Tag Archive | "urinary incontinence"

How to Care for Urinary Incontinence

Urinary incontinence is a condition that results in the involuntary loss of urine.  It is a condition that affects millions of American men and women.  As we age, our body undergoes many changes.  Some of these changes involve the urinary tract and may lead to incontinence as men and women get older.

Both men and women may develop urinary incontinence, but several actions exist that women, specifically, can take to decrease or even limit involuntary release of urine.

The skin around the outside of the vagina in women is called the vulva.  This area includes the skin around the urethra and the vaginal lips, or labia.  Frequently, in incontinent women, this area is red, raw, and sore from urine irritating the skin.  These tips may help make women more comfortable and avoid irritation of the bladder, urethra, and surrounding skin.

Women who are incontinent should avoid synthetic or nylon underwear or synthetic pantyhose.  Instead, use full underwear made of cotton, also avoiding thongs and g-strings.  In addition, women may find that washing underwear in pure soap or soap flakes, instead of harsh detergents, may reduce irritation to the vulva.  Also, women should not wash the vulvar area no more than twice a day, using only plain water or mild soap.

Although bath oils, bubble baths, and bath salts feel nice, women with incontinence should avoid them.  The ingredients in relaxation baths can be very irritating to the already sensitive skin of the vulva.  Vaginal deodorants or douches should be avoided.  And tampons should not be used as they may irritate the bladder and urethra.

After bathing, gently dry the vulvar area with a towel.  Women may use a hair dryer on cool or low setting to dry the area completely.  If a powder is necessary, use corn starch and not talcum powder.

Finally, drink plenty of pure water.  Avoid caffeinated beverages such as coffee, tea, and cola.  Alcohol should also be avoided, especially excessive amounts of alcohol, as it also irritates the bladder and urethra.

Urinary incontinence can be helped and in many cases may be cured with proper treatment.  If you are experiencing any of the symptoms of urinary incontinence, contact your physician to discuss treatment options.

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Weight Loss Eases Urinary Incontinence in Heavy Women

Leslee L. Subak, MD, of the University of California, San Francisco, and colleagues, reported in a January issue of the New England Journal of Medicine that weight loss may significantly improve urinary incontinence for overweight and obese women.  A loss of about 17 pounds in an extensive six-moth diet and exercise program reduced the average number of weekly incontinence episodes by 47% compared with 28% for the control group.

Losing weight was particularly effective against stress incontinence in the randomized trial, and was as effective overall as behavioral treatments, such as pelvic muscle exercises.  Dr. Subak reports that these findings may help motivate incontinent patients to overcome the common fear of episodes occurring during exercise.  The researchers’ Program to Reduce Incontinence by Diet and Exercise (PRIDE) study included 338 overweight and obese women with at least 10 urinary incontinence episodes per week, with an average of 24 episodes per week.  Participants were randomized to an intensive six-month weight-loss program of reduced-calorie diet, exercise, and behavior modification (226 participants) or to four group classes on the benefits of exercise, a healthy diet, and weight loss (112 participants). By the end of the program, the average weight loss from baseline was 8.0, compared with 1.6% among controls.

More women in the weight-loss group had a clinically relevant reduction of at least 70% in total weekly incontinence episodes, stress-incontinence episodes per week, and urge-incontinence episodes per week.  The primary effect of weight loss was on stress incontinence, which dropped by 57.6% compared with 32.7% among controls.

Urge incontinence, which was more common in both groups at baseline, tended to also decrease with weight loss, but the effect was not significant compared with other controls.

Limitations of the study include the fact that it relied on self-reports, the lack of blinding, and the fact that participants were selected by potential for adhering to behavioral modification, which might limit generalizability.

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Urinary Incontinence is More Frequent Among White than Black Women

Elisa R. Trobridge, MD, of the University of Virginia, and colleagues have found that urinary incontinence occurs in more than twice as many white women as black women.  The reasons are not known; neither frequency of symptoms nor risk factors explained the difference.  The results were reported in the April issue of the Journal of Urology and were based on a survey of about 3,000 women.

Black women, however, with incontinence experienced significantly more urine loss.  Half of black incontinent women described their urine loss as enough to wet their underwear or pads, compared with 37.7% of white incontinent women.  Also, while black women had more urge incontinence, white women had more stress incontinence.

Previous studies derived from surveys and clinical evaluations have suggested differences between black and white women in the prevalence and type of urinary incontinence, but those studies had problems with design, population, and other factors.

This study, on the other hand, was a population-based cross-sectional one.  Dr. Trowbridge and colleagues examined racial differences in prevalence, frequency, quantity, and type of urinary incontinence in community dwelling women ages 35 to 64.  They also investigated demographic, medical history, lifestyle, and obstretric/gynecologic factors that might influence continence status.  Estimates were weighted to reflect probability and nonresponse characteristics of the sample, and to increase generalizability of the findings.

The survey was conducted by telephone and included 1,922 black women and 892 white women living in three counties in southeast Michigan.  The overall prevalence of urinary incontinence was 26.5%.  White women had a significantly higher prevalence (33.1%) than black women (14.6%).  There were no differences in incontinence frequency (about 15 episodes each month).

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Cesarean Section May Not Prevent Incontinence

Vaginal delivery has been thought to cause urinary incontinence through physical trauma and damage to nerves as such there is a suggestion that women who choose c-section over vaginal delivery might be protecting themselves against urinary or fecal incontinence down the road.

This might not be necessarily true according to the findings of a recent study.  Dr. Cathryn Glazener of the University of Aberdeen in the UK and her colleagues tracked almost 4,000 women who gave birth in the UK and New Zealand for 12 years after their delivery.

The researchers recorded how the first babies were delivered and kept in touch with the women through questionnaires to find out if they had more children and whether those children were born through c- sections or vaginal deliveries.  They also asked the participants if they had symptoms of urinary or fecal incontinence and if so, how often.

In women who had given birth only through vaginal delivery, 55% reported experiencing urinary incontinence compared to 59% of women who had at least one baby through vaginal delivery and one baby through c-section. In women who only had c-section, 40% reported experiencing urinary incontinence.

Regardless of how they delivered their children, women who were heavier, had given birth more times, and were older at their first delivery reported higher rates of incontinence.

Recent evidence shows that the rate of C-sections performed in the U.S. has been rising, from one in five births in 1996 to almost one in three births in 2007, according to the Centers for Disease Control and Prevention. Many doctors see this trend as risky because C-sections have been linked to a higher chance of breathing problems in babies and future pregnancy complications in moms.

Glazner and her colleagues concluded that, “Unless women are resolved to have all their deliveries by the abdominal (c-section) route (and their medical advisors agree), cesarean section does not protect from subsequent” urinary incontinence.

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Hemoglobin Levels Linked to Severity of Incontinence in Older Women

Sei Lee, MD, Assistant Professor of Geriatrics at the University of California in San Francisco, and colleagues found that in older women in diabetes and urinary incontinence, very high hemoglobin A1c (HbA1C) levels are associated with patient reports of more severe limitations due to incontinence.  The data also showed, however, that in older women with diabetes, poor glycemic control does not predict the presence or absence of urinary incontinence.  The results were reported at the 71st Scientific Sessions of the American Diabetes Association.

They analyzed a large, diverse cohort of older women enrolled in the Diabetes and Aging Study, which is sponsored by the National Institutes of Health.  This five-year study examines medical care and outcomes in roughly 112,000 type 2 patients who are aged 59 years and older and enrolled in the Kaiser Permanente California Diabetes Registry.

Glycosuria has long been known to result from hyperglycemia.  Previous studies that have examined the relationship between poor glycemic control and urinary incontinence have found no association, but these studies included few patients with poor glycemic control and thus have had limited statistical power.

The outcome variables measured in this study were the presence/absence of incontinence and the severity of limitations due to incontinence.  The patients were asked “Do you experience occasional accidental urine leakage?” and “During the past 12 months, how much did the leakage of urine affect your day-to-day activities?”  The patients had the options of responding, “not at all,” “slightly,” “moderately,” “quite a bit,” or “extremely.”

The results from 3,916 older women with diabetes and urinary incontinence showed that HbA1C did not predict the presence or absence of urinary incontinence, after adjusting for age, ethnicity, education, income, parity, diabetes duration, diabetes treatment, co-morbid conditions, and body mass index.  Diabetic women with very poor control with an HbA1C greater than nine percent were about 50% more likely to be more severely limited by incontinence than women with excellent control with an HbA1C below six percent.  Dr. Lee recommended that clinicians routinely ask older female patients about incontinence.

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Botox Approved in Ireland for Treatment of Urinary Incontinence

The Irish Medicines Board has approved Botulinum toxin type A to treat urinary incontinence management in adults with neurogenic detrusor overactivity (NDO).

Neurogenic detrusor overactivity results from nuerogenic bladder due to multiple sclerosis or stable sub-cervical spinal cord injury.

Allergan Inc. has said that this step is important in securing national licenses in fourteen European countries that are involved in the Mutual Recognition Procedure.  The positive opinion came after the Irish regulatory agency evaluated Allergan’s successful global Phase III program.

Bladder dysfunction affects approximately 60 percent to 80 percent of people with multiple sclerosis (MS) and 75 percent to 80 percent of those with spinal cord injury (SCI), including urinary incontinence.

Both MS and SCI patients often have bladders which contract during the filling stage, during which time they should be relaxed.  This condition is known as neurogenic detrusor overactivity, which can result in uncontrolled urinary leakage, known as urinary incontinence.

When Botox is injected into the bladder muscle, the involuntary contractions subside and bladder activity increases, resulting in fewer urinary leaking incidents.  Sometimes the problem is completely resolved.

Urinary incontinence can often be a socially isolating and disabling condition. People who suffer from it frequently experience low self esteem, loss of independence, embarrassment, and depression.   MS and SCI patients with urinary incontinence are also more likely to develop skin irritations and ulcers, recurrent and kidney failure.

Douglas Ingram, President of Allergan in Europe, Africa and the Middle East, said that Allergan was pleased about the Irish Medicines Board’s decision.

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Post Prostate Surgery Pelvic Floor Exercises Ineffective in Improving Male Incontinence

According to a two randomized trials reported in The Lancet one-to-one pelvic floor exercise therapy for urinary incontinence after prostate surgery is no more effective than standard care.

Cathryn Glazener, PhD, from the University of Aberdeen, United Kingdom, and colleagues, reported that urinary incontinence is common immediately after prostate surgery.  As a result men are often advised to do pelvic floor exercises, but evidence to support this had been inconclusive.  The study sought to establish if formal one-to-one pelvic floor muscle training reduces incontinence.  It was supported by the National Institute of Health and Health Technology Assessment Programme.

The first trial enrolled men in the United Kingdom who had incontinence six weeks after radical prostatectomy, and the second trial enrolled men in the United Kingdom who had incontinence six weeks after transurethral resection of the prostate (TURP).  These trials compared the effect of four one-to-one therapy sessions during a three-month period to standard are and lifestyle advice only.

In trial 1, the rate of urinary incontinence at 12 months in the intervention group was not significantly different from that in the control group. Findings were similar in trial 2. These findings were unchanged by adjustment for minimization factors or by treatment-received analyses.  There were no adverse effects reported in either trial.

The authors conclude that one-to-one conservative physical therapy for men who are incontinent after prostate surgery is unlikely to be physically effective or cost effective.

Limitations of this study include incomplete blinding and lack of objective measures of incontinence.

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Sleep Problems Associated with Incontinence

According to the results of a new study, sleep problems are associated with urologic conditions such as incontinence, lower urinary tract symptoms (LUTS) and nocturia – the need to get up during the night to urinate.

For five years, researchers at New England Research Institutes, Inc. in Watertown Massachusetts followed 1,610 men and 2,535 women assessing sleep disturbances and the development of urologic symptoms.

The investigators found that short sleep duration among men and restless sleep in both men and women was strongly associated with the incidence of lower urinary tract symptoms – 8% among men and 13% among women. Incidences of urinary incontinence and nocturia were associated with restless sleep among women but not in men.

The study is scheduled to be presented to the media during a special press conference at the American Urological Association’s (AUA) annual meeting in Washington, D.C. along with another study that examined the relationship between obstructive sleep apnea (OSA) and erectile dysfunction.

In the association’s news release, Dr. Kevin T McVary, AUA spokesman said “We know that proper amounts of sleep and quality of sleep can impact a wide range of health conditions, these data may help us better assess how helping patients modify their sleep patterns may help improve their health and overall quality of life.”

The data and conclusions of these studies should be viewed as preliminary until published in a peer-reviewed journal because these studies were presented during a medical meeting.

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Drinking Less to Avoid Incontinence

A study which pulled data from more than 65,000 health and lifestyle surveys of female nurses looked at women who had not yet developed incontinence, to see whether fewer beverages each day could prevent the onset of incontinence later. The survey tracked nurses for 2-4 years, asking how much they drank each day and seeing who later developed incontinence.  The researchers tallied all beverages, including alcohol, coffee, milk, water and juice.  The survey did not ask how many beverages each day the women had, but rather the total amount of fluids they drank.

Drinking ranged from a little more than a liter – about three 12 ounce cans of soda – to nearly three liters each day. The researchers grouped the women into five categories, from the smallest amount of fluid intake to the largest.

“The rate of developing incontinence was the same” said Fran Grodstein, the lead researcher of the study. About 30 percent of the women later came to have at least one leaking episode per month which is consistent with other estimates of incontinence among women.

Incontinence can be caused by poor control over a full bladder or forced leaks from sneezing or laughing.  People who experience it frequently limit how much they drink to manage the problem and reduce leaks.

“Adequate hydration especially for older women is important and they shouldn’t be restricting fluids for fear of causing incontinence” Grodstein added.

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Susceptibility to Urinary Incontinence Linked to Genetic Factors

University of Gothenburg in collaboration with the Swedish Twin Registry at Karolinska Institutet in Stockholm, Sweden studied just over 25,000 Swedish twins aged 20 to 46. Information about urinary incontinence, overactive bladder and other lower urinary tract symptoms were analysed using a statistical method which measures how much of the difference between people is due to genetic variation. By comparing the prevalence of these symptoms in identical twins, who have identical genes, and non-identical twins, who share half of their genetic material, the researchers were able to draw conclusions about the relative significance of genetic and environmental factors.

Gynecologist Anna Lena Wennberg, one of the researchers behind the study said “incontinence is caused by a combination of factors and we already knew that there are hereditary factors, but now we’ve been able to show for the first time how important the genetic component is for various types of urinary tract disorder”.

In urinary incontinence, half of the variation (51%) can be explained by genetic factors. This means that around 50% of people’s susceptibility to urinary incontinence can be explained by their genes.

In nocturia – the need to get up in the night to urinate, 34% of the variation has a genetic explanation.

Wennberg does not believe that there is a single incontinence gene, rather that a number of different genes play a role. These genes combine with various environmental factors or cause disorders which, in turn, increase the risk of urinary incontinence.

“Urinary incontinence is a multifactorial condition, and while we now know that much of the variation between people is down to their genes, treatment will continue to focus on environmental factors which are easier to influence, such as smoking and excess weight.”

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