Expanded paper towel test: An objective test of urine loss for stress incontinence

Paper towel test as independently self-administered to quantify cough-related urine loss: Compliance and comparisons with survey-only data in SWAN

AIMS

The epidemiologic Study of Women's Health Across the Nation (SWAN) includes urinary incontinence (UI) questionnaire items. We introduced an independently self-administered paper towel test (PTT-ISA; invention disclosure #2021-347) to objectively demonstrate UI. Aims were to determine: (1) PTT-ISA compliance and (2) relationship to questionnaire results.

METHODS

276 community women were invited to complete both SWAN questionnaire and PTT-ISA. For PTT-ISA, a woman holds a trifold brown paper towel against her perineum while coughing hard three times. She checks the towel for wetness and compares it with pictorial showing wetted area gradations (dry towel through >6 ml/saturated). She then selects the best photo match for her towel. A newly conceptualized variable constructed as PTT-ISA plus questionnaire results was formed.

RESULTS

Of 276 women, noncompliance with PTT-ISA was 2.2% (6 women). Four others (1.5%) were missing questionnaires. For the remaining 266 women, conceptual cohesiveness between questionnaire-only and PTT-ISA + questionnaire was demonstrated in 165 (62.0%). Lack of cohesiveness occurred in 101 (38.9%), including 41 women who said "no" to the questionnaire item indicative of stress UI and had leakage on PTT-ISA; leakage degree varied across the full pictorial spectrum from drops to saturated.

CONCLUSION

PTT-ISA demonstrates high compliance, with rate comparable to survey compliance. It is a novel measure for objective sign of urine loss when independently self-administered by community women outside of a clinic environment. Further research comparing PTT-ISA with clinician-observed cough test is warranted. As independently self-administered, PTT-ISA is simple, noninvasive, inexpensive, and an acceptable test that adds value to otherwise survey-dependent research.

Clarification and confirmation of the Knack maneuver: the effect of volitional pelvic floor muscle contraction to preempt expected stress incontinence

The aim of the study was to determine the immediate effect of timing a pelvic muscle contraction with the moment of expected leakage (the Knack maneuver) to preempt cough-related stress incontinence. Women performed a standing stress test using three hard coughs without and then with the Knack maneuver. Volume of urine loss under both conditions was quantified with paper-towel test. Two groups of women were tested: nonpregnant women (n = 64) and pregnant women (n = 29). In nonpregnant women, wetted area decreased from a median (range) of 43.2 (0.2-183.7) cm2 without the Knack maneuver to 6.9 (range of 0 to 183.7 cm2) with it (p < 0.0001); while in pregnant women it decreased from 14.8 (0-169.7) cm2 to 0 (0-96.5) cm2, respectively (p = 0.001). This study confirms the effect from the Knack maneuver as immediate and provides a partial explanation for early response to widely applied pelvic muscle training regimens in women with stress incontinence.

The costs and benefits of physiotherapy as first-line treatment for female stress urinary incontinence

OBJECTIVE

To evaluate the costs and benefits of physiotherapy for stress urinary incontinence (SUI) in Australia.

METHODS

We evaluated the costs and benefits of physiotherapy for the treatment of SUI using outcome data from a prospective multicentre observational study conducted in 1999/2000. Women presenting with SUI to physiotherapists trained in continence management in 35 centres across Australia were recruited into the study. The outcomes of treatment were assessed using subjective, objective and quality-of-life measures at the conclusion of treatment and with 12-month follow-up. The number of treatments in an average episode of care was calculated and adverse events were recorded.

RESULTS

Of the 274 consenting subjects, 208 completed an episode of physiotherapy care consisting of a median (IQ range) of five (4-6) visits. The estimated average costs for an episode of ambulatory physiotherapy treatment were dollar 302.40. Based on 'intention to treat' principles, 64% of women were objectively cured. There was a clinically and statistically significant improvement (p < 0.05) in all outcomes after treatment and these were maintained at one-year follow-up. No adverse events were reported.

CONCLUSIONS AND IMPLICATIONS

Specialised ambulatory physiotherapy for SUI in Australia is a low-cost, low-risk and effective treatment. These results provide evidence to support international recommendations that physiotherapy should be routinely implemented as first-line treatment before consideration of surgery. This information has important economic implications for planning future health services.

Physiotherapy for female stress urinary incontinence: a multicentre observational study

BACKGROUND

No previous data are available on the effectiveness of physiotherapy management of urinary stress incontinence with relevance to the Australian health system.

AIMS

To evaluate Australian ambulatory physiotherapy management of stress urinary incontinence.

METHODS

Observational multicentre clinical study of physiotherapy management of female stress urinary incontinence between February 1999 and October 2000, with 1-year follow-up. Outcome measures were a stress test and a 7-day diary of incontinent episodes (pretreatment and at every visit) and a condition-specific quality of life (QoL) questionnaire (pre- and post-treatment). Subjects were followed-up 1 year after treatment by questionnaire with a 7-day diary, QoL questionnaire, and assessment of subjective outcome, subjective cure, satisfaction and need for surgery.

RESULTS

Of the 274 consenting subjects, 208 completed an episode of physiotherapy care consisting of a median (IQ range) of five (four to six) visits. At the end of the episode, 84% were cured and 9% improved on stress testing, whilst 53% were cured and 25% improved according to the 7-day diary. Mean volume of urine loss on stress testing reduced from 2.4 (2.5) mL to 0.1(0.4) mL after treatment. There was a significant improvement in all QoL domains. Median (interquartile range) incontinent episodes per week were reduced from five (three to 11) to zero (zero to two) (P < 0.05) after treatment and to one (zero to four) at 1 year (P < 0.05). At 1 year, approximately 80% of respondents had positive outcomes on all outcome measures.

CONCLUSIONS

Physiotherapy management in Australian clinical settings is an effective treatment option for women with stress urinary incontinence.