Pelvic floor muscle training effect on urinary incontinence knowledge, attitudes, and severity: an experimental study

This study of Taiwanese women investigated effects of pelvic floor muscle training (PFMT) on urinary incontinence (UI) severity and on participants' knowledge and attitudes regarding UI and PFMT. Of 114 participants in a 4-h PFMT program, 55 suffering from UI completed 2 questionnaires, 1 before and 1 after the program. Among them, 78% reported experiencing UI under increased abdominal pressure, and 82% had suffered the condition for more than 1 year. Participants achieved reductions in UI severity after PFMT; and the program produced a significant difference in their knowledge about, though not in their attitudes toward, both UI and PFMT.     

ICIQ-SF问卷在尿失禁诊断中的应用研究

目的：分析ICIQ-SF问卷对于诊断不同类型尿失禁（UI）的价值。方法：对2007年8月—2009年7月期间北京大学深圳医院泌尿外科就诊的118例UI女性患者进行研究。由患者自行填写ICIQ-SF问卷表,然后接受尿动力学检查。分别计算ICIQ-SF诊断不同类型UI的敏感性、特异性、阳性预测价值、阴性预测价值和似然比LR值。结果：根据ICIQ-SF问卷,46/118例（39%）患者表现为压力性UI,18/118例（15%）为急迫性UI,54/118例（46%）为混合性UI。ICIQ-SF诊断压力性UI、急迫性UI和混合性UI的敏感性分别为58%,52%和75%;特异性分别为74%,95%和63%。ICIQ-SF诊断压力性UI、急迫性UI和混合性UI阳性预测价值分别为61%,72%,38%;阴性预测价值分别为72%,88%,89%。结论：ICIQ-SF问卷对于诊断不同类型UI具有重要的临床意义。ICIQ-SF问卷在临床实践中具有良好的应用前景。     

Protection of continence in pregnancy,labor and postpartum periods

Urinary incontinence (UI) is a common problem among women. Pregnancy and labor are the major risk factors for UI among young and middle‐aged women. In some studies, the presence of incontinence before and during pregnancy has been shown to be an independent risk factor for urinary and anal incontinence after delivery and beyond. Recently, the need and consequences of many routine interventions applied during each delivery are questioned on an evidence‐based basis. Episiotomy and interventions (forceps, fundal pressure) at the second phase of delivery result in pelvic floor injury by perineal trauma. Similar interventions during delivery pose a risk for urinary and fecal incontinence. Therefore, episiotomy should be avoided as much as possible during delivery, and spontaneous and non‐interventional labor opportunities should be created. Pelvic floor muscle training (PFMT) is often advised as a conservative management method in UI during pregnancy. Investigations suggest that women with stress, urge or mixed UI should be advised to perform PFMT that is part of the conservative management program. There is some evidence in primiparous women that PFMT may prevent UI on the late weeks of pregnancy and the postpartum period. When postpartum pelvic floor exercises are applied along with feedback, they induce a decrease in postpartum incontinence. Furthermore, motivation and the initiative in reminding women regarding kegel exercises were not found to be effective in the postpartum prevention of UI. Postpartum pelvic floor exercises were not found to be consistent with decreased incidence of fecal incontinence. Multidisciplinary approaches are needed to inform women about the risk of postpartum UI.     

Effectiveness of pelvic floor muscle training and bladder training for women with urinary incontinence in primary care: a pragmatic controlled trial

Background

Although the efficacy of pelvic floor muscle training (PFMT) and bladder training are well established, there is a paucity of patient centered models using these interventions to treat women with UI at primary level of health assistance in Brazil.

Using a video assisted teaching program to reduce the severity of urinary incontinence symptoms in women

Urinary incontinence (UI) is still a common chronic health problem affecting physical, psychological and social well‐being of women in developing countries. UI is a challenge to women's health because of the number affected and lack of access to affordable care that can cure or relieve associated symptoms especially in resource limited settings. This study explored the prevalence of UI and assessed effectiveness of a Video Assisted Teaching Program for Kegel's Exercises (VATPKE) in reducing severity of UI symptoms among community dwelling women. A survey was used to obtain data from a sample of 598 community dwelling Indian women in Coimbatore district in Tamilnadu State. A pre–posttest design was then used to assess effectiveness of the VATPKE in reducing UI symptom severity in affected women. Data were analysed using a paired samples t‐test. Of the 598 women, 202 (34%) reported having some level of UI and most participants affected were married (78%), less educated (56%), had high BMI (52%) and lower socio‐economic status. Affected women mostly reported the severity level of UI symptoms at pre‐intervention as moderate (78%) or mild (22%).The mean post‐intervention UI symptoms severity score (M = 21·72, SD = 3·99) was lower than pre‐ intervention (M = 29·91, SD = 5·12) and paired t‐test results showed that the difference was highly statistically significant (p < 0·00). The VATPKE used in this study was effective in reducing the severity of self‐reported UI symptoms in community dwelling Indian women.     

Prevalence of urinary incontinence among community-dwelling adults receiving home care

We conducted a cross-sectional survey in 2005 to determine the prevalence of and factors associated with urinary incontinence (UI) in adults receiving home care. Of the 2,866 patients surveyed, 46% suffered from UI; 6.5% had stress, 16.6% had urge, 9% had mixed, and 17.6% had functional incontinence. No diagnosis regarding type of UI had been established in 50.2%. Factors associated with UI were advanced age, higher body mass index, and impaired mobility. UI is prevalent in older persons receiving home care, but the lack of diagnosis of type of UI in half of the participants surveyed impedes management of UI.     

Developing a rehabilitation programme for male urinary incontinence: detailed schemes and results on 122 patients

Urinary incontinence (UI) is a common complication of prostatectomy. International guidelines suggest using pelvic floor muscle training (PFMT) as a first‐line intervention (grade A) to help patients reduce the involuntary urine leakages. In the literature it is hard to find a complete exercise scheme, with full details (e.g. body position during PFMT, how to avoid antagonist synergies), information on how to make exercises progressively more difficult, and data showing the efficacy of the whole programme. This study presents a complete PFMT programme, with full details and outcomes. A scheme of five progressive exercises was built, each with precise characteristics and times. Totally 131 patients with stress UI after radical retropubic prostatectomy were enrolled and followed a written scheme of PFMT with the five exercises. Leakages were quantified using the 24‐h pad test. Rehabilitation ended when patients had leakages less than 10 g/d. Nine patients could not achieve results and decided to exit the programme after a median of five sessions (InterQuartile Range, IQR = [4;7]). Out of the 122 patients, 90 patients who followed the full programme achieved the rehabilitation (70.3%); they had median leakages of 150 g, IQR = [90;300]. Those who did not reach the result had higher leakages [540 g/d, IQR = (300;840)] but obtained clinically significant reduction and reached a median of 90 g/d, IQR = [90;157] after comparable rehabilitation times (median of 6 or 7 sessions, corresponding to 8 or 10 weeks, for rehabilitated and non‐rehabilitated patients, respectively). Future studies will investigate the long‐term results of this programme.     

Quality of life and self-esteem in women living with urinary incontinence in Turkey

This study was conducted to determine the quality of life and self-esteem levels of women with urinary incontinence (UI). A total of 180 women participated in this cross-sectional study. This study was conducted in two stages. First, the international consultation on incontinence questionnaire-UI short form (ICIQ-SF) was implemented, and then other measures were applied to the women who scored 8 or more as the most appropriate cut-off point for ‘irritating’ UI. More specifically, a personal information form, the Rosenberg self-esteem scale (RBSS), the urogenital distress inventory-6 (UDI-6), and the incontinence impact questionnaire-7 (IIQ-7) were applied. It was observed that the mean self-esteem score of women with UI was generally sufficient. In line with the data obtained, it was observed that as the UI levels of women increased, their quality of life decreased. Similarly, a decrease was observed in the self-esteem levels of women whose quality of life decreased. As a woman's UI worsens, levels of urogenital distress increase and quality of life decreases, which leads to decreased self-esteem. Urinary incontinence is often kept secret, ignored, considered private, and seen as an unavoidable consequence of ageing.     

社区中老年女性尿失禁患者对疾病认知和需求状况的调查

目的 了解社区中老年女性尿失禁患者对疾病知识的掌握情况、所持态度及需求.方法 对北京某2个社区的66名中老年女性尿失禁患者进行问卷调查,并对结果进行分析.结果 中老年女性尿失禁患者对疾病认识不足;疾病影响了患者的身心健康;多数患者希望了解治疗知识,最希望获得的服务方式是医护人员的主动宣教.患者对疾病知识的掌握情况与其病情严重程度、年龄无关,而与文化程度和经济收入呈正相关.结论 应加强尿失禁知识的宣传普及,为患者提供健康教育和情感支持,并加强医护人员对患者尿失禁教育的培训.     

Training bar staff in preventing and managing aggression in licensed premises

Objectives: (1) to evaluate changes in knowledge and attitudes of participants in the “Safer Bars” training programme to reduce aggression in bars; (2) to assess the relationship of scores on knowledge/attitudes questionnaires with participant's role in bar, gender and years of experience, and geographic location of the bar; and (3) to assess consumer satisfaction and elicit subjective feedback regarding the programme.

Methods: Five hundred and twenty‐two bar staff and managers from 23 bars completed knowledge/attitude tests before and after the 3‐h training and provided consumer satisfaction ratings.

Results: Participants rated the training very highly and showed significant improvements in knowledge and attitudes related to preventing aggression and managing problem behaviour. In multivariate analyses, being male, having more years of experience, being a manager or bartender and being employed at a city‐centre bar were all independent predictors of higher pre‐test training scores; however, only being a manager and being employed at a city‐centre bar significantly predicted higher scores on post‐test knowledge and attitudes.

Conclusions: The positive response to the “Safer Bars” training and the significant improvement in knowledge and attitudes indicate that programmes of this type have the potential to be an effective public health strategy for reducing bar‐related violence and injury.     

Prevalence of urinary incontinence in older Korean women

Worldwide prevalence of any type urinary incontinence (UI) in women 20 years and over is estimated to be over 275 million in 2013 and the 4th International Consultation on Incontinence expects it to increase to over 300 million in 2018. While UI in women is considered to be an aging and public health issue with global implications, most research cited in the UI literature comes from English language sources. The absence of information from many Asian and other countries may be due to reliance on scientific reports written in English by editorial policies, authors of systematic literature reviews and other researchers. Moreover, the financial costs and time constraints associated with translation and dissemination of findings into English language journals could act as dissemination barriers. Therefore, the purpose of this study was to describe the current state of knowledge about prevalence and correlates of UI in Korean older women from non‐English language sources. Twelve research articles, two research monographs and one master's thesis, and data on UI abstracted from South Korea's 2008 National Health Insurance Cooperation Reports were reviewed in full. The prevalence of UI in women 60 years and older ranged from 11·2% to 76·3%. Personal, physical and psychological factors were found to be associated with UI including age, income and educational level, presence of comorbidities, body mass index, depression, anxiety and cognitive impairment. There was little difference between rural and urban dwelling older women in help‐seeking behavior: 93.8% rural and 90.5% urban dwelling older women sought no help for their incontinence. Inclusion of reports from non‐English sources is considered as an important contribution to better understanding of the worldwide epidemiology of UI in older women.     

Is pelvic floor muscle training effective when taught in a general fitness class in pregnancy? A randomised controlled trial

Objectives

Pelvic floor muscle training (PFMT) following vaginal assessment of correct contraction can prevent and treat urinary incontinence in the peripartum period. The aim of this study was to evaluate the effectiveness of PFMT instructed in a general fitness class for pregnant women.

Design

Single-blind randomised controlled trial.

Setting

University-conducted primary care study.

Participants

One hundred and five sedentary primiparous women randomised to a general fitness class including PFMT (n = 52) or a control group (n = 53). Ten and 11 women were lost to follow-up in the exercise and control groups, respectively.

Intervention

Twelve weeks of training comprising twice-weekly 1-hour fitness classes including three sets of eight to 12 maximal pelvic floor muscle contractions. The control group received usual care.

Outcome measure

Number of women reporting urinary, flatus or anal incontinence.

Results

No significant differences were found in the number of women reporting urinary, flatus or anal incontinence between the exercise group and the control group during pregnancy or at 6 weeks post partum.

Conclusions

No effect of PFMT was found when the exercises were taught in a general fitness class for pregnant women without individual instruction of correct PFM contraction. Low adherence and the small sample size may have contributed to the negative results. Further studies are warranted to assess the effect of population-based PFMT in the prevention of urinary and fecal incontinence.     

Urinary incontinence in a community sample of older adults: prevalence and impact on quality of life

Purpose.?To measure the prevalence of urinary incontinence (UI) in a community-dwelling sample and the impact of self-reported UI on well-being and activity in older men and women.

Method.?Participants were older adults aged ≥65 years. Measures included the frequency of urgency incontinence, depression, positive and negative affect and social activity, independence in activities of daily living (IADL) and self-rated health. The data were collected by face to face interview (1994) and computer assisted telephone interviews (1996).

Results.?Of the 796 participants, 28%% experienced urgency incontinence and 21%% reported stress incontinence occasionally or often, with higher rates among women. The threshold for the impact on depression, negative affect and IADL was with occasional occurrence of urinary urgency incontinence. For positive affect and self-rated health, the threshold was experiencing urinary urgency incontinence often. The presence of urinary stress incontinence was associated with depression, IADL dependence, self-rated health and positive affect. Overall, women with incontinence had higher negative affect scores, but men with stress incontinence had higher scores than those without.

Conclusions.?The impact of incontinence highlights the need for more effective management of the condition. The threshold for the effects of urinary urgency incontinence on mental health and functionality is lower than for the effects on general health. There is a need to consider how older people judge the impact of UI in the design of targeted health promotion programmes.     

Urinary incontinence and the criteria of frailness among the elderly outpatients

The objectives of this study were to verify the occurrence of urinary incontinence (UI) and its characteristics in pre-frail and frail elderly patients of a geriatrics outpatient clinic, compare the presence of frailness criteria among the elderly with and without UI and identify among the frailty criteria the chance of risk for UI among those elderly outpatients. Participants were 100 elderly individuals, with an average age of 76.2 years; 65 participants reported UI, 71.3% of which presented three or more frailness criteria. The occurrence of UI was greater in frail participants (p=0.0011). Multivariate analysis showed that the criteria slowness (OR=4.99) and exhaustion (OR=4.85) has a statistically significant relation with UI. The occurrence of UI was high and participants who presented slowness have a risk almost five times greater to presenting UI while those reporting exhaustion have a risk five times greater for UI compared to those without these criteria.     

Contraceptive self‐efficacy and contraceptive knowledge of Hong Kong Chinese women with unplanned pregnancy

Aim and objectives. The purpose of this study was to explore contraceptive practice, the level of knowledge and self‐efficacy of contraception among Chinese women with unplanned pregnancy and to determine the relationships between these variables. Background. The construct of self‐efficacy can be employed as a theory to design a nursing intervention to prevent sexually active women from unplanned pregnancy. Only a few western studies have investigated the relationships between self‐efficacy and contraception behaviour yet none targeted at the Chinese population. Design. Cross‐sectional survey. Methods. This study employed a cross‐sectional survey design. A convenience sample of 117 eligible Chinese females completed all the questionnaires, which included the Chinese version of the Contraceptive Self‐efficacy Scale and Contraceptive Knowledge Scale. Results. The findings in this study suggested that younger, unmarried women at the lower income group, who adopted male condoms are at risk for unplanned pregnancy. The sample demonstrated an above medium level of knowledge and self‐efficacy in contraception. However, no significant relationship was found between contraceptive self‐efficacy and knowledge (p>0·05). Conclusions. Contraceptive obstacles were revealed by participants’ moderate level of contraceptive self‐efficacy and contraceptive knowledge. The relationship between contraceptive knowledge of specific methods and contraceptive self‐efficacy need further exploration in future studies. Relevance to clinical practice. The dominant use of male condoms by the sample of this study sheds light on future direction in the development of educational programmes and contraceptive promotion strategies appropriate for women with unplanned pregnancy.     

Ferrans and Powers' Quality of life index applied in urinary incontinence research--a pilot study

Scand J Caring Sci; 2011; 25; 410–416
Ferrans and Powers’ Quality of life index applied in urinary incontinence research – a pilot study Background: The aim of this study was to explore the usefulness of applying a global, evaluation‐based quality of life (QoL) questionnaire in assessing the impact of urinary incontinence (UI) on women’s lives. Methods: The study population comprised long‐term gynaecological cancer survivors (n = 160) and controls from the general population (n = 493). The presence of UI was assessed by the question ‘Do you leak urine?’ while UI perceived as a problem was assessed on a five‐point scale from ‘No problem’ to ‘A very large problem’. QoL was measured by Ferrans & Powers’ QoL index (QLI), generic version II. Results: UI was distributed equally among women with a history of gynaecological cancer and among women from the general population (34%). UI has a negative impact on overall QLI as well as a wide range of items. Approximately 20% of the incontinent women defined UI as no problem, with QLI scores similar to continent women. Only 5% experienced UI as a large/very large problem; with exceptionally low QLI scores. The psychometric testing of QLI (acceptability, internal consistency reliability and known‐group validity) supports the use of QLI in UI‐studies. Conclusions: The Ferrans & Powers’ QLI is considered an acceptable tool for UI research, but further psychometric testing is required.