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Kasoff M, Alishahian L, Gimoto J, Steinhart A, Grimes CL, Pape DM. Mobile Phone Apps for Pelvic Floor Disorders. UROGYNECOLOGY (PHILADELPHIA, PA.) 2024:02273501-990000000-00261. [PMID: 39159315 DOI: 10.1097/spv.0000000000001541] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/21/2024]
Abstract
IMPORTANCE Up to 50% of patients report not readily seeking treatment for pelvic floor disorders (PFDs). The increase in phone applications (apps) for health care information is an opportunity to increase access to care. OBJECTIVE The aim of the study was to systematically evaluate content and function of apps for patients with PFDs. STUDY DESIGN Apps were screened using PFD-related search terms. Included apps were on the Apple store, in English, and targeted patients with PFDs. The primary outcome was app quality based on the APPLICATIONS scoring system (scored 0-16). Secondary outcomes included professional medical involvement, iTunes rating details, the presence of a voiding/bowel diary, tracking of diet, pain/symptoms, exercise, and medication, graphing or social functions, reminders, disease information, and decision support. Data was reported with descriptive statistics (medians (ranges) and n (percentages). RESULTS Eight hundred forty apps were identified and 83 were analyzed. The top 3 PFD categories represented were defecatory dysfunction (29), overactive bladder (28), and stress incontinence (27). The median APPLICATIONS score was 7 (3-12). Most apps (78%) were developed without professional medical involvement. Most apps were free, while the remainder ranged from $1.99 to $4.99. No app had all features. Twenty-five apps (30%) included a voiding diary, 33 (40%) had a bowel diary, 27 (33%) included exercise tracking, and 44 (53%) had reminder systems. CONCLUSIONS Most apps had reasonable, but not high, functionality. Current apps provide varying degrees of overall utility, with limited disease information and decision support. Further collaboration with medical providers in app development would support better integration of clinician and patient needs.
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Chatterjee S, Bulchandani S. Retrospective review of history vs. ePAQ-PF in complex urogynaecology patients. Eur J Obstet Gynecol Reprod Biol 2022; 276:69-73. [PMID: 35809461 DOI: 10.1016/j.ejogrb.2022.07.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Revised: 06/29/2022] [Accepted: 07/01/2022] [Indexed: 11/04/2022]
Abstract
INTRODUCTION AND AIM OF THE STUDY Urinary incontinence and prolapse are debilitating conditions significantly affecting quality of life. They are extremely prevalent, affecting a significant number of women attending gynaecology clinics with complex symptoms. ePAQ-PF offers a user-friendly clinical tool, which provides valid and reliable data. The system offers comprehensive symptoms and quality of life evaluation which is an advantage over history and may enhance the clinical episodes detection as well as the quality of care for women with pelvic floor disorders. The aim of the study is to compare effectiveness of ePAQ-PF against history for diagnosis in complex urogynaecology patients. MATERIALS AND METHODS Data was collected retrospectively from ePAQ-PF and history in a tertiary level urogynaecology unit and collated onto microsoft excel. 40 patients were selected randomly from 56 eligible (administered and succeessfully completed ePAQ-PF) patients attending Urogynaecology and PEARL (combined urogynaecology and colorectal) clinics between July 2018 and July 2021. Fisher's exact test was used for inferring on statistical significance in the comparative analysis. The software used for this analysis was SAS version 9.4. RESULTS Thirty-four out of the forty patients were eligible for analysis for overactive bladder and stress urinary incontinence; twenty-four for prolapse and twenty-six patients for voiding difficulty. Patients were between 18 and 80 years of age with highest participants between 40 and 69 years. Four scored symptom domain was chosen for statistical analysis due to adequate power of comparative data in these domains. The additional diagnostic yield by ePAQ-PF for overactive bladder (OAB), stress urinary incontinence (SUI), voiding difficulty (VD) and prolapse was 26.47%, 0%, 67% and 16.67% respectively. P value for OAB, VD and prolapse was 0.0294, 0.0031 and 0.01 respectively. Apart from these four symptoms ePAQ-PF contributed additional symptoms over and above history in all 40 patients due to its wide range of symptom domains. History provided additional symptoms in 3 women with recurrent urinary tract infection which was not identified on ePAQ-PF. INTERPRETATION OF RESULTS ePAQ-PF has shown significant additional diagnostic yield for overactive bladder, voiding difficulty and prolapse. P value for each has supported this statement. Although there was no additional diagnostic yield for stress urinary incontinence by ePAQ-PF, it has shown an accuracy of 96.97% (n = 33) for diagnosing the cases like history taking for SUI. ePAQ-PF enabled us to identify more symptoms in 100% cases (n = 40) which includes body image, general sex life, pain and altered sensation of vagina, reduced capacity of vagina etc, in comparison to history, for complex urogynaecology patients. History contributed to additional symptom diagnosis such as recurrent urinary tract infection in 7.5% (n = 40) of cases. CONCLUSION ePAQ-PF is a useful diagnostic tool providing additional benefit for the diagnosis of the complex urogynaecology patient. Overall recommendation is to implement a policy of using ePAQ-PF evaluation in all complex urogynaecology patients in addition to history. Further studies are needed to assess the pattern of the yield across age, parity, disease severity related to complex urogynaecology symptoms.
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Affiliation(s)
- Suvalagna Chatterjee
- Clinical Research Fellow, Urogynaecology, University Hospitals Coventry and Warwickshire, UK.
| | - Supriya Bulchandani
- Consultant Gynaecologist and Subspecialist Urogynaecology, University Hospitals Coventry and Warwickshire, UK
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Niederauer S, Bérubé MÈ, Brennan A, McLean L, Hitchcock R. Pelvic floor tissue damping during running using an intra-vaginal accelerometry approach. Clin Biomech (Bristol, Avon) 2022; 92:105554. [PMID: 34974336 PMCID: PMC8863648 DOI: 10.1016/j.clinbiomech.2021.105554] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2021] [Revised: 12/08/2021] [Accepted: 12/20/2021] [Indexed: 02/07/2023]
Abstract
BACKGROUND While cumulative loading of the pelvic floor during exercise appears to increase the risk of developing pelvic floor disorders, the pathophysiologic role of pelvic floor loading is poorly understood. The aim of this exploratory study was to present a method for evaluating vibrational frequency damping of the female pelvic floor and to investigate the potential utility of this approach in a preliminary evaluation. METHODS Female participants were instrumented with an intravaginal accelerometer and a hip-mounted accelerometer, then ran on a treadmill at 7 km/h and 10 km/h both before and after a 30-min self-selected pace. Displacement of the pelvic floor relative to the bony pelvis was calculated using double integration of the accelerometer data. Vibrational damping coefficients were calculated using a wavelet-based approach to determine the effect of continence status, parity, running speed and time on vibrational damping. FINDINGS Seventeen women (n = 10 reported regularly leaking urine while exercising, while n = 7 reported not leaking) completed the running protocol. No differences in vibrational damping were detected between continent and incontinent women when all frequency bands were evaluated together, however significant effects of parity, time, running speed and continence status were found within specific frequency bands. Parous women demonstrated less damping in the 25-40 Hz band compared to nulliparae, damping in the 13-16 Hz band was lower after the 30-min run, and incontinent women demonstrated lower damping in the 4.5-5.5 Hz band than continent women when running at 7 km/h. INTERPRETATION Intra-vaginal vibrational damping may be useful in detecting biomechanical mechanisms associated with pelvic floor disorders experienced by females during exercise.
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Affiliation(s)
- Stefan Niederauer
- Department of Biomedical Engineering, University of Utah, Salt Lake City, United States
| | - Marie-Ève Bérubé
- School of Rehabilitation Sciences, University of Ottawa, Ottawa, Canada
| | - Ana Brennan
- Department of Mechanical Engineering, University of Ottawa, Ottawa, Canada
| | - Linda McLean
- School of Rehabilitation Sciences, University of Ottawa, Ottawa, Canada
| | - Robert Hitchcock
- Department of Biomedical Engineering, University of Utah, Salt Lake City, United States
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Primary and Specialty Outpatient Visits for Older Women With Urinary Incontinence: A Comparison of Nurses to the General Population. Female Pelvic Med Reconstr Surg 2021; 27:551-555. [PMID: 33411454 DOI: 10.1097/spv.0000000000000984] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE We evaluated patterns of outpatient visits seen for urinary incontinence (UI) among women 65 years or older in the Nurses' Health Study and the general Medicare population. We were interested in understanding whether nurses, with high health literacy, may receive more care for UI than the general population. METHODS Medicare Fee for Service claims data for women aged 66-91 years were compared for Nurses' Health Study participants (n = 3,213) and a propensity-matched sample from general Medicare Fee for Service beneficiaries (n = 3,213) with 1 or more outpatient evaluation and management visits for UI in 2012. We examined the mean number of outpatient visits for UI and the type of provider seen, using t tests and χ2 tests. Providers were categorized as specialist and nonspecialist providers using taxonomy codes. RESULTS The percentage of women 65 years or older who had an outpatient visits for UI over 12 months was 6.4% in the Nurses' Health Study cohort and 5.4% in the general population. The mean number of office visits for UI in 2012 was similar between nurses and the matched general population (mean = 1.8 vs 1.8; P = 0.3). A small percentage of women saw both nonspecialists and specialists for UI (9.3% in the Nurses' Health Study and 10.0% in the Center for Medicare Services cohorts). CONCLUSIONS We found that less than 7% of older women had outpatient evaluation of UI symptoms during a 12-month period, despite UI being very common in this age group. This was similar in nurses and the general population, suggesting that even high health care literacy does not increase UI care seeking.
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Lane GI, Hagan K, Erekson E, Minassian VA, Grodstein F, Bynum J. Patient-Provider Discussions About Urinary Incontinence Among Older Women. J Gerontol A Biol Sci Med Sci 2021; 76:463-469. [PMID: 32353111 DOI: 10.1093/gerona/glaa107] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2020] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Urinary incontinence (UI) is prevalent in women and has been associated with decreased quality of life and institutionalization. Despite this, and the fact that several treatment options exist, few women discuss UI with clinicians. The aim of this study was to examine the proportion of middle aged and older women with urinary incontinence who have discussed UI with clinicians, focusing on female health professionals as a way to examine this question outside of issues of health care access. METHODS Data are from the Nurses Health Studies (NHS), two ongoing observational, prospective, cohort studies. The surveys collected detailed information about UI, including frequency, amount and type. Women were also asked if they had discussed UI with a clinician. We used multivariable-adjusted logistic regression to estimate odds ratios (OR) of participants reporting discussion about UI. RESULTS 94,692 women with UI aged 49-91 years old were included in this study. Of these, 34% reported that they had discussed their incontinence with a clinician. Women with daily UI had 4.4 times greater odds of discussing it with clinicians when compared to those with monthly UI (OR = 4.36, 95% confidence interval [CI] 4.06-4.69). When controlling for severity of symptoms, the oldest women, greater than eighty years, were 20% less likely to have discussed UI with their clinician, compared to the youngest women (OR = 0.81, 95% CI 0.73-0.89). CONCLUSIONS A minority of women with UI, even among health professionals, discuss their symptoms with clinicians. Oldest women were the least likely to discuss their UI with a provider.
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Affiliation(s)
- Giulia I Lane
- Department of Urology, University of Michigan, Ann Arbor.,Institute of Health Policy and Research, University of Michigan, Ann Arbor
| | - Kaitlin Hagan
- Channing Division of Network Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts.,Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston, Massachusetts
| | - Elisabeth Erekson
- Department of Obstetrics and Gynecology, Maine Medical Center, Portland.,Department of Obstetrics and Gynecology, Tufts University School of Medicine, Boston, Massachusetts
| | - Vatche A Minassian
- Division of Urogynecology, Department of Obstetrics and Gynecology, Brigham and Women's Hospital, Boston, Massachusetts
| | - Francine Grodstein
- Rush Alzheimer's Disease Center, Rush Medical College, Chicago, Illinois
| | - Julie Bynum
- Department of Internal Medicine, University of Michigan, Ann Arbor.,Institute of Health Policy and Research, University of Michigan, Ann Arbor
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Biyik I, Usturali Mut AN, Albayrak M, Kucuk B, Koras O, Keskin F, Demirci H. Effect of health literacy on help-seeking behavior: A comparison of patients accepting surgery and refusing surgery for urinary incontinence. J Gynecol Obstet Hum Reprod 2020; 50:101908. [PMID: 32920179 DOI: 10.1016/j.jogoh.2020.101908] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2020] [Revised: 07/22/2020] [Accepted: 09/02/2020] [Indexed: 11/25/2022]
Abstract
OBJECTIVE(S) To compare the health literacy (HL) of the adult females with SUI complaints in terms of their acceptance or non-acceptance of surgery. METHODS In this cohort study, the European Health Literacy Survey Questionnaire (HLS-EU- Q47) scores as a measure of health literacy were compared among the two groups of patients who accepted to undergo surgery for SUI and the ones who did not. Demographic features, weight and BMI values, comorbidity, menopausal status, duration and type of UI, socioeconomic characteristics (marital status, educational level, level of income) and HLS-EU- Q47 survey results of the two groups were compared. We also investigated the reasons regarding the acceptance or refusal of SUI surgery. RESULTS Among the patients who were offered surgery 474% accepted to undergo operation. Total HLS-EU-Q47 score was 30.04 in the group of patients who accepted surgery and 23.46 in the group who refused surgery. The patients that refused surgery had more often insufficient health literacy level (p=0.001). An excellent health literacy level was higher for patients who agreed to anti-incontinence surgery (p=0.021). CONCLUSIONS Health literacy score of patients with urinary incontinence (UI) who refused surgery was lower than those who accepted surgery. Acceptance of surgery may be increased by providing more understandable and clear information, especially for women with lower HL levels.
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Affiliation(s)
- Ismail Biyik
- Kütahya Health Sciences University, Department of Obstetrics and Gynecology, Kütahya, Turkey.
| | - Ayse Nur Usturali Mut
- Ankara University Medical School, Public Health Department, Division of Epidemiology, Turkey.
| | - Mustafa Albayrak
- Florence Nightingale Hospital, Department of Obstetrics and Gynecology, Istanbul, Turkey.
| | - Bilgen Kucuk
- University of Health Sciences Bursa Yuksek Ihtisas Training and Research Hospital, Department of Family Medicine, Turkey.
| | - Omer Koras
- Mustafakemalpasa State Hospital, Department of Urology, Turkey.
| | - Fatih Keskin
- Mustafakemalpasa State Hospital, Department of Obstetrics and Gynecology, Turkey.
| | - Hakan Demirci
- University of Health Sciences Bursa Yuksek Ihtisas Training and Research Hospital, Department of Family Medicine, Turkey.
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Chow JS. Stress urinary incontinence: An undertreated problem which deserves attention. CURRENT OPINION IN BIOMEDICAL ENGINEERING 2019. [DOI: 10.1016/j.cobme.2019.10.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Abstract
PURPOSE The aims of this investigation were to examine how often outpatient visits addressing urinary incontinence in women with self-reported incontinence symptoms occur and to explore characteristics associated with an outpatient visit for incontinence. MATERIALS AND METHODS We studied the records of 18,576 women from the Nurses' Health Study who were 65 years old or older, reported prevalent incontinence symptoms in 2012 on a mailed questionnaire and were linked with Medicare utilization data. We compared demographic, personal and clinical characteristics in women with and without claims for outpatient visits for urinary incontinence. In logistic regression models we controlled for potential confounding factors, including age, race, parity, body mass index, medical comorbidities, smoking status, health seeking behavior, disability, physical function and geographic region. RESULTS In this linkage between symptom report and insurance claims data we found that only 16% of older women with current incontinence symptoms also had an outpatient visit addressing incontinence in the prior 2 years. In multivariable adjusted models severe vs slight incontinence (OR 3.75, 95% CI 3.10-4.53) and urgency vs stress incontinence (OR 1.80, 95% CI 1.56-2.08) were the strongest predictors of undergoing outpatient evaluation. CONCLUSIONS Overall only a small percent of women who report urinary incontinence symptoms also have medical outpatient visits for incontinence, which is a marker of care seeking. Our study highlights the discordance between the high prevalence of incontinence in older women and the lack of clinical assessment despite symptoms even among nurses with high health care literacy.
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Chen CCG, Cox JT, Yuan C, Thomaier L, Dutta S. Knowledge of pelvic floor disorders in women seeking primary care: a cross-sectional study. BMC FAMILY PRACTICE 2019; 20:70. [PMID: 31122187 PMCID: PMC6533649 DOI: 10.1186/s12875-019-0958-z] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/06/2018] [Accepted: 04/30/2019] [Indexed: 11/10/2022]
Abstract
Background Pelvic floor disorders including urinary incontinence (UI) and pelvic organ prolapse (POP) are common conditions; however, most women with these symptoms do not seek care. Failure to seek care may be related to misconceptions about these conditions. The aim of this study was to assess the baseline knowledge of UI and POP among adult women presenting to primary care clinics, as well as factors associated with knowledge levels. Methods A survey with questions from previously validated UI and POP knowledge questionnaires (PIKQ-UI and PIKQ-POP, respectively) was self-administered to a cross-sectional group of adult female patients presenting to three primary care clinics: geriatric, community-based, and hospital-based. Participants’ demographics and medical histories were compared using ANOVA or Kruskal-Wallis for continuous variables and Chi-square test or Fisher’s exact test for categorical variables. In order to compare various covariates with knowledge non-proficiency on PIKQ-UI and PIKQ-POP scales, unadjusted and adjusted ORs with 95% CIs were calculated using bivariate analysis and multivariate logistic regression, respectively. Results Of 346 participants, knowledge non-proficiency was similar and consistent across clinic sites and reached 72.0% for UI and 53.6% for POP. On multivariate analysis, lower educational attainment, being unaware of UI or POP as medical conditions, and having no history of care-seeking for these conditions were significantly associated with knowledge non-proficiency on UI, POP, or both. Conclusions Knowledge non-proficiency for UI and POP is common among women presenting for primary care. For UI, healthcare providers should assess patients’ actual understanding of the disease, especially among those with lower educational attainment, to eliminate any possible misconceptions. For POP, the focus should be on increasing awareness of this disease, as many women may have not previously heard of this condition. Simple strategies may increase knowledge in these areas and change care-seeking behaviors. Study registration None.
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Affiliation(s)
- Chi Chiung Grace Chen
- Department of Gynecology and Obstetrics, Johns Hopkins Hospital, Baltimore, MD, 21224, USA.
| | - Jacob T Cox
- Johns Hopkins University School of Medicine, Baltimore, MD, 21205, USA
| | - Chloe Yuan
- John A. Burns School of Medicine, Honolulu, HI, 96813, USA
| | - Lauren Thomaier
- Department of Gynecology and Obstetrics, Johns Hopkins Hospital, Baltimore, MD, 21224, USA
| | - Sonia Dutta
- Department of Gynecology and Obstetrics, Johns Hopkins Hospital, Baltimore, MD, 21224, USA
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Nelson HD, Cantor A, Pappas M, Miller L. Screening for Urinary Incontinence in Women: A Systematic Review for the Women's Preventive Services Initiative. Ann Intern Med 2018; 169:311-319. [PMID: 30105353 DOI: 10.7326/m18-0225] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Urinary incontinence is infrequently addressed during routine health care despite its high prevalence and adverse effects on health. PURPOSE To evaluate whether screening for urinary incontinence in women not previously diagnosed improves outcomes (symptoms, quality of life, and function) and to evaluate the accuracy of screening methods and potential harms of screening. DATA SOURCES English-language searches of Ovid MEDLINE, Cochrane Central Register of Controlled Trials, and Cochrane Database of Systematic Reviews (1 January 1996 to 30 March 2018); ClinicalTrials.gov (April 2018); and reference lists of studies and reviews. STUDY SELECTION Randomized trials, cohort studies, systematic reviews of studies that enrolled nonpregnant women without previously diagnosed urinary incontinence and compared clinical outcomes and adverse effects between women who were and were not screened, and diagnostic accuracy studies that reported performance measures of screening tests. DATA EXTRACTION Dual extraction and quality assessment of individual studies. DATA SYNTHESIS No studies evaluated the overall effectiveness or harms of screening. Seventeen studies evaluated the diagnostic accuracy of 18 screening questionnaires against a clinical diagnosis or results of diagnostic tests. Of these, 14 poor-quality studies were based in referral clinics, enrolled only symptomatic women, or had other limitations. One good-quality and 2 fair-quality studies (evaluating 4 methods) enrolled women not recruited on the basis of symptoms. Areas under the receiver-operating characteristic curve for stress, urge, and any type of incontinence in these studies were 0.79, 0.88, and 0.88 for the Michigan Incontinence Symptom Index; 0.85, 0.83, and 0.87 for the Bladder Control Self-Assessment Questionnaire; and 0.68, 0.82, and 0.75 for the Overactive Bladder Awareness Tool. The Incontinence Screening Questionnaire had a sensitivity of 66% and specificity of 80% for any type of incontinence. LIMITATION Studies enrolled few participants, often from symptomatic referral populations; used various reference standards; and infrequently reported CIs. CONCLUSION Evidence is insufficient on the overall effectiveness and harms of screening for urinary incontinence in women. Limited evidence in general populations suggests fairly high accuracy for some screening methods. PRIMARY FUNDING SOURCE Health Resources and Services Administration.
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Affiliation(s)
- Heidi D Nelson
- Oregon Health & Science University, Portland, Oregon (H.D.N., A.C., M.P., L.M.)
| | - Amy Cantor
- Oregon Health & Science University, Portland, Oregon (H.D.N., A.C., M.P., L.M.)
| | - Miranda Pappas
- Oregon Health & Science University, Portland, Oregon (H.D.N., A.C., M.P., L.M.)
| | - Liev Miller
- Oregon Health & Science University, Portland, Oregon (H.D.N., A.C., M.P., L.M.)
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Abstract
OBJECTIVES The aim of this study was to investigate knowledge and demographic factors associated with a lack of knowledge proficiency about urinary incontinence (UI) and pelvic organ prolapse (POP) among pregnant and postpartum women. METHODS This was a cross-sectional survey of women receiving antepartum and postpartum care at 9 Connecticut sites. Knowledge was assessed using the validated Prolapse and Incontinence Knowledge Questionnaire. Lack of knowledge proficiency was defined as less than 80% and less than 50% correct responses on the Prolapse and Incontinence Knowledge Questionnaire UI and POP subscales. Logistic regression was used to evaluate unadjusted and adjusted odds ratios (ORs) and 95% confidence intervals (CIs). P < 0.05 was considered statistically significant. RESULTS Surveys from 399 diverse pregnant and postpartum women were analyzed. Three quarters showed a lack of knowledge proficiency about UI and POP (74.2%, 70.6%). After adjustment, increased odds of lacking UI knowledge proficiency were associated with primiparity versus nulliparity (OR, 4.73; 95% CI, 2.24-9.98), Hispanic versus white race (OR, 2.72; 95% CI, 1.18-6.01), and having a high school diploma/General Education Development/less (OR, 3.17; 95% CI, 1.34-7.48) or some college (OR, 2.55; 95% CI, 1.08-6.01) versus bachelor's degree; greater lack of POP knowledge proficiency was associated with having a high school diploma/General Education Development versus bachelor's degree (OR, 2.11; 95% CI, 1.05-4.26) and never seeing a urologist/urogynecologist versus those who had (OR, 0.30; 95% CI, 0.12-0.77). Women working in a medical field versus those who did not demonstrated decreased odds of lacking UI and POP knowledge proficiency (ORs, 0.26 [95% CI, 0.13-0.52] and 0.38 [95% CI, 0.21-0.70]). CONCLUSIONS Pregnant and postpartum women lack knowledge about UI and POP. Preconceptional counseling provides an opportunity for educational intervention.
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A cost-effectiveness analysis of Onabotulinumtoxin A as first-line treatment for overactive bladder. Int Urogynecol J 2018; 29:1213-1219. [DOI: 10.1007/s00192-018-3653-z] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2017] [Accepted: 04/03/2018] [Indexed: 11/26/2022]
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13
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Urinary Incontinence and Associated Female Sexual Dysfunction. Sex Med Rev 2017; 5:470-485. [DOI: 10.1016/j.sxmr.2017.07.001] [Citation(s) in RCA: 43] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2017] [Revised: 06/30/2017] [Accepted: 07/03/2017] [Indexed: 01/23/2023]
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Saiki L, Meize-Grochowski R. Urinary Incontinence and Psychosocial Factors Associated With Intimate Relationship Satisfaction Among Midlife Women. J Obstet Gynecol Neonatal Nurs 2017; 46:555-566. [PMID: 28477970 DOI: 10.1016/j.jogn.2017.02.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/01/2017] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVE To explore associations among symptoms of urinary incontinence, severity of symptoms, and measures of psychosocial health that may be assessed during a well-woman screening examination and the possible contribution of these variables to the relationship satisfaction of partnered midlife women living with urinary incontinence. DESIGN Exploratory correlational design using self-report questionnaires. SETTING Community recruitment by posted fliers, advertisements, and social media. PARTICIPANTS Partnered women, ages 45 to 65 years, with urinary incontinence (N = 57). METHODS Self-report measures of severity of incontinence symptoms, relationship satisfaction, self-concept/emotional health (self-esteem, body image, depression, anxiety), and relationship factors (sexual quality of life, incontinence-related communication). Data were analyzed using Spearman rho correlation with an exploration of the contribution of study factors to relationship satisfaction through standard multiple regression. RESULTS The severity of urinary incontinence symptoms had no significant correlation with scores on relationship satisfaction or psychosocial health. Measures of self-concept/emotional health and relationship factors were significantly correlated with each other (rs = .40-.75, p < .01) and with relationship satisfaction (rs = .35-.71, p < .05). Preliminary exploration of the contribution of study factors to relationship satisfaction through exploratory regression analysis showed unique contributions from sexual quality of life (18.7%, p < .001) and depression (8.7%, p = .004). CONCLUSION Midlife women with urinary incontinence, regardless of symptom severity, might benefit from screening for poorer sexual quality of life and mild depression symptoms because these two study factors significantly contributed to poorer intimate relationship satisfaction among this study's participants.
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Lai DWL, Bai X, Guo A. Mediating Effect of Social Participation on the Relationship between Incontinence and Depressive Symptoms in Older Chinese Women. HEALTH & SOCIAL WORK 2017; 42:94-101. [PMID: 28431101 DOI: 10.1093/hsw/hlx018] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/21/2016] [Accepted: 06/18/2016] [Indexed: 06/07/2023]
Abstract
Urinary and fecal incontinence affect older women's social participation and mental health. This study examined the relationship between incontinence severity and depressive symptoms, focusing on the mediating effect of social participation, based on secondary analysis of structured interview data collected in December 2010 from 467 women age 60 and over in mainland China. Incontinence was significantly and positively associated with depressive symptoms but negatively associated with social participation. Social participation was significantly and negatively associated with depressive symptoms and fully mediated the relationship between incontinence and depressive symptoms. These findings can inform mental health interventions for incontinent older women, including preventing and responding to depressive symptoms by promoting social participation.
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Affiliation(s)
- Daniel W L Lai
- Daniel W. L. Lai, PhD, is chair, professor of social work and gerontology, and head of Department of Applied Social Sciences, Hong Kong Polytechnic University, HJ403, Yuk Choi Road, Hung Hom, Kowloon, Hong Kong; e-mail: . Xue Bai, PhD, is assistant professor, Department of Applied Social Sciences, Hong Kong Polytechnic University, Hong Kong. Aimei Guo, PhD, is professor, Ginling Women's College, Nanjing Normal University, Nanjing, China
| | - Xue Bai
- Daniel W. L. Lai, PhD, is chair, professor of social work and gerontology, and head of Department of Applied Social Sciences, Hong Kong Polytechnic University, HJ403, Yuk Choi Road, Hung Hom, Kowloon, Hong Kong; e-mail: . Xue Bai, PhD, is assistant professor, Department of Applied Social Sciences, Hong Kong Polytechnic University, Hong Kong. Aimei Guo, PhD, is professor, Ginling Women's College, Nanjing Normal University, Nanjing, China
| | - Aimei Guo
- Daniel W. L. Lai, PhD, is chair, professor of social work and gerontology, and head of Department of Applied Social Sciences, Hong Kong Polytechnic University, HJ403, Yuk Choi Road, Hung Hom, Kowloon, Hong Kong; e-mail: . Xue Bai, PhD, is assistant professor, Department of Applied Social Sciences, Hong Kong Polytechnic University, Hong Kong. Aimei Guo, PhD, is professor, Ginling Women's College, Nanjing Normal University, Nanjing, China
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Saldana Ruiz N, Kaiser AM. Fecal incontinence - Challenges and solutions. World J Gastroenterol 2017; 23:11-24. [PMID: 28104977 PMCID: PMC5221273 DOI: 10.3748/wjg.v23.i1.11] [Citation(s) in RCA: 90] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2016] [Revised: 10/14/2016] [Accepted: 12/08/2016] [Indexed: 02/06/2023] Open
Abstract
Fecal incontinence is not a diagnosis but a frequent and debilitating common final pathway symptom resulting from numerous different causes. Incontinence not only impacts the patient's self-esteem and quality of life but may result in significant secondary morbidity, disability, and cost. Treatment is difficult without any panacea and an individualized approach should be chosen that frequently combines different modalities. Several new technologies have been developed and their specific roles will have to be defined. The scope of this review is outline the evaluation and treatment of patients with fecal incontinence.
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Care-Seeking for Stress Incontinence and Overactive Bladder Among Parous Women in the First Two Decades After Delivery. Female Pelvic Med Reconstr Surg 2016; 22:199-204. [PMID: 26945268 DOI: 10.1097/spv.0000000000000262] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE This study aimed to establish the extent to which care-seeking for urinary incontinence is a function of symptom bother; and to identify bother-score thresholds that predict care-seeking in the first 2 decades after delivery. METHODS In this longitudinal cohort, women were assessed annually for symptom bother related to stress urinary incontinence (SUI) and overactive bladder (OAB), as well as for recent episodes of care-seeking for urinary symptoms. Because the goal was to model care-seeking as a function of the woman's characteristics at her prior visit, women who completed 2 or more consecutive visits were included. The population was randomly divided into "training" (model development) and "testing" (model validation) sets. The predictive model was developed in the training set. For SUI and OAB bother scores, we identified thresholds to define statistically distinct probabilities of care-seeking. A multivariable model was created, including SUI and OAB bother categories as well as characteristics associated with care seeking at the P < 0.05 level. The resultant prediction model was then applied to the "testing set"; predicted and observed care-seeking frequencies were compared. RESULTS Care-seeking was strongly associated with SUI and OAB bother. We defined 3 categories for OAB score and 4 categories for SUI score. The resulting 12 risk categories were then collapsed into 5 distinct risk-groups. These groups accurately predicted care-seeking in the testing set (area under the receiver operating curve, 0.760; 95% confidence interval, 0.713-0.807). Inclusion of other risk factors did not improve the model. CONCLUSIONS Symptom bother is a strong determinant of care-seeking in the first 2 decades after delivery. These results define 5 ordinal categories that predict seeking care for urinary symptoms in a community population.
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Bridging the gap: determinants of undiagnosed or untreated urinary incontinence in women. Am J Obstet Gynecol 2016; 214:266.e1-266.e9. [PMID: 26348382 DOI: 10.1016/j.ajog.2015.08.072] [Citation(s) in RCA: 49] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2015] [Revised: 08/07/2015] [Accepted: 08/31/2015] [Indexed: 01/01/2023]
Abstract
BACKGROUND More than a third of middle-aged or older women suffer from urinary incontinence, but less than half undergo evaluation or treatment for this burdensome condition. With national organizations now including an assessment of incontinence as a quality performance measure, providers and health care organizations have a growing incentive to identify and engage these women who are undiagnosed and untreated. OBJECTIVE We sought to identify clinical and sociodemographic determinants of patient-provider discussion and treatment of incontinence among ethnically diverse, community-dwelling women. STUDY DESIGN We conducted an observational cohort study from 2003 through 2012 of 969 women aged 40 years and older enrolled in a Northern California integrated health care delivery system who reported at least weekly incontinence. Clinical severity, type, treatment, and discussion of incontinence were assessed by structured questionnaires. Multivariable regression evaluated predictors of discussion and treatment. RESULTS Mean age of the 969 participants was 59.9 (±9.7) years, and 55% were racial/ethnic minorities (171 black, 233 Latina, 133 Asian or Native American). Fifty-five percent reported discussing their incontinence with a health care provider, 36% within 1 year of symptom onset, and with only 3% indicating that their provider initiated the discussion. More than half (52%) reported being at least moderately bothered by their incontinence. Of these women, 324 (65%) discussed their incontinence with a clinician, with 200 (40%) doing so within 1 year of symptom onset. In a multivariable analysis, women were less likely to have discussed their incontinence if they had a household income < $30,000/y vs ≥ $120,000/y (adjusted odds ratio [AOR], 0.49, 95% confidence interval [CI], 0.28-0.86) or were diabetic (AOR, 0.71, 95% CI, 0.51-0.99). They were more likely to have discussed incontinence if they had clinically severe incontinence (AOR, 3.09, 95% CI, 1.89-5.07), depression (AOR, 1.71, 95% CI, 1.20-2.44), pelvic organ prolapse (AOR, 1.98, 95% CI, 1.13-3.46), or arthritis (AOR, 1.44, 95% CI, 1.06-1.95). Among the subset of women reporting at least moderate subjective bother from incontinence, black race (AOR, 0.45, 95% CI, 0.25-0.81, vs white race) and income < $30,000/y (AOR, 0.37, 95% CI, 0.17-0.81, vs ≥ $120,000/y) were associated with a reduced likelihood of discussing incontinence. Those with clinically severe incontinence (AOR, 2.93, 95% CI, 1.53-5.61, vs low to moderate incontinence by the Sandvik scale) were more likely to discuss it with a clinician. CONCLUSION Even in an integrated health care system, lower income was associated with decreased rates of patient-provider discussion of incontinence among women with at least weekly incontinence. Despite being at increased risk of incontinence, diabetic women were also less likely to have discussed incontinence or received care. Findings provide support for systematic screening of women to overcome barriers to evaluation and treatment.
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Schüssler-Fiorenza Rose SM, Gangnon RE, Chewning B, Wald A. Increasing Discussion Rates of Incontinence in Primary Care: A Randomized Controlled Trial. J Womens Health (Larchmt) 2015; 24:940-9. [PMID: 26555779 DOI: 10.1089/jwh.2015.5230] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND A minority of women with urinary incontinence (UI) and even fewer with fecal incontinence (FI) report having discussed it with a health care provider in the past year. Thus our aim was to evaluate whether the use of an electronic pelvic floor assessment questionnaire (ePAQ-PF) improves communication about incontinence in primary care. METHODS Women 40 years and older who were scheduled for an annual wellness physical at an internal medicine clinic between August 2007 and August 2008 were randomized to complete the ePAQ-PF prior to (n = 145) or after (n = 139) their visit. Clinicians of women in the intervention group received the ePAQ-PF report prior to the visit. Outcome measures from clinic note abstraction included mention of UI (primary) and FI. Participant-reported outcome measures included discussion of UI and FI and initiator of discussion. RESULTS Discussions of UI was more common in the intervention group than the control group: (27% vs. 19%; odds ratio [OR], 1.6 95% confidence interval [95%CI] 0.9-2.8, particularly for women over 60 (33% vs. 12%; OR 3.8, 95%CI 1.2-11.8) and for women with UI (42% vs. 25%; OR 2.2, 95%CI 1.1-4.1). The intervention primarily led to an increase in clinician-initiated UI discussions which were more common in the intervention group (18% vs. 4%, OR 4.8, 95%CI 1.9-12.0) Participants in the intervention group more frequently reported discussion of FI (14% vs. 6%; OR 2.5, 95%CI 1.1-6.0) which was clinician initiated in over half the cases (9% vs. 3%; OR 3.5, 95%CI 1.1-11.0). CONCLUSIONS Use of the ePAQ-PF prior to clinic visits increases discussion of UI and FI, particularly clinician-initiated discussion. These findings suggest that such instruments may increase the detection and treatment of this often "silent" affliction.
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Affiliation(s)
- Sophia Miryam Schüssler-Fiorenza Rose
- 1 Spinal Cord Injury Service, Veteran Affairs Palo Alto Health Care System , Palo Alto, California.,2 Department of Neurosurgery, Stanford University , Stanford, California
| | - Ronald E Gangnon
- 3 Department of Population Health Sciences, University of Wisconsin School of Medicine and Public Health , Madison, Wisconsin.,4 Department of Biostatistics and Medical Informatics, School of Pharmacy, University of Wisconsin , Madison, Wisconsin
| | - Betty Chewning
- 5 Department of Sonderegger Research Center, School of Pharmacy, University of Wisconsin , Madison, Wisconsin
| | - Arnold Wald
- 6 Department of Medicine, University of Wisconsin School of Medicine and Public Health , Madison, Wisconsin
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Mandimika CL, Murk W, Mühlhäuser McPencow A, Lake A, Wedderburn T, Collier CH, Connell KA, Guess MK. Knowledge of pelvic floor disorders in a population of community-dwelling women. Am J Obstet Gynecol 2014; 210:165.e1-9. [PMID: 24126299 DOI: 10.1016/j.ajog.2013.10.011] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2013] [Revised: 09/24/2013] [Accepted: 10/10/2013] [Indexed: 10/26/2022]
Abstract
OBJECTIVE The objective of the study was to investigate baseline knowledge and demographic factors associated with a lack of knowledge about urinary incontinence (UI) and pelvic organ prolapse (POP). STUDY DESIGN This study was a community-based, cross-sectional survey of 431 racially and socioeconomically diverse women aged 19-98 years. The Prolapse and Incontinence Knowledge Questionnaire was used to assess participants' knowledge. Primary endpoints were the total number of correct responses on the UI and POP scales, respectively. Percentages of individuals answering each item or group of items correctly were explored as secondary outcomes. RESULTS All women lacked knowledge proficiency about UI and POP, although knowledge about UI was slightly greater than knowledge about POP. Overall, 71.2% of subjects lacked UI proficiency (<80% correct), whereas 48.1% lacked proficiency in POP knowledge (<50% correct). Black women demonstrated significantly less knowledge about UI and POP than white women, both before and after adjustment for age, education, and household income. When combined into 1 group, Asian, Hispanic, and other women also showed significantly less UI and POP knowledge than white women. Most women who reported symptoms of UI had not received treatment for their problems. CONCLUSION There is a global lack of knowledge about UI and POP among community-dwelling women, with more pronounced knowledge gaps among nonwhite women. UI and POP are chronic medical conditions that should be included in routine screening questions for well-woman care. Further studies are needed to explore how best to educate and improve women's awareness of these prevalent pelvic floor disorders.
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Delarmelindo RDCA, Parada CMGDL, Rodrigues RAP, Bocchi SCM. Between suffering and hope: rehabilitation from urinary incontinence as an intervening component. CIENCIA & SAUDE COLETIVA 2013; 18:1981-91. [DOI: 10.1590/s1413-81232013000700013] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2012] [Accepted: 07/23/2013] [Indexed: 11/21/2022] Open
Abstract
This is a qualitative study seeking to understand Brazilian women's experience of urinary incontinence (UI) and design a representative theoretical model for the experience. Theoretical saturation occurred after analysis of the 18th non-directive interview in accordance with Grounded Theory. Two phenomena emerged: living with the challenges of UI and experiencing the hope and disappointment of rehabilitation from UI. Upon re-alignment of the components, the core category emerged, namely: between suffering and hope - rehabilitation from urinary incontinence as an intervening component. From the analysis in light of symbolic interactionism, pregnancy and vaginal birth were observed to be symbols of women's vulnerability to the suffering from living with the moral and physio-psychosocial challenges of UI. It is also inferred that the lack of consideration of the Unified Health System (SUS) in investing in the process of rehabilitation from UI may be having a negative effect on the incentive programs for promoting vaginal birth. Most of all, it reveals the ongoing suffering of women with UI, most of whom do not have access to rehabilitation due to the lack of programs geared to the real needs of these users of the Unified Health System.
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Rebassa M, Taltavull J, Gutiérrez C, Ripoll J, Esteva A, Miralles J, Navarro M, Ribot M, Llobera J. Urinary incontinence in Mallorcan women: prevalence and quality of life. Actas Urol Esp 2013; 37:354-61. [PMID: 23398810 DOI: 10.1016/j.acuro.2012.11.004] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2012] [Revised: 08/30/2012] [Accepted: 11/27/2012] [Indexed: 11/26/2022]
Abstract
GOALS To estimate the prevalence, age distribution, impact on quality of life and type of urinary incontinence (UI) in women over 30 years in Mallorca (Spain). MATERIAL AND METHODS Cross-sectional descriptive study on a randomized sample of 673 women in the health district affiliated to Son Llàtzer Hospital and the 14 Community Health Centres on its area of influence. Following an invitation to participate in the study, women were interviewed twice by their Community Nurse, through the phone and face-to-face. Every interview comprised the completion of the Spanish versions of the ICIQ-SF and EuroQol-5D questionnaires. Prevalence, type and severity (ICIQ-SF) of UI, previous health history and quality of life of women suffering from and free from UI were all estimated. RESULTS 24% (CI 95%=20.9-27.5%) of women suffered from UI and prevalence increased significantly with age. Most frequently identified type of UI was stress incontinence (45%) followed by mixed incontinence (29%), urge incontinence (19.4%) and continuous incontinence (6.5%). For women suffering from UI, ICIQ-SF mean total score was 9.2, 25.2% of these suffering from moderate to severe UI. Women suffering from mixed or continuous UI scored highest at ICIQ-SF. Women suffering from UI showed worse quality of life in every dimension of EuroQol-5D. Quality of life was especially poor for women suffering from mixed or continuous UI. CONCLUSIONS One in four women suffers from UI. UI prevalence increases with age. Half of identified women suffered from stress UI. A fourth of identified incontinences were described as moderate to severe. Women suffering from UI showed worse quality of life.
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El-Hefnawy AS. Editorial comment. Arab J Urol 2011; 9:287-8. [PMID: 26579314 PMCID: PMC4150604 DOI: 10.1016/j.aju.2011.10.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2011] [Accepted: 10/25/2011] [Indexed: 11/16/2022] Open
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Berger MB, Patel DA, Miller JM, Delancey JO, Fenner DE. Racial differences in self-reported healthcare seeking and treatment for urinary incontinence in community-dwelling women from the EPI Study. Neurourol Urodyn 2011; 30:1442-7. [PMID: 21717504 PMCID: PMC3184333 DOI: 10.1002/nau.21145] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2011] [Accepted: 03/28/2011] [Indexed: 11/07/2022]
Abstract
AIMS Objectives of this study are: (1) to examine the prevalence of healthcare seeking among black and white women with self-reported urinary incontinence (UI), (2) to investigate barriers to treatment for incontinence, and (3) To investigate commonly used therapeutic modalities for UI. METHODS This is a planned secondary analysis of responses from 2,812 black and white community-dwelling women living in southeastern Michigan, aged 35-64 years, who completed a telephone interview concerning UI, healthcare-seeking behaviors and management strategies. The study population was 571 subjects (278 black, 293 white) who self-identified as having urinary incontinence. RESULTS Of these women with UI, 51% sought healthcare with no statistically significant difference between the two races (53% black, 50.6% white, P = 0.64). In multivariate logistic regression analysis, a higher likelihood of seeking healthcare was associated with increased age, body mass index lower than 30 kg/m(2) , prior surgery for UI, having regular pelvic exams, having a doctor, and worsening severity of UI. There was no significant association between hypothesized barriers to care seeking and race. Almost 95% of the subjects identified lack of knowledge of available treatments as one barrier. Black and white women were similar in percentage use of medications and some self-care strategies, for example, pad wearing and bathroom mapping, but black women were significantly more likely to restrict fluid intake than white women and marginally less likely to perform Kegels. CONCLUSIONS Black and white women seek healthcare for UI at similar, low rates. Improved patient-doctor relationships and public education may foster healthcare seeking behavior.
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Affiliation(s)
- Mitchell B Berger
- Department of Obstetrics and Gynecology, School of Nursing, University of Michigan, Ann Arbor, Michigan, USA.
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Major depression and urinary incontinence in women: temporal associations in an epidemiologic sample. Am J Obstet Gynecol 2009; 201:490.e1-7. [PMID: 19716547 DOI: 10.1016/j.ajog.2009.05.047] [Citation(s) in RCA: 92] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2008] [Revised: 03/31/2009] [Accepted: 05/26/2009] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To determine whether: (1) major depression is associated with increased risk for onset of urinary incontinence, and (2) urinary incontinence is associated with increased risk for onset of depression. STUDY DESIGN Longitudinal cohort study of female Health and Retirement Study participants completing baseline interviews at Wave 3 (1996-1997) and follow-up interviews at Waves 4-6 (1998-2003). RESULTS In a cohort of 5820 women with a mean age 59.3 (+/- 0.5) years, 6-year cumulative incidences of depression and incontinence were 11% and 21%, respectively. Major depression was associated with increased odds of incident incontinence (adjusted odds ratio, 1.46; 95% confidence interval, 1.08-1.97) during follow-up compared with those without major depression at baseline. Conversely, incontinence was not associated with increased odds of incident depression (adjusted odds ratio, 1.03; 95% confidence interval, 0.75-1.42) compared with those without incontinence at baseline. CONCLUSION Major depression predicted onset of urinary incontinence in a population-based sample of at-risk, community-dwelling women. Incontinence did not predict onset of depression.
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Melville JL, Wagner LE, Fan MY, Katon WJ, Newton KM. Women's perceptions about the etiology of urinary incontinence. J Womens Health (Larchmt) 2009; 17:1093-8. [PMID: 18774894 DOI: 10.1089/jwh.2007.0606] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE Incontinent women have low rates of care seeking and treatment, some of which may be explained by their beliefs about the causes of their own urine loss. As little is known about these beliefs, our aim was to qualitatively assess what women perceive as the etiology of their urinary incontinence (UI). METHODS In a written survey on urinary symptoms administered to female HMO enrollees aged 30-90 years, incontinent women were asked the open-ended question: "Why do you think you lose urine?" Qualitative analyses of the responses identified themes, which were quantified and organized into major categories. Subjects were assigned multiple themes/categories as indicated. Relationships between major categories and subject/incontinence characteristics were explored. RESULTS Of the 1458 women with incontinence who completed the survey, 1192 (82%) responded to the open-ended question. Qualitative analyses identified 23 themes, with 5 themes cited by >or=10% of subjects: pelvic floor/bladder muscles (31%), pregnancy/childbirth (18%), age (14%), exertional triggers (12%), and waiting too long to void (10%). The 23 themes were organized into 5 major categories: pelvic floor/bladder related (53%), uncontrollable factors (23%), part of being female (21%), personal/lifestyle attributes (21%), and don't know (12%). Subjects expressed a range of 1-4 themes/categories. Major categories differed by age, and significant associations were seen between major categories and incontinence severity. CONCLUSIONS Women attribute their UI to a number of causes, which can be condensed into workable themes and categories. By understanding women's beliefs about the etiology of incontinence, clinicians may improve their ability to educate, counsel, and treat women with incontinence.
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Affiliation(s)
- Jennifer L Melville
- Department of Obstetrics & Gynecology, University of Washington, Seattle, Washington 98104-2499, USA.
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Erekson EA, Sung VW, DiSilvestro PA, Myers DL. Urinary symptoms and impact on quality of life in women after treatment for endometrial cancer. Int Urogynecol J 2009; 20:159-63. [PMID: 18985266 PMCID: PMC2887706 DOI: 10.1007/s00192-008-0755-z] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2008] [Accepted: 10/19/2008] [Indexed: 11/26/2022]
Abstract
The primary objective of our study is to describe urinary symptoms in women treated for endometrial cancer. We performed a cross-sectional survey of women who had undergone surgical treatment for endometrial cancer. Three validated questionnaires were utilized: the Sandvik Severity Index, the Urinary Distress Inventory-6 (UDI-6), and Incontinence Impact Questionaire-7 (IIQ-7). Our study included 70 women treated for endometrial cancer; 35.7% (25/70) of women reported adjuvant radiation therapy after surgical staging. Urinary incontinence was reported in over 80% of women. Mean UDI-6 and IIQ-7 scores for women treated with adjuvant radiation therapy were higher compared to women with no adjuvant radiation therapy [47(+/-26.8) vs. 35.6(+/-21.7; p = 0.05)] and [24.4(+/-28.5) vs. 8.1(+/-16.4; p = 0.004)], respectively. Treatment with adjuvant radiation therapy was associated with more severe incontinence symptoms and impact on quality of life.
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Affiliation(s)
- E A Erekson
- Division of Urogynecology and Pelvic Reconstructive Surgery, Alpert Medical School at Brown University, Women and Infants' Hospital of Rhode Island, 695 Eddy St, Ste. 12, Providence, RI 02903, USA.
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Townsend MK, Danforth KN, Lifford KL, Rosner B, Curhan GC, Resnick NM, Grodstein F. Incidence and remission of urinary incontinence in middle-aged women. Am J Obstet Gynecol 2007; 197:167.e1-5. [PMID: 17689637 PMCID: PMC3025861 DOI: 10.1016/j.ajog.2007.03.041] [Citation(s) in RCA: 57] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2006] [Revised: 01/03/2007] [Accepted: 03/12/2007] [Indexed: 11/22/2022]
Abstract
OBJECTIVE The objective of the study was to describe changes in urinary incontinence in middle-aged women. STUDY DESIGN A prospective analysis of 64,650 women aged 36-55 years in the Nurses' Health Study II. Participants reported urine leaking in 2001 and 2003. Two-year incidence and remission proportions were estimated. RESULTS The 2-year incidence of incontinence was 13.7%. Incidence generally increased through age 50 years and then declined slightly in older women. Among women with incident incontinence at least weekly, the incidence of stress incontinence increased through age 50 years (2-year incidence 1.7%), and the incidence of urge incontinence was stable across age groups (2-year incidence 0.4%). Also, a minority (38%) mentioned leaking to their physician. Complete remission of symptoms occurred in 13.9% of women with incontinence at baseline. CONCLUSION We found that incontinence occurs frequently in middle-aged women. Yet few women mentioned incontinence to their physicians; thus, it may be important to initiate conversations about urinary symptoms even among younger patients.
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Affiliation(s)
- Mary K Townsend
- Channing Laboratory, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA 02115, USA.
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Morrill M, Lukacz ES, Lawrence JM, Nager CW, Contreras R, Luber KM. Seeking healthcare for pelvic floor disorders: a population-based study. Am J Obstet Gynecol 2007; 197:86.e1-6. [PMID: 17618770 DOI: 10.1016/j.ajog.2007.02.051] [Citation(s) in RCA: 59] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2006] [Revised: 01/31/2007] [Accepted: 02/27/2007] [Indexed: 11/30/2022]
Abstract
OBJECTIVE The purpose of this study was to identify characteristics that are associated with seeking care for pelvic floor disorders (PFD). STUDY DESIGN Strategies for seeking care for pelvic organ prolapse, urinary incontinence (UI), and anal incontinence (AI) were assessed in 4392 women. Women were dichotomized into women who had sought care and women with disorders who had not. Chi-square and t tests were used to compare demographic and medical variables. Logistic regression was used to calculate adjusted odds ratios (ORs) with 95% CI. RESULTS Women who sought care were significantly older (64 +/- 13.1 vs 55 +/- 14.8 years old; P < .001). After an adjustment for significant variables, care-seeking was associated with increasing age per year (prolapse OR, 1.07 [95% CI, 1.04-1.11]; UI OR, 1.04 [95% CI, 1.02-1.05]), hysterectomy (prolapse OR, 4.30 [95% CI, 2.16-8.55]; UI OR, 1.40 [95% CI, 1.05-1.89]), hormone replacement (UI OR, 1.78 [95% CI, 1.29-2.45]), and urinary infections (AI OR, 1.67 [95% CI, 1.04-2.68]). CONCLUSION Seeking care for PFD is associated with older age, hysterectomy, hormone use, and frequent urinary tract infection. This reinforces the need for PFD treatment as our population ages and demand increases.
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Affiliation(s)
- Michelle Morrill
- Department of Women's Pelvic Medicine, University of California, San Diego, School of Medicine, San Diego, CA 92037, USA.
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DRACH GEORGEW. Editorial comment: Advances in geriatric female pelvic surgery. BJU Int 2006. [DOI: 10.1111/j.1464-410x.2006.06302.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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