Postmenopausal women's adherence to pelvic floor muscle exercises over 2 years.

OBJECTIVE: This study aimed to investigate women's adherence patterns to pelvic floor muscle exercises (PFME), their associated factors and within-pattern changes. METHODS: This was a secondary analysis using data collected from 647 women aged 55 years and older in the USA. Women were randomly assigned to either a 2-h class group or an equivalent content 20-min DVD group to receive PFME complemented with adherence enhancement strategies. Adherence was assessed at 3, 12 and 24 months using three self-reported items matching PFME parameters. The k-mean clustering and multinomial logistic regression were used to investigate adherence patterns and their associated factors, respectively. Descriptive statistics were used for within-pattern changes over time. RESULTS: Four adherence patterns, A, B, C and D, were identified. Women who displayed optimal adherence to all three aforementioned items, i.e. adherence pattern A, constituted 49.1%, 38.2% and 37.2% of women at 3, 12 and 24 months, respectively. Women with income > US$100,000 were more likely to display adherence pattern A within 12 months. Of women who had adherence pattern A at 3 months, 63.9% and 49.2% continued in this pattern at 12 and 24 months. CONCLUSIONS: Fewer than half of women displayed adherence pattern A for 2 years. Early optimal adherence predicted women's subsequent optimal adherence.

Women's toileting behaviours: an online survey of female advanced practice providers.

AIMS: An online survey of female advanced practice providers (APPs) in a large urban healthcare system was conducted to describe behaviours they use to manage their personal bladder emptying. METHODS: The questionnaire contained items on demographics, presence of urinary incontinence (UI), and behaviours used to void in work, public and home settings. RESULTS: One hundred thirteen female APPs responded to the survey and 109 responded to items on UI. Over half (53%) reported experiencing UI at least once a week. In general, the APPs reported being worried about the cleanliness of public toilets and delaying voiding when busy. Incontinent APPs were older and had histories of more pregnancies than continent women. Incontinent APPs also used public toilets more frequently and when there was no or little need to void, and delayed or put off voiding while at work and when busy. CONCLUSION: Although APPs have specialised knowledge about lower urinary tract anatomy and physiology, many engage in behaviours that may be detrimental to bladder health. More research is needed to explore behaviours women use to manage voiding and the effect of these behaviours on bladder health.

A healthy bladder: a consensus statement.

A panel of experts in urology, urogynecology, nursing, and behavioral therapy convened in 2010 to discuss the importance of a healthy bladder on overall health. They determined that a consensus statement was necessary to raise awareness among the general public, healthcare providers, payors, and policymakers, with the goals of minimizing the impact of poor bladder health and stimulating primary prevention of bladder conditions. In this statement, 'healthy' bladder function is described, as well as internal and external factors that influence bladder health. It is suggested that primary prevention strategies should be aimed at providing education regarding normal lower urinary tract structures and functioning to the public, including patients and healthcare providers. This education may promote the achievement of optimal bladder health by increasing healthy bladder habits and behaviors, awareness of risk factors, healthcare seeking, and clinician engagement and reducing stigma and other barriers to treatment. Promoting optimal bladder health may reduce the personal, societal and economic impact of bladder conditions, including anxiety and depression and costs associated with conditions or diseases and their treatment. While adopting healthy bladder habits and behaviors and behaviors may improve or maintain bladder health, it is important to recognize that certain symptoms may indicate the presence of conditions that require medical attention; many bladder conditions are treatable with a range of options for most bladder conditions. Lastly, the authors propose clinical directives based on persuasive and convergent research to improve and maintain bladder health. The authors hope that this statement will lead to promotion and achievement of optimal bladder health, which may improve overall health and help minimize the effects of bladder conditions on the public, healthcare professionals, educators, employers, and payors. The advisors are in consensus regarding the recommendations for improving and maintaining bladder health presented herein.

Incontinence in a manufacturing setting: women's perceptions and responses.

The true prevalence of urinary incontinence (UI) and its impact on the quality of life in working women are not well established. Many women do not report UI to a health care provider because they mistakenly believe UI is a natural part of aging. This situation exists despite the dissemination of a national guideline for UI in adults. The aims of this study were to (1) explore what incontinent women in a manufacturing setting name or identify as the proposed cause of urinary leakage (2) analyze an association between identifying a UI cause and reporting it to a health care provider and (3) determine how many women were aware of the AHCPR Guideline. The results indicate that the majority of incontinent women (62%) have not reported this to a health care provider. Most women attributed urinary leakage to parity and waiting too long to empty the bladder. There was no relationship between identifying a UI cause and reporting it to a health care provider. Only 2 of the women out of 78 had heard of the AHCPR Guideline but the majority of women wanted more information about UI (85%). Mechanisms are suggested for querying women with UI and disseminating the AHCPR Guideline.

Professional information about urinary incontinence on the World Wide Web: is it timely? Is it accurate?

OBJECTIVE: Access to timely and accurate information about urinary continence and incontinence is important to the assessment and treatment of adults with urinary incontinence. The aims of this study were to identify current Web sites containing information about urinary continence that are easily accessible to health care providers and to determine the timeliness and accuracy of the information included on these Web sites. METHODS: The World Wide Web was searched for sites devoted to health care provider information about urinary continence and incontinence. Two external content reviewers evaluated content in terms of timeliness and accuracy. A table outlining each sites credibility, content, and function was constructed. RESULTS: Two hundred sixty-five sites were located, but only 15 met the inclusion criteria. Readability levels ranged from 6.2 to 14.5 years. All sites provided links, and 53% had internal search engines. Most information located was accurate; however, some sites contained dated information. Forty percent of the sites were not dated, and thus determining the currency of the information was impossible. CONCLUSIONS: The World Wide Web is a valuable tool containing state-of-the-art knowledge about urinary continence that WOC nurses can use to educate themselves and others. However, using critical skills to evaluate the information posted on these and any other sites is essential.

Using epidemiology in patient education for post-prostatectomy urinary incontinence.

This article reviews and discusses the prevalence and incidence of and risk factors for urinary incontinence after prostate cancer surgery. The reported prevalence rates of urinary incontinence in men vary among studies due to different definitions and methodologies; however, it is agreed that urinary incontinence is a common condition, especially immediately after surgery. Although few risk factors have been identified, damage to the sphincter or its nerves is an accepted underlying pathology. Urinary incontinence can be devastating to men and sensitivity to emotional and educational needs is critical.

Path analysis of efficacy expectations and exercise behaviour in older adults.

The benefits of regular exercise for older adults are well documented and include improvements in physical, functional, as well as psychological, health. The purpose of this descriptive study was to test a theoretically and empirically based model describing the factors that influence exercise behaviour of older adults in the United States of America. The hypothesized model suggested that age, gender, and mental and physical health have an effect on self-efficacy and outcome expectations, and that all these variables influence exercise behaviour. Exercise behaviour was hypothesized to have a reciprocal relationship with self-efficacy expectations and mental and physical health. The convenience sample was 187 older adults living in a continuing care retirement community (CCRC) in Baltimore, Maryland. A one-time health interview was conducted which included a measure of self-efficacy and outcome expectations related to exercise, a measure of health status (SF-12), and gathering of information from participants about their actual exercise behaviour. Of the 187, 71 (38%) reported participating in 20 minutes of continuous aerobic exercise at least three times per week over the previous 3 months. Six hypothesized paths were significant. The model fitted the data and accounted for 32% of the variance in exercise behaviour. Interventions that focus on strengthening self-efficacy and outcome expectations can improve exercise behaviour in older adults.

Urinary incontinence. Impact on working women.

Until recently, the impact of urinary incontinence (UI) on working women, a population generally characterized as healthy, has not been the focus of research. Women employed full time at a large university center participated in a cross sectional survey about UI. Of the 1,113 women surveyed, age 18 and older, 21% (n = 232) reported UI at least monthly. Incontinent women were significantly older and had a higher body mass index than continent women. Using disposable products, limiting fluids, avoiding caffeinated beverages, using voiding schedules, and keeping extra clothes or underwear were strategies used to manage UI at work. Responses to an open ended question related to the impact of UI on working life included: interference with sleep and resulting fatigue at work, embarrassment, alteration of concentration, and emotional distress. Implications for nurses are discussed in relation to assessment, education, and management of UI in the occupational setting.

Postprostatectomy incontinence: the magnitude of the problem.

Prostate cancer is being detected earlier in its development as a result of heightened public awareness and better screening and assessment techniques. Localized prostate cancer is often surgically treated, leaving many men incontinent of urine on either a short-term or long-term basis. This article explores the epidemiology of prostate cancer and the prevalence and incidence of urinary incontinence in men after they have undergone radical prostatectomy. Implications for WOC nursing research and practice are addressed.

Urinary incontinence in working women: an exploratory study.

Women who work for a large academic center were surveyed about urinary incontinence. The response rate was 57%. Of the 1113 usable questionnaires, 232 (21%) indicated that urinary incontinence occurred at least monthly. The average age of incontinent women was 45 years (SD = 10 years). Incontinent women were significantly older and had a higher body mass index than continent women. There were also ethnic differences between incontinent and continent groups, although ethnicity was not a predictor of incontinence. Only a third of the women thought incontinence was an important problem to resolve and 46% reported incontinence to their physician or nurse. Forty percent reported that they did not know if the incontinence could be improved, but 81% wanted to learn more about incontinence.

Perceived causes of urinary incontinence and reporting: a study with working women.

The purposes of this study were to describe what working women perceived as the cause of their urinary incontinence (UI) and to determine if there was a relationship between identifying their UI cause and reporting it.

Staff compliance with and ratings of effectiveness of a prompted voiding program in a long-term care facility.

BACKGROUND: Despite findings that prompted voiding is effective in reducing urinary incontinent (UI) episodes, the prevalence of UI in this population has remained unchanged. It is estimated that 50% of all nursing home residents have UI. Staff involvement is considered a critical factor, yet little is known about staff perception of the effectiveness of prompted voiding. METHODS: This descriptive study of staff perceptions of a prompted voiding intervention was conducted at a university-affiliated 255-bed geriatrics center. A 12-week prompted voiding program was conducted with 17 residents with UI. Baseline continence status was compared with continence status at the end of the program, and a survey was conducted to assess staff perceptions of the program. The aims of the study were: (1) to determine effectiveness of a prompted voiding program, (2) to assess staff perception of overall effectiveness of the prompted voiding program, (3) to assess staff compliance with the prompted voiding program, and (4) to compare staff perception of prompted voiding effectiveness with actual continence outcomes. RESULTS: Overall UI status improved in 5 residents (31%), remained the same in 6 residents (38%), and declined in 5 residents (31%). Sixty-four (73%) of 88 staff members who participated in the program responded to a survey. Staff members were asked to rate their overall impressions of the prompted voiding program, and to rate improvement in continence status for specific residents who participated in the program. Ninety-five percent of staff members thought drier residents were happier; 80% thought the prompted voiding program should continue. Only 52% of staff thought residents participating in the prompted voiding program were better, and 43% perceived no change. A majority (58%) of staff thought compliance with prompted voiding was 80% to 90%; however, unobtrusive observations during the study revealed only 70% compliance. There was no correlation between staff ratings of improvement in continence and actual continence outcomes for individual residents (r = 0.02, P = .709). CONCLUSIONS: Staff reports of compliance with a prompted voiding program were inflated, and they were unable to determine which residents had actually improved and which residents had not improved with regard to UI. These findings suggest that nursing home staff, and particularly nursing assistants, need more meaningful definitions of UI and quantifiable evidence that residents benefit from prompted voiding.

Incontinence and PPS: a new era.

Urinary incontinence (UI) is a prevalent and costly problem in nursing homes. Assessing residents with incontinence is necessary to determine the pathophysiologic causes and associated factors that can interfere with self-toileting. Nurses can perform this assessment at the bedside. Guideline tools have been developed to assist nursing home staff through the evaluation of UI and intervention. Treatment techniques, specifically behavioral interventions and toileting assistance programs, can be readily incorporated into nursing practice. Most nursing home staffs can easily implement interventions such as bowel and nighttime voiding management and dietary modifications. Nursing home research has demonstrated the effectiveness of toileting assistance programs; however, very little of this research and documented techniques has been used by nursing home staff. Scheduled toileting and bladder training programs can be successfully implemented in nursing home residents. The key to the success of these programs is identifying residents who should be targeted for each specific program. Staff education remains an ongoing issue, as caregivers must be aware of attitudes and beliefs about the aging process and its impact on the genitourinary system in order to provide effective care. Under the Prospective Payment System, nursing homes need to change business as usual and remain abreast of new innovations and research in different behavioral interventions and continence technology.

In their own words: nursing assistants' perceptions of barriers to implementation of prompted voiding in long-term care.

Prompted voiding is an effective intervention for the improvement of continence in long-term care. This study investigated certified nursing assistants' (CNAs) perceptions of incontinence etiologies, as well as perceived barriers to prompted voiding implementation. A questionnaire was administered to CNAs in 23 long-term care facilities. Data analysis was conducted using descriptive statistics and correspondence analysis. CNAs perceived prompted voiding as helpful; however, inadequate staffing, workload, and turnover/absenteeism hindered implementation. CNA recommendations for long-term success included increased staff, staff support, improved communication, ongoing education, and alternative delivery models of care.

Pelvic muscle rehabilitation: where do we go from here?

Pelvic muscle rehabilitation has been used in the treatment of stress and urge urinary incontinence for many years. This article reviews the anatomy of the female pelvic floor and its role in the maintenance of continence. The purpose and goals of pelvic muscle rehabilitation are reviewed, and implications for future applications and research are discussed.