13/23 (56.5%) were still incontinent after surgery compared with 9/22 patients (40.9%) in group B (P = 0.298). No significant changes were observed between the first and the current followup. The update of long-term followup confirmed that BC did not improve outcome significantly in incontinent women when they undergo POP repair. PMID:22028719

  18. Anticholinergic Therapy vs. OnabotulinumtoxinA for Urgency Urinary Incontinence

    PubMed Central

    Visco, Anthony G.; Brubaker, Linda; Richter, Holly E.; Nygaard, Ingrid; Paraiso, Marie Fidela R.; Menefee, Shawn A.; Schaffer, Joseph; Lowder, Jerry; Khandwala, Salil; Sirls, Larry; Spino, Cathie; Nolen, Tracy L.; Wallace, Dennis; Meikle, Susan F.

    2012-01-01

    BACKGROUND Anticholinergic medications and onabotulinumtoxinA are used to treat urgency urinary incontinence, but data directly comparing the two types of therapy are needed. METHODS We performed a double-blind, double-placebo–controlled, randomized trial involving women with idiopathic urgency urinary incontinence who had five or more episodes of urgency urinary incontinence per 3-day period, as recorded in a diary. For a 6-month period, participants were randomly assigned to daily oral anticholinergic medication (solifenacin, 5 mg initially, with possible escalation to 10 mg and, if necessary, subsequent switch to trospium XR, 60 mg) plus one intradetrusor injection of saline or one intradetrusor injection of 100 U of onabotulinumtoxinA plus daily oral placebo. The primary outcome was the reduction from baseline in mean episodes of urgency urinary incontinence per day over the 6-month period, as recorded in 3-day diaries submitted monthly. Secondary outcomes included complete resolution of urgency urinary incontinence, quality of life, use of catheters, and adverse events. RESULTS Of 249 women who underwent randomization, 247 were treated, and 241 had data available for the primary outcome analyses. The mean reduction in episodes of urgency urinary incontinence per day over the course of 6 months, from a baseline average of 5.0 per day, was 3.4 in the anticholinergic group and 3.3 in the onabotulinumtoxinA group (P = 0.81). Complete resolution of urgency urinary incontinence was reported by 13% and 27% of the women, respectively (P = 0.003). Quality of life improved in both groups, without significant between-group differences. The anticholinergic group had a higher rate of dry mouth (46% vs. 31%, P = 0.02) but lower rates of catheter use at 2 months (0% vs. 5%, P = 0.01) and urinary tract infections (13% vs. 33%, P<0.001). CONCLUSIONS Oral anticholinergic therapy and onabotulinumtoxinA by injection were associated with similar reductions in the frequency of

  19. Heart Failure Update: Inpatient Management.

    PubMed

    Korabathina, Ravi

    2016-03-01

    Acute decompensated heart failure (HF) is one of most common reasons for hospitalization among individuals older than 65 years. A thorough evaluation, including history, physical examination, and laboratory assessment, is required to optimize care of these patients. In uncertain cases, serum brain-type natriuretic peptide (BNP) or N-terminal proBNP level, stress testing, and/or invasive coronary angiography may be helpful in establishing the diagnosis. The hospital setting provides an opportunity to identify etiologies and stabilize the patient. The primary goal of inpatient HF therapy is systemic and pulmonary decongestion, achieved most effectively using intravenous diuretic therapy. Rate and rhythm control may be needed for patients with concurrent atrial fibrillation and, in American College of Cardiology/American Heart Association stage D HF, intravenous inotropes may become necessary. New pharmacologic or device therapies also are considered as a means of transitioning patients, especially those with severe disease, to the outpatient setting. Patients hospitalized for acute decompensated HF have high postdischarge mortality and rehospitalization rates and, thus, should be monitored carefully. PMID:26974002

  20. Endoanal ultrasonography in fecal incontinence: Current and future perspectives.

    PubMed

    Albuquerque, Andreia

    2015-06-10

    Fecal incontinence has a profound impact in a patient's life, impairing quality of life and carrying a substantial economic burden due to health costs. It is an underdiagnosed condition because many affected patients are reluctant to report it and also clinicians are usually not alert to it. Patient evaluation with a detailed clinical history and examination is very important to indicate the type of injury that is present. Endoanal ultrasonography is currently the gold standard for sphincter evaluation in fecal incontinence and is a simple, well-tolerated and non-expensive technique. Most studies revealed 100% sensitivity in identifying sphincter defect. It is better than endoanal magnetic resonance imaging for internal anal sphincter defects, equivalent for the diagnosis of external anal sphincter defects, but with a lower capacity for assessment of atrophy of this sphincter. The most common cause of fecal incontinence is anal sphincter injury related to obstetric trauma. Only a small percentage of women are diagnosed with sphincter tears immediately after vaginal delivery, but endoanal ultrasonography shows that one third of these women have occult sphincter defects. Furthermore, in patients submitted to primary repair of these tears, ultrasound revealed a high frequency of persistent sphincter defects after surgery. Three-dimensional endoanal ultrasonography is currently largely used and accepted for sphincter evaluation in fecal incontinence, improving diagnostic accuracy and our knowledge of physiologic and pathological sphincters alterations. Conversely, there is currently no evidence to support the use of elastography in fecal incontinence evaluation. PMID:26078826

  1. Endoanal ultrasonography in fecal incontinence: Current and future perspectives

    PubMed Central

    Albuquerque, Andreia

    2015-01-01

    Fecal incontinence has a profound impact in a patient’s life, impairing quality of life and carrying a substantial economic burden due to health costs. It is an underdiagnosed condition because many affected patients are reluctant to report it and also clinicians are usually not alert to it. Patient evaluation with a detailed clinical history and examination is very important to indicate the type of injury that is present. Endoanal ultrasonography is currently the gold standard for sphincter evaluation in fecal incontinence and is a simple, well-tolerated and non-expensive technique. Most studies revealed 100% sensitivity in identifying sphincter defect. It is better than endoanal magnetic resonance imaging for internal anal sphincter defects, equivalent for the diagnosis of external anal sphincter defects, but with a lower capacity for assessment of atrophy of this sphincter. The most common cause of fecal incontinence is anal sphincter injury related to obstetric trauma. Only a small percentage of women are diagnosed with sphincter tears immediately after vaginal delivery, but endoanal ultrasonography shows that one third of these women have occult sphincter defects. Furthermore, in patients submitted to primary repair of these tears, ultrasound revealed a high frequency of persistent sphincter defects after surgery. Three-dimensional endoanal ultrasonography is currently largely used and accepted for sphincter evaluation in fecal incontinence, improving diagnostic accuracy and our knowledge of physiologic and pathological sphincters alterations. Conversely, there is currently no evidence to support the use of elastography in fecal incontinence evaluation. PMID:26078826

  2. Anti-diuresis in the management of daytime urinary incontinence

    PubMed Central

    Robinson, D.; Cardozo, L.

    2009-01-01

    Urinary incontinence and lower urinary tract dysfunction, whilst not life threatening conditions, remain an important cause of morbidity in women and are responsible for significant impairment of quality of life. Drug therapy is often used to treat women who complain of urgency and urge incontinence and has an emerging role in the management of stress urinary incontinence. However, bothersome side effects are known to affect compliance and therefore compromise efficacy, making longterm drug therapy unpopular. The principle aim of this thesis is to assess the role of antidiuresis in women complaining of daytime urinary incontinence and also to examine its role as a ‘designer therapy’ which women can choose to use as, or when, required. In addition both the patients’ and clinicians’ attitudes towards treatment have been studied to clarify the meaning of ‘cure’, and to determine treatment acceptability, overall outcome and patient satisfaction. In the first study the patients’ concept of cure is explored as well as their expectations regarding treatment and outcome. The second study examines cure from the clinician’s perspective in addition to reviewing outcome measures in the clinical and research settings. Finally in the third study the use of desmopressin in women complaining of daytime urinary incontinence is reported. PMID:25478070

  3. Faecal incontinence: Current knowledges and perspectives

    PubMed Central

    Benezech, Alban; Bouvier, Michel; Vitton, Véronique

    2016-01-01

    Faecal incontinence (FI) is a disabling and frequent symptom since its prevalence can vary between 5% and 15% of the general population. It has a particular negative impact on quality of life. Many tools are currently available for the treatment of FI, from conservative measures to invasive surgical treatments. The conservative treatment may be dietetic measures, various pharmacological agents, anorectal rehabilitation, posterior tibial nerve stimulation, and transanal irrigation. If needed, patients may have miniinvasive approaches such as sacral nerve modulation or antegrade irrigation. In some cases, a surgical treatment is proposed, mainly external anal sphincter repair. Although these different therapeutic options are available, new techniques are arriving allowing new hopes for the patients. Moreover, most of them are non-invasive such as local application of an α1-adrenoceptor agonist, stem cell injections, rectal injection of botulinum toxin, acupuncture. New more invasive techniques with promising results are also coming such as anal magnetic sphincter and antropylorus transposition. This review reports the main current available treatments of FI and the developing therapeutics tools. PMID:26909229

  4. The Artificial Urinary Sphincter in the Management of Incontinence.

    PubMed

    Suarez, Oscar A; McCammon, Kurt A

    2016-06-01

    Despite the emergence of different devices in the treatment of postprostatectomy urinary incontinence, the AMS 800 (American Medical Systems, Minnetonka, MN) remains the gold standard for the treatment of stress urinary incontinence in men. We reviewed the current literature regarding the indications, surgical principles, outcomes, and complications of artificial urinary sphincter placement for stress urinary incontinence after prostatectomy. Despite all the available information, heterogeneous data, different success definitions, and the lack of high-quality prospective studies with long-term follow-up, it is difficult to compare outcomes between studies. In spite of these, the perineal implantation of a single cuff artificial urinary sphincter has withstood the test of time. PMID:26845050

  5. Pathophysiology of Overactive Bladder and Urge Urinary Incontinence

    PubMed Central

    Steers, William D

    2002-01-01

    Storage symptoms such as urgency, frequency, and nocturia, with or without urge incontinence, are characterized as overactive bladder (OAB). OAB can lead to urge incontinence. Disturbances in nerves, smooth muscle, and urothelium can cause this condition. In some respects the division between peripheral and central causes of OAB is artificial, but it remains a useful paradigm for appreciating the interactions between different tissues. Models have been developed to mimic the OAB associated with bladder instability, lower urinary tract obstruction, neuropathic disorders, diabetes, and interstitial cystitis. These models share the common features of increased connectivity and excitability of both detrusor smooth muscle and nerves. Increased excitability and connectivity of nerves involved in micturition rely on growth factors that orchestrate neural plasticity. Neurotransmitters, prostaglandins, and growth factors, such as nerve growth factor, provide mechanisms for bidirectional communication between muscle or urothelium and nerve, leading to OAB with or without urge incontinence. PMID:16986023

  6. Evaluation of a behavioral treatment for female urinary incontinence

    PubMed Central

    Santacreu, Marta; Fernández-Ballesteros, Rocío

    2011-01-01

    Urinary incontinence is a medical, psychological, social, economic, and hygienic problem. Although it is difficult to state its prevalence, all authors agree that it is related to age and gender. This study aimed to carry out a urinary incontinence behavioral treatment in order to reduce urine leakages in 14 participants recruited from a senior center. The program consists of daily training of the pelvic floor muscles with a weekly control by a supervisor during a 2-month period and follow-up of results 2 months after the last control session. Urinary incontinence episodes were reduced by 75.67% after program completion. It appears that pelvic floor muscles training, carried out under controlled and constant supervision, significantly reduces urinary leakage. Moreover, maintaining this improvement after treatment depends on the continuation of the exercises as well as on the urinary leakage frequency baseline and the urinary leakage frequency during the last treatment session. PMID:21753868

  7. Post-stroke emotional incontinence or bipolar disorder?

    PubMed Central

    Mnif, Leila; Sellami, Rim; Masmoudi, Jawaher

    2016-01-01

    Introduction Post-stroke emotional incontinence and bipolar disorder are two disorders that involve the dysfunction of brain structures responsible for emotional regulation. The objective of this work is to study the links between these disorders through a clinical case. Case report We present the case of a 43-year-old man without previous psychiatric history who experienced emotional incontinence after cerebrovascular events. He reacted promptly to selective serotonin reuptake inhibitor treatment. However, he experienced his first episode of hypomania after 6 months of antidepressant therapy. Adjunctive therapy with valproic acid and low-dose paroxetine was eventually added, resulting in complete improvement of both emotional incontinence and hypomania after 4 additional months of treatment. Conclusion The clinician should carefully explore any history of premorbid bipolar disorder, personality disorder characterized by mood instability, and family history of bipolar disorder. PMID:27536109

  8. Clinical challenges of preventing incontinence-associated dermatitis.

    PubMed

    Beeckman, Dimitri; Woodward, Sue; Rajpaul, Kumal; Vanderwee, Katrien

    Incontinence-associated dermatitis (IAD) is a common skin disorder in patients with faecal and/or urinary incontinence. The past decade has seen a huge growth in publications focusing on the complexity and inconsistency of the clinical observation of IAD and the differentiation between IAD and pressure ulcers. IAD and superficial pressure ulcers cause confusion in clinical practice when trying to determine the true nature and underlying pathology of the lesion. It is a daily challenge for health professionals in hospitals, nursing homes and community care to maintain a healthy skin in patients with incontinence. The aim of this article is to provide a brief update on recent developments regarding the differentiation between pressure ulcers and IAD and the prevention of IAD. Recommendations for clinical practice and research are provided. PMID:21841685

  9. Vaginal diaphragm rings in the treatment of stress urinary incontinence.

    PubMed

    Realini, J P; Walters, M D

    1990-01-01

    To assess the effectiveness of wearing vaginal diaphragm rings in the treatment of stress urinary incontinence, 10 women with genuine stress incontinence were studied. Patients underwent urodynamic evaluation and perineal pad testing before and after fitted diaphragm rings were in place. Patients kept symptom diaries for 1 week without the ring and then for 1 week with the ring. They also gave an overall subjective evaluation of their experience. Urodynamic findings were essentially unchanged by wearing diaphragm rings. Trends toward improvement were observed in the results of pad tests and symptom diaries. Four of the 10 women experienced clinically significant improvement in amount of urine lost during pad tests, number of leaks per week, and overall assessment of response. Vaginal diaphragm rings may be an effective treatment for some women with stress urinary incontinence. PMID:2333769

  10. Diagnostic evaluation of urinary incontinence in geriatric patients.

    PubMed

    Weiss, B D

    1998-06-01

    In most cases, the evaluation of urinary incontinence requires only a history, a physical examination, urinalysis and measurement of postvoid residual urine volume. The initial purposes of the evaluation are to identify conditions requiring referral or specialized work-up and to detect and treat reversible causes that may be present. If the patient does not appear to require referral and a reversible cause is not identified, the next step is to categorize the patient's symptoms as typical of either urge or stress incontinence and treat the patient accordingly. If treatment fails or a presumptive diagnosis of urge or stress incontinence cannot be reached, the final step would be to perform more sophisticated tests or refer the patient for testing to define the cause and determine the best treatment. PMID:9636332

  11. Stress incontinence and pelvic floor exercises in pregnancy.

    PubMed

    Sahakian, Josine

    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. PMID:23123811

  12. Update on the Management of Fecal Incontinence for the Gastroenterologist

    PubMed Central

    2016-01-01

    Many patients with fecal incontinence respond to conservative measures based upon a careful assessment and a multimodality approach that Is within the expertise of the practicing gastroenterologist. However, there Is a need for new and effective strategies when conservative therapy fails. This article reviews established therapies for fecal incontinence, such as biofeedback, as well as new therapies that have been approved by the US Food and Drug Administration (FDA), such as sacral neuromodulation and an injectable bulking agent. Also reviewed are some of the newer approaches that have not yet been approved by the FDA or that have uncertain efficacy. PMID:27231444

  13. Update on the Management of Fecal Incontinence for the Gastroenterologist.

    PubMed

    Wald, Arnold

    2016-03-01

    Many patients with fecal incontinence respond to conservative measures based upon a careful assessment and a multimodality approach that Is within the expertise of the practicing gastroenterologist. However, there Is a need for new and effective strategies when conservative therapy fails. This article reviews established therapies for fecal incontinence, such as biofeedback, as well as new therapies that have been approved by the US Food and Drug Administration (FDA), such as sacral neuromodulation and an injectable bulking agent. Also reviewed are some of the newer approaches that have not yet been approved by the FDA or that have uncertain efficacy. PMID:27231444

  14. Prevention and management of incontinence-associated dermatitis.

    PubMed

    Nix, Denise; Haugen, Vicki

    2010-06-01

    Perineal dermatitis, recently relabelled 'incontinence-associated dermatitis' (IAD), is an inflammation of the skin that occurs when urine and/or stool comes into contact with the skin. It can range in severity from erythema with or without loss of skin integrity to infection. IAD affects as many as 41% of adults in long-term care; it is costly, painful and, for the most part, preventable. An effective plan of care for individuals with IAD must include assessment and management of incontinence aetiology, perineal skin and risk assessment, gentle cleansing and moisturization, application of skin barriers and treatment of secondary infection, and the use of containment devices if indicated. PMID:20524708

  15. Non-surgical management of urinary incontinence in children.

    PubMed

    Duel, Barry

    2009-01-01

    Urinary incontinence and neurogenic bladder are common in children, and can be difficult to treat. This themed issue includes contributions by experts in the management of these disorders. Dr. John Kryger discusses the nonsurgical management of neurogenic bladder in children with spina bifida. Drs. Lori Dyer and Israel Franco summarize the literature and their experience with the use of botulinum toxin in neurogenic and non-neurogenic incontinence in children. Dr. Paul Austin summarizes the use of alpha-adrenergic blockers. These drugs are primarily used to treat bladder outlet obstruction due to prostatic hyperplasia, but show great promise in the treatment of dysfunctional voiding in children. PMID:19936567

  16. [Duloxetine. A new preparation for patients with urinary incontinence].

    PubMed

    Walter, Steen

    2005-11-28

    Stress Urinary Incontinence is a common symptom among women. The urethral closure is insufficient. Pelvic floor exercise can minish the symptoms, but many women need an operation. Duloxetine, a new drug, is believed to strengthen the contraction of the external urethral sphincter through central neuromodulation, resulting in enhanced urethral closure during the urine storage phase. In controlled studies a significant effect are found in women suffer from Stress Urinary Incontinence. Discontinuate rates for adverse events were high especially nausea and fatigue. The adverse event deminish after 4 weeks. PMID:16324435

  17. Pregnancy and postpartum bowel changes: constipation and fecal incontinence.

    PubMed

    Shin, Grace Hewon; Toto, Erin Lucinda; Schey, Ron

    2015-04-01

    Pregnancy and the postpartum period are often associated with many gastrointestinal complaints, including nausea, vomiting, and heartburn; however, the most troublesome complaints in some women are defecatory disorders such as constipation and fecal incontinence, especially postpartum. These disorders are often multifactorial in etiology, and many studies have looked to see what risk factors lead to these complications. This review discusses the current knowledge of pelvic floor and anorectal physiology, especially during pregnancy, and reviews the current literature on causes and treatments of postpartum bowel symptoms of constipation and fecal incontinence. PMID:25803402

  18. Hospital Organization and Importance of an Interventional Radiology Inpatient Admitting Service: Italian Single-Center 3-Year Experience

    SciTech Connect

    Simonetti, Giovanni; Bollero, Enrico; Ciarrapico, Anna Micaela; Gandini, Roberto; Konda, Daniel Bartolucci, Alberto; Di Primio, Massimiliano; Mammucari, Matteo; Chiocchi, Marcello; D'Alba, Fabrizio; Masala, Salvatore

    2009-03-15

    In June 2005 a Complex Operating Unit of Interventional Radiology (COUIR), consisting of an outpatient visit service, an inpatient admitting service with four beds, and a day-hospital service with four beds was installed at our department. Between June 2005 and May 2008, 1772 and 861 well-screened elective patients were admitted to the inpatient ward of the COUIR and to the Internal Medicine Unit (IMU) or Surgery Unit (SU) of our hospital, respectively, and treated with IR procedures. For elective patients admitted to the COUIR's inpatient ward, hospital stays were significantly shorter and differences between reimbursements and costs were significantly higher for almost all IR procedures compared to those for patients admitted to the IMU and SU (Student's t-test for unpaired data, p < 0.05). The results of the 3-year activity show that the activation of a COUIR with an inpatient admitting service, and the better organization of the patient pathway that came with it, evidenced more efficient use of resources, with the possibility for the hospital to save money and obtain positive margins (differences between reimbursements and costs). During 3 years of activity, the inpatient admitting service of our COUIR yielded a positive difference between reimbursements and effective costs of Euro 1,009,095.35. The creation of an inpatient IR service and the admission of well-screened elective patients allowed short hospitalization times, reduction of waiting lists, and a positive economic outcome.

  19. Concomitant repair of stress urinary incontinence with proximal urethrovaginal fistula: Our experience

    PubMed Central

    Chodisetti, Subbarao; Boddepalli, Yogesh; Kota, Malakonda Reddy

    2016-01-01

    Introduction: Proximal urethrovaginal fistula (UVF) located close to the bladder neck may cause extensive sphincter damage and is usually associated with continuous incontinence, which may mask the associated stress urinary incontinence (SUI). Simultaneous correction of SUI avoids a second surgery for SUI, which needs dissection in ischemic fields and carries a high risk of failure. The aim of this study is to describe our technique of concomitant repair of SUI with proximal UVF and our results. Methods: Between July 2010 and August 2014, 14 patients underwent UVF repair in Jackknife position by the interposition of a Martius flap and simultaneous correction of SUI by modified McGuire pubovaginal autologous fascial sling. The procedure was carried out a minimum of 3 months of presentation and after detailed preoperative evaluation. Results: After a mean follow-up of 28 months, all 14 patients were continent. None of the patients developed recurrence of the UVF. Two patients presented with retention immediately after catheter removal and clean intermittent catheterization training was given to both of them. Two patients became pregnant during the follow-up period and were advised cesarean section near term. Conclusions: Repair of proximal UVF and correction of SUI can be performed in the same session to avoid the operation in an ischemic field. PMID:27555683

  20. Minimally invasive treatment for female stress urinary incontinence – Romanian highlights

    PubMed Central

    Surcel, C; Chibelean, C; Iordache, A; Mirvald, C; Gîngu, C; Margaritis, S; Stoica, R; Codoiu, C; Savu, C; Marksteiner, R; Sinescu, I

    2011-01-01

    Rationale: Stress urinary incontinence is still a "battlefield" for many minimally invasive therapies, but, unfortunately, few can restore the anatomical and functional background of this disorder. Objective: Assessing the latest minimally invasive procedures of intra and perisphincterian injection of autologous stem cells. Method and Result: The first stem cell implantation (myoblasts and /or mature fibroblasts grown and multiplied in the laboratory from biopsy samples taken from the pectoralis muscle) in the urethral sphincter was performed on October 18, 2010, in “Fundeni” Clinic of Urology and Renal Transplantation, in Romania. Discussion: The follow-up at six weeks with the quality of life questionnaires, micturition diary and clinical examination revealed a decrease of urine loss from six pads/ day at one per day, which significantly improved the patient’s quality of life according to visual analogue scale. Clinical and urodynamic evaluations will continue and will be future scientific topics. Abbreviations: SUI = stress urinary incontinence; TVT = tension free vaginal tape; TVT-O = tension free vaginal tape obturator; QoL = quality of life PMID:22514562

  1. The artificial bowel sphincter for faecal incontinence: a single centre study

    PubMed Central

    Melenhorst, Jarno; Koch, Sacha M.; van Gemert, Wim G.

    2007-01-01

    Background and aims Faecal incontinence (FI) is a socially devastating problem. The treatment algorithm depends on the aetiology of the problem. Large anal sphincter defects can be treated by sphincter replacement procedures: the dynamic graciloplasty and the artificial bowel sphincter (ABS). Materials and methods Patients were included between 1997 and 2006. A full preoperative workup was mandatory for all patients. During the follow-up, the Williams incontinence score was used to classify the symptoms, and anal manometry was performed. Results Thirty-four patients (25 women) were included, of which, 33 patients received an ABS. The mean follow-up was 17.4 (0.8–106.3) months. The Williams score improved significantly after placement of the ABS (p < 0.0001). The postoperative anal resting pressure with an empty cuff was not altered (p = 0.89). The postoperative ABS pressure was significantly higher then the baseline squeeze pressure (p = 0.003). Seven patients had an infection necessitating explantation. One patient was successfully reimplanted. Conclusion The artificial bowel sphincter is an effective treatment for FI in patients with a large anal sphincter defect. Infectious complications are the largest threat necessitating explantation of the device. PMID:17929038

  2. Diagnosis and office-based treatment of urinary incontinence in adults. Part two: treatment

    PubMed Central

    Jimbo, Masahito; Heidelbaugh, Joel J.

    2013-01-01

    Urinary incontinence is a common problem in both men and women. In this review article we address treatment of the various forms of incontinence with conservative treatments, medical therapy, devices and surgery. The US Preventive Services Task Force, The Cochrane Database of Systematic Reviews, and PubMed were reviewed for articles focusing on urinary incontinence. Conservative therapy with education, fluid and food management, weight loss, timed voiding and pelvic floor physical therapy are all simple office-based treatments for incontinence. Medical therapy for incontinence currently is only available for urgency incontinence in the form of anticholinergic medication. Condom catheters, penile clamps, urethral inserts and pessaries can be helpful in specific situations. Surgical therapies vary depending on the type of incontinence, but are typically offered if conservative measures fail. PMID:23904858

  3. [Urinary incontinence - what can be done by the family doctor and when is the urologist needed?].

    PubMed

    Keller, Isabelle Sonja; Brachlow, Jan Frederic; Padevit, Christian; Kurz, Michael; John, Hubert

    2014-10-01

    About 15% of the women and 10% of the men past the age of 65 years suffer from urinary incontinence. In most cases, accurate history taking can help differentiate between urge incontinence, stress incontinence and overflow incontinence, and is essential in choosing the appropriate treatment. Initial diagnostic testing can be conducted by the general practitioner, especially tests to exclude urinary tract infections or to rule out an overactive bladder. Patient education on changes to fluid intake and voiding habits as well as advice on suitable incontinence products are important first steps in the management of urinary continence. Also, drug treatment can be initiated in general practice. Patients with refractory urinary incontinence, particularly those who did not respond to anticholinergic medication, should be referred to a urologist for further evaluation since there may be an underlying tumour or other disorder of the bladder that is causing the incontinence. PMID:25270747

  4. [Translabial ultrasonography in pelvic floor prolapse and urinary incontinence diagnostics].

    PubMed

    Pietrus, Miłosz; Pityński, Kazimierz; Bałajewicz-Nowak, Marta; Wiecheć, Marcin; Knafel, Anna; Ludwin, Artur; Dziechciowski, Marek; Nocuń, Agnieszka

    2012-09-01

    increasingly frequent in the surgical treatment of pelvic organs prolapse. The remedial kits currently in use are not visible in classic X-ray examinations and CT however, they can be easily visualized by means of a sonographic test. This way it is possible to locate the positioned tapes or meshes and to establish their orientation towards the urethra, the bladder and the anus. It is also possible to observe the complications (e.g. hematomas) following the surgical procedures via the transvaginal access. Transperineal sonography is a relatively inexpensive method that may be performed in almost every ultrasonographic laboratory Its value, approaching the MRI diagnostic value in the assessment of the pelvic floor defects and its low cost, place ultrasonography on the first place among the methods of imaging the pelvic and uro-genital diaphragm. The results of diagnostics of pelvic organs prolapse obtained by placing the sonographic head on the patient's perineum may also help in establishing the changes of the support apparatus for the uterus and the vagina, bladder urethra and perineum during functional testing and, thus, to verify the clinically established degree of the prolapse. It seems, also, that this method may be used during peri-urethral injections of specific substances and post-application follow-up, an increasingly frequently employed method of urinary incontinence treatment. PMID:23342899

  5. Outpatient versus inpatient uterine polyp treatment for abnormal uterine bleeding: randomised controlled non-inferiority study

    PubMed Central

    Cooper, Natalie A M; Middleton, Lee; Diwakar, Lavanya; Smith, Paul; Denny, Elaine; Roberts, Tracy; Stobert, Lynda; Jowett, Susan; Daniels, Jane

    2015-01-01

    Objective To compare the effectiveness and acceptability of outpatient polypectomy with inpatient polypectomy. Design Pragmatic multicentre randomised controlled non-inferiority study. Setting Outpatient hysteroscopy clinics in 31 UK National Health Service hospitals. Participants 507 women who attended as outpatients for diagnostic hysteroscopy because of abnormal uterine bleeding and were found to have uterine polyps. Interventions Participants were randomly assigned to either outpatient uterine polypectomy under local anaesthetic or inpatient uterine polypectomy under general anaesthesia. Data were collected on women’s self reported bleeding symptoms at baseline and at 6, 12, and 24 months. Data were also collected on pain and acceptability of the procedure at the time of polypectomy. Main outcome measures The primary outcome was successful treatment, determined by the women’s assessment of bleeding at six months, with a prespecified non-inferiority margin of 25%. Secondary outcomes included generic (EQ-5D) and disease specific (menorrhagia multi-attribute scale) quality of life, and feasibility and acceptability of the procedure. Results 73% (166/228) of women in the outpatient group and 80% (168/211) in the inpatient group reported successful treatment at six months (intention to treat relative risk 0.91, 95% confidence interval 0.82 to 1.02; per protocol relative risk 0.92, 0.82 to 1.02). Failure to remove polyps was higher (19% v 7%; relative risk 2.5, 1.5 to 4.1) and acceptability of the procedure was lower (83% v 92%; 0.90, 0.84 to 0.97) in the outpatient group Quality of life did not differ significantly between the groups. Four uterine perforations, one of which necessitated bowel resection, all occurred in the inpatient group. Conclusions Outpatient polypectomy was non-inferior to inpatient polypectomy. Failure to remove a uterine polyp was, however, more likely with outpatient polypectomy and acceptability of the procedure was slightly lower. Trial

  6. Prevalence and risk factors of urinary incontinence in Indian women: A hospital-based survey

    PubMed Central

    Singh, Uma; Agarwal, Pragati; Verma, Manju Lata; Dalela, Diwakar; Singh, Nisha; Shankhwar, Pushplata

    2013-01-01

    Background and Objectives: Urinary incontinence is a problem that creates both physical and psychological nuisance to a woman. This problem needs to be studied in detail in Indian population because of lack of precise data. The objectives of this study were to study the prevalence and risk factors of urinary incontinence in Indian women. Materials and Methods: This hospital-based cross-sectional study conducted from August 2005 to June 2007 included women attending gynecology OPD (consulters) and hospital employees (nonconsulters). Subjects who were incontinent were asked a standard set of questions. Incontinence was classified as urge, stress, or mixed based on symptoms. A univariate followed by multivariate analysis was done to look for risk factors. Results: Of 3000 women enrolled, 21.8% (656/3000) women were incontinent. There was no significant difference in incontinence rate between consulters and nonconsulters [618/2804 (22.1%) vs. 38/196 (19.4%); P value = 0.6). Of the total women having incontinence, highest numbers were found to have stress incontinence [73.8% (484/656)] followed by mixed [16.8% (110/656)] and urge incontinence [9.5% (62/656)]. Age more than 40 years; multiparity; postmenopausal status; body mass index more than 25; history of diabetes and asthma; and habit of taking tea, tobacco, pan, and betel are risk factors found to be associated with increased prevalence of urinary incontinence in univariate analysis. On multivariate analysis, age more than 40 years, multiparity, vaginal delivery, hysterectomy, menopause, tea and tobacco intake, and asthma were found to be significantly associated with overall incontinence. Stress incontinence was separately not associated with menopause. Urge incontinence was not associated with vaginal delivery. Conclusion: Urinary incontinence is a bothersome problem for women. Simple questionnaire can help to detect this problem and diagnose associated risk factors, so that necessary steps can be taken in its

  7. An Update on Inpatient Hypertension Management.

    PubMed

    Axon, R Neal; Turner, Mason; Buckley, Ryan

    2015-11-01

    Hypertension is highly prevalent affecting nearly one third of the US adult population. Though generally approached as an outpatient disorder, elevated blood pressure is observed in a majority of hospitalized patients. The spectrum of hypertensive disease ranges from patients with hypertensive emergency including markedly elevated blood pressure and associated end-organ damage to asymptomatic patients with minimally elevated pressures of unclear significance. It is important to note that current evidence-based hypertension guidelines do not specifically address inpatient hypertension. This narrative review focuses primarily on best practices for diagnosing and managing nonemergent hypertension in the inpatient setting. We describe examples of common hypertensive syndromes, provide suggestions for optimal post-acute management, and point to evidence-based or consensus guidelines where available. In addition, we describe a practical approach to managing asymptomatic elevated blood pressure observed in the inpatient setting. Finally, arranging effective care transitions to ensure optimal ongoing hypertension management is appropriate in all cases. PMID:26362300

  8. Confusion ahead as CMS changes inpatient criteria.

    PubMed

    2013-10-01

    In the Inpatient Prospective Payment System final rule for 2014, the Centers for Medicare & Medicaid Services established a benchmark of two midnights for an inpatient admission and issued robust requirements for documentation. Case managers must work closely with physicians to ensure that the documentation includes the expected length of stay, the rationale for hospital treatment, the treatment plan, and a written order for admission. Case managers must review every admission within 24 hours to make sure the hospital doesn't lose reimbursement. Auditors will be looking for incidents where hospitals keep patients over two midnights when it's not medically necessary in order to get inpatient reimbursement. CMS continues to emphasize quality in care. PMID:24195133

  9. The development of national quality performance standards for disposable absorbent products for adult incontinence.

    PubMed

    Muller, Nancy; McInnis, Elaine

    2013-09-01

    Disposable absorbent products are widely used in inpatient care settings and in the community to manage adult urinary and fecal incontinence, but few product standards exist to help guide their production or optimal use. Increasing costs and reduced revenues have caused a number of states to evaluate absorbent product use among persons who receive care at home with the assistance of the Medicaid Waiver Program, further increasing concerns about the lack of product performance standards. To address these issues, the National Association For Continence (NAFC) formed a council of experts and key stakeholders with the objective of establishing national, independent quality performance standards for disposable absorbent products provided by states to Waiver Program recipients. The Council consisted of representatives from five purposefully selected states, technical directors from six nonwoven product manufacturers, an officer of the nonwoven manufactures trade association, a delegate from an academic nursing program and professional societies, a family caregiver, and a patient representative. Following a consensus method and guidelines for use, nine specific recommendations were developed, posted for public comment, and further refined. Final recommendations for product performance assessment include: rewet rate (a measure of a product's ability to withstand multiple incontinent episodes between changes), rate of acquisition (a measure of the speed at which urine is drawn away from the skin by a product, product retention capacity (a measure of a product's capacity to hold fluid without rewetting the skin), sizing options, absorbency levels, product safety, closure technology, breathable zones (a measure of the air permeability across a textile-like fabric at a controlled differential pressure), and elasticity. The Council also set values for and recommended four quantifiable parameters, and the testing methodology associated with each, to help consumers and states

  10. Rural and Urban Hospitals' Role in Providing Inpatient Care, 2010

    MedlinePlus

    ... CDC/NCHS, National Hospital Discharge Survey, 2010. How did rural hospital inpatients differ from urban hospital inpatients ... CDC/NCHS, National Hospital Discharge Survey, 2010. How did patients' first-listed diagnoses differ in rural and ...

  11. Severe rectal haemorrhage after treatment for faecal incontinence

    PubMed Central

    Taggarshe, Deepa; Visco, Jeffrey J.

    2014-01-01

    Bulking agent injected submucosally is an alternative effective treatment for faecal incontinence in elderly patients who fail conservative measures. Since most elderly patients are on antiplatelet therapy and are sometimes unaware of their medication, this can lead to serious complications. PMID:25180215

  12. Management of faecal incontinence in graft-versus-host disease.

    PubMed

    Woodward, Sue

    Graft-versus-host disease (GvHD), a common yet serious complication of allogeneic haemopoietic stem cell transplantation, can cause significant morbidity and negatively impact on patients' quality of life. The gastrointestinal tract is frequently affected resulting in nausea and vomiting, abdominal pain and profuse diarrhoea (Washington and Jagasia, 2009) which can be both distressing and humiliating for patients. The volume of watery, green diarrhoea produced can be greater than 2 litres per day (Ferrara et al, 2009) and is one indicator of the severity of GvHD. It may, in some cases, lead to faecal incontinence. Management of GvHD-associated diarrhoea involves the use of high-dose steroids to control the exaggerated immune response, anti-diarrhoeal medication, management of fluid and electrolytes, and nutritional management. It may also require management of faecal incontinence and prevention of incontinence-associated dermatitis. This paper describes the pathology of GvHD, the management of GvHD-associated diarrhoea and faecal incontinence and discusses the potential use of a faecal management system inappropriately selected individuals with uncontrolled diarrhoea and limited mobility. PMID:22306636

  13. Electrokinetic profiles of nonowoven cotton for absorbent incontinence material

    Technology Transfer Automated Retrieval System (TEKTRAN)

    This paper discusses recent work on cotton/synthetic nonwovens, their electrokinetic analysis, and their potential use in incontinence materials. Electrokinetic analysis is useful in exploring fiber surface polarity properties, and it is a useful tool to render a snap shot of the role of fiber char...

  14. Quality of life in women with urinary incontinence.

    PubMed

    Senra, Cláudia; Pereira, M Graça

    2015-01-01

    The aim of this study is to examine the relationship among psychological, clinical and sociodemographic variables, and quality of life in women with urinary incontinence. The sample consisted of 80 women diagnosed with urinary incontinence (UI) followed in a Northern Central Hospital in Portugal. Participants answered the Incontinence Quality of Life (I-QOL); Satisfaction with Sexual Relationship Questionnaire (SSRQ); Hospital Anxiety and Depression Scales (HADS) and the Brief Cope. The results revealed that women with higher quality of life considered their symptoms of urine loss as mild or moderated compared to those with severe urine loss. The less severe urine loss was associated with greater sexual satisfaction and less use of religion and self-blame as coping strategies. In terms of coping, women who considered the loss of urine as severe expressed more feelings regarding UI. Stress urinary incontinence, high sexual satisfaction, and less use of denial, distraction, and religion as coping strategies, predicted higher quality of life. According to the results, UI has an impact on women's sexual satisfaction and quality of life. Therefore, intervention programs should target these women, including their partners, helping them to adjust to their condition and teaching effective coping strategies in order to improve their sexual satisfaction and quality of life. PMID:26107369

  15. Fecal Incontinence and Pelvic Floor Dysfunction in Women: A Review.

    PubMed

    Freeman, Alison; Menees, Stacy

    2016-06-01

    Pelvic floor dysfunction and fecal incontinence is a common and debilitating condition in women, particularly as women age, and often goes under-reported to health care providers. It is important for providers to ask patients about possible symptoms. An algorithm for evaluation and treatment is presented. Current and future therapies are described and discussed. PMID:27261895

  16. Urinary incontinence, pelvic floor dysfunction, exercise and sport.

    PubMed

    Bø, Kari

    2004-01-01

    Urinary incontinence is defined as "the complaint of any involuntary leakage of urine" and is a common problem in the female population with prevalence rates varying between 10% and 55% in 15- to 64-year-old women. The most frequent form of urinary incontinence in women is stress urinary incontinence, defined as "involuntary leakage on effort or exertion, or on sneezing or coughing". The aim of this article is to systematically review the literature on urinary incontinence and participation in sport and fitness activities with a special emphasis on prevalence and treatment in female elite athletes. Stress urinary incontinence is a barrier to women's participation in sport and fitness activities and, therefore, it may be a threat to women's health, self-esteem and well-being. The prevalence during sports among young, nulliparous elite athletes varies between 0% (golf) and 80% (trampolinists). The highest prevalence is found in sports involving high impact activities such as gymnastics, track and field, and some ball games. A 'stiff' and strong pelvic floor positioned at an optimal level inside the pelvis may be a crucial factor in counteracting the increases in abdominal pressure occurring during high-impact activities. There are no randomised controlled trials or reports on the effect of any treatment for stress urinary incontinence in female elite athletes. However, strength training of the pelvic floor muscles has been shown to be effective in treating stress urinary incontinence in parous females in the general population. In randomised controlled trials, reported cure rates, defined as <2g of leakage on pad tests, varied between 44% and 69%. Pelvic floor muscle training has no serious adverse effects and has been recommended as first-line treatment in the general population. Use of preventive devices such as vaginal tampons or pessaries can prevent leakage during high impact physical activity. The pelvic floor muscles need to be much stronger in elite athletes

  17. Guideline-Based Strategies in the Surgical Treatment of Female Urinary Incontinence: The New Gold Standard is Almost the Same as the Old One

    PubMed Central

    Viereck, V.; Bader, W.; Lobodasch, K.; Pauli, F.; Bentler, R.; Kölbl, H.

    2016-01-01

    The modern sling procedures for treating female stress urinary incontinence encompass numerous methods, materials and manufacturers. On the basis of the current S2e guidelines, the methods used most frequently in the diagnosis of and therapy for stress urinary incontinence in women are critically illustrated. An individualised procedure is necessary for the choice of the surgical method, especially in the presence of accompanying pathologies. This article is intended to help the treating physician to carry out quality-assured diagnostics and therapy for the patient and to offer the best possible urogynaecological management. In addition to the complications and chances of success of the surgical options, the legal aspects of therapy planning are also taken into consideration. PMID:27570251

  18. Beyond incontinence: The stigma of other urinary symptoms

    PubMed Central

    Elstad, Emily A.; Taubenberger, Simone P.; Botelho, Elizabeth M.; Tennstedt, Sharon L.

    2010-01-01

    Aim This paper is a report of a study conducted to characterize the stigma of urinary frequency and urgency and differentiate it from the stigma of incontinence and to describe race/ethnic and gender differences in the experience of stigma among a diverse sample of individuals. Background Lower urinary tract symptoms, including frequency, urgency and incontinence, are susceptible to stigma, but previous stigma research has focused almost exclusively on incontinence. Method The Boston Area Community Health Survey is a population-based, random sample epidemiological survey of urologic symptoms (N=5503). Qualitative data for this study came from in-depth interviews conducted between 2007 and 2008 with a random subsample of 151 black, white and Hispanic men and women with urinary symptoms. Findings Respondents reported stigma associated with frequency and urgency – not just incontinence. The stigma of frequency/urgency is rooted in social interruption, loss of control of the body, and speculation as to the nature of a non-specific “problem.” Overall, the stigma of urinary symptoms hinged upon whether or not the problem was “perceptible.” Men felt stigmatized for making frequent trips to the bathroom and feared being seen as impotent. Women feared having an unclean body or compromised social identity. Hispanic people in particular voiced a desire to keep their urinary symptoms a secret. Conclusion The stigma of urinary symptoms goes beyond incontinence to include behaviors associated with frequency and urgency. Healthcare practitioners should assess for stigma sequelae (e.g. anxiety, depression) in individuals with frequency and urgency, and stress treatment options to circumvent stigmatization. PMID:20735505

  19. 42 CFR 409.83 - Inpatient hospital coinsurance.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... 42 Public Health 2 2010-10-01 2010-10-01 false Inpatient hospital coinsurance. 409.83 Section 409... MEDICARE PROGRAM HOSPITAL INSURANCE BENEFITS Hospital Insurance Deductibles and Coinsurance § 409.83 Inpatient hospital coinsurance. (a) General provisions—(1) Inpatient hospital coinsurance is the...

  20. 42 CFR 409.82 - Inpatient hospital deductible.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... 42 Public Health 2 2010-10-01 2010-10-01 false Inpatient hospital deductible. 409.82 Section 409... MEDICARE PROGRAM HOSPITAL INSURANCE BENEFITS Hospital Insurance Deductibles and Coinsurance § 409.82 Inpatient hospital deductible. (a) General provisions—(1) The inpatient hospital deductible is a...

  1. 42 CFR 441.12 - Inpatient hospital tests.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... 42 Public Health 4 2010-10-01 2010-10-01 false Inpatient hospital tests. 441.12 Section 441.12... General Provisions § 441.12 Inpatient hospital tests. Except in an emergency situation (see § 440.170(e)(1) of this chapter for definition), FFP is not available in expenditures for inpatient hospital...

  2. Racial and Ethnic Disparities in Time to Cure of Incontinence Present at Nursing Home Admission

    PubMed Central

    Bliss, Donna Z.; Gurvich, Olga; Savik, Kay; Eberly, Lynn E.; Harms, Susan; Wyman, Jean F.

    2015-01-01

    As many as half of older people that are admitted to nursing homes (NHs) are incontinent of urine and/or feces. Not much is known about the rate of cure of incontinence present at NH admission, but available reports suggest the rate is low. There have been racial and ethnic disparities in incontinence treatment, but the role of disparities in the cure of incontinence is understudied. Using the Peters-Belson method and multilevel predictors, our findings showed that there were disparities in the time to cure of incontinence for Hispanic NH admissions. A significantly smaller proportion of older Hispanic admissions were observed to have their incontinence cured and cured later than expected had they been White. Reducing disparities in incontinence cure will improve health outcomes of Hispanic NH admissions. Significant predictors in our model suggest strategies to reduce the disparity including attention to managing fecal incontinence and incontinence in those with cognitive impairment, improving residents’ functional status, and increasing resources to NHs admitting older Hispanics with incontinence to develop innovative and cost effective ways to provide equitable quality care. PMID:26295010

  3. Stress Urinary Incontinence in Women with a History of Gestational Diabetes Mellitus

    PubMed Central

    McEwen, Laura N.; Sarma, Aruna V.; Piette, John D.; Herman, William H.

    2008-01-01

    Abstract Objective Stress urinary incontinence may serve as a barrier to lifestyle modification among women at high risk for diabetes, but the prevalence of stress urinary incontinence among women with histories of gestational diabetes mellitus (hGDM) is unknown. The purpose of this study was to examine the prevalence of stress incontinence among women with hGDM and to examine its association with their current physical activity. Methods We surveyed women with hGDM within the past 5 years who were currently enrolled in a managed care plan (n = 228). In a cross-sectional analysis, self-reported weekly or more frequent stress incontinence was the primary independent variable and measures of physical activity and body mass index (BMI) were the outcomes of interest. We constructed multivariable models that adjusted for participant characteristics associated with the measure of incontinence or outcomes in bivariate analyses. Results Of the 228 women with hGDM, 49% reported weekly or more frequent incontinence during pregnancy, and 28% reported that incontinence affected their activities during pregnancy. Fifty percent reported weekly or more frequent incontinence after delivery, with 27% reporting interference of incontinence with activity. Less than a third of women reported optimal physical activity, and 42% were obese. After adjustment for characteristics associated with measures of activity and incontinence, there was minimal association between levels of activity and stress urinary incontinence; similarly, there was no association between BMI and measures of stress incontinence. Conclusions Stress urinary incontinence is common among women with hGDM but does not appear to be associated with physical activity levels or BMI. PMID:18537481

  4. Dynamic versus Adynamic Graciloplasty in Treatment of End-Stage Fecal Incontinence: Is the Implantation of the Pacemaker Really Necessary? 12-Month Follow-Up in a Clinical, Physiological, and Functional Study

    PubMed Central

    Walega, Piotr; Romaniszyn, Michal; Siarkiewicz, Benita; Zelazny, Dorota

    2015-01-01

    Purpose. The aim of the study is to compare functional results of end-stage fecal incontinence treatment with dynamic graciloplasty and adynamic graciloplasty augmented with transanal conditioning of the transposed muscle. Methods. A total of 20 patients were qualified for graciloplasty procedure due to end-stage fecal incontinence. 7 patients underwent dynamic graciloplasty (DGP), whereas 13 patients were treated with adynamic graciloplasty, with transanal stimulation in the postoperative period (AGP). Clinical, functional, and quality of life assessments were performed 3, 6, and 12 months after the procedures. Results. There were no intraoperative or early postoperative complications. The detachment of gracilis muscle tendon was observed in one patient in DGP group and two in AGP group. There was a significant improvement of Fecal Incontinence Quality of Life (FIQL) and Fecal Incontinence Severity Index (FISI) scores in both groups 12 months after procedure. Anorectal manometry showed improvement regarding basal and squeeze pressures in both groups, with significantly better squeeze pressures in AGP group. Conclusions. The functional effects in the DGP and AGP groups were similar. Significantly lower price of the procedure and avoidance of implant-related complication risk suggest the attractiveness of the AGP method augmented by transanal stimulation. PMID:25861261

  5. Detecting Depression in Elderly Medical Inpatients.

    ERIC Educational Resources Information Center

    Rapp, Stephen R.; And Others

    1988-01-01

    Used Research Diagnostic Criteria to assess base rate of detection of depression in 150 elderly medical inpatients by nonpsychiatric physicians, and evaluated psychometric properties of screening instruments to assess depression. Found detection of depression by house staff extremely low (8.7 percent). Beck Depression Inventory (BDI), BDI…

  6. Depression in Geriatric and Adult Medical Inpatients.

    ERIC Educational Resources Information Center

    Magni, Guido; And Others

    1985-01-01

    Administered two scales for the evaluation of depression to two groups of medical inpatients: adults (N=201) and geriatric subjects (N=178). Results confirmed a high presence of depressive symptoms among patients with medical problems, particularly among geriatric subjects. Factors most predictive of depressive symptoms are identified. (JAC)

  7. The Impact of Central Obesity on Storage Luts and Urinary Incontinence After Prostatic Surgery.

    PubMed

    Gacci, Mauro; Sebastianelli, Arcangelo; Salvi, Matteo; De Nunzio, Cosimo; Tubaro, Andrea; Gravas, Stavros; Moncada, Ignacio; Serni, Sergio; Maggi, Mario; Vignozzi, Linda

    2016-09-01

    In the developed and developing countries, the overall prevalence of central obesity in the elderly men is growing. In addition, the progressive aging of male population increased the possibilities of coexisting morbidities associated with obesity such as lower urinary tract symptoms (LUTS) due to benign prostatic enlargement (BPE) or to prostate cancer (PCa) needing primary treatment, including radical prostatectomy (RP), which can further adversely affect the quality of life. Simple and radical prostatectomy are the most common surgical procedures in urologic unit all over the world for BPE and PCa, respectively. After both interventions, patients can present bothering storage LUTS that can worsen all the other clinical outcomes. Preset study will review the role of central obesity as a risk factor for storage LUTS or urinary incontinence, after prostatic surgery for BPE or PCa. PMID:27432378

  8. Durability, safety and efficacy of polyacrylamide hydrogel (Bulkamid®) in the management of stress and mixed urinary incontinence: three year follow up outcomes

    PubMed Central

    Al-Singary, Waleed

    2015-01-01

    Introduction There are a myriad of treatment options available for patients suffering with the increasingly prevalent condition of stress urinary incontinence (SUI). The minimally invasive nature of periurethral bulking agents makes them an attractive proposition in the correctly selected patient. There is, however, limited data available on the medium to long term safety and efficacy of this procedure. The aim of our study is to evaluate the outcomes of Polyacrylamide Hydrogel (PAHG) (Bulkamid®) as a periurethral bulking agent at our institution. Material and methods From 2006 to 2011, two hundred and fifty six women underwent periurethral bulking with PAHG in the management of SUI or mixed urinary incontinence (MUI). Women were assessed with at least yearly quality of life and ICIQ questionnaires. Results The majority of patients had the procedure under a local anaesthetic, with a median operative time of 9 minutes. Median follow up was 38 months. 82% of patients reported cure/significant improvement at 3 months. Importantly, this high satisfaction rate was maintained at final follow up and was reflected in both VAS and ICIQ scores. There were no reported adverse reactions and no significant safety concerns. Conclusions We conclude that Bulkamid® injection is an efficacious, minimally invasive, and safe procedure for a selected group of patients with stress incontinence. In our study, PAHG has been shown to be durable and safe. PMID:26855795

  9. An Open Multicenter Study of Clinical Efficacy and Safety of Urolastic, an Injectable Implant for the Treatment of Stress Urinary Incontinence: One-Year Observation

    PubMed Central

    Miotła, Paweł; Gałczyński, Krzysztof; Baranowski, Włodzimierz; Doniec, Jacek; Jóźwik, Maciej; Oniszczuk, Małgorzata; Rechberger, Tomasz

    2015-01-01

    The prevalence of stress urinary incontinence rises and affects up to 30% of women after 50 years of age. Midurethral slings are currently the mainstay of surgical anti-incontinence therapy. Some patients experience recurrent SUI (RSUI) which is defined as a failure of anti-incontinence surgery after a period of time or persistence of SUI after the procedure aimed at correcting it. The urethral bulking agent application decreases invasiveness of treatment and meets patients requirements. The objective of this study was to assess the safety and clinical efficacy of Urolastic injection. One hundred and five patients with SUI (including 91 patients with RSUI) were treated with Urolastic in three tertiary gynecological clinics. The efficacy of the procedure was assessed objectively at each follow-up visit by means of cough test and a standard 1-hour pad test. Objective success rate after 12 months after primary procedure in RSUI patients was found in 59.3% of patients. In 14 patients with primary SUI improvement after 1 year was found in 71.4% of patients. Although cure rates after MUS are up to 90% there is still place for less invasive treatment option like periurethral injection of bulking agents, especially in patients with previous SUI surgical management. PMID:26106616

  10. An Open Multicenter Study of Clinical Efficacy and Safety of Urolastic, an Injectable Implant for the Treatment of Stress Urinary Incontinence: One-Year Observation.

    PubMed

    Futyma, Konrad; Miotła, Paweł; Gałczyński, Krzysztof; Baranowski, Włodzimierz; Doniec, Jacek; Wodzisławska, Agnieszka; Jóźwik, Maciej; Oniszczuk, Małgorzata; Rechberger, Tomasz

    2015-01-01

    The prevalence of stress urinary incontinence rises and affects up to 30% of women after 50 years of age. Midurethral slings are currently the mainstay of surgical anti-incontinence therapy. Some patients experience recurrent SUI (RSUI) which is defined as a failure of anti-incontinence surgery after a period of time or persistence of SUI after the procedure aimed at correcting it. The urethral bulking agent application decreases invasiveness of treatment and meets patients requirements. The objective of this study was to assess the safety and clinical efficacy of Urolastic injection. One hundred and five patients with SUI (including 91 patients with RSUI) were treated with Urolastic in three tertiary gynecological clinics. The efficacy of the procedure was assessed objectively at each follow-up visit by means of cough test and a standard 1-hour pad test. Objective success rate after 12 months after primary procedure in RSUI patients was found in 59.3% of patients. In 14 patients with primary SUI improvement after 1 year was found in 71.4% of patients. Although cure rates after MUS are up to 90% there is still place for less invasive treatment option like periurethral injection of bulking agents, especially in patients with previous SUI surgical management. PMID:26106616