Single blind, randomised controlled trial of pelvic floor exercises, electrical stimulation, vaginal cones, and no treatment in management of genuine stress incontinence in women. (1/52)

OBJECTIVE: To compare the effect of pelvic floor exercises, electrical stimulation, vaginal cones, and no treatment for genuine stress incontinence. DESIGN: Stratified, single blind, randomised controlled trial. SETTING: Multicentre. PARTICIPANTS: 107 women with clinically and urodynamically proved genuine stress incontinence. Mean (range) age was 49.5 (24-70) years, and mean (range) duration of symptoms 10.8 (1-45) years. INTERVENTIONS: Pelvic floor exercise (n=25) comprised 8-12 contractions 3 times a day and exercise in groups with skilled physical therapists once a week. The electrical stimulation group (n=25) used vaginal intermittent stimulation with the MS 106 Twin at 50 Hz 30 minutes a day. The vaginal cones group (n=27) used cones for 20 minutes a day. The untreated control group (n=30) was offered the use of a continence guard. Muscle strength was measured by vaginal squeeze pressure once a month. MAIN OUTCOME MEASURES: Pad test with standardised bladder volume, and self report of severity. RESULTS: Improvement in muscle strength was significantly greater (P=0.03) after pelvic floor exercises (11.0 cm H2O (95% confidence interval 7.7 to 14.3) before v 19.2 cm H2O (15.3 to 23.1) after) than either electrical stimulation (14.8 cm H2O (10. 9 to 18.7) v 18.6 cm H2O (13.3 to 23.9)) or vaginal cones (11.8 cm H2O (8.5 to 15.1) v 15.4 cm H2O (11.1 to 19.7)). Reduction in leakage on pad test was greater in the exercise group (-30.2 g; -43. 3 to 16.9) than in the electrical stimulation group (-7.4 g; -20.9 to 6.1) and the vaginal cones group (-14.7 g; -27.6 to -1.8). On completion of the trial one participant in the control group, 14 in the pelvic floor exercise group, three in the electrical stimulation group, and two in the vaginal cones group no longer considered themselves as having a problem. CONCLUSION: Training of the pelvic floor muscles is superior to electrical stimulation and vaginal cones in the treatment of genuine stress incontinence.  (+info)

Practical use of the pessary. (2/52)

The pessary is an effective tool in the management of a number of gynecologic problems. The pessary is most commonly used in the management of pelvic support defects such as cystocele and rectocele. Pessaries can also be used in the treatment of stress urinary incontinence. The wide variety of pessary styles may cause confusion for physicians during the initial selection of the pessary. However, an understanding of the different styles and their uses will enable physicians to make an appropriate choice. Complications can be minimized with simple vaginal hygiene and regular follow-up visits.  (+info)

History of intrauterine devices.(3/52)

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Vaginal mucosa serves as an inductive site for tolerance. (4/52)

These data demonstrate that tolerance can be induced by vaginal Ag exposure. In these experiments, mice were given vaginal agarose gel suppositories containing either 5 mg OVA or saline for 6 h. Mice were given suppositories either during the estrous (estrogen dominant) or diestrous (progesterone dominant) stage of the estrous cycle. Mice were restrained during the inoculation period to prevent orovaginal transmission of the Ag. After 1 wk, mice were immunized s. c. with OVA in CFA. After 3 wk, mice were tested for delayed-type hypersensitivity responses by measuring footpad swelling and measuring in vitro proliferation of lymphocytes to Ag. Using ELISA, the magnitude of the serum Ab response was also measured. In some mice, FITC conjugated to OVA was used to track the dissemination of the protein into the systemic tissues. The magnitude of footpad swelling was significantly reduced in mice receiving OVA-containing suppositories during estrus compared with mice receiving saline suppositories. Concomitant decreases in the Ag-specific proliferative response were also observed in lymph node lymphocytes and splenocytes. Conversely, mice inoculated during diestrus did not show a decreased response to Ag by either footpad response or in vitro proliferation. Serum Ab titers in the estrus-inoculated mice did not decrease significantly. These data demonstrate that the reproductive tract can be an inductive site for mucosally induced tolerance. However, unlike other mucosal sites such as the lung and gastrointestinal tract, reproductive tract tolerance induction is hormonally regulated.  (+info)

Effectiveness of estriol-containing vaginal pessaries and nitrofurantoin macrocrystal therapy in the prevention of recurrent urinary tract infection in postmenopausal women. (5/52)

We compared the efficacy and safety of estriol-containing vaginal pessary use with those of oral nitrofurantoin macrocrystal (NM) therapy for preventing urinary tract infection (UTI) in postmenopausal women with recurrent UTI. Over a period of 9 months, 86 women received an estriol-containing vaginal pessary (0.5 mg estriol) twice weekly, and 85 women received NM (100 mg) once daily. We recorded 124 episodes of UTI in women who received estriol-releasing pessaries and 48 episodes of UTI in women treated with NM (P=.0003). Twenty-eight women (32.6%) who received estriol had no episodes of UTI versus 41 women (48.2%) in the NM group. There was a significant increase in the number of superficial cells in women who received estriol, whereas in the NM group, no such changes occurred. However, there was no change in the extent of Lactobacillus colonization and in the vaginal pH in women who received estriol. Use of an estriol-containing pessary is less effective than oral NM therapy in the prevention of bacteriuria in postmenopausal women because of its failure to restore the population of lactobacilli and to reduce the vaginal pH in these women.  (+info)

Approach to urinary incontinence in women. Diagnosis and management by family physicians. (6/52)

OBJECTIVE; To outline an approach to diagnosis and management of the types of urinary incontinence seen by family physicians. SOURCES OF INFORMATION: Recommendations for diagnosis are based on consensus guidelines. Treatment recommendations are based on level I and II evidence. Guidelines for referral are based on the authors' opinions and experience. MAIN MESSAGE: Diagnoses of stress, urge, or mixed urinary incontinence are easily established in family physicians' offices by history and gynecologic examination and sometimes a urinary stress test. There is little need for formal diagnostic testing. Management by family physicians (without need for specialist referral) includes lifestyle modification, pelvic floor muscle strengthening, bladder retraining, and pharmacotherapy with muscarinic receptor antagonists. Patients with pelvic organ prolapse might require specialist referral for consideration of pessaries or surgery, but family physicians can provide follow-up care. Women with more complex problems, such as severe prolapse or failed continence surgery, require referral. CONCLUSION: Urinary incontinence is a common condition in women. In most cases, it can be diagnosed and managed effectively by family physicians.  (+info)

Lesson of the week: perils of pessaries. (7/52)

Vaginal pessaries are widely considered to be a safe alternative to surgery in older women. We report a case of near fatal septicaemia in a 75-year-old woman associated with a shelf pessary, the presence of which was identified during an exploratory laparotomy. This case highlights the importance of the gynaecological history and examination when assessing older women with septicaemia of unknown source.  (+info)

Exogenous oxytocin dilates the cervix in ewes. (8/52)

Cervical anatomy in ewes usually prevents nonsurgical, intrauterine AI and transcervical embryo transfer (ET), which limits their commercial use in sheep. This study was conducted to determine whether oxytocin would dilate the cervix in ewes and permit passage of a stainless steel rod into the uterus. In Exp. 1, at 44 and 52 h after removal of progestogenated pessaries, ewes were injected i.v. with 0 (saline), 200, 400, or 600 USP units of oxytocin. Immediately before and after treatments, stainless steel rods were used to evaluate cervical dilation and determine whether the uterus could be entered. A rod could not be passed through the cervix and into the uterus in any of the saline-treated ewes. All doses of oxytocin given at 44 and 52 h after pessary removal dilated the cervix and permitted easy passage of a rod into the uterus. At both 44 and 52 h, a stainless steel rod was passed into the uterus in 33 of 43 (77%) of the oxytocin-treated ewes. In 93% (40/43) of these ewes, a rod could be passed into the uterus during either the 44-h or during the 52-h attempt. In Exp. 2, on d 9 after pessary removal, ewes were injected i.v. with oxytocin (400 USP units) at 6 or 12 h after i.v. estradiol-17 beta (0, 100, or 200 micrograms). Cervical dilation was evaluated as in Exp. 1. Dose of estradiol x time of oxytocin affected (P less than .01) the proportion of ewes in which a rod could be passed transcervically into the uterus.(ABSTRACT TRUNCATED AT 250 WORDS)  (+info)

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