Aging and recurrent urinary tract infections are associated with bladder dysfunction in type 2 diabetes.

OBJECTIVE: The objective of this study was to demonstrate the diversity of urodynamic findings and temporal effects on bladder dysfunction in diabetes as well as to evaluate the predisposing factors that attenuate the storage and voiding function of diabetic women. MATERIAL AND METHODS: In this prospective study, 181 women with type 2 diabetes mellitus (DM) and lower urinary tract dysfunction underwent complete urogynecological evaluations and urodynamic studies. The patients' histories of DM and the treatment agents used were documented from chart records and interviews. The urodynamic diagnoses were recategorized into two groups for comparison, namely overactive detrusor (detrusor overactivity and/or increased bladder sensation as well as mixed incontinence) and voiding dysfunction (detrusor hyperactivity with insufficient contractility and detrusor underactivity with poor voiding efficiency) in order to evaluate the temporal effect of DM on diabetic bladder dysfunction. RESULTS: The development of bladder dysfunction showed a trend involving time-dependent progression, beginning with storage problems (i.e. advancing from urodynamic stress incontinence to detrusor overactivity and/or increased bladder sensation) and eventually led to impaired voiding function. The duration of DM relative to the urodynamic diagnoses of these women was longer in women with voiding dysfunction (6.8 ± 2.8 years with urodynamic stress incontinence, 7.3 ± 6.5 years with detrusor overactivity and/or increased bladder sensation, and 10.4 ± 8.3 years with women with voiding dysfunction). Notwithstanding these findings, stepwise logistic regression analysis indicated that age and recurrent urinary tract infections were the two independent factors associated with developing voiding dysfunction. CONCLUSION: The urodynamic study revealed a temporal effect on bladder function, and women with diabetic voiding dysfunction were found to have had a longer duration of DM than women with an overactive detrusor. However, aging and recurrent urinary tract infections are the two independent factors that contribute to impaired voiding function and diabetic bladder dysfunction.

Nursing intervention to enhance efficacy of home practice of pelvic floor muscle exercises in treating mixed urinary incontinence.

This study was conducted to evaluate nursing intervention to enhance the efficacy of a home-based pelvic floor muscle exercise (PFME) in treating mixed urinary incontinence among a community-based population. Eighty-eight women with mixed incontinence were recruited for this study and were asked to practice PFME at home as instructed. A registered nurse monitored the study group via telephone checkups twice a week. The Symptoms (LUTS) Questionnaire and a disease-specific questionnaire of impact index were used for repeat measurements before intervention, at 3 and 6 months after PFME. Symptoms such as frequency, nocturia, urge incontinence, and urinary stress incontinence improved significantly in the study group at 6 months. Quality of life with regard to worry about pads/towels leakage and getting wet also improved in the study group at 6 months. Nursing intervention can significantly improve the efficacy of a home-based PFME program in community women with mixed storage symptoms.

Overweight is associated with allergy in school children of Taiwan and Vietnam but not Japan.

We collected information concerning diagnosed allergy from 2027 school children in Japan, Taiwan and Vietnam. Children were classified according to the age and sex-specific body mass index (BMI) per-age as indicator of weight status. Logistic regression was performed to examine the relationship between percentiles of BMI-per-age and allergy. Compared with children at the lowest percentile group Taiwanese children at > 85th percentile group showed a tendency toward higher risk of allergy (OR = 1.79, 95% CI 0.98 to 3.27; p = 0.060). When children with rhino-conjunctivitis were excluded from the analysis the association reached statistical significance (OR = 2.89, 95% CI 1.08 to 7.75; p = 0.035). Vietnamese children at > 85th percentile group showed a significantly higher risk of allergy (OR = 2.34, 95% CI 1.06 to 5.17; p = 0.035). This association was not observed when children with atopic dermatitis or food allergy were excluded from the analysis, although a tendency toward increased risk of allergy at BMI-per-age > 85th percentile remained. Our study sample of Japanese school children showed no association between being overweight and allergy.

What affects the occurrence of nocturia more: menopause or age?

OBJECTIVES: Prevalence studies show that nocturia is a very common condition, affecting older age groups in particular. In this study, we evaluate (1) the community-based prevalence of nocturia and its associated overactive bladder according to the patient's perception and disturbance to sleep and (2) whether age or menopausal (MP) transition has a greater effect on the occurrence of nocturia. METHODS: The questions regarding nocturia were part of the Bristol female lower urinary tract symptoms questionnaire (translated into Mandarin, the correlation coefficient r = 0.91). A total of 1253 (79.1% response rate) women were randomly sampled from a community-based female population, aged 20 years or older. Samples were subdivided into reproductive age, perimenopausal stage and elderly. If the participants reported having nocturia, they were further questioned with, "Does it interfere with your sleep or bother your daily life?" The chi-square test and the Cochran-Armitage trend test were used to analyze the data. RESULTS: Nocturia in older age groups was significantly higher than that of the younger age groups. The occurrence of nocturia was significantly associated with the elderly (compared with the reproductive age, P < 0.05). There were no significant differences in the prevalence of nocturia between the perimenopausal stage and the reproductive age (P > 0.05). CONCLUSIONS: Our data implies that the increasing occurrence of nocturia is age-related and is not affected by the transition from pre- to postmenopause. Large-scale prospective longitudinal studies need to be conducted to clarify the effects of the aging process and estrogen deficiency.

Exercise motivation and processes of change in community-dwelling older persons.

Although exercise is important for the health of older persons, many older persons fail to participate in exercise. Knowledge and skills about changing exercise behavior is needed for health professionals to develop appropriate interventions to engage older persons in exercise. The purpose of this study was to determine how exercise processes of change were used by community-dwelling older persons to engage in exercise. A cross- sectional correlational design was employed. Cluster sampling was used to obtain potential subjects. A sample of 167 older persons participated in the study. The age of the participants ranged from 65 to 89 years (M = 73.7, SD = 6.14). Each participant was interviewed face-to-face with the investigator reading the questions and marking the answers on the Exercise Stages of Change Questionnaire and the Exercise Processes of Change Questionnaire. The results revealed that half of the older persons were underactive or inactive. One- way ANOVAs and Scheffe post-hoc analyses revealed that 10 processes of change were significantly different among the stages of change (all p values <.05). The study findings provide guidance in designing exercise interventions to increase compliance of older persons with exercise.

Prevalence and correlations of anal incontinence and constipation in Taiwanese women.

Anal incontinence and constipation are not only physically and psychologically disabling symptoms but also a significant social and public health problem. The epidemiology of anal incontinence and constipation from community-bases remains largely unknown, especially in Asian women. This study is a continuation of a previous survey taken on the epidemiology of urinary incontinence and overactive bladder in Taiwanese women by using a second questionnaire (correlation coefficient for symptoms, r=0.87; P<0.05). We evaluated the prevalence and potential risk factors associated with anal incontinence and constipation in the general population. Of the 1,584 (2.92%) women sampled, 1,253 (79.1%) were successfully interviewed at home. The prevalence of fecal incontinence and flatus incontinence was 35 (2.8%) and 107 (8.6%), respectively. There were 306 (24.5%) participants who reported constipation. However, according to the current medical criteria for constipation, the prevalence of constipation was only 2.7%. The prevalence of anal incontinence did not increase after the age of 65 years (9.7%, including 3.5% of elderly women with fecal incontinence and 6.2% of elderly women with flatus incontinence). The prevalence of constipation significantly increased in the women aged 65 years and over (self-reported prevalence: 32.4%, fitted in medical criteria for constipation: 8.3%). Our results demonstrated that constipation shares some of the same risk factors, namely, symptoms of uterovaginal prolapse, prior gynecologic surgery, and overactive bladder that predispose women to the occurrence of anal incontinence. The questionnaire needs a higher discriminatory capacity, and a longitudinal study should be conducted to clarify this conflict further.

Is the occurrence of storage and voiding dysfunction affected by menopausal transition or associated with the normal aging process?

OBJECTIVES: To evaluate whether the increasing occurrence of urinary and voiding dysfunction is independently influenced by the transition from pre- to postmenopause or by the interactive and additive effects of age-associated changes in bladder and urethral function. DESIGN: Of the 1,584 women randomly sampled from a community-based health population, 1,253 (79.1%) were successfully interviewed. The participants were asked to reply to the Bristol Female Urinary Tract Symptoms Questionnaire regarding various storage symptoms and voiding dysfunction. The chi2 test and Cochran-Armitage trend test were used for analysis. RESULTS: The prevalence of storage symptoms such as frequency, urgency, nocturia, and urge incontinence in premenopausal and menopausal groups was 18.0% versus 29.8%, 9.8% versus 20.7%, 21.2% versus 38.2%, and 6.8% versus 15.7%, respectively (all P < 0.05). In premenopausal and menopausal groups, the prevalence of hesitancy, poor stream, incomplete emptying, voiding with abdominal straining, discontinuous urine flow, and dribbling was also significantly different (17.2% v 22.9%, 17.8% v 25.7%, 12.7% v 21.9%, 4.9% v 11.6%, 16.2% v 24.5%, and 9.4% v 17.6%, respectively; all P < 0.05). However, the occurrences of various storage symptoms, namely, frequency, urgency, nocturia, and urge incontinence, as well as voiding symptoms such as incomplete emptying, discontinuous urine flow, and dribbling, were also significantly associated with the normal aging process (P < 0.05). CONCLUSIONS: Our results imply that the increasing occurrences of storage and voiding dysfunctions are not only affected by pre- and postmenopausal transition but are also closely associated with aging changes.

Prevalence and correlation of urinary incontinence and overactive bladder in Taiwanese women.

AIMS: We randomly sampled a community-based, healthy population to evaluate the prevalence and correlation of urinary incontinence and overactive bladder. We also assessed the influences of these conditions on quality of life and associated risk factors. METHODS: Of the 1,581 women sampled (2.92% of registered female residents aged 20 years and older), 1,253 (79.1%) women were successfully interviewed by using the Bristol Female Urinary Tract Symptoms Questionnaire (r=0.87, P<0.05) and the Questionnaire of Impact index regarding the impact on quality of life (r=0.91, P<0.05). RESULTS: A total of 53.7% of the women sampled suffered from urinary incontinence and related symptoms. The prevalence of stress urinary incontinence, overactive bladder, and mixed incontinence, mutually exclusive of each, was 18.0%, 18.6%, and 17.1%, respectively, from the patients' perceptions. Judging by the criteria of the International Continence Society, the prevalence of the above three conditions was 4.3%, 2.4%, and 1.8%, respectively. Of the women who perceived storage symptoms, 21.1% experienced frequency, 12.6% had urgency, 25.5% had nocturia, and 9.1% had urge incontinence. The occurrence of stress urinary incontinence increased with age up to 65 years old (25% in 50-65-year-old cohort), and the number of overactive bladder conditions significantly increased in the elderly women (over 65 years old, 39.3%). Approximately two thirds of the incontinent women had restricted their social activities (due to worrying about wetting or leakage and no toilet facilities available), and approximately 19% of the incontinent women had an affected sexual life. However, only 27.1% of the women with urinary incontinence and related symptoms in this study had reported seeking medical services to solve these problems. CONCLUSIONS: The prevalence of urinary incontinence and overactive bladder in Taiwanese women is similar to that of Western women.