A comparison between experienced and objectively demonstrated urinary leakage in 85-year old men and women

The ability of 37 urinary incontinent 85-year old men and women to perform the 48-h pad test in their home environment was studied. Assessment of the magnitude of urinary incontinence by the 48-h pad test was compared with a subjective assessment, performed by the men and women themselves. Twenty-eight of the 37 men and women successfully performed the 48-h pad test. Early signs of dementia and defective vision were the main reasons for not completing the test successfully. The six women who considered their urinary incontinence to be slight had a maximum leakage per pad of 5.3 +/- 1.4 g. The corresponding figure for women with moderate incontinence was 48.8 +/- 12.3 g. None of the women considered their incontinence to be severe, even though eight of the women had a leakage per pad of greater than 30 g. Six men considered their incontinence to be moderate (25.0 +/- 8.1 g) and one man considered his incontinence to be severe (31 g/pad). Fourteen of the 28 men and women underestimated the magnitude of their urinary incontinence.     

Reducing the leakage of body-worn incontinence pads

The aim of this research was to evaluate the effect of various absorbent materials (fluff pulp and superabsorbent) on the leakage performance of incontinence pads. A shaped pad-and-pant system was used as the basic design and four pad types made to different specifications were compared using a double-blind technique. Forty-five elderly hospital residents who were incontinent of urine used all four pad types in a randomly allocated order. Data were recorded on more than 5000 pads over a 2-month period. Leakage was reduced by adding a second layer of fluff pulp and, whilst the addition of a superabsorbent material tended to reduce leakage further, we found no clear relationship between the amount of superabsorbent and the reduction of leakage. Other data indicated the importance of securing the pad in place with the appropriate net pants and the leakage rates of pads in relation to the amount of urine they contained. This research suggests that superabsorbent materials have great potential for reducing the leakage rate of incontinence pads but that the way in which they are incorporated into the pad, the amount of fluff pulp and the design of the pad also play an important part.     

How to choose: nurses' judgements of the effectiveness of a range of currently marketed continence aids

• ? Continence is a costly health problem, both in terms of financial burden in continence aids, but also in terms of quality-of-life issues for the person who has continence problems.
• ? Manufacturers arc often perturbed as to why products specially designed to help continence problems are not popular, or do not appear to be applied as intended.
• ? This paper reports on a study involving a quantitative evaluation of a range of continence aids presently being marketed, as applied in a large elderly care centre.
• ? The evaluation used nursing judgements on a series of comfort and effectiveness criteria: amount of leakage around the pad, comfort to the client when the pad was cither wet or dry, skin integrity and snugness of fit, as well as whether the pad concealed well beneath clothing.
• ? Five body pads were evaluated two disposable and three washable and three bed wider-sheets.
• ? Effectiveness of pads was found to vary substantially according to sex of client and voiding type, that is whether the client had heavy or moderate incontinent episodes.

     

Validity and reliability of a pad test model using a simulated urine leak and healthy continent females

The objective of this study was to determine the validity and reliability of a modified pad test to assess urinary incontinence. Urine leakage was simulated using normal saline that was dosed onto super-absorbent incontinence pads, and worn by healthy continent females over two sequential 12-hour time periods. The results indicate that the two x 12-hour pad test provides a reliable assessment of urine leak in female subjects.     

老年男性尿失禁用物的调查研究

目的：了解成都市住院老年男性尿失禁患者尿失禁处理用物的使用及并发症发生情况。方法：用自行设计的量表对188位尿失禁老人的一般情况、尿失禁的分级及处理用物等进行调查。结果：随着尿失禁的严重程度的增加,患者或其家人选择的处理用物增加。男性尿失禁的不同处理用物被选用的多少依次为：尿布（58.5%）、尿壶（34.0%）、一次性尿垫（25.5%）、保鲜袋（18.6%）、避孕套式尿袋（6.9%）、留置导尿（3.7%）及假性尿器（2.7%）,不同尿失禁分级的患者对处理用物的选择差异有统计学意义（P〈0.05）;2周患者39.9%发生漏尿,13.3%局部皮肤发红,2.7%皮肤糜烂及2.1%尿路感染。结论：临床工作中应该根据尿失禁的不同分级及患者的综合情况指导患者及其照顾者选择合适的处理用物,目前老年男性尿失禁患者仍然欠缺舒适、经济、实用的接尿设备。     

One hundred and fifty men with urinary incontinence: III. Psychosocial consequences

Objective: To investigate the psychosocial impact of urinary incontinence among men.

Design: Telephone interviews with men who had give their written consent to participate.

Subjects: 150 men were available for interviews out of 571 who had asked for information about urinary incontinence and free samples of pads by post.

Main outcome measures: Questionnaire which mapped demographic data, occupational status, medical history, medication, and toilet habits. Duration, frequency, and amount of leakage were registered, and the incontinence was classified according to a symptom questionnaire. Consultations and other sources of help were also registered, together with use of control methods, emotional, practical, and social consequences.

Results: Twenty-four per cent stated that their incontinence was a negligible problem. Generally, increasing severity of the incontinence caused more mental distress and social restrictions. Younger men were more handicapped than the older men. Practical inconveniences and social restrictions increased with longer duration of the incontinence. A multiple regression analysis, using a severity index, duration, type, and age as explanatory variables for the degree of mental distress, practical inconveniences, and social restrictions could explain 7%, 12%, and 25% of the variation in these groups of consequences, respectively.

Conclusion: Urinary incontinence is associated with negative psychosocial effects, the impact increasing with the severity of the incontinence and decreasing with age of the incontinent men.     

Exploring the relationship between skin property and absorbent pad environment

Aim. The aim of this study is to identify the related factors of skin lesions found in the surrounding environment of absorbent pads by clinical investigation. Background. Most older patients with incontinence use absorbent products, therefore causing many patients to have skin lesion in the absorbent pad area. To prevent these skin lesions from occurring, it is necessary to examine the absorbent pad environment of clinical patients since there are many contributing factors that complicate the pathophysiology in this area. Design. A cross‐sectional design was used. Methods. One hundred older Japanese patients with faecal and/or urinary incontinence using diapers and absorbent pads participated. Excluding blanchable erythema, the presence of skin lesions in the absorbent pad area was confirmed. Skin pH, hydration level and bacterial cultures were used to assess the skin property. Absorbent pad environment and patient demographics were also investigated. Results. The overall prevalence of skin lesions was 36%. Forty percent of the skin lesions were contact dermatitis. Multivariate logistic regression analysis revealed that only the presence of diarrhoea independently affected contact dermatitis. Conclusion. There was a significant relationship between contact dermatitis and the use of absorbent pads when the patient had diarrhoea. Although the factors related to skin lesions in the absorbent pad area are complexly intertwined, this study was the first to be able to determine diarrhoea as one specific factor in clinical setting. Relevance to clinical practice. This finding suggests that the presence of diarrhoea is significantly related with contact dermatitis. Therefore, when a patient has diarrhoea, health‐care professionals should immediately implement a preventative care program which includes careful skin observation and improved skin care. It is also necessary to develop a more effective absorbent pad to protect the skin of incontinent patients who suffer from the irritating effects of liquid stool.     

Health interventions and satisfaction with services: a comparative study of urinary incontinence sufferers living in two health authorities in England

? This comparative study found that significantly more people with severe incontinence had contacted a health professional than had those with slight to moderate incontinence (P=0.00008). There was a significant linear trend towards people with severe incontinence seeing a health professional (P=0.00007). ? The majority of people who were incontinent had not been asked to complete a bladder chart, which is an essential requirement for assessment and diagnosis of the type of incontinence and the subsequent health interventions that are offered. ? Significantly more people in the health authority with an established continence advisory service had completed a bladder chart, had received physiotherapy and currently undertook pelvic floor muscle exercises than did those in the health authority without a continence service. ? The majority of sufferers did not use any aids or appliances. Of those who did use incontinence aids, a majority bought their own. There was a significant linear trend for increased pad usage with increasing severity of incontinence (P=0.0003). ? Significantly more people in the health authority with the continence service were satisfied with their healthcare and services, while more of those in the health authority without a service were unsatisfied (P=0.005). Significantly more people in the health authority without a service felt that healthcare and services could be improved (P=0.00001). ? Significantly more people with severe incontinence were dissatisfied with services than were those with slight to moderate incontinence (P=0.01).     

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.     

The effects of multidimensional exercise treatment on community-dwelling elderly Japanese women with stress, urge, and mixed urinary incontinence: a randomized controlled trial

Background

Urinary incontinence is one of the most prevalent health problems and a significant cause of disability and dependence in the elderly. Pelvic floor exercise is effective in reducing stress urinary incontinence, but few studies have investigated the effect of behavioral management on urge and mixed incontinence.

Objectives

To determine the effects of multidimensional exercise treatment on reducing urine leakage in elderly Japanese women with stress, urge, and mixed urinary incontinence.

Design

Randomized controlled, follow-up trial.

Settings

Urban community-based study.

Participants

127 community-dwelling women aged 70 and older with stress, urge, and mixed urinary incontinence were randomly assigned to the intervention (n = 63) or the control group (n = 64).

Methods

Urine leakage and fitness data were collected at baseline, and after the intervention and follow-up. The intervention group received a multidimensional exercise treatment twice a week for 3-month. After treatment, the participants were followed for 7-month.

Results

There were significant differences in changes of functional fitness and incontinence variables between the intervention and control groups. The intervention group showed urine leakage cure rates of 44.1% after treatment and 39.3% after follow-up (χ² = 21.96, p < 0.001); whereas, the control group showed no significant improvement. The multidimensional exercise treatment was significantly effective in decreasing all three types of urinary incontinence. However, the effects of the exercise treatment were greater on stress urinary incontinence than on urge or mixed urinary incontinence. At the 7-month follow-up, while cure rates of all three types of urinary incontinence were significantly maintained, a slight reversal was seen only in the urge and mixed urinary incontinence (χ² = 10.28, p = 0.008). According to the logistic regression model, urine leakage volume (adjusted odds ratio OR = 0.69, 95% confidence interval CI = 0.39–0.98), compliance (OR = 1.03, 95%CI = 1.01–1.16), and BMI reduction (OR = 0.67, 95%CI = 0.48–0.89) were significantly associated with the cure of urine leakage after intervention. The cure rate of urine leakage after the follow-up was significantly associated with compliance (OR = 1.13, 95%CI = 1.02–1.29) and BMI reduction (OR = 0.78, 95%CI = 0.60–0.96).

Conclusions

The intervention group showed higher urine leakage cure rates than control group. This result suggests that multidimensional exercise strategies may be effective for all three types of urinary incontinence. BMI reduction and compliance to the intervention was the consistent predictor for the effectiveness of the exercise treatment.     

Self-reported urinary incontinence in the postpartum period: clinical characteristics

The objective of this cross-sectional study was to characterize the manifestations of self-reported urinary incontinence in the postpartum period. We interviewed 288 women who were clients of a teaching health center in S?o Paulo, between the months of January and August of 2009. The data showed that among the 71 incontinent women (24.6%), 44 (62%) reported stress urinary incontinence, 65 (91.5%) were aware of urine leakage, 33 women (46.5%) experienced urine loss more than once a week, and 24 (33.8%) reported persistent urinary incontinence at the time of interview. The severity classified as moderate urinary incontinence was identified in 53 women (74.7%). The findings highlight the importance of studies on urinary incontinence in the postpartum period, as well as approaching this issue in education and health care interventions with women in the reproductive stage.     

升阳举陷法艾灸在肾阳虚型压力性尿失禁老年女性患者中的应用研究

目的 评价升阳举陷法艾灸在肾阳虚型压力性尿失禁老年女性患者中的应用效果.方法 采用方便抽样法,选取2019年9月—2021年5月在杭州市某三级甲等医院就诊的肾阳虚型压力性尿失禁老年女性患者80例作为研究对象,采用随机数字表法,分为试验组和对照组,每组各40例,试验组在盆底肌功能训练和膀胱功能训练的基础上实施升阳举陷法艾...     

Urinary incontinence: a vibration alert system for detecting pad overflow

A sensor and electronics system is described that monitors the leakage of urine from continence pads into surrounding underwear. Urinary incontinence is involuntary loss of urine and occurs when the bladder muscles contract without warning or the sphincter muscles surrounding the urethra are too weak to prevent leakage. The system comprises a wetness sensor and electronics unit. The sensor is stitched into the underwear and detects overspills of urine from the pad. The electronics unit is attached to the underwear and responds by vibrating, signaling to the wearer that pad has failed. This system has application for individuals who use continence pads in the community, but it could also be used in care homes.     

Longitudinal comparison study of pelvic floor function between women with and without stress urinary incontinence after vaginal delivery

Purpose

To compare the pelvic floor function between women with and without stress urinary incontinence after vaginal delivery.

Methods

Seventeen women (age 35.5 ± 3.5) were prospectively studied at about 6 weeks, 3 months, and 6 months after vaginal delivery. Urinary incontinence was assessed by the International Consultation on Incontinence Questionnaire – Short Form. Pelvic floor function was assessed by antero-posterior diameter of the levator hiatus using transperineal ultrasound.

Results

Five of 17 women experienced postpartum stress urinary incontinence. The antero-posterior diameter of the levator hiatus at rest was significantly longer in stress urinary incontinent women than in continent women until 3 months after delivery (p < 0.01), though shortening of the antero-posterior diameter of the levator hiatus was not significantly different between continent women and stress urinary incontinent women. Regardless of urinary incontinence, the antero-posterior diameter of the levator hiatus at rest shortened at 6 months postpartum, compared to 6 weeks postpartum (p < 0.001). The antero-posterior diameter of the levator hiatus during contraction had shortened only in continent women by 6 months postpartum (p = 0.02).

Conclusion

The extended pelvic floor may be a cause of stress urinary incontinence in the postpartum period. Therefore, treatment to improve the extended pelvic floor should be developed for the prevention of stress urinary incontinence.     

新型射频治疗女性压力性尿失禁的疗效分析

目的 研究新型射频治疗女性轻、中度压力性尿失禁的疗效分析.方法 回顾性分析本院2019年10月-12月门诊就诊的SUI女性患者42例行新型射频治疗女性轻、中度压力性尿失禁的临床资料.其中轻度尿失禁32例,中度尿失禁10例,年龄(48.51±4.13)岁,且均已生育,治疗前行国际尿失禁咨询委员会尿失禁问卷(ICI-Q-S...     

Urinary incontinence and use of pads--clinical features and need for help in home care at 11 sites in Europe

Aim:  The aim of this study was to obtain evidenced-based knowledge about older persons in home care; we conducted a population-based study at 11 sites in Europe (2001/2002). This article focuses on urinary incontinence and need for help in home care.
Methods:  A sample of 4010 respondents 65 years or older were assessed by the Resident Assessment Instrument for Home Care. Urinary incontinence was defined as leakage once a week or more including use of catheters.
Results:  A total of 1478 individuals had urinary incontinence, 45% men and 47% women. The use of pads ran from 29% to 52% between the sites. The associates of urinary incontinence were: moderate or severe cognitive impairment, dependency in toileting and other activities of daily living compared with less impaired; urinary infections, obesity and faecal incontinence. Caregivers to persons with urinary incontinence reported burden or stress more often then carers to nonurinary incontinence individuals (OR = 2.2, 95% CI 1.8–2.7).
Conclusions:  To enable older people with incontinence to stay at home with a better quality of life, they need caring assistance during toileting on a regular basis.     

Bacteriuria is associated with urge urinary incontinence in older women

Objective

To investigate the association between bacteriuria and frequency and type of urinary incontinence in elderly people living in the community. Bacteriuria and urinary incontinence are common conditions and often coexisting in this population; the authors have previously reported the prevalence of bacteriuria to be 22.4% in women and 9.4% in men.

Design

Cross-sectional study.

Setting

The catchment area of a primary healthcare centre in a Swedish middle-sized town.

Subjects

Residents, except for those in nursing homes, aged 80 and over. Participation rate: 80.3% (431/537).

Main outcome measures

Urinary cultures and questionnaire data on urinary incontinence.

Results

In women the OR for having bacteriuria increased with increasing frequency of urinary incontinence; the OR was 2.83 (95% CI 1.35–5.94) for women who were incontinent daily as compared with continent women. Reporting urge urinary incontinence increased the risk of having bacteriuria: 3.36 (95% CI 1.49–7.58) in comparison with continent women while there was no significant association between stress urinary incontinence and bacteriuria. The prevalence of bacteriuria among men was too low to make any meaningful calculations about the association between bacteriuria and frequency and type of incontinence.

Conclusion

Bacteriuria is associated with more frequent leakage and predominantly with urge urinary incontinence. The causes of this association and their clinical implications remain unclear. There might be some individuals who would benefit from antibiotic treatment, but further studies are warranted.     

Female Urinary Incontinence

One hundred and eighty-seven Norwegian women with urinary incontinence (UI) were interviewed after having responded to a marketing campaign for incontinence aids. Nineteen per cent stated that UI was a negligible problem. Urge incontinence was associated with more mental distress, practical inconveniences, and social restrictions than stress incontinence. Young women were more handicapped by stress incontinence than old women. Severe incontinence was associated with more mental distress and practical inconveniences than slight incontinence. A wide variety of control measures was used, the most popular being absorbent products. Only four had not used any control measure. Fifty-seven per cent had mentioned their UI-problem with a doctor. The consultation rate increased with the severity and duration of UI. Only 36% were satisfied with the outcome of the consultation.     

Urinary incontinence in stroke patients after admission to a postacute inpatient rehabilitation program

OBJECTIVE: To determine the incidence of poststroke urinary incontinence in stroke patients admitted for a postacute inpatient rehabilitation program and its association with discharge destination. DESIGN: Cohort study of first-time stroke patients admitted for a postacute inpatient rehabilitation program from August 1994 to August 1997. SETTING: Rehabilitation center in the Netherlands. PARTICIPANTS: Consecutive first-time stroke patients (n = 143). INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Incidence rates calculated with observation time at risk in the denominator. Measures for outcome include the Modified Barthel Index (MBI) and the discharge destination. RESULTS: The incidence rate of urinary incontinence was 29/1000 persons per month (95% confidence interval [CI], 18-48/1000 persons monthly). For incontinent patients, the mean initial MBI score +/- standard deviation was 6.0 +/- 2.3 (range, 2-12); for continent patients, it was 11.5 +/- 9.8 (range, 2-18). This difference was statistically significant (t(139) = 2.12; p = .036; 95% CI for difference of the means, .379-10.84). Patients continent at time of discharge were more often discharged to their own homes than were incontinent patients (Fisher's exact test, p = .0006). CONCLUSIONS: In this select cohort, the incidence of urinary incontinence was lower than that reported in the literature. An association was found between urinary incontinence and discharge destination and between urinary incontinence and functional ability on admission.     

Absorbent products for incontinence: 'treatment effects' and impact on quality of life

Abstract Aim. This study aimed to determine how the use and characteristics of absorbent products for incontinence impact on women's quality of life, and to examine the concept of ‘treatment effects’ in the context of pad use. Method. Key pad performance characteristics were identified from the literature and focus group work. Semi‐structured interviews with 99 women with light incontinence were used to investigate the impact of pad use on women's quality of life, including both positive and negative ‘treatment effects’, and to rank pad characteristics by their importance. Results. Achieving effective and discrete containment of urine was the dominant factor impacting on women's lives. Sub‐themes embraced physical effects, psychological impact and social functioning. The five pad characteristics ranked most important for day time use were: ‘to hold urine, to contain smell, to stay in place, discreteness, and comfort when wet. For night use discreteness was replaced by to keep skin dry’. High levels of reported anxiety were associated with perceived risk of poor pad performance, lack of discreteness and need for complex regimes for pad management. Conclusion. Insufficient attention has been paid to the balance between the beneficial and negative treatment effects of absorbent pads to date. Existing continence‐related quality of life measures are not designed for conditions where change in symptoms is not an outcome measure. The study findings provide the basis for developing a more sensitive, patient‐oriented, quality of life measure for pad‐users which can aid product selection, new product development and inform future evaluative comparisons between products/products and treatments. Relevance to clinical practice. This paper illustrates the complex influence on quality of life caused by using absorbent pads to contain incontinence. It raises awareness of the importance of careful selection of the most appropriate pad for each individual to minimize unfavourable side effects, and the need for a new quality of life measure designed for pad‐users.