The effects of low-frequency endo-anal electrical stimulation on faecal incontinence: a prospective study

Background and aims Faecal incontinence is a distressing problem that is often not amenable to surgical correction. Chronic low-frequency electrical stimulation of damaged axons is thought to reduce synaptic resistance, increase the size of motor units by axonal sprouting and increase the rate of conduction of the pudendal nerve. The aim of this study was to prospectively evaluate the effect of chronic low-frequency endo-anal electrical stimulation on faecal incontinence using a home-based unit and hospital-supervised therapy.Materials and methods Forty-eight patients with faecal incontinence completed a prospective randomised trial. Patients were allocated randomly to one of two groups; group 1 was exposed to endo-anal pudendal nerve stimulation daily at home with a portable home unit, group 2 attended the physiotherapy department for endo-anal electrical stimulation under supervision.Results Continence scores improved significantly after treatment in both groups (p<0.001). Both groups showed improved manometric scores, although only group 1 showed significant improvement in both resting and squeeze pressures (mean total resting pressure 184–224 mmHg, p<0.001; mean total squeeze pressure 253–337 mmHg, p<0.001). This was also reflected by an improvement in quality of life in both groups.Conclusions Low-frequency endo-anal electrical stimulation significantly improves continence scores and quality of life in patients with faecal incontinence not amenable to surgical correction. It leads to improved manometric values when carried out on a daily basis with a portable home unit.     

Etiology and predictors of urinary incontinence and its effect on quality of life

Aim: Urinary incontinence associated with dementia can result in medical comorbidities. We aimed to determine the prevalence of urinary incontinence and to identify the etiology and factors associated with urinary incontinence in dementia patients. Methods: Patients with an Mini‐Mental State Examination (MMSE) score of more than 10, attending the memory clinic were recruited. Basic demographic data, types and duration of dementia, use of cholinesterase inhibitor and other drugs with anticholinergic effects, carer stress and presence of urinary incontinence in the previous 6 months were recorded. Urodynamic studies were carried out in those patients with urinary incontinence. Results: One hundred and forty‐four subjects with a mean age of 78 years (standard deviation 6.8) were included. Forty‐eight (33.3%) had urinary incontinence. There was no statistically significant difference between continent and incontinent groups regarding age, MMSE, duration of dementia, use of cholinesterase inhibitor and of drugs with anticholinergic effects. Presence of nocturia of more than twice per night (odds ratio [OR] 4, 95% confidence interval [CI] 1.7, 9.2), use of walking aids (OR 2.6, 95% CI 1.1, 5.9) and male sex (OR 1.36, 95% CI 1.1, 5.2) were independent predictors of urinary incontinence. Urodynamic studies showed that 21 subjects had detrusor overactivity, 13 had bladder outlet obstruction, two with low compliance bladder, two with small bladder capacity, four with detrusor hyperactivity and impaired contractility. Conclusion: Urinary incontinence commonly occurs in dementia subjects. Poor mobility and presence of nocturia increase the risk of urinary incontinence. Correction of the possible reversible factors may help to reduce the prevalence of urinary incontinence in patients with dementia and reduce carer stress.     

盆底肌电刺激疗法治疗老年女性真性压力性尿失禁

目的 探讨盆底肌电刺激疗法（以下简称电刺激疗法）治疗老年妇女真性压力性尿失禁（GSI）的疗效。方法 对40例老年女性GSI患者行电刺激疗法治疗;将神经肌肉电刺激治疗仪（ETS）皮肤表面电极置于会阴部（阴道与肛门连线的两侧）。电刺激模式为专为盆底肌锻炼设计的一组程序化刺激。每周3次,每次60min,12周为1个疗程。观察治疗前后主观及客观指标变化,评估治疗效果。结果 尿失禁症状消失11例,改善21例,无改善8例。症状消失和改善者功能性膀胱容量、valsalva漏尿点压、最大尿道压和最大尿道闭合压显著高于治疗前（P〈0．05）,总排尿次数、总漏尿事件次数和ICI-Q-SF评分显著低于治疗前（P〈0．05）,总排尿量、最大尿流率、膀胱顺应性、最大膀胱压测定容量、最大尿流率时逼尿肌压力和功能性尿道长度治疗前后无明显差异（P〉0．05）。结论 神经肌肉电刺激疗法治疗老年女性GSI疗效显著．且具有无创性和经济方便等优点。     

Postpartum urinary incontinence of nulliparous women: A prospective cohort study

Postpartum urinary incontinence affects women’s quality of life. It is associated with different risk factors during pregnancy and childbirth. We evaluated the persistence of postpartum urinary incontinence and associated risk factors among recently delivered nulliparous women with incontinence during pregnancy. This was a prospective cohort study, which followed up all nulliparous women recruited antenatally from 2012 to 2014 in Al-Ain Hospital, Al-Ain, United Arab Emirates, who developed urinary incontinence for the first time during pregnancy. Three months after giving birth they were interviewed face-to-face, using a structured and pre-tested questionnaire, and divided into 2 groups: those who had urinary incontinence and those without it. Risk factors were compared between the 2 groups. Of the 101 participants interviewed, postpartum urinary incontinence continued in 14 (13.7%) while 87 (86.3%) recovered from it. The comparative analysis did not show any statistically significant difference between the 2 groups for sociodemographic risk factors nor for antenatal risk factors. Childbirth-related risk factors were also not statistically significant. Recovery from incontinence during pregnancy in nulliparous women was over 85% as postpartum urinary incontinence affected only a small proportion at 3 months following delivery. Expectant management is advised instead of invasive interventions in these patients.     

Relationship between urinary incontinence and quality of life/depression in elderly patients

PurposeThe aim of this study was to investigate the relationship between urinary incontinence (UI) and quality of life/depression in elderly patients.MethodsThe study included a total of 109 elderly adults aged 65 years and older, consisting of 44 patients with and 65 patients without UI. Demographic data were recorded and UI was assessed using a questionnaire. The Standardized Mini-Mental State Examination was used to evaluate cognitive function. Depression status was assessed using the Yesavage Geriatric Depression Scale and quality of life was assessed using Short Form-36 (SF-36) Health Survey scoring.ResultsThe mean ± standard deviation (SD) age of the elderly patients with UI was 80.06 ± 6.25 years; 21 (47.7%) were women and the other 23 (52.3%) were men. The mean ± SD visual analog scale score for the severity of UI was 6.22 ± 0.85; the mean ± SD number of diurnal voidings was 7.20 ± 0.87 and the mean ± SD number of nocturnal voidings was 3.81 ± 0.97. The mean ± SD depression score of elderly patients with UI was significantly higher than those without UI (p < 0.0001). There was a strong negative correlation between depression and UI (p < 0.0005; r = −0.886). Both the mental and physical scores of the SF-36 quality of life scale were significantly lower in elderly patients with UI than in those without (p < 0.005). An increased risk of depression (5.90-fold) was found in elderly patients with UI compared with those without UI. UI was found to cause a 0.037 point reduction in the physical component score and a 0.055 point reduction in the mental component score; these are statistically significant.ConclusionUI in elderly adults leads not only the loss of physical abilities, but also to changes in their mental condition.     

骶神经磁刺激联合托特罗定治疗老年女性混合性尿失禁的疗效观察

目的 探讨骶神经磁刺激联合托特罗定治疗老年女性混合性尿失禁的临床疗效.方法 选取61例老年女性混合性尿失禁病人,根据就诊顺序分为对照组和观察组,对照组(n=30)服用酒石酸托特罗定缓释片(4mg/粒,1粒/d),共服用2个月;观察组(n=31)在托特罗定基础上联合骶神经磁刺激治疗(2次/周,40 min/次),共治疗2...     

The effect of urinary incontinence on quality of life in older nursing home residents

OBJECTIVES: To determine whether nursing home residents with urinary incontinence (UI) have worse quality of life (QoL) than continent residents, whether the relationship between UI and QoL differs across strata of cognitive and functional impairment, and whether change in continence status is associated with change in QoL. DESIGN: Retrospective cohort study using a Minimum Data Set (MDS) database to determine cross-sectional and longitudinal (6 month) associations between UI and QoL. SETTING: All Medicare- or Medicaid-licensed nursing homes in Kansas, Maine, Mississippi, New York, and South Dakota during 1994 to 1996. PARTICIPANTS: All residents aged 65 and older, excluding persons unable to void or with potentially unstable continence or QoL status (recent nursing home admission, coexistent delirium, large change in functional status, comatose, near death). MEASUREMENTS: UI was defined as consistent leakage at least twice weekly over 3 months and continence as consistent dryness over 3 months. QoL was measured using the validated MDS-derived Social Engagement Scale. RESULTS: Of 133,111 eligible residents, 90,538 had consistent continence status, 58,850 (65%) of whom were incontinent. UI was significantly associated with worse QoL in residents with moderate cognitive and functional impairment. New or worsening UI over 6 months was associated with worse QoL (odds ratio = 1.46, 95% confidence interval = 1.36-1.57) and was second only to cognitive decline and functional decline in predicting worse QoL. CONCLUSION: This is the first study to quantitatively demonstrate that prevalent and new or worsening UI decreases QoL even in frail, functionally and cognitively impaired nursing home residents. These results provide a crucial incentive to improve continence care and quality in nursing homes and a rationale for targeting interventions to those residents most likely to benefit.     

老年尿失禁的病因和治疗

老年尿失禁的评估和治疗遵循一定综合模式,可因生理年龄改变和伴发疾病等多种相关的危险因素导致不同的结果。医生有责任处理老年性尿失禁,通过职业培训和宣传教育让人们知道尿失禁是可通过传递关怀,进行药物和手术治疗及其他综合治疗的一种疾病。     

Effect of biofeedback on psychological burden and symptoms in older women with urge urinary incontinence

OBJECTIVES: To determine the effect of biofeedback (BFB) therapy on psychological burden of urge urinary incontinence (UI) and whether prior depression or current depressive symptoms affect older women's response to BFB.
DESIGN: Secondary analysis of an ongoing trial.
SETTING: Academic medical center.
PARTICIPANTS: Forty-two community-dwelling women aged 60 and older with urge UI.
INTERVENTION: BFB and behavioral training in urge suppression provided over 8 weeks.
MEASUREMENTS: UI frequency on 3-day bladder diary, psychological burden assessed using Urge Impact Scale (URIS-24) total and subscale scores, history of depression, and depressive symptoms on the Mental Component Subscale (MCS) of the Medical Outcomes Study 36-item Short Form Survey (SF-36). Age and chronic conditions were included as covariates.
RESULTS: BFB improved UI (by 45%, P =.001) and psychological burden ( P =.001 for total URIS-24 score and for all three of its subscales; P =.01 for SF36-MCS). However, although the magnitude of UI improvement was equivalent for those with and without a history of depression, improvement in psychological outcomes was twice as great in those with a history of depression, especially on the perception of control subscale, and improvement was not related to baseline depressive symptoms.
CONCLUSION: In older women with urge UI, BFB significantly improves psychological burden, especially in those with a history of depression, in whom psychological burden is linked to change in perception of control. Psychological factors are relevant outcome measures for UI, and these data suggest that focusing on UI frequency alone may have underestimated BFB's efficacy and additional therapeutic benefits.     

Effect of sacral nerve stimulation in patients with fecal and urinary incontinence

PURPOSE: Preliminary studies have shown improvement in fecal incontinence in several patients who received temporary or permanent stimulation. The purpose of this study was to report our experience in sacral nerve stimulation in the treatment of fecal incontinence and to target patients who would benefit most from stimulation. METHODS: Patients with fecal incontinence were studied clinically and manometrically before, during, and after temporary nerve stimulation. If temporary nerve stimulation was clinically successful, the patient was implanted and followed up for six months. RESULTS: Nine patients (6 female) with a mean age of 50.7 ± 12.3 years underwent temporary nerve stimulation. Temporary nerve stimulation was successful in eight patients, six of whom were implanted. Of the patients who could be evaluated, three of five had improved at the six-month follow-up visit, particularly in relation to the number of urgency episodes and delay in postponing defecation. All implanted patients had urinary symptoms. Urinary urgency was also improved by stimulation. During temporary nerve stimulation, the maximal squeeze pressure amplitude increased. After implantation, only the duration of maximal squeeze pressure seemed to improve. CONCLUSION: Sacral nerve stimulation can be used in the management of fecal incontinence, particularly in cases of urge fecal incontinence associated with urinary urgency. This study seems to confirm the effect of sacral nerve stimulation on striated sphincter function.Presented in part at the 7th United European Gastroenterology Week, Rome, Italy, November 13 to 17, 1999; the Brain-Gut 2000 Symposium, Toulouse, France, July 2 to 5, 2000; and the Second International Conference on the Pelvic Floor, Oxford, England, September 9 to 12, 2000.     

Development and testing of a measure of health-related quality of life for men with urinary incontinence

OBJECTIVES: To describe the development and psychometric testing of male versions of the Urogenital Distress Inventory (UDI) and Incontinence Impact Questionnaire (IIQ). DESIGN: Instrument development. SETTING: Urology clinic at a large urban Veterans Affairs Medical Center. PARTICIPANTS: Convenience sample of English-speaking community-dwelling male urology clinic patients who acknowledged concerns about urine leakage. MEASUREMENTS: Content experts and male clinic patients evaluated items for clarity and fit. Revised instruments were administered to 153 participants. Data were analyzed to examine issues of feasibility of administration, internal consistency reliability, and validity. RESULTS: Modal completion time for the Male Urogenital Distress Inventory (MUDI) (27 items) and Male Urinary Symptom Impact Questionnaire (MUSIQ) (32 items) was 20 minutes. Cronbach's coefficients were.89 for the MUDI and.95 for the MUSIQ. Total MUDI and MUSIQ scores were moderately correlated (r =.59, P <.001). Mean MUDI and MUSIQ scores varied significantly with self-reported desire for socialization, urine leakage, and depression. Principal components analyses suggested the presence of seven factors accounting for 65.4% of the variance in the MUDI and six factors accounting for 72.9% of the variance in the MUSIQ. CONCLUSIONS: It is feasible to use the MUDI and MUSIQ to measure health-related quality of life in men with continence problems. The scores appeared to be reliable and valid in this racially and educationally diverse sample. Use of the MUDI and MUSIQ may provide more sensitive measurement of the specific effect of urinary incontinence and related symptoms on health-related quality of life in men. Future research should determine reproducibility and responsivity and reexamine the construct validity of these instruments.     

Isolated urinary, fecal, and double incontinence: Prevalence and degree of soiling in stroke survivors

OBJECTIVES: To investigate the prevalence of isolated urinary and fecal incontinence and double incontinence in community-living stroke survivors and to assess the degree of soiling. DESIGN: Community-based postal survey. SETTING: Leicestershire, United Kingdom. PARTICIPANTS: Sixty-four thousand seven hundred forty-nine community-dwelling residents (aged > or = 40) were randomly selected from the Leicestershire Health Authority register. Residents living in institutional settings were excluded. MEASUREMENTS: Respondents were asked about previous stroke, urinary and bowel symptoms, and general health and demographic details including age, sex, and ethnicity. Urinary incontinence was defined as leakage several times a month or more often. Major fecal incontinence was defined as soiling of underwear, outer clothing, furnishings, or bedding several times a month or more often. RESULTS: A 65% response rate to the postal survey was obtained, with the return of 39,519 eligible questionnaires; 4% (n = 1,483) reported stroke. Five percent of stroke survivors reported major fecal incontinence, with 4.3% reporting fecal and urinary incontinence and 0.8% reporting isolated fecal incontinence. Major fecal incontinence was four and a half times as prevalent in stroke survivors as in the nonstroke population, and stroke survivors were also twice as likely to report soiling of furnishings or bedding. Functional limitations influence the presence of fecal incontinence in the stroke and nonstroke population. CONCLUSION: Fecal incontinence is common in stroke survivors, and the degree of soiling can be considerable. Future research needs to explore the effect fecal incontinence can have on the lives of stroke survivors and on how it can best be managed in those living in the community.     

Anatomical urinary stress incontinence in women with rheumatoid arthritis: Its frequency and coping strategies

Objective. The objectives of this study were to develop a valid screening tool for anatomical urinary stress incontinence (AUSI), to use it to determine the frequency of AUSI in women with RA, and to identify the cognitive, behavioral, and psychological coping strategies used by these women to deal with incontinence. Methods. A screening tool concerning AUSI was validated by comparing self-reported incidences of AUSI with clinical evaluation. Questionnaires regarding presence of AUSI and cognitive, behavioral, and psychological coping strategies were sent to 750 women clinically diagnosed with RA. Results. Of the 262 respondents (35% response rate), 21% had characteristics of AUSI, a rate similar to general population studies. Coping strategies varied depending on whether the women were at home or away from home and whether the women were alone or with others. Conclusions. There is a need for women with incontinence and the health care workers who serve them to be educated about AUSI and its treatments.     

Transcutaneous electrical posterior tibial nerve stimulation for faecal incontinence: effects on symptoms and quality of life

Purpose  

Faecal incontinence is a disabling symptom which may be particularly difficult to treat. Recent studies showed that transcutaneous electrical posterior tibial nerve stimulation may improve faecal continence. In this study, we aimed to evaluate the effectiveness of this technique and tried to individualize predictive factors of success.