The prevalence and severity of urinary incontinence in women

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.

Reproducibility of instruments designed to measure subjective evaluation of female stress urinary incontinence

The aim of this study was to construct two instruments by which detailed knowledge of women's problems related to stress urinary incontinence (SUI) could be registered, and to test the reproducibility of the results obtained. Fourteen women with urodynamically proven SUI, and a mean age of 42.8 years (range 18-56) participated in the study. The leakage index was a five point scale (1 = never, 5 = always) containing thirteen types of physical exertions known to trigger urinary leakage. The social activity index contains nine social settings in which women may have problems to participate. For each parameter a 10 cm visual analogue scale (0 = impossible to participate, 10 = no problem to participate) was used for registration. The correlation coefficient for test 1 and 2 was .92 (p < 0.01) and .94 (p < 0.01) for the leakage and the social activity index, respectively. The results obtained were reproducible, and the instruments gave detailed information about how women perceived SUI.

Female urinary stress incontinence in terms of connective tissue biochemistry

The role of connective tissue in the aetiology of female stress incontinence has been investigated. Collagen content and extractability as well as estrogen receptor concentration in vesico-vaginal fascia were measured after small tissue biopsies had been obtained during vaginal repair surgery in cases of urinary incontinence. The mean concentration of estrogen receptor in vesico-vaginal fascia among incontinent women was 49.4 +/- 14.8 fmol/mg of protein as compared to 29.6 +/- 13.1 in continent control group (P < 0.03; t-test). The mean hydroxyproline concentration in vesico-vaginal fascia of incontinent women was 13.8 +/- 2.6 micrograms/mg wet weight, whereas in the control group it was significantly higher 20.6 +/- 2.4 (P < 0.001). The role of connective tissue components in the aetiology of female stress incontinence is discussed.

Dimensions of urine loss among older women with genuine stress incontinence

The specific maneuvers that cause women to be incontinent can become important diagnostic aids and major factors in differentiating the effectiveness of the current pharmacological, surgical, and behavioral treatments for urinary incontinence. The purpose of this study was to evaluate whether meaningful dimensions could be identified within the multiple movements that produce urine loss in stress-incontinent women. The Stress Incontinence Questionnaire (SIQ) was constructed from items derived from a compilation of studies and reports of urinary incontinence experts. An exploratory factor analysis using maximum likelihood method of extraction and a varimax rotation procedure identified four dimensions: active maneuvers, passive maneuvers, planned maneuvers, and unplanned maneuvers. The alpha coefficients for the four identified factors were acceptable and ranged from .71 to .79, with 8-week test-retest correlations for the active (r = .87), passive (r = .87), planned (r = .85), and the unplanned maneuvers (r = .60) all highly significant. The four factors also showed differential patterns of relationships with various gynecologic and urologic measures. These latter findings suggest that the factors identified in this study may be acknowledging different types or components of stress incontinence. In either case, the findings may have implications for treatment approaches to stress incontinence. Further research is needed to substantiate the various components of stress incontinence found in this study and the implications these findings may have for treatment of incontinence.

The menopause, urinary incontinence and other symptoms of the genito-urinary tract

In a study on incontinence and other symptoms of the genito-urinary tract in postmenopausal women covering their prevalence, consequences and predisposing factors, the prevalence of incontinence was found to be 26.4%. Daily incontinence was present in postmenopausal women more than twice as often as before the menopause (P < 0.05). The frequency of medical consultation for such incontinence was low; only 26.1% of the postmenopausal women had ever seen their doctor about it. Urgency, nocturia and dyspareunia were more prevalent in postmenopausal women, while vaginal itching and discharge were more frequent in premenopausal women (P < 0.05). The prevalence of incontinence and the other genito-urinary symptoms was higher after surgical than after natural menopause. Multivariate analysis showed the menopause to be the only factor that contributed significantly to the onset of incontinence (P < 0.001).

Subjective and objective effects of intravaginal electrical myostimulation and biofeedback in patients with genuine stress urinary incontinence

A group of 36 patients (18 premenopausal and 18 postmenopausal), all suffering from genuine stress urinary incontinence, underwent conservative treatment with 6 sessions of intravaginal electromyostimulation followed by 6 sessions of biofeedback; 89% of patients reported an improvement, 5.5% considered themselves cured and 5.5% reported no change. Intravaginal pressure measured before and after therapy increased by an average of 11 cm H2O in premenopausal patients and 17 cm H2O in the postmenopausal group. Intravaginal pressure increased in all patients and, according to maximal urethral closure pressure, this increasing intravaginal pressure was observed even in patients with low pressure urethras. The urodynamic factors studied were functional length, maximum urethral closing pressure and pressure transmission, together with urethral surface at rest and during stress, and residual surface. No significant changes were noted before and after treatment. The excellent subjective results contrast with the absence of improvement in these values.

Urinary incontinence in women from 35 to 79 years of age: prevalence and consequences

We investigated the prevalence and the consequences of urinary incontinence in a group of 1299 women aged 35 to 79. Incontinence was present in 344 women (26.5%), in 5.9% the incontinence occurred at least once daily. The prevalence was highest in the younger age-groups and lowest between 65 and 69 years of age, thereafter it increased again. Almost half of the incontinent women used protective sanitary towels. In contrast to this, only 13.3% considered themselves handicapped by their symptoms, and only 28.2% had ever sought medical help, although the symptoms had been present for as long as 7.5 years on average. The major reason for not seeking medical help was that the symptoms were not considered to be so serious.

Urinary incontinence: nursing home staff reaction toward residents

1. ISQ-SR is a reliable and valid tool to measure psychological stress associated with working with urinary incontinent patients. 2. ISQ-SR can be used to measure efficacy of continuing education programs aimed at reducing staff stress associated with urinary incontinence. 3. Eighty percent of the staff reported that they looked for ways to help patients with their incontinence all the time, but only 50% said that they felt comfortable working with urinary incontinent patients all of the time. 4. Sixty-three percent of the staff reported that they felt frustrated about working with urinary incontinence some of the time, indicating a need for continuing education.

Prevalence, incidence and correlates of urinary incontinence in healthy, middle-aged women

The prevalence, incidence and correlates of urinary incontinence were studied in a community-based sample of 541 healthy, middle-aged women 42 to 50 years old. Participants were evaluated on 2 occasions approximately 3 years apart. Of the participants 58% reported urine loss at some time and 30.7% reported incontinence on a regular basis at least once per month. During 3 years the cumulative incidence of regular incontinence in previously continent women was 8.0%. Among those with regular incontinence 64.9% said the volume of loss was 1 or 2 drops, while 35.1% reported that they needed to change their garments. Only 25.5% of the patients had sought treatment. Continence status was significantly related to body mass index and race but not to patient age, parity, caffeine or alcohol intake, smoking, physical activity, prior gynecological surgery or several psychological variables. The results indicate that urinary incontinence is common among middle-aged women. That few seek treatment suggests a need for more information about women's attitudes toward incontinence and more attention to this problem by health care providers.

Surgery for stress urinary incontinence

Stress urinary incontinence is a common problem, with various degrees of disability. Its etiology may be defective external or internal urethral sphincter mechanisms. Evaluation of the patient with symptoms of stress incontinence requires objective testing for diagnostic accuracy. Patient management may be individualized to conservative measures or to one of the various surgical approaches, which produce success rates between 80% and 95%. Retropubic suspension or long needle procedures should be considered for patients with stress incontinence and evidence of bladder neck detachment. Sling procedures, artificial sphincters, and periurethral injections should be considered for patients with minimal bladder neck mobility or low urethral pressures and for those with a high risk of failing other procedures.

Pelvic muscle exercise for stress urinary incontinence in elderly women

PURPOSE

To compare pelvic muscle exercise to pharmacologic treatment of stress urinary incontinence, the most common cause of urine leakage reported by community-living elderly women.

SUBJECTS

Convenience sample of 157 community-living women, aged 55 to 90 years, after completion of a comprehensive diagnostic evaluation.

METHODS

Eighty-two subjects were randomly assigned to the exercise protocol (with a 34% attrition rate). Pelvic muscle exercises were taught and monitored for 6 months. Phenylpropanolamine hydrochloride was given to the other group in a dose of 50 mg a day, increasing to 50 mg twice a day.

MAIN RESULTS

Treatment outcomes (subjective improvement, self recorded frequency of wetting) were equally satisfactory in both groups. The response to exercises was as good in 5 months as in 6. It was also as good when the minimum recommended number of exercises per day was 80 as when it was 125.

CONCLUSIONS

Among those completing the protocol, pelvic exercises were beneficial in reducing stress incontinence, and the benefit was comparable to that produced by phenylpropanolamine.

Self-care practices of women with urinary incontinence--a preliminary study

The purpose of this preliminary study was twofold: (a) to explore self-care practices of 10 noninstitutionalized women who experience urinary incontinence (UI) and (b) to evaluate two instruments, the Urinary Incontinence Interview Guide and the Self-Care Responses Questionnaire. Data analysis was accomplished by data reduction and tabulation and comparison of responses from both instruments. Data are presented in a descriptive format. The most frequently reported self-care practices included regular toileting, alteration of fluid intake, exercises, weight reduction, seeking medical treatment, and protection to contain the problem. Half of the women reported embarrassment and all reported some negative feelings about UI. Recommendations are made in relation to both instruments for future use with UI research.

The quality of life in women with urinary incontinence as measured by the sickness impact profile

The objectives of this paper were to assess the quality of life of community-living women with urinary incontinence according to age, symptom group, amount of leakage, and duration, by use of the Sickness Impact Profile (SIP). Thirty-six women aged between 40 and 60 years and 40 women aged 70 years or more were randomly selected from the clients attending an incontinence clinic and interviewed using the SIP questionnaire. Urge and stress incontinence subgroups were defined by means of a symptom questionnaire. Total, psychosocial, and physical dysfunctions were moderate (8%, 7%, and 8% respectively) in general, but major differences were found when age and symptom groups were analysed. Urge symptoms were associated with more impairment than symptoms of stress incontinence. The elderly women with symptoms of stress incontinence were relatively little affected, while their younger counterparts were severely affected, especially in the categories of emotional behavior and recreation and pastimes. We conclude that urinary incontinence in women adversely affects quality of life to a significant degree; the extent depends on the nature of incontinence and the age of the person.

Prevalence of urinary incontinence among women at a Swedish primary health care centre

Information on urinary incontinence was obtained by means of a questionnaire from women visiting a Swedish health centre. Among women aged 18 and above, 44% stated that they had urinary incontinence. About one-third of these women reported stress incontinence, one-third urge incontinence, and one-third both. Urinary incontinence was more prevalent with increasing age and was more common among women who had given birth to children, in overweight women, in women taking diuretics, and in women with some defined diseases. Of those with incontinence, 13% stated that it impaired their work and 28% that it impaired leisure activities. Many of them had not asked for medical help for the symptom. It is important to emphasize the high prevalence of the symptom, and even more important to increase our knowledge of how best to take care of these women.

Effects of hysterectomy on bowel and bladder function

A case control study compared the bowel habit of 91 post-hysterectomy women with paired controls from the same family doctor practice. More cases had an abnormal bowel frequency, a firmer stool consistency and assessed themselves as having abnormal bowel function, predominantly constipation after hysterectomy, than controls. Significantly more cases than controls had consulted a doctor because of constipation but there was no significant difference in laxative usage. There was a significant short-term association between decreased bowel frequency and increased urinary frequency after hysterectomy. This became highly significant in those patients who developed chronic symptoms. Oophorectomy, unilateral or bilateral, did not significantly affect bowel habit other than to intensify the change in stool consistency. The hypothesis is discussed that the post-hysterectomy effects on bowel and bladder function may have a common aetiology in a degree of autonomic denervation of both viscera.

An investigation of recognized incontinence within a health authority

Incontinence affects a very large proportion of the population bringing with it considerable physical, social, psychological and often financial implications for the sufferer. Hence, it poses a considerable challenge to the providers of health care in relation to service provision and appropriate treatment of the problem. This descriptive study focused on the service provided by one health authority to sufferers of incontinence. The service in operation prior to the study had mushroomed with little thought being given to its organization or management, with the result that little was known about the people receiving the service. The study was commissioned to establish the number of people receiving assistance and the nature of the assistance given. Data were collected using pre-existing records, by questionnaire and by interview. A total of 847 people were found to receive assistance from the health authority, the majority of these being female and over the age of 65. Less than half of the study population were in regular contact with the community nursing service with regard to their incontinence. Of the remainder, inadequate incontinence products were found to be supplied without prior assessment of the problem to a proportion of the study population. Some strategies used by this group to manage their incontinence, disclosed during interview, were considered to be detrimental to the general health and well-being of the individuals practising them. These include non-compliance with prescribed diuretics and self-restriction of fluids. The service provided was considered to be a basic one providing assistance to 0.47% of the population of the study area. The implications of the service provided, highlighted by the findings, are wide-reaching in terms of the resultant underprovision which led to increased misery for some sufferers and the employment of inappropriate coping strategies.

Women with urinary incontinence: self-perceived worries and general practitioners' knowledge of problem

In the context of a large scale survey of health problems in women aged 50 to 65 years, a study was undertaken on the effects of incontinence on daily life. For this purpose 1442 women randomly selected from the practice files of 75 general practitioners in the eastern part of the Netherlands were interviewed at home (response rate 60%). In cases of moderate or severe incontinence the general practitioner of the woman concerned was asked whether this problem had been diagnosed in general practice. Incontinence was reported in 22.5% of the women. Overall, 77.8% of the women did not feel worried about it and 75.4% did not feel restricted in their activities; even for women with severe incontinence (daily frequency and needing protective pads) only 15.6% experienced much worry and 15.7% much restriction. About a third of the women with incontinence (32.0%) had been identified by their general practitioner. The greater the worries and restrictions owing to incontinence, the greater the chance that the incontinence was known to the general practitioner concerned. Only a small minority of the women who felt severely restricted were not identified by their general practitioner. There was a positive relation between recognized incontinence and a history of hysterectomy. This study contradicts the image of the incontinent woman as isolated and helpless; most women in this study seemed able to cope.

Objective methods for evaluation of interferential therapy in the treatment of incontinence

Electrotherapy is a treatment for various conditions, and can be difficult to quantify in effect. This paper examines the form known as interferential therapy, with particular application in the management of urinary incontinence. Objective validation of the treatment is described, which allows optimal positioning of the electrodes for a particular patient.

Profile of urinary incontinent elderly in long-term care institutions

This article presents a profile of incontinent elderly in long-term care institutions. One hundred thirty-three frail elderly women were recruited from seven nursing homes in central Pennsylvania for a three-year clinical trial to test the effectiveness of a behavioral therapy on urinary incontinence. All of the patients had more than one medical diagnosis. Eighty percent had cardiorespiratory conditions; the most prevalent diagnoses were cardiovascular diseases. Eighty percent had one or more neurological diseases, including "organic brain syndrome" (47%) and senile dementia (30%); 44% had arthritis/rheumatism. Half of the patients showed severe cognitive impairment; only 12% showed no cognitive impairment. Sixty-three percent were totally dependent; 68% used wheelchairs, 61% were chairbound; 50% had impairments in vision, one-third in hearing, and 14% in speech. Normal bladder capacity, absence of detrusor instability, and satisfactory bladder emptying, as evidenced by low residual urines, was found in 41% of the patients, suggesting that incontinence in this elderly group may not be a primary bladder problem, but rather that mental and physical disabilities may be a more important underlying cause of incontinence in these patients. An important finding in this study is that 34% of the patients had detrusor instability. It is theoretically possible that pharmacologic therapy with anticholinergic agents or imipramine could improve incontinence in this group. Five percent were found to have large residual urine volumes in association with high-capacity bladders suggesting overflow incontinence as the cause of their daily leakage. Pelvic relaxation and stress leakage was far less common in this elderly group of nursing home patients than in young and middle-aged women.

Urinary incontinence: medical and psychosocial aspects

Recognition has been growing over the past two decades that urinary incontinence is a rather widespread condition among older adults. Prevalence rates of about 30% for any incontinence and about 5% for severe incontinence among older adults were suggested by several European studies and have recently been confirmed by American studies. The rates are typically higher among women than men. Despite these findings, much about the true distribution of urinary incontinence remains to be firmly established. The proportion of different types and the differences between sexes, ages, and races need to be confirmed using representative population samples and valid measures of incontinence. These distributions cannot be accurately described using clinical populations. Perhaps because urinary incontinence is viewed as highly embarrassing, it has not been a focus of media coverage or public discussion. More attention by the media and by health-care professionals would build public awareness of the condition. Older adults and their caregivers need to know that urinary incontinence is common and treatable, so that they will identify it promptly and bring it to their physicians' attention. Health-care providers and social workers must also be alert to the possibility of incontinence among their clients. They should be prepared to ask older patients directly, because many patients may disregard urine loss or be too embarrassed to mention it. Currently, much of the management of urinary incontinence appears to be self-devised. Many incontinent persons have not talked to a physician about their problem. The largest proportion of those who attempt to control their urine loss use absorbent products or try to avoid loss by awareness of toilet locations and frequent toileting. Reliance on these methods is unfortunate because much progress has been made in developing diagnostic and treatment procedures for urinary incontinence. For example, surgical procedures to rectify an incompetent sphincter have been shown to be effective and are generally accepted. There are a number of medications effective for controlling detrusor instability. Further, various behavioral techniques appear to be promising as noninvasive initial interventions for many patients. We are on weaker ground regarding the prevention of and early intervention in urinary incontinence. The existing epidemiological data on the development of incontinence are poor. We do not know the proportion of urinary incontinence that is transient and the proportion that is chronic or established. Nor do we know the risk factors for onset and progression of the condition.(ABSTRACT TRUNCATED AT 400 WORDS)

Prevalence of urinary incontinence in patients receiving home care services

We conducted a 1-day survey to determine the prevalence of urinary incontinence among patients in four home care programs in southern Ontario and the characteristics of incontinent patients. Of the 2801 patients for whom the continence status was known, 22% were assessed as incontinent. The mean age of the incontinent patients was 74 (extremes 18 and 101) years, and 65% were women. A total of 89% had at least one functional disability in cognition, mobility, transferring in and out of bed or chair, or undoing garments. The incontinence was moderate to severe in 41% of the patients, and 95% of the family caregivers living with these patients viewed the incontinence as a problem. Palliative rather than remedial treatment was used most frequently; only 5% of the patients had undergone a urodynamic assessment in the previous year. Future research should emphasize the assessment of remedial interventions.

Behavioral training for urinary incontinence in elderly ambulatory patients

Research questions addressed by this study were: 1) Is the treatment of chronic urinary incontinence (UI) in elderly, nondemented ambulatory patients using bladder-sphincter biofeedback as effective when performed by an internist/geriatrician and a nurse practitioner as that reported by behavioral scientists?; and 2) how does bladder-sphincter biofeedback compare to a program of behavioral training that does not utilize biofeedback? Twenty-seven patients with UI were assigned based on the number of baseline accidents documented in a self-maintained log, their sex, and the predominant pattern of symptoms (urge or stress) to one of two treatment groups: biofeedback (13 patients) or behavioral training not utilizing biofeedback (14 patients). Patients were given up to six treatments. Patients in both groups achieved a highly significant (P less than .001) reduction in urinary accidents 1 month following treatments compared with their baseline number of accidents. The average reduction of accidents over this time period was 79% for the biofeedback group and 82% for the group receiving behavioral training without biofeedback. All patients showed improvement and no patient experienced any side effect. A internist/geriatrician and a geriatric nurse practitioner may achieve success utilizing behavioral therapy with or without biofeedback for the treatment of chronic urinary incontinence for ambulatory elderly patients.

Urinary incontinence in the elderly: etiology and treatment

Urinary incontinence is a common, though often hidden, medical problem among the elderly. Urinary continence requires integrity of the neural, muscular, and hormonal systems. Five distinct types of urinary incontinence can be distinguished based on patient symptoms. A variety of factors can impair continence, including aging, environmental barriers, and medications. Both pharmacological and nonpharmacological measures are useful in the treatment of incontinence.

Urinary incontinence in a community-residing elderly population

A self-administered postal questionnaire was presented to all attending members (843) of local summer meetings of a national association for retired persons. A 71% response rate (599) revealed that 33% of the total sample population experienced some form of urinary incontinence. Twenty-three and seven-tenths percent (142) experienced occasional urine dribbling, 2.3% (14) were unable to prevent involuntary emptying of their bladder, and 7.3% (44) suffered both problems. Eighty-three percent of the respondents were between the ages of 65 and 85 years. Females accounted for 75% of all respondents. Respondents 75 years of age or older had a higher occurrence of all forms of urinary incontinence (P = 0.57), and a strong association existed with the same age-group and uncontrolled emptying of the bladder (P = .02). Thirty-seven percent of the females and 22% of the males reported having had an incontinent episode (P = .002). High parity (four or more births) was significantly associated with incontinence in females (P = .04). These survey findings provide prevalence estimates of urinary incontinence that are greater than those previously reported and show statistical differences by age and gender. The study population is not representative of all the noninstitutionalized elderly, but consists primarily of individuals who are active, ambulatory, generally healthy and may underestimate the magnitude of the problem. Urinary incontinence is substantiated as a major health problem in even the most functional community-residing elderly citizens.

The measurement of residual urine in the evaluation of incontinent nursing home residents

Seventy-six nursing home residents with urinary incontinence (59 females, 17 males, Mean age = 84 years) underwent an evaluation which included the measurement of residual urine and cystometric studies. Upon catheterization 18 subjects were found to have urine volumes greater than 100 ml. Only two subjects had urine volumes greater than 250 ml. Cystometry revealed detrusor instability in the majority (83%) of the 76 subjects. Although the measurement of the post-voiding residual urine is a simple method to assess for ineffective bladder emptying, at volumes less than 250 ml, it is not always possible to predict the type of bladder dysfunction without additional studies. There can be problems in obtaining an accurate measurement of the post-voiding residual urine in elderly institutionalized patients. Many of our subjects (36 subjects) experienced difficulty urinating prior to catheterization. The residual urine measurement should not be solely relied upon in the prediction of bladder dysfunction in the elderly. This measurement should be combined with other data to effectively investigate the etiology of urinary incontinence.

Urinary incontinence in elderly women: urodynamic evaluation

The objective of this study is to characterize urinary incontinence observed in elderly women and to assess the importance of various parameters used to evaluate urinary incontinence. Two hundred consecutive, ambulatory, outpatient, incontinent women 55 years of age and over who were seen at the Continence Program Clinic and completed a medical and urodynamic protocol are included in this paper. After a thorough medical history and a complete physical examination, urodynamic tests were performed. The urodynamic results showed that 77% of incontinent women had an incompetent urethra. Twenty-five percent had a hyperactive bladder, 8% had "other" types, and 7% had a normal study. Comparison of the clinical diagnosis with the actual urodynamic diagnosis for stress incontinence revealed a 78% accuracy and only a 6% false negative. In contrast, a similar comparison for urge incontinence found only 44% accurate and 45% false negative. Analysis of the urodynamic tests revealed that the simple provocative full-bladder stress test was as effective as the radiographic or electronic pressure measurement in detecting incompetent urethra producing stress urinary incontinence. Provocative upright cystometry was helpful in uncovering 33% of hyperactive bladders not provoked in the supine position. Complex urodynamic tests should be reserved for unexplained incontinence or when symptomatology is complex.

Urinary incontinence in elderly women: clinical findings

Two-hundred women self-described as having urinary incontinence, aged 55 to 90 years and living in the community completed a comprehensive history and physical examination. Initial presentation of urine loss was most commonly stress incontinence symptoms (35%). Scoring of peak response to volume lost and frequency revealed urine loss necessitating a clothing change for 78% and daily loss experienced by 73%. Over half had experienced a urine loss problem for more than five years. Most (65%) had sought treatment, but a minority reported current (11%) or previous (36%) treatment. Thirty-six percent were found to have severe atrophic vaginitis with severe urethocele (10%), cystocele (13%), rectocele (12%) less common. Pelvic floor strength by clinical scoring was weak (mean, 1.05 on a 5-point scale). The vaginal electromyograph first contraction peak mean was 5.94 microvolts sustained at 50% or better for 3.92 seconds. Clinical criteria established that 66% had stress, 27% a mixture of stress and urge, only 4% pure urge incontinence, and 4% other.