Female urinary incontinence: long-term follow-up after treatment in general practice.
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BACKGROUND: Several reports have been published showing that women with urinary incontinence (UI) can be taken care of and treated satisfactorily in general practice. AIM: To find out whether the treatment of women with UI in general practice is effective also in the long term. METHOD: One hundred and five women with UI who consulted their general practitioner (GP) were examined and treated according to a treatment protocol. Treatment options were pelvic floor exercises, electrical stimulation, oestrogen supplements, bladder training, and protective pads. Three to six years after inclusion, all women received a postal questionnaire to evaluate the long-term effectiveness of treatment. Women who had been referred to a specialist were excluded. RESULTS: Eighty out of 82 eligible patients answered the questionnaire after a mean follow-up period of 56 months. Twenty-seven per cent were continent, 26% much better, 23% a little better, 21% unchanged, and 3% were worse compared with before the treatment. The median score on a 100 mm visual analogue scale was 16 compared with 31 before treatment, and the percentage of women that were 'much' or 'a great deal' bothered by UI was reduced from 35% to 12%. The percentage of women with severe UI was reduced from 59% to 30%, and the number of women using pads was reduced from 62% to 39%. CONCLUSION: This study confirms that management of female UI in general practice is effective also in the long term. (+info)
Long-term effect of treatment of female incontinence in general practice.
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BACKGROUND: Urinary incontinence in women can be treated successfully by the general practitioner. However, little is known about the long-term effects of conservative treatment. AIM: To evaluate the long-term effect of treatment of female incontinence by the general practitioner (pelvic floor exercises, and bladder training) in female urinary incontinence. METHOD: A total of 88 women, aged between 20 and 65, who had participated in a controlled trial between 1987 and 1990, were contacted to participate in a five-year follow-up study. Stress incontinence and urge incontinence were treated by means of pelvic floor exercises and bladder training respectively, while a mixed incontinence was treated by bladder training followed by pelvic floor exercises. The outcome measures were a constructed scale for the severity of the incontinence, a seven-day bladder chart, and a questionnaire concerning patients' opinions. All patients were evaluated by an independent researcher. RESULTS: Compared with the one-year follow-up, the number of continent women remained the same, but a significantly greater number of patients worsened. Forty per cent of the women stayed in the same category of severity, while 45% moved into the contiguous categories. The weekly frequency of wet episodes increased significantly, with a mean increase of 2.65 episodes. Women with mixed incontinence were especially prone to relapse in the long-term. Compliance with the exercises had a positive influence on the outcomes, with 67% of the women expressing satisfaction with the results. CONCLUSIONS: Despite a decline in the effect of conservative treatment in the long-term, the majority of the women are satisfied with their treatment. Patient compliance is the key to long-term success. (+info)
Health screening in older women.
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Health screening is an important aspect of health promotion and disease prevention in women over 65 years of age. Screening efforts should address conditions that cause significant morbidity and mortality in this age group. In addition to screening for cardiovascular disease, cerebrovascular disease and cancer, primary care physicians should identify risk factors unique to an aging population. These factors include hearing and vision loss, dysmobility or functional impairment, osteoporosis, cognitive and affective disorders, urinary incontinence and domestic violence. Although screening for many conditions cannot be proved to merit an "A" recommendation (indicating conclusive proof of benefit), special attention to these factors can decrease morbidity and improve quality of life in aging women. (+info)
Mortality in relation to urinary and faecal incontinence in elderly people living at home.
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OBJECTIVE: To examine the relationship between incontinence and mortality in elderly people living at home. DESIGN: Of the randomly selected people aged 65 years and older living in Settsu city, Osaka in October 1992, 1405 were contacted and constituted the study cohort. Follow-up for 42 months was completed for 1318 (93.8%; 1129 alive, 189 dead). MEASURES: Data on general health status, history of health management, psychosocial conditions and urinary and faecal incontinence were collected by interview during home visits at the time of enrolment. RESULTS: From the Kaplan-Meier analysis, the estimated survival rates decreased with a decline in continence in both the 65-74 and 75 years and older age groups. From the Cox proportional hazards model, unadjusted hazard ratios of minor, moderate and severe incontinence for mortality, compared with continence, were 2.27, 2.96 and 5.94, respectively. Multivariate analysis yielded adjusted hazard ratios of minor, moderate and severe incontinence of 0.99, 1.17 and 1.91, respectively, leaving severe incontinence as the significant factor, when other indicators are controlled. CONCLUSIONS: Incontinence is related to mortality and severe incontinence represents an increased risk factor for mortality in elderly people living at home. (+info)
Translabial color Doppler for imaging in urogynecology: a preliminary report.
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OBJECTIVE: A prospective study was conducted to evaluate the use of color Doppler ultrasound in the investigation of female urinary incontinence. METHODS: Thirty-seven patients underwent a full urodynamic assessment and translabial ultrasound examination using color Doppler-capable equipment with 5-7-MHz curved array transducers, both in the supine and in the erect positions. RESULTS: More than minimal leakage was seen in 13 patients by Doppler and in 16 by fluoroscopic imaging. Results were in agreement in 28/37 cases (kappa 0.49). The observed discrepancies may have been due to initial technical difficulties, differences in bladder filling and the presence of a catheter on fluoroscopic imaging. In five incontinent patients, urethral flow velocities ranged from 0.064 to 0.34 m/s, which is equivalent to physiological venous and slow arterial blood flow and one to two orders of magnitude above the detection threshold of standard Doppler ultrasound equipment. CONCLUSIONS: Translabial color Doppler imaging of the lower urinary tract allows the documentation of fluid leakage from the bladder. It has the potential to become the new imaging standard for urogynecology. (+info)
Blood gases and sex hormones in women with and without genital descensus.
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BACKGROUND: Abnormalities in connective tissue and spirometric disorders have previously been found in women with genital descensus. OBJECTIVE: To evaluate the association of descensus and respiratory function. METHODS: The blood gases and sex hormones were measured in 130 women scheduled for surgical correction of descensus and 60 matched women without descensus. All subjects were nonsmokers and without past or present cardiorespiratory disease. RESULTS: Women with descensus had a lower pH (7.39+/-0.04 vs. 7.41+/-0.04, p = 0.01), lower arterial tensions of oxygen (12.7+/-12. vs. 14.1+/-0.9 kPa, p = 0.003) and carbon dioxide (5.1+/-0.4 vs. 5.3+/-0.3 kPa) but a higher hemoglobin concentration (141+/-11 vs. 132+/-9 g/l) and a higher serum progesterone in the follicular phase of the cycle (3.1+/-4 vs. 1.5+/-1 ng/ml, p = 0.03). In 39 (30%) women with descensus, the arterial carbon dioxide tension was below 4.9 kPa. All subjects ventilated more in the luteal compared to the follicular phase of the cycle. In women with descensus, the hemoglobin concentration increased with decreasing arterial oxygen tension (p = 10(-4)) and with decreasing pH (p<10(-3)). CONCLUSION: Women with descensus frequently hyperventilate and, compared with women without descensus, have a lower arterial oxygen tension, increased hemoglobin concentration and slightly lower pH. (+info)
Time course of symptomatic orthostatic hypotension and urinary incontinence in patients with postmortem confirmed parkinsonian syndromes: a clinicopathological study.
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OBJECTIVE: Although both orthostatic hypotension and urinary incontinence have been reported in a number of parkinsonian syndromes, such as Parkinson's disease (PD), multiple system atrophy (MSA), dementia with Lewy bodies (DLB), corticobasal degeneration (CBD), and progressive supranuclear palsy (PSP), differences in the evolution of these features have not been studied systematically in pathologically confirmed cases. METHODS: 77 cases with pathologically confirmed parkinsonian syndromes (PD, n=11; MSA, n=15; DLB, n=14; CBD, n=13; PSP, n=24), collected up to 1994, formed the basis for a multicentre clinicopathological study organised by the NINDS to improve the differential diagnosis of parkinsonian disorders. The present study determined the time course-that is, latency to onset and duration from onset to death, of symptomatic orthostatic hypotension, and urinary incontinence in the NINDS series. Furthermore, the diagnostic validity of a predefined latency to onset within 1 year of disease onset of symptomatic orthostatic hypotension or urinary incontinence was analysed. RESULTS: Significant group differences for latency, but not duration, of symptomatic orthostatic hypotension and urinary incontinence were found. Latencies to onset of either feature were short in patients with MSA, intermediate in patients with DLB, CBD, and PSP, and long in those with PD. Symptomatic orthostatic hypotension occurring within the first year after disease onset predicted MSA in 75% of cases; early urinary incontinence was less predictive for MSA (56%). CONCLUSION: Latency to onset, but not duration, of symptomatic orthostatic hypotension or urinary incontinence differentiates PD from other parkinsonian syndromes, particularly MSA. (+info)
Urinary incontinence: an unexpected large problem among young females. Results from a population-based study.
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BACKGROUND: The International Continence Society has defined urinary incontinence as a condition in which involuntary loss of urine is objectively demonstrable and is a social or hygiene problem. Urinary incontinence is presumably a common health problem among women even in younger ages. OBJECTIVES: The primary aim was to investigate the prevalence of urinary incontinence (UI) in a female population with a special focus on younger women (18-30 years old). The secondary aim was to investigate the association between UI and number of deliveries, use of contraceptives or oestrogen substitutions, and urinary tract infections (UTIs). METHODS: A population-based study with a self-administered questionnaire was set in the community of Surahammar, Sweden. Subjects were all women (3493) aged 18-70 years living in Surahammar during 1995. The main outcome measures were the prevalence of UI and variables such as number of deliveries, use of contraceptives or oestrogen substitutions, and UTIs. RESULTS: Twenty-six per cent of the women reported problems of UI. The prevalence of UI in younger women was 12%. The number of reported complaints of UTIs was significantly higher in the women with UI compared with women without urinary incontinence (wUI). In the younger women UTI, nulliparous or having given birth to one or two children were most frequent in those with UI. The use of contraceptives was more common in younger women without UI (P < 0.05). However, the use of oestrogen was more common in older women in the age group 51-70 years with UI (P < 0.01). CONCLUSION: Our findings have shown that 26% of the women who took part in the survey reported problems of UI. Among women below 30 years of age, 12% reported complaints of UI. We found a high prevalence of UI in younger women with a UTI, not taking oestrogen, nulliparous or having given birth to one or two children. There are needs for further investigations with a special focus on younger women. (+info)