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.     

Urinary incontinence prevalence and risk factors in women aged 20 and over in Malatya

The purpose of this population‐based cross‐sectional study is to determine the prevalence and risk factors of urinary incontinence (UI) in women over 20 years old. The study was conducted with 800 women and the participants were stratified by age and residence. The data obtained from the study revealed that prevalence of UI was 32·4%, while the most frequently encountered type of UI was mixed urinary incontinence (72·6%). Logistic regression analysis results demonstrated the most important risk factors for UI as aging [≥50, Odds ratio (OR) 2·94, 95% confidence interval (CI) 1·68–5·13], chronic obstructive pulmonary disease (OR 2·90, 95% CI 1·15–7·34) and recurrent urinary tract infections (OR 3·30, 95% CI 1·94–5·61).     

The prevalence of and the related factors for urinary and fecal incontinence among older residing in nursing homes

Aims and objectives. To determine the prevalence of urinary incontinence and fecal incontinence among older people residing in nursing homes in Istanbul. Background. Urinary incontinence (UI) is a multifactorial condition associated with age‐related changes and disorders of the genitourinary system and systemic problems affecting normal micturition. The impact of UI and fecal incontinence (FI) on older people living in nursing homes is more significant than those living in the community. Design. Cross‐sectional study. Methods. This study was performed with 1110 older people who were 60 years and older residing in five government rest homes on the European side of Istanbul in Turkey. An interview was conducted with the residents that had sufficient cognitive function and agreed to participate. Demographic findings and complaints about incontinence were analyzed using a special questionnaire. Results. The total number of older people who participated was 694; 56·5% females and 43·5% males; 43·4% of females and 20·9% of males. Urge incontinence was common in both groups. FI was more common among females (14%, males 6%) and the mean duration of symptoms was longer. The related factors for UI among older females revealed that history of an episiotomy, frequency, urgency, fecal incontinence and functional incapacity among males; whereas history of stroke and pulmonary disorders were independent variables that increased the incidence of frequency, recurrent urinary tract infections and fecal incontinence. The related factors for fecal incontinence among older females included history of stroke and functional status. Diabetes mellitus requiring medical treatment, frequency, functional incapacity and urinary incontinence were significant related factors for fecal incontinence among males. Conclusions. According to similar studies, the urinary and fecal incontinence rates in nursing home residents were lower compared to the other countries. Incontinence was more common among females according to males. Understanding related factors of incontinence are important for providing care and counseling in nursing homes. Relevance to clinical practice. Nurses can provide appropriate information and support at each step in the protecting, screening, diagnosis and treatment process so that elders’ incontinence is minimized.     

Impact of urinary incontinence on sexual quality of life in Portuguese adults

Urinary incontinence (UI) is a symptom of an underlying disorder with a high prevalence, constituting an important public health problem due to its physical, psychological and social consequences. The impact it has on the individuals' quality of life is revealed in their daily activities, self‐perception, socialization, emotional health and in their sexual life. The objective of this study is to analyse the impact of incontinence on the sexual quality of life, identifying the role of the variables: gender, duration and severity of incontinence, impact of incontinence on the quality of life and type of incontinence. The sample was composed by 55 patients (54·05% male and 45·5% female) from health facilities, in Lisbon, with a mean age of 55 years, who answered a set of questionnaires, which included: the Incontinence Impact Questionnaire (IIQ‐7); the Urogenital Distress Inventory (UDI‐6); the Questionnaire on Sexual Quality of Life, male and female versions (SQoL‐F/SQoL‐M) and a sociodemographic questionnaire. The results indicate that UI has a negative impact on the sexual quality of life in general, especially if the incontinence symptoms endure for a long period of time; also the impact of UI on social relationships, and the stress UI has a significant and negative impact on the sexual quality of life. In this study, UI has a negative impact on sexual life compounded by restrictions and other negative consequences of living with urinary leakage. The authors conclude that further research is required to ascertain the full impact of UI on sexual quality of life. Finally, implications for nurses are also discussed: in addressing the sexual health of their patients, nurses have an important contribution in assuring that experiencing UI should not necessarily translate into negative sexual quality of life.     

Prevalence of urinary and faecal incontinence and nocturnal enuresis and attitudes to treatment and help‐seeking amongst a community‐based representative sample of adults in the United Kingdom

Aim: To determine relative prevalence in the same population of urinary incontinence (UI), faecal incontinence (FI) and nocturnal enuresis (NE). To explore attitudes and behaviours relating to help‐seeking and beliefs about incontinence prevalence, impact, causes and treatments. Design: Online survey. Subjects: A total of 1040 community‐based adults in the UK, representative in terms of age, gender, region and socio‐economic status. Outcomes: Prevalence of UI, FI and NE; help‐seeking behaviour and beliefs; beliefs about cause, impact and treatment of incontinence. Results: Twenty‐three per cent (n = 239) reported UI, 11% (n = 110) FI and 6% (n = 57) NE. Of those known to have sought help, 77% did so from a general practitioner (GP). Of those with no incontinence, 75% said they would seek help from a GP, while 23% said they did not know who they would seek help from. Many were unsure whether treatments were available. Around 90% recognised the serious personal impact of incontinence. Conclusions: This survey suggests that, relative to UI, the prevalence of FI and NE may be higher than previous UK studies. That the majority of those who had sought help did so from a GP, and that those with no incontinence thought that they would do so if affected, underlines the importance of GP education in the diagnosis and management of incontinence and the need to raise public awareness of other sources of help. That many respondents were unsure of treatment options and yet aware of the impact of incontinence underlines the importance of awareness‐raising.     

Mind over bladder: Women,aging, and bladder health

The purpose of this study was to explore the efficacy and acceptability of an innovative, electronically delivered self-management intervention for urinary incontinence (UI) that included daily mindfulness practice, completion of sequential bladder diaries, and bladder health education to improve UI in older women living independently in a retirement community. A mixed methods pilot study was conducted over ten weeks using a custom website or CD. Ten women were recruited and 8 completed the study; 5 of those (71%) experienced fewer daily UI episodes post intervention (p = 0.055). The women also reported a statistically significant decrease in the impact UI had on their everyday life (p = 0.04). Seventy-one percent (N = 5) reported subjective improvement in UI, and high acceptability scores also were achieved. The intervention was both effective in helping older women self-manage UI and acceptable to the population group. Further research is needed with a larger and diverse population of older women.     

Validation of the Korean language version of the incontinence‐quality of life scale

The purpose of this study is to determine the reliability and validity of the translated Korean version of the incontinence‐quality of life (I‐QOL) in a sample of community‐dwelling Korean American women with urinary incontinence in the USA. A survey design was used and a convenience sampling method of 176 Korean American women who reported having urinary incontinence symptoms was used. Translation–back translation procedures were used to translate the English version of the I‐QOL into Korean version. Reliability of the Korean I‐QOL questionnaire was demonstrated by Cronbach's α coefficients. Pearson's correlations of an item with its own scale and other scales were calculated to evaluate item‐convergent and item‐discriminant validity. Confirmatory factor analysis was performed to examine the underlying factor structure of the Korean version of the I‐QOL. Cronbach's α coefficient for all three subscales was greater than 0·70. The results of item‐convergent validity indicated that each item was strongly correlated with the originally belonged subscale. Item‐discriminant validity was evidenced by all lower correlations of an item to the other subscales than that of own subscale. Three factors were extracted from I‐QOL, accounting for 67·37% of the variance. The findings supported the reliability and validity of Korean version of I‐QOL questionnaire. It would be considered as a valuable instrument to assess the different aspects of health‐related quality of life in incontinence patients and recommended for use in clinical research.     

Prevalence and incidence of urinary incontinence of Swiss nursing home residents at admission and after six, 12 and 24 months

Aims and objectives. To study the prevalence and incidence of urinary incontinence in a Swiss nursing home population at admission and at six, 12, 18 and 24 months after admission. Background. No prevalence data for urinary incontinence in people older than 65 years living in nursing homes are available in Switzerland and other German‐speaking parts of Europe. Prevalence of urinary incontinence elsewhere varies between 49% and 77%. Methods. This is a secondary analysis of the data of the minimum data set of the Resident Assessment Instrument 2.0 in which 2719 residents were assessed. Prevalence rates and incidence were calculated at admission and at six, 12, 18 and 24 months after admission. Special focus was placed on sex‐ and age‐related differences. Results. Prevalence of urinary incontinence was 51·5% (men 51·4%, women 51·5%) and was found to rise with increasing age. At the time of admission, 37% (men 43%, women 34%) were urinary incontinent. The prevalence increased from admission to 24 months after admission. Conclusion. The high prevalence rates indicate the relevance of the problem for residents and caregivers alike. Early identification of individuals likely to become incontinent is crucial in the development of interventions and the prevention of urinary incontinence in this vulnerable population. Relevance to clinical practice. The study provides valuable data about the extent of the problem of urinary incontinence in nursing homes.     

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.     

Sex differences in the use of absorbent (incontinence) pads in independently living elderly people: do men receive less care?

Aim: To examine the use and satisfaction of absorbent (incontinence) pads in independently living men and women aged 60 and above with urinary incontinence (UI). Methods: The subjects participated in a large‐scale study about the prevalence of UI. All the independently living patients in nine family practices aged 60 or above with uncomplicated UI, who were willing to participate in the study were interviewed at home. Results: In total, 56 men and 314 women were interviewed. Fifteen per cent of the men and 87% of the women with UI used pads. All men and nine out of 10 women used different kinds of absorbent pads, and half of the men and women used pads specifically made for UI. Only half of the men and two‐third of the women felt satisfied with the pads. The reasons for not being satisfied were: leakage, irritation and discomfort. The use of pads, the use at daytime and the type of pads were correlated to the severity of incontinence. Conclusion: Only one out of nine men with UI uses pads in contrast with four out of five women. Only half of them wear pads specifically made for UI. Men are less satisfied about the pads compared with women.     

Quality of life in climacteric Turkish women with urinary incontinence

Urinary incontinence (UI) is a common health problem and negatively affects the quality of life of women who are afflicted. The aim of the study is to explore the prevalence and risk factors of UI among climacteric Turkish women and to examine the effects of UI on their quality of life. This cross‐sectional study was conducted with 258 women aged 40–64 years who visited the outpatient clinic in Ankara, Turkey, between 15 June 2012 and 15 January 2013. The data were collected using the International Consultation on Incontinence Questionnaire Short Form and the Incontinence Quality of Life Questionnaire. This paper reveals that the overall prevalence of UI was 45.3%. Stress UI, mixed UI, and urge UI were reported by 54.7%, 22.2%, and 10.3% of the subjects, respectively. The proportion of women suffering from UI who seek medical treatment was low despite mild or moderate negative effect impacts on their quality of life. Increasing women's awareness of UI and protective measures is essential, and standard UI assessment should be added to all patient examinations.     

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.     

Incontinence in a manufacturing setting: women's perceptions and responses

The true prevalence of urinary incontinence (UI) and its impact on the quality of life in working women are not well established. Many women do not report UI to a health care provider because they mistakenly believe UI is a natural part of aging. This situation exists despite the dissemination of a national guideline for UI in adults. The aims of this study were to (1) explore what incontinent women in a manufacturing setting name or identify as the proposed cause of urinary leakage (2) analyze an association between identifying a UI cause and reporting it to a health care provider and (3) determine how many women were aware of the AHCPR Guideline. The results indicate that the majority of incontinent women (62%) have not reported this to a health care provider. Most women attributed urinary leakage to parity and waiting too long to empty the bladder. There was no relationship between identifying a UI cause and reporting it to a health care provider. Only 2 of the women out of 78 had heard of the AHCPR Guideline but the majority of women wanted more information about UI (85%). Mechanisms are suggested for querying women with UI and disseminating the AHCPR Guideline.     

The effectiveness of pelvic floor exercise on urinary incontinence in radical prostatectomy patients

Urinary incontinence (UI) is a major complication among patients after radical prostatectomy (RP). Although previous research supports the efficacy of pelvic floor exercises for male UI, there are both positive and no significant effects. The purpose of this study was to examine the effect of pelvic floor exercises on UI after RP. This was a quasi‐experimental, randomized, mixed‐method study design. All participants were older than 45 years and had undergone an RP. Outcome measurements included a 1‐h pad test, personal demographics, and disease‐related data. After catheter removal, participants were distributed into either an exercise group (n = 39) or a non‐exercise group (n = 28). Patients in the exercise group took part in a pelvic floor exercise during their regular daily activities. The non‐exercise group did not perform the prescribed exercise. We examined urinary function at 1, 3 and 6 months after catheter removal. Following a mixed‐model anova test for differences, the results of the pad test revealed significant differences for the main effect of time (F = 75·30,P < 0·001), indicating that the amount of urine leakage decreased over time regardless of the group. Results for the main effect of group were statistically significant (F = 8·85,p < 0·01), indicating that urine leakage also decreased over time in both groups, but that urinary control in the exercise group was better than in the non‐exercise group. Although improvements in surgical technique have significantly improved the outcome of prostate surgery, we believe that patient education regarding pelvic floor exercises by a nurse prior to and after surgery has a significant impact on the early recovery of urinary continence. We believe these exercises would certainly have a positive impact on our patients undergoing RP by improving the quality of life after major urological surgery.     

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.     

Urinary incontinence: The Social Health Maintenance Organization's approach (CE)

Urinary incontinence (UI) is a problem that affects more than 16 million Americans, most of them women. Although nearly half of the elderly in America have episodes of UI, it is not a normal consequence of aging. It remains a largely neglected problem despite its considerable prevalence, morbidity, and expense. This article reports on a successful proactive health risk screening process to treat this major problem.     

The meaning of women's experience of living with long-term urinary incontinence is powerlessness

Aim. The aim was to illuminate the meaning of women's experiences of living with urinary incontinence (UI). Background. Living with long‐term UI means a variety of consequences for everyday life. Women's narratives about their lived experiences are important in enabling nurses to better understand and to help women achieve symptom control. No previous study could be found that has focused on the meaning of women's experience of living with UI from a symptom management perspective. Method. Fourteen women with UI (range: 34–52 years) who had sought professional help were interviewed. A phenomenological hermeneutic method was used to analyse and interpret the interview texts. Findings. The women's experiences of living with UI are presented in terms of two interlaced themes of being in a vulnerable situation and striving for adjustment. Being in a vulnerable situation means that the women had no control over UI and experienced powerlessness. The sub‐themes in this case were living with an uncontrolled body, living with incontinence as taboo and experiencing a less satisfying encounter. Striving for adjustment means that the women tried to handle their incontinence in different ways to regain power and continue to live as normal. The sub‐themes here were living in readiness, making urine leakage comprehensible, accepting living with UI and being familiar with the situation. Conclusion. The meaning of women's experience of living with UI is powerlessness. Relevance to clinical practice. Nurses should supervise women in pelvic floor muscle training to achieve control over incontinence, thereby helping them regain power. Additionally, Integrated Approach to Symptom Management can help nurses enhance women's self‐care abilities.