Methods used to manage urinary incontinence by older adults in the community

Perceptions and help-seeking behaviours among community-dwelling older people with urinary incontinence: A systematic integrative review

AIM

To synthesize research evidence on perceptions and help-seeking behaviours in community-dwelling older people with urinary incontinence based on the Capability-Opportunity-Motivation-Behaviours model.

BACKGROUND

Urinary incontinence is highly prevalent in community-dwelling older people, yet only a small proportion seek help from health professionals. Untreated urinary incontinence has a detrimental impact on older people's quality of life and distresses their caregivers.

DESIGN

Systematic integrative review.

DATA SOURCES

Ten databases were searched systematically between 9 November 2020 and 17 December 2020 including Medline (PubMed), CINAHL, Ageline, Web of Science, Scopus, ProQuest, Psyclnfo, CNKI, Wanfang and Vip.

REVIEW METHODS

Quality appraisal was applied to assess the quality of selected articles. Data relevant to the review aim were extracted from included articles for analysis. Convergent qualitative synthesis was used to synthesize findings.

RESULTS

Twenty articles were included and two main themes with six sub-themes were identified. Theme one described three common perceptions including urinary incontinence as a part of normal ageing, a stigma and a health problem. Each perception had a profound impact on older people's motivation to self-report the problem to health professionals. Theme two revealed three main help-seeking approaches comprising self-help, help from friends and help from health professionals. Of these, self-help was the dominant approach used to conceal urinary incontinence and contributed to social isolation.

CONCLUSION

Improving urinary incontinence management in community-dwelling older people requires the development of their capability and motivation, and increased opportunities to access and gain help from skilled health professionals.

IMPACT

Findings can facilitate resource development to improve health literacy for the general public pertinent to urinary incontinence and associated stigma. Moreover, findings can inform a user-friendly reporting and referral system for the problem. In addition, findings can inform education and skill training for health professionals, older people and their caregivers to effectively manage the problem.

A Pilot Study to Determine Reasons for Patient Withdrawal From a Pelvic Muscle Rehabilitation Program for Urinary Incontinence

This project explored reasons why patients with urinary incontinence withdrew from a behavioral treatment program before completion of all sessions. In-depth, semistructured interviews were conducted with 10 of 25 patients who had not completed prescribed behavioral treatment at the University of North Carolina–Chapel Hill School of Medicine Continence Clinic. The women interviewed made positive or neutral comments about Kegel exercises and understood the relationship between urinary incontinence and pelvic muscle weakness. They perceived a relationship between age and urinary incontinence but did not think that incontinence was inevitable with aging. Treatment of urinary incontinence became less of a priority when work, physical impairments, or illness intervened and when there appeared to be some misunderstanding about the treatment. These findings suggest that clinicians need to better understand perceived barriers to adherence in order to discuss these barriers and to design a more individualized approach for each patient in a continence clinic.

A qualitative analysis of individual and family caregiver responses to the impact of urinary incontinence on quality of life

PURPOSE

The purpose of the original mixed-design study was to compare affected individual and family caregiver perceptions of urinary incontinence quality of life in relation to their empathic responses toward one another and to explore their qualitative responses of factors that hinder or facilitate these responses. The aim of this secondary analysis is to report responses shared by affected individuals and family caregivers on how their lives have been impacted by urinary incontinence.

DESIGN

Qualitative study with content analysis.

SUBJECTS AND SETTING

The sample comprised 13 persons with urinary incontinence and 13 family caregivers. Their mean age was 78 years and the mean age for caregivers was 67 years. Caregivers were mainly the spouses or daughters of affected respondents. Interviews were conducted in participants' homes in Winnipeg, Manitoba, Canada.

METHODS

Data were collected via 26 audio-recorded interviews. Content analysis was used to capture major themes arising from the data.

RESULTS

Five major themes with respective subthemes highlight how urinary incontinence influenced the quality of life of affected individuals and their family caregivers, including (1) life changes, (2) psychological responses and coping, (3) painful responses of others, (4) reticence to seek medical attention, and (5) advice to health care professionals.

CONCLUSIONS

Health care professionals should recognize that dealing with urinary incontinence in the home is a "team effort" between affected individuals and family caregivers. Educational efforts need to counter attitudes in care providers who avoid talking about urinary continence and enhance sensitivities toward affected individuals' and family caregivers' ongoing need for control in continence care based on their unique needs and preferences.

Continence Index: a new screening questionnaire to predict the probability of future incontinence in older women in the community

PURPOSE

Urinary incontinence (UI) is a chronic, costly condition that impairs quality of life. To identify older women most at risk, the Medical Epidemiologic and Social Aspects of Aging (MESA) datasets were mined to create a set of questions that can reliably predict future UI.

METHODS

MESA data were collected during four household interviews at approximately 1 year intervals. Factors associated with becoming incontinent at the second interview (HH2) were identified using logistic regression (construction datasets). Based on p values and odds ratios, eight potential predictive factors with their 256 combinations and corresponding prediction probabilities formed the Continence Index. Its predictive and discriminatory capability was tested against the same cohort's outcome in the fourth survey (HH4 validation datasets). Sensitivity analysis, area under receiver operating characteristic (ROC) curve, predicted probabilities and confidence intervals were used to statistically validate the Continence Index.

RESULTS

Body mass index, sneezing, post-partum UI, urinary frequency, mild UI, belief of developing UI in the future, difficulty stopping urinary stream and remembering names emerged as the strongest predictors of UI. The confidence intervals for prediction probabilities strongly agreed between construction and validation datasets. Calculated sensitivity, specificity, false-positive and false-negative values revealed that the areas under the ROCs (0.802 and 0.799) for the construction and validation datasets, respectively, indicated good discriminatory capabilities of the index as a predictor.

CONCLUSION

The Continence Index will help identify older women most at risk of UI in order to apply targeted prevention strategies in women that are most likely to benefit.

Onset of action of the β3-adrenoceptor agonist, mirabegron, in Phase II and III clinical trials in patients with overactive bladder

Purpose

Long-term persistence with pharmacotherapy for overactive bladder (OAB) requires a drug with an early onset of action and good efficacy and tolerability profile. Although antimuscarinics improve OAB symptoms within 1–2 weeks of initiating treatment, adherence after 3 months is relatively poor due to bothersome side effects (e.g., dry mouth and constipation). Mirabegron, a β₃-adrenoceptor agonist, has demonstrated significant improvements in key symptoms of OAB and good tolerability after 12 weeks in Phase III studies.

Methods

This was a prespecified pooled analysis of three randomized, double-blind, placebo-controlled, 12-week studies, and a Phase II study, to evaluate efficacy and tolerability of mirabegron 25 and 50 mg versus placebo. The main efficacy endpoints were change from baseline to week 1 (Phase II only), week 4, and final visit in mean number of incontinence episodes/24 h, micturitions/24 h, and mean volume voided/micturition (MVV).

Results

A significant benefit for mirabegron 25 and 50 mg versus placebo was evident at the first assessment point, 4 weeks after initiation of therapy, in Phase III studies for incontinence, micturitions, and MVV. The earliest measured benefit was after 1 week, in the Phase II study. Quality-of-life parameters also significantly improved with mirabegron 25 and 50 mg as early as week 4. Significant benefits continued throughout the studies. Mirabegron was well tolerated.

Conclusions

The early onset of action and good overall efficacy and tolerability balance that mirabegron offers may lead to high rates of persistence with mirabegron in the long-term treatment of OAB.

Randomized controlled trial for Salvia sclarea or Lavandula angustifolia: differential effects on blood pressure in female patients with urinary incontinence undergoing urodynamic examination

OBJECTIVES

The aim of this study was to investigate the effect of inhalation of Salvia sclarea (clary sage; clary) or Lavandula angustifolia (lavender) essential oil vapors on autonomic nervous system activity in female patients with urinary incontinence undergoing urodynamic assessment. STUDY DESIGN, LOCATION, AND SUBJECTS: This study was a double-blind, randomized, controlled trial carried out in 34 female patients with urinary incontinence.

OUTCOME MEASURE

The subjects were randomized to inhale lavender, clary, or almond (control) oil at concentrations of 5% (vol/vol) each. Systolic blood pressure, diastolic blood pressure, pulse rate, respiratory rate, and salivary cortisol were measured before and after inhalation of these odors for 60 minutes.

RESULTS

The clary oil group experienced a significant decrease in systolic blood pressure compared with the control (p=0.048) and lavender oil (p=0.026) groups, a significant decrease in diastolic blood pressure compared with the lavender oil group (p=0.034) and a significant decrease in respiratory rate compared with the control group (p<0.001). In contrast, the lavender oil group tended to increase systolic and diastolic blood pressure compared with the control group. Compared with the control group, inhalation of lavender oil (p=0.045) and clary oil (p<0.001) resulted in statistically significant reductions in respiratory rate.

CONCLUSIONS

These results suggest that lavender oil inhalation may be inappropriate in lowering stress during urodynamic examinations, despite its antistress effects, while clary oil inhalation may be useful in inducing relaxation in female urinary incontinence patients undergoing urodynamic assessments.

Self-Care Among Older Adults

Cette synthèse de la documentation sur les soins personnels chez les personnes ^gées définit le concept en termes des comportements préventifs et des réponses à la maladie adoptés par les profanes à leur propre bénéfice. Après avoir placé les soins personnels dans leur contexte historique, l'auteur examine les perspectives théoriques et les principales constatations sur son incidence ainsi que les corrélats et les barrières. Cet examen est suivi d'une revue du processus et des résultats des interventions destinées à promouvoir les soins personnels. L'auteur termine en présentant des recommandations en vue du développement de la recherche, des politiques et de la pratique.

Goals of fecal incontinence management identified by community-living incontinent adults

The purpose of this study was to identify goals of fecal incontinence (FI) management and their importance to community-living adults if complete continence would not be possible. Participants expressed their goals of FI management in a semistructured interview, selected others from 12 investigator-identified goals, and rated their importance. Five thematic categories emerged from the 114 participant-identified goal statements: Fecal Incontinence/Bowel Pattern, Lifestyle, Emotional Responses, Adverse Effects of Fecal Incontinence, and Self-Care Practices. Participants selected a median of seven investigator-identified goals (range = 2 to 12). Goals selected by the most participants were decreased number of leaks of stool and greater confidence in controlling fecal incontinence. These goals also had the highest importance along with decreased leakage of loose or liquid stool. The type and number of management goals identified by participants offer a toolbox of options from which to focus therapy when cure is not possible and promote patient satisfaction.

A prospective observational study of the effects of treatment with extended-release tolterodine on health-related quality of life of patients suffering overactive bladder syndrome in Sweden

OBJECTIVE

Overactive bladder (OAB) is a chronic condition that has a profound impact on health-related quality of life (HRQoL). This study measured changes in bother of OAB symptoms and self-perceived HRQoL over 6 months in patients treated with extended-release (ER) tolterodine in a naturalistic setting.

MATERIAL AND METHODS

This was a prospective, single-cohort observational study of patients diagnosed with OAB, naïve to antimuscarinic treatment and prescribed tolterodine ER for the first time. Patients were asked to complete the Overactive Bladder Questionnaire (OAB-q) containing a symptom bother scale (0-100) and an HRQoL scale (0-100), which measures coping, social interaction, concern and sleep, at baseline and after 3 and 6 months.

RESULTS

In total, 235 patients (211 women and 24 men), with a mean age of 61 years (30-87), were recruited. The numbers of patients who completed the OAB-q were 220 and 169 at 3 and 6 months, respectively. The mean reductions in the symptom bother score from baseline were 19.6 and 19.3 at 3 and 6 months, respectively. Significant improvement (p < 0.0001) was seen in all HRQoL subscale scores. The proportion of responders who met the minimally important difference (change in the score of 10 or more units between baseline and 6 months) was 64% for the symptom bother score and 34-60% for the total HRQoL and subscale scores.

CONCLUSIONS

OAB patients beginning treatment with tolterodine ER reported clinically significant improvement in OAB symptoms and self-perceived HRQoL over the 6 months of this observational study. The rate of discontinuation from treatment was 49%.

Daily-living management of urinary incontinence: a synthesis of the literature

This article is an integrative review of the research literature on daily-living management of urinary incontinence (UI) by people who live in the community. While most self-management literature investigates how people self-manage clinical treatments and therapies, this article focuses on how UI symptoms are managed in everyday living to maintain social functioning. Control of UI in everyday living is achieved using a range of strategies, which were identified and conceptualized as containing, restricting, concealing, and modifying. Understanding the strategies people use to manage UI in daily life will enable WOC and continence nurses to provide more appropriate and personally tailored advice.

Maximal functional electrical stimulation as a single treatment: is it cost-effective?

OBJECTIVE

The ideal electrical parameters for maximal functional electrical stimulation (MFES) in the treatment of an overactive bladder have not yet been well established. It has been speculated that unsatisfactory results may be due to a low stimulation intensity and that the number of sessions may also be an outcome-determining factor. Herein, we present the results obtained in a group of consecutively treated patients who were given 10 sessions of MFES at the highest tolerable amplitude.

MATERIAL AND METHODS

A total of 60 patients (29 females, 31 males) with an overactive bladder were treated. All subjects underwent a urodynamic assessment and completed a 48-h micturition chart prior to treatment, immediately after the last session and 3 months after termination of treatment. The patients were thoroughly informed that the result of the treatment depended on the amplitude that they could endure; there was a gradual increase in amplitude to the maximum level that did not cause painful discomfort.

RESULTS

Immediately after termination of the stimulation, almost half of the subjects reported an improvement in their condition. However, few subjects experienced sustained symptom amelioration 3 months post-stimulation. Decreases in micturition frequency and the number of leakage episodes were noted immediately after cessation of treatment but these decreases were no longer significant 3 months post-treatment.

CONCLUSIONS

In this series, although MFES was effective in the short term, the long-term treatment outcome was unsatisfactory. A critical review suggests that outcome success is proportional to the patient's ability and willingness to accept quite a high stimulation intensity or, alternatively, follow-up home treatment. Hence, the implementation of strict primary as well as secondary selection criteria can hopefully identify patients most suitable for MFES. Another lesson to be learnt is that the identification of crucial prerequisites of successful treatment is mandatory before embarking on controlled studies.

A simple visual analogue scale to assess the quality of life in women with urinary incontinence

AIM

The objective of this study is to determine whether a simple visual analogue scale; "incontinence bothersome scale (IBS)" can reliably assess the quality of life in women with urinary incontinence.

DESIGN

A prospective cohort study in a UK district general hospital.

METHODS

Two hundreds women with urinary incontinence participated in the study over 1-year period. They completed Kings health questionnaire version 7 (KHQ) and the incontinence bothersome scale (IBS). The results of the IBS were then compared to the total KHQ score and to each domain separately, using the Pearson correlation test. Women in the study were then classified into two main groups according to their urodynamics diagnosis (urodynamic stress incontinence group/detrusor overactivity group) and the total KHQ scores were compared with the IBS scores in each group.

RESULTS

The IBS scores had poor correlation with the total KHQ scores (r=0.656) and the difference between both arms was not statistically significant (p=0.084). Further analysis of KHQ domains showed that except for the impact of incontinence domain (r=0.728) all other domains correlated poorly to the IBS. This poor correlation pertained in sub-analysis of women with DO and USI (r=0.65 and 0.48, respectively).

CONCLUSION

This study has shown that a simple visual scale is not a reliable tool in assessing the QoL in women with urinary incontinence. A formal, validated and reliable QoL questionnaire is still the method of choice for QoL assessment, even if it takes longer to complete.

Managing Fecal Incontinence: SELF-CARE PRACTICES OF OLDER ADULTS

Little is known about the ways in which community-dwelling elderly individuals manage fecal incontinence (FI) in their daily lives. In this study, community-dwelling elderly individuals were surveyed at clinics of a health maintenance organization (HMO) to describe the self-care practices used to manage FI and to examine factors that influenced the number of self-care practices used and the reporting of FI to a health care practitioner. Responses of 242 elderly individuals who reported that they had FI several times per year were analyzed. The self-care practices used most commonly were changing diet, wearing a sanitary pad/brief, and reducing activity or exercise. Elderly women and those with a greater severity of FI and more chronic health problems engaged in more self-care practices. Factors associated with reporting FI to a clinician were considering FI to be a problem, uncertainty about the cause of FI, and changing diet to avoid FI. There is a need to promote effective management strategies for FI to older individuals living in the community.

Tolterodine for the treatment of overactive bladder: a review

Overactive bladder (OAB) is a prevalent condition. Numerous clinical trials have demonstrated the efficacy and safety of immediate release tolterodine in the treatment of OAB in different patient populations. This review details the characteristics, clinical efficacy and safety of extended release (ER) tolterodine. This formulation yields a flatter serum concentration profile and provides clinically meaningful symptom improvement as early as week 1 of treatment. Tolterodine ER is effective in diverse patient populations with varying levels of symptom severity, and efficacy is maintained with long-term treatment. Tolterodine is an effective, safe, and convenient treatment option for long-term relief of OAB symptoms.

Breaking the Cycle of Stigmatization

Incontinence is a highly stigmatizing condition. This article explores the dynamics of stigmatization in interpersonal interactions from the perspective of both individuals who are stigmatized and individuals who are not stigmatized. When people who are stigmatized and nonstigmatized interact with each other, both experience threats to self-esteem, but for different reasons. Individuals who are stigmatized may experience self-esteem decrements because they feel that their group is devalued in the eyes of others. Those who are nonstigmatized may fear that their actions will be perceived as biased, thereby threatening their self-image as an unprejudiced person. Individuals who are stigmatized and nonstigmatized act in ways that make their worst fears more than likely come true. Ways that nurses can facilitate ending this cycle with patients who are incontinent are discussed.

The prevalence of urinary incontinence in women in four European countries

OBJECTIVE

To determine the prevalence, type and treatment behaviour of women with urinary incontinence in four European countries.

SUBJECTS AND METHODS

Data were collected using a postal survey which was sent to 29,500 community-dwelling women aged > or = 18 years in France, Germany, Spain and the UK. Subjects were asked about the type of urinary incontinence they had experienced and their treatment behaviour.

RESULTS

Of the women who responded, 35% reported involuntary loss of urine in the preceding 30 days; stress urinary incontinence was the most prevalent type. The lowest prevalence was in Spain (23%), while the prevalence was 44%, 41% and 42% for France, Germany and the UK, respectively. About a quarter of women with urinary incontinence in Spain (24%) and the UK (25%) had consulted a doctor about it; in France (33%) and Germany (40%) the percentages were higher. Overall, <5% of the women had ever undergone surgery for their condition. While pads were used by half of the women, there were some differences among the countries.

CONCLUSIONS

Millions of women in Europe have urinary incontinence; the consultation and treatment rates were low in the European countries included in this study.

Early diagnosis and treatment of genuine stress urinary incontinence in women after pregnancy: midwives as detectives

Genuine stress incontinence is often a hidden problem in that many women suffering from genuine stress incontinence after delivery do not seek medical advice. This article reviews signs and symptoms of genuine stress incontinence that, when identified, may enable midwives to initiate or suggest treatment as needed. A comprehensive literature search was performed in relevant medical databases. The following adverse risk factors for the development of genuine stress incontinence are vaginal delivery, multiparity, and obesity, with an increased risk for women who did not actively exert pelvic floor training. Prolonged second stage of labor and heavier babies were two factors associated with an increase in the risk of damage to the pelvic floor innervation as well as genuine stress incontinence. Several conservative treatment options, such as special instructions for pelvic floor training, the use of weight cones, and electrical stimulation, are reported to alleviate genuine stress incontinence symptoms.

Managing urinary incontinence across the lifespan

In the 1996 baseline surveys of the Australian Longitudinal Study of Women's Health (ALSWH), 36.1% of mid-age women (45-50) and 35% of older women (70-75) reported leaking urine. This study aimed to investigate (a) the range of self-management strategies used to deal with urinary incontinence (UI); (b) the reasons why many women who report leaking urine do not seek help for UI; and (c) the types of health professionals consulted and treatment provided, and perceptions of satisfaction with these, among a sample of women in each age group who reported leaking urine "often" at baseline. Five hundred participants were randomly selected from women in each of the mid-age and older cohorts of the ALSWH who had reported leaking urine "often" in a previous survey. Details about UI (frequency, severity, and situations), self-management behaviors and help-seeking for UI, types of health professional consulted, recommended treatment for the problem, and satisfaction with the service provided by health care professionals and the outcomes of recommended treatments were sought through a self-report mailed follow-up survey. Most respondents had leaked urine in the last month (94% and 91% of mid-age and older women, respectively), and 72.2% and 73.1% of mid-aged and older women, respectively, had sought help or advice about their UI. In both age groups, the likelihood of having sought help significantly increased with severity of incontinence. The most common reasons for not seeking help were that the women felt they could manage the problem themselves or they did not consider it to be a problem. Many women in both cohorts had employed avoidance techniques in an attempt to prevent leaking urine, including reducing their liquid consumption, going to the toilet "just in case," and rushing to the toilet the minute they felt the need to.

Effects of age and causal attribution to aging on health-related behaviors associated with urinary incontinence in older women

PURPOSE

The purpose of this study was to assess the effects of age and patients' attribution of incontinence to aging on health-related behaviors associated with incontinence.

DESIGN AND METHODS

Participants in this study were 74 women who either sought treatment for urinary incontinence at a multidisciplinary continence program or volunteered for a randomized clinical trial of behavioral and drug therapy for incontinence. As part of their clinical evaluation, women were interviewed about how they managed their incontinence and their perceptions of what had caused the condition. Self-management of incontinence was defined as behaviors used to cope with incontinence, rather than treat or cure incontinence. Self-treatment was defined as self-implementation of Kegel exercises, and formal treatment was defined as interaction with a health care provider.

RESULTS

Over half of the respondents attributed their incontinence to aging. In multivariate analyses, age was associated with self-management of incontinence, but not self-treatment or formal treatment. In contrast, attribution of incontinence to aging was associated with self-management and self-treatment of incontinence. There was also a trend for attribution of incontinence to aging to be associated with formal treatment for incontinence. Women who attributed their incontinence to aging were less likely to have engaged in self-management strategies and to have received a previous evaluation or treatment; but, they were more likely to have engaged in self-treatment for incontinence. When other relevant variables were added to the regression models, perception that incontinence restricted one's activities became the most significant predictor of performing self-management strategies and performing Kegel exercises.

IMPLICATIONS

Attribution to aging may be an impediment to seeking treatment. Education to promote understanding of the actual causes and treatment of urinary incontinence may encourage people to seek appropriate intervention. Additionally, whereas attribution to aging is an important factor contributing to health-related behaviors, other factors, such as perception that one's activities are restricted, may play an important role.

A multicenter, prospective, open-label study of tolterodine extended-release 4 mg for overactive bladder: the speed of onset of therapeutic assessment trial (STAT)

BACKGROUND

Antimuscarinic agents are the primary treatment for overactive bladder (OAB), but there is a lack of information regarding when maximum symptom relief and maximum perceived patient benefit occur.

OBJECTIVE

This study assessed the speed of onset of therapeutic benefit with tolterodine extended-release (ER) 4 mg.

METHODS

This 12-week, multicenter, prospective, open-label study enrolled patients with OAB who either had received no previous pharmacologic treatment for OAB (drug naive) or were receiving such treatment at enrollment (previously treated). Efficacy was assessed at 1, 4, and 12 weeks using a micturition diary and measures of patients' and physicians' perceptions of improvement. Safety was assessed in terms of adverse events and study withdrawals.

RESULTS

The intent-to-treat population included 1138 patients (302 men, 836 women; 88.4% white; age range, 18-91 years), 735 drug naive and 403 receiving treatment for OAB at enrollment. After 1 week, tolterodine ER 4 mg had produced a significant improvement in all efficacy variables in both groups of patients (P < 0.01); 72% of the maximum effect on urge incontinence was observed in both groups; and 84.7% of drug-naive patients and 83.6% of previously treated patients perceived a benefit from treatment. After 4 weeks, drug-naive and previously treated patients reported a respective 93% and 100% of the maximum effect on episodes of urge incontinence. Tolterodine was well tolerated, with dry mouth (mostly mild) the most commonly reported adverse event (15.5% in each group). The 330 (81.9%) patients who had reported unacceptable efficacy and the 87 (21.6%) patients who had reported unacceptable tolerability of previous OAB treatment responded favorably to tolterodine ER 4 mg.

CONCLUSIONS

Tolterodine ER 4 mg was effective and well tolerated in both drug-naive and previously treated patients with OAB. More than 80% of patients reported benefit from treatment after 1 week, but maximum symptom relief was achieved with longer treatment.

Urinary incontinence in pregnancy and the puerperium

OBJECTIVE

To describe the incidence of urinary incontinence (UI) during pregnancy and the puerperium and to identify potential contributing factors.

DESIGN

A descriptive correlational design, using participant interviews and reviews of the existing medical records to determine the incidence of UI in pregnancy and the puerperium and to examine relationships between and among several variables. The variables included parity, episiotomy, use of forceps/vacuum extractor, type of anesthesia, prolonged Stage II labor, and race. Data were collected via two personal interviews and review of medical records. The first interview was conducted during the recruitment of each participant; the second was a telephone interview conducted 4 to 6 weeks postpartum. Data collected from the medical records included obstetric history, weeks of gestation, and estimated date of delivery. Data were entered into data files for analysis with SPSS 8.0 and summarized with descriptive statistics.

SETTING

A secluded area of a university teaching hospital prenatal clinic.

PARTICIPANTS

A convenience sample of 50 pregnant women, at least 18 years old, who received their care at a large university hospital prenatal clinic in the southeastern part of the United States.

RESULTS

First Interview (N = 50). More than half (62%; n = 31) of the sample reported some degree of involuntary urine loss during their pregnancy. The racial distribution of those reporting UI was the following: white (70%; 21 out of 30); African American (44%; 8 out of 18); Hispanic/Asian (100%; n = 2). Among the participants who experienced UI (n = 31), 76% (n = 23) reported that their health care provider never asked if they were experiencing any UI symptoms. Second Interview (n = 24). Only 48% of the initial participants could be contacted for the second interview because of changes in residence or telephones being disconnected with no forwarding number. Of the women in this sample who reported UI during the first interview (59%; n = 14), 7 (50%) continued to experience UI 4 to 6 weeks postpartum. The 2 remaining participants who reported UI 4 to 6 weeks postpartum (22%) had not experienced UI during pregnancy. Of the participants experiencing postpartum UI, 77% (n = 7) were white. Almost half of the participants with postpartum UI were ages 35 or older (44%; n = 4). Among the participants reporting episiotomy (n = 4), 3 (75%) reported having UI 4 to 6 weeks postpartum.

CONCLUSIONS

Study results support the conclusion that childbirth, specifically vaginal birth, is a major factor in developing UI in the early postpartum period. Age, race, and use of episiotomy appear to be contributing risk factors.

Coping strategies and health care-seeking behavior in a US national sample of adults with symptoms suggestive of overactive bladder

BACKGROUND

Although millions of individuals have symptoms suggestive of overactive bladder (OAB), few ever seek or receive medical treatment for their condition.

OBJECTIVE

The purpose of this study was to describe coping strategies and health care-seeking behavior in a community-based sample of adults with symptoms suggestive of OAB.

METHODS

A cross-sectional household telephone survey of an age- and sex-stratified sample of adults was conducted. The survey consisted of general health-related questions as well as questions related to OAB symptoms. A total of 4896 adults completed the interview Respondents were considered to have OAB if they reported > or = 1 symptom of urinary urgency, frequency, or urge incontinence. A follow-up questionnaire was then mailed to a subsample of the telephone interview respondents. The mailed questionnaire contained questions related to type and severity of OAB symptoms, coping strategies, medical care/treatment, feelings/beliefs about OAB, and quality of life. Half of the phone respondents with urinary incontinence (n = 638) and a random sample of all other phone respondents received the mailed questionnaire (n = 873); 1,034 questionnaires were returned.

RESULTS

Of the respondents with OAB, 69.6% tried > or = 1 nonmedical coping strategy. Respondents with incontinent OAB were significantly more likely than those with continent OAB or those with no OAB (controls) to use nonmedical coping strategies (incontinent OAB, 76.1%; continent OAB, 59.0%; controls, 31.9%; P < 0.001). Fewer than half of the respondents with OAB (43.5%) had spoken with a provider about OAB in the previous 12 months. Medical consultation was associated with sex, type and severity of OAB, number of nonmedical coping strategies tried, number of OAB information sources consulted, inclination to try new OAB medications, and feelings/beliefs about OAB. In 90% of patient-provider discussions about OAB, the patient initiated the topic.

CONCLUSIONS

Individuals manage symptoms suggestive of OAB primarily by using nonmedical coping strategies rather than consulting health care providers. Results of this study support the need for improved clinical recognition of OAB and increased patient-provider communication about this condition.

[Communication, diagnosis and treatment of urinary incontinence in the elderly in a basic health area]

OBJECTIVE

To investigate the frequency in which aged people who suffers on urinary incontinence (UI) talk about this problem with primary care professionals, variables related to no healthcare-seeking as well as diagnostic and therapeutic habits of these professionals.

DESIGN

Cross-sectional study.Location. Basic Health Zone of Cabra (Córdoba, Spain).

PATIENTS

A random age-stratified sample of 869 patients selected from a total of 5139 persons >= 65 years of age.Interventions. Home interview.

MEASUREMENTS

Proper questionnaire with questions about reporting of incontinence to health professionals and the procedures used for routine screening as well as diagnostic and therapeutic assessment of incontinence. A logistic regression model was elaborated to identify explanatory factors for reporting incontinence to healthcare professionals.

RESULTS

Of 330 incontinents, only 32% reported their problem to healthcare professionals. The remaining 68% did not report their incontinence because most thought it was a minor problem and/or part of the ageing process. The explanatory factors for seeking medical help were the frequency, duration and impact of incontinence, and dependence in self-care. Physicians performed routine screening for incontinence in 10% of 827 inquired aged. In 1 out of 5 incontinents, the physician did not take any diagnostic or therapeutic measures.

CONCLUSIONS

Seeking of UI medical help was very limited and depends on variables related to perception in symptom's changes. Diagnosis and treatment done by professionals was suboptimal. Severity of UI conditions diagnosis and treatment.

Self-care practices used by older men and women to manage urinary incontinence: results from the national follow-up survey on self-care and aging

OBJECTIVES

To estimate the extent to which self-care practices are employed by older adults with urinary incontinence (UI); to determine how demographic and functional status measures are associated with self-care practice use; and to explore the relationship between contacting a doctor and disposable pad use.

DESIGN

A cross-sectional analysis of a national probability sample using multiple logistic regression.

SETTING

Responses of subjects with UI (n = 787) from the 1993-1994 National Follow-up Survey on Self-Care and Aging, a follow-up survey of older Medicare beneficiaries living in the community within the contiguous United States drawn in 1990-1991

MEASURES

Subject responses about UI, fecal incontinence, dressing, eating, bathing, Instrumental Activities of Daily Living (IADL), Mobility Activities of Daily Living (MADL), age, gender, place of residence, race, education, proxy response to the survey, and self-reported medical conditions.

RESULTS

Self-care practices used by more than 25% of respondents with UI included using disposable pads, limiting trips, and limiting fluids. Among older adults with incontinence, more women used disposable pads (44.5%; 95% CI, 36.9-52.1) and performed exercises (14.2%; 95% CI, 9.7-18.9) than did men (15.1%; 95% CI, 8.1-22.1; and 4.3%; 95% CI, 1.0-7.7, respectively). Bi-variate analysis showed respondents with severe UI or fecal incontinence reported greater use of self-care practices. In multivariate models of the three most commonly used self-care practices, measures of UI severity were not always associated independently with self-care practice use, whereas ADL measures of functional status were. Disposable pad use was positively independently associated (OR 3.36; 95% CI, 2.01-5.63) in multivariate models with contacting a doctor about incontinence, even after controlling for age, gender, demographics, and self-reported medical conditions.

CONCLUSIONS

Use by older adults of self-care practices to manage urinary incontinence is predicted independently in multivariate models by measures of functional status such as dressing, eating, bathing, IADLs or MADLs, but not by all UI measures. Disposable pad users had increased odds of contacting a doctor, suggesting that self-care practices and formal medical care are not always inversely related.

Outcomes of a small group educational intervention for urinary incontinence: health-related quality of life

OBJECTIVES

This article examines change in general and condition-specific measures of health-related quality of life (HRQL) among participants in a randomized trial of a community-based intervention for urinary incontinence (UI).

METHODS

Participants were randomized into intervention or wait control conditions. Participants were women aged 65 or older with urinary incontinence residing in Oklahoma. General HRQL measures included the Physical Function, Mental Health, Vitality, and Health Perceptions subscales of the Medical Outcomes Study Short Form-36. Condition-specific measures included the Impact of UI and self-management strategies.

RESULTS

There were no significant group effects for the general HRQL measures. Intervention participants reported decreased Impact of UI and greater change in self-management strategies than control participants.

DISCUSSION

The intervention affected condition-specific quality of life and self-management but not general HRQL. The intervention's impact on quality of life involves change in how the condition is seen as impacting on life and on selection of self-management behaviors.

The impact of information on health behaviors of older adults with urinary incontinence

The purpose of this study was to explore the impact of education about urinary incontinence on the subsequent help-seeking behaviors of older adults. Forty-five community-dwelling seniors were randomized to two groups. One group received individualized instruction supported by written information, the other received written information alone. All participants received a list of local health care professionals specializing in the assessment and treatment of urinary incontinence. Seventeen participants sought professional help following the intervention; however, there was no significant difference in help-seeking behaviors between intervention groups, chi2 = 1.42, alpha = 0.05. The most common reasonfor lack of help-seeking postintervention was a preference for self-care. Eighty-eight percent of those who initiated self-help behaviors reported a subjective improvement in the frequency or volume of their incontinence. Results emphasize the important role registered nurses should play in the dissemination of complete and accurate information about urinary incontinence.

Epidemiology and classification of urinary incontinence

Urinary incontinence is a common symptom affecting the physical, psychological, social and economic well-being of individuals and their families. It also poses a considerable economic burden on health and social services. The literature reports widely varying prevalence rates for incontinence that are partially explained by methodological differences between studies. However, community-based studies indicate that approximately 6% of the population, particularly women and older people, will have urinary incontinence of sufficient severity to interfere with their quality of life. This represents a significant demand for health care. Although further research on prevalence is unlikely to add anything new to current knowledge on the size of the problem, more information is needed on the onset, progression and risk factors of urinary incontinence to inform methods of effective treatment and preventive strategies. In addition, there has been little investigation of the triggers to seeking professional help or of the response of health professionals to patients' demands for treatment, either for incontinence or other lower urinary tract symptoms. The aetiology of incontinence is multifactorial; incontinence is caused by pathophysiological impairments to the lower urinary tract and neurological system, as well as a range of external factors. The key to effective management, therefore, is a comprehensive assessment of the patient, including other lower urinary tract symptoms, so that appropriate intervention is tailored on a diagnosis and not on symptoms.

Coping strategies for women with urinary incontinence

Incontinence is a common and complex condition affecting women of all ages, social and cultural backgrounds. 'Coping strategies' play an important role for managing incontinence and include changes in lifestyle, protection, aids, and catheters, whether they are indwelling or intermittent. By the time women seek medical advice for urinary incontinence they have usually tried various tactics to either limit the leakage or protect themselves from it. The most common tactics to limit leakage include fluid restriction, regular toileting, exercises and weight reduction. With medical advice, women can change concomitant medication that may be exacerbating the problem. Aids for mobilization can also have a dramatic effect on the ability to cope with urinary problems. Pads used for protection are often unsuitable and some even wear 'home-made' pads in the form of rolled up tissue, commonly to save money. Many different types of pads are available although women are often ignorant as to what is best for them. Catheters should only be used for intractable incontinence and following appropriate investigation. When possible intermittent catheterization should be considered. It is essential that all women are assessed and investigated before any form of containment becomes long-term management.

Managing urinary incontinence in the nursing home: residents' perspectives

The purpose of this study was to develop a substantive theory describing and explaining cognitive, psychosocial, and behavioural aspects of living with urinary incontinence in a nursing home. Using grounded theory methodology, data were obtained from interviews, participant observation, and minutes from meetings of resident advisory councils, and analysed concurrently using the constant comparative method. Three nursing homes located in the metropolitan area of a major American city served as sites for the study. Ethical approval was obtained from the administrator of each facility and institutional review board of a major university. Ten residents served as primary participants, consenting to provide one audiotaped formal interview, subsequent opportunities to observe and discuss their methods of bladder control, and access to their health care records. Another 33 residents from these facilities served as secondary participants, providing opportunities for observation and informal interview when their bladder control needs, issues, or methods were visible to the investigator and seemed relevant to the evolving theory. Data were collected over a period of 17 months. Findings suggest that nursing home residents with actual or potential urinary incontinence engage in a process called managing urinary incontinence. Managing urinary incontinence occurs in the context of believing that it is an inevitable part of ageing and seeking to protect physical, psychological, and social integrity. Managing urinary incontinence is a dynamic process with consequences that are influenced by the degree to which six specific strategies are used with satisfaction by the resident and supported by staff and significant others. Implications for nursing practice and research are discussed.

Urinary incontinence in a community-based cohort: prevalence and healthcare-seeking

OBJECTIVE

To estimate the prevalence of urinary incontinence and to assess care-seeking behavior for urinary symptoms among community-dwelling people.

DESIGN

A community-based cross-sectional study.

SETTING

Randomly selected men and women from Olmsted County, Minnesota.

PARTICIPANTS

Two cohorts, one comprised of both men (n = 778) and women (n = 762) 50 years of age or older and a second comprised of men aged 40 years or older (n = 2150).

MEASUREMENTS

Participants completed questionnaires assessing urinary incontinence in the previous 12 months, the number of days leaked, the amount leaked, and healthcare-seeking measures for urinary symptoms.

RESULTS

In the first cohort, the prevalence of incontinence was 24% in men and 49% in women; 29% of men and 13% of women with incontinence had sought care for urinary symptoms. Urinary incontinence was more strongly associated with care-seeking measures for urinary symptoms in men (Odds Ratio (OR) = 4.3, 95% Confidence Interval (CI) = 2.4, 8.0) than in women (OR = 2.1, 95% CI = 1.2, 3.9). Moderate or severe urinary incontinence was associated significantly with care-seeking for urinary symptoms (OR = 10.5, 95% CI = 5.6, 19.8). In the second cohort, the prevalence of urinary incontinence was 17.3%; 8.5% of men with incontinence had sought care for urinary symptoms. Men with incontinence were 1.2 times (95% CI = .8, 1.9) as likely to seek care for urinary symptoms as men without incontinence.

CONCLUSION

Our findings indicate that although urinary incontinence is relatively common in the community, care-seeking for urinary symptoms among persons with urinary incontinence is low, particularly among women, for whom the prevalence exceeds 40% between the ages of 50 and 70 years. These findings suggest that strategies to promote care-seeking for incontinence need to be investigated and employed in the community.

Urinary incontinence among a 65-year old Swedish population: medical history and psychosocial consequences

Urinary incontinence (UI) is a disability caused by an impairment, which can lead to a handicap of importance for nursing care. This means that UI is not only a practical-medical concern but also a socio-economic problem. The purpose of the study was to determine the prevalence of UI among 65 year-olds in a Swedish Health Care District and to compare gender differences concerning medical history and psychosocial consequences. In a Primary Health Care District, a questionnaire pertaining to UI was mailed to all women and men 65 years of age (N = 458). A total of 91% (n = 419) was sufficient for data analysis, which was performed by descriptive and inferential statistics. It was found that 28% (n = 61) of the women and 9% (n = 21) of the men were afflicted with UI. Women reported significantly more urge incontinence (p < .05) as well as stress incontinence (p < .05). Information from the health service about UI had been given to 46% (n = 28) of the women and 33% (n = 7) of the men. The strongest reason reported, both in women (42%, n = 26) and men (40%, n = 8), for not seeking help from the health service was that UI was a normal condition for people of their age. Most of the women had to urinate at least twice per night (42%) compared to once per night (44%) for the men. It is important to establish a UI clinic at every main Primary Health Care Centre which builds on nursing care and whose aim is to inform the general public that UI is a common problem, that it leads to psychosocial consequences, and that the health service can offer active rehabilitation interventions.

Diagnostic assessment of geriatric urinary incontinence

Urinary incontinence affects 15% to 30% of the population and 50% of those living in nursing homes. Care for incontinence is difficult because this condition is underreported by patients and underdiagnosed by physicians. This article describes the medical and nursing diagnostic assessment of urinary incontinence of geriatric populations, and the criteria for referral. Comprehensive review of urinary incontinence, including treatment, is available elsewhere. Although this article focuses on the assessment of urinary incontinence, the type of treatment being considered guides the scope of the evaluation, and therefore, treatment of incontinence is discussed.

Managing acute and chronic urinary incontinence. U.S. Department of Health and human services

This Quick Reference Guide for Clinicians contains highlights from the Clinical Practice Guideline Update on Urinary Incontinence in Adults: Acute and Chronic Management, which was developed by a multidisciplinary panel of health care providers and a consumer representative. Findings and recommendations are presented for identification and evaluation of urinary incontinence (UI); use of behavioral, pharmacologic, and surgical treatment as well as supportive devices; long-term management of chronic intractable UI; and education of health care providers and the public. An algorithm is included to show the sequence of events related to the overall management of UI. Tables and forms are included to outline assessment and treatment options.

Epidemiology of urinary symptoms in the geriatric population

As the US population ages, there is a growing need for information about the urologic health problems facing older adults. In conjunction with findings from clinical studies and basic research on biological mechanisms, the epidemiologic approach offers insights on the prevalence, etiology, and impact of these geriatric conditions. This information can provide the basis for planning health care services and intervention programs. The authors discuss trends associated with population aging and the challenges posed by the epidemiologic study of older adults. Also reviewed are current findings on the prevalence, incidence, and correlates of urinary incontinence and other common urologic symptoms.

Psychosocial issues in geriatric urology: problems in treatment and treatment seeking

Psychological and social issues are important in geriatric urology because they affect not only the patient's ability and willingness to seek out therapy, but also their ability to benefit from it. Many older adults with problems of bladder control, such as frequency, urgency, nocturia, and incontinence are deterred from seeking treatment by factors such as social disapproval and belief that bladder symptoms are normal or untreatable. Many older adults who present for treatment experience limitations of mental status or functional ability that merit attention because they can interfere with learning, motivation, and cooperation needed for successful treatment. Strategies are described that help to address these psychosocial issues and needs in older patients.

Self-care behaviors of older women with urinary incontinence

1. Despite the availability of effective treatments for urinary incontinence, many women self-manage incontinence and never have it evaluated or treated. 2. The vast majority of women in this study used one or more self-care behaviors to manage their incontinence; the most frequently used behaviors were locating or staying near bathrooms when out, voiding more frequently, and wearing some type of protective garment. 3. Most women reported that incontinence was not at all or only a little difficult to manage and were satisfied with the self-care behaviors they used to manage this problem despite the fact that most of these behaviors had little or no potential to reduce or eliminate their incontinence.